Cabo Verde Minister of Health: 5 Steps to Eliminate Malaria 30/05/2024 Maayan Hoffman Cabo Verde’s Minister of Health, Filomena Mendes Gonçalves. Cabo Verde, a group of 10 islands in the Central Atlantic Ocean, was declared malaria-free in January. This milestone makes it one of the 43 countries and territories globally recognised with this certification by the World Health Organization (WHO). Cabo Verde is only the third country in the WHO African region to be certified malaria-free in the past 50 years, following Mauritius in 1973 and Algeria in 2019. The African continent bears the heaviest malaria burden, with around 95% of global malaria cases and 96% of malaria-related deaths occurring there in 2021, according to WHO. The most affected are impoverished rural communities, where children under five and pregnant women suffer the most, according to the Global Fund. The latest World Malaria Report revealed that there were approximately 608,000 malaria deaths worldwide in 2022. Additionally, the number of malaria cases saw a significant increase in Pakistan, Ethiopia, Nigeria, Uganda, and Papua New Guinea compared to the previous year. Cabo Verde’s certification means that the transmission of malaria by local Anopheles mosquitoes has been stopped across the country for at least three years. Additionally, the government has shown it can effectively prevent malaria from returning. So, how did Cabo Verde achieve success? On Wednesday, Cabo Verde’s Minister of Health, Filomena Mendes Gonçalves, shared five steps for malaria eradication that worked for her country: strong political engagement; surveillance and rapid response; a multi-sectoral approach, where the government worked closely with the community; international partnerships with organisations such as WHO and the Global Fund; and diligence – once the disease appears eradicated, a plan to prevent re-establishment is required. Cabo Verde eliminated malaria after implementing a strategic plan from 2009 to 2013, focusing on expanded diagnosis, effective treatment, and increased surveillance, According to WHO. To prevent imported cases, free diagnosis and treatment were offered to international travellers and migrants. In 2017, the country improved its response to an outbreak, achieving zero Indigenous cases for three consecutive years. During the COVID-19 pandemic, Cabo Verde maintained progress by enhancing vector control, malaria diagnosis, and surveillance, particularly at entry points and high-risk areas. Impact of climate change Cabo Verde’s story took centre stage at an opening discussion on the third day of the Geneva Health Forum. The event, run in collaboration with the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) and on the margins of the 77th World Health Assembly, focused on vector-borne diseases, including neglected tropical diseases, exacerbated by climate change and other environmental factors. The Geneva Health Forum, organized by the University of Geneva, brings together key global health scientists and policymakers with medical practitioners and other field actors. Last week, WHO and Reaching the Last Mile published a major review in the Transactions of the Royal Society of Tropical Medicine and Hygiene, analysing 42,693 articles on climate change and vector-borne diseases. The study found that rising temperatures and changing weather patterns alter the spread of these diseases, posing significant health risks and straining healthcare systems. As mosquitoes and other disease vectors expand their range, the report showed, the risk of these diseases reaching new, unprepared areas increases. Samal, a father from Nepal, contracted visceral leishmaniasis (black fever) in 2022. He became so ill that he lost 15 kilograms and was unable to work for three months. Samal lost nearly 100,000 Nepalese Rupees as a farmer and woodcutter, equivalent to three months’ wages. Thoko Elphick-Pooley, executive director of Uniting to Combat NTDs and Co-Chair of the G7 Taskforce on Global Health His nephew and brother also caught the disease. Fortunately, Samal received treatment and survived. However, as Thoko Elphick-Pooley, executive director of Uniting to Combat NTDs and Co-Chair of the G7 Taskforce on Global Health, explained, “Many are not so lucky.” Nepal, a village in the foothills of the Himalayan Mountains, sits about 1,300 meters above sea level. Historically, temperatures seldom rose above 30 degrees Celsius. Today, they regularly soar past that mark, bringing with the heat many new diseases like black fever, which thrive in dark and humid environments. “Nepal is now breeding grounds for sandflies,” which causes black fever, Elphick-Pooley said. “If untreated, it is fatal in over 95% of cases. Samal’s story shows the catastrophic impact of climate change on individuals, families, communities, and entire countries.” Climate change has dealt a blow to Nepal’s fight against black fever, said Elphick-Pooley. The country, which had seen cases plummet from 2,200 to under 300 in ten years and was on track to eliminate the disease, must now postpone its goal of eradication. Countless other countries are experiencing a similar phenomenon, facing a rise in diseases from dengue to malaria. Pakistan reported a staggering 900% increase in dengue cases following severe flooding, as revealed at the United Nations Climate Change Conference last year. Authorities, even in affluent European nations, are now on high alert for dengue outbreaks, with health agencies warning that threats will soon emerge in the southern United States and previously unaffected regions of Africa. The WHO and Reaching the Last Mile report indicated that better evidence was needed to understand the link between climate change and these diseases. It also noted a lack of evidence tied to mitigation and adaptation. But Elphick-Pooley said that “while generating more and better evidence is critical, we cannot let gaps in evidence stop us from moving. We cannot stand still while waiting for better evidence; we must act based on what we know now. We are already seeing the impacts of climate change. This is urgent.” She called on health leaders to develop new treatments, disease management, and prevention strategies to advance a disease-elimination agenda. “We already know how to treat or prevent many of the 21 NTDs. let’s do it,” Elphick-Pooley said. Malaria in the United States The link between climate change and vector-borne diseases has even alerted the U.S. Department of Health and Human Services. Loyce Pace, assistant secretary for global affairs in the department, said the country has been having the conversion “about our friends in Brazil who are facing a crisis.” She said Brazil’s floods are not only producing hundreds of thousands of climate refugees but precipitating additional waterborne diseases “in a way that is absolutely putting these constraints not only on the public health system” but on the people. Moreover, the Centers for Disease Control and Prevention (CDC) identified a handful of locally acquired mosquito-transmitted malaria in Texas and Florida last year. Locally acquired mosquito-borne malaria has not occurred in the United States since 2003. “These mosquitoes are getting smarter,” Pace said. “They’re getting better at what they do. They’re showing up in places they’re not supposed to, like Maryland, down the street from Washington, D.C.. This is happening in real time. This is not a tomorrow problem. This is a problem today.” She said the U.S. is prepared to take a one-health approach and called on other countries to do the same. “It’s not hopeless, right? We have this problem in front of us, but we absolutely do have the solutions we need to deploy,” Pace said. “I trust that we can get it done together.” Image Credits: Geneva Health Forum. BREAKING – Israel Wins WHA Approval of Hostage Reference in Draft Decision on Health in Occupied Palestinian Territories 29/05/2024 Elaine Ruth Fletcher Israel scored a tactical victory Wednesday evening when World Health Organization (WHO) member states agreed in a vote of 50-44 to amend a draft decision denouncing the health situation in the Occupied Palestinian Territories, with a reference calling for the release of some 125 Israeli hostages still held by Hamas. Another 83 member states were absent or abstained from the politically-charged vote. The original draft WHA decision was led by Algeria and supported by some 35 member states, including Russia, Egypt, Colombia, Cuba, Venezuela, and Iran. The decision denounces “acts of violence,” the “use of starvation of civilians” and the “wanton destruction of health facilities” – and calls upon the “occupying power” to fulfill its obligations under international law,” including replenishment of medical supplies, safe passage of fuel and health supplies and additional humanitarian assistance. WHA debate on issue adjourns while member states debate next moves South Africa’s delegate speaks on behalf of the original resolution condemning the health situation in Gaza, and other Israeli-occupied territories. As of publication, it was unclear if the draft decision, with the amendment referring to Israeli hostages, would indeed be brought to a vote. Immediately following the vote on the amendment, Egypt, on behalf of the co-sponsors, requested that it be withdrawn altogether. However, WHO rules would require Israel’s agreement to withdraw the Algerian-led resolution, now that Israel’s amendment has been approved. Ultimately, the WHA debate on the draft decision was adjourned until later Friday. That leaves both Israeli delegates and the resolution’s supporters, including sworn enemies such as Iran, unsure of what to do next. Neither side will want to cede more diplomatic points to the other. At the debate preceeding the vote on the amendment, dozens of member states, from Africa, Latin America, Asia and Europe, as well as Palestine that holds observer status, deplored the humanitarian situation that has been created by Israel’s war on Hamas in Gaza, including the interruptions in humanitarian aid, destruction of health facilities, and the recent deaths of displaced Palestinian civilians sheltering in a supposedly safe zone near Rafah from a nearby Israeli aerial bombing. “The international community should exert all efforts through the various instruments at our disposal to improve the ongoing humanitarian catastrophe in the occupied Palestinian territory, including Gaza,” said South Africa’s delegate to the Assembly, referring to South Africa’s case against Israel for alleged genocide before the International Court of Justice. Israeli Ambassador to Israel, Meirav Eilon Shahar calls for a vote over an amendment on Israeli hostages held by Hamas. Speaking to the assembly, Israeli Ambassador Meirav Eilon Shahar said “a decision that does not also condemn the militarization of health facilities by terrorists in Gaza has no intention of improving the health conditions on the ground… A decision on health that does not demand the immediate and unconditional release of all hostages – who are held by a terrorist organization, raped and tortured – is an unforgivable moral failure.” Wednesday’s debate was only the first of two scheduled by the assembly on the war in Gaza and its humanitarian fallout, which has led to the displacement of over 1 million Palestinians, and over 34,000 deaths, along with severe hunger and malnutrition in parts of Gaza. Some 1,200 Israelis died and more than 250 were taken hostage during the October 7 Hamas incursion into Israeli communities that triggered Israel’s invasion of Gaza. While an estimated 125 hostages, including over a dozen sick and elderly people, young women, and several young children are still being held in Gaza, it’s unclear how many are still alive. Second Gaza resolution has wider support A second draft resolution on Gaza, to be considered tomorrow, has much wider WHA suport and is likely to be adopted by consensus. It makes a call on “all parties to fully comply with their obligations” under the 1949 Geneva conventions, and ensure “unimpeded, safe, and unobstructed” passage for medical personnel.” That resolution, which was the focus of a special session of WHO’s Executive Board on 10 December, was approved by consensus, including with support from the United States, Israel’s closest ally, in what was then a first such vote in the UN system. That draft resolution to be considered Friday, makes no direct mention of either the Israeli hostages or Palestinian prisoners held by Israel. But Article 2 “reaffirms that all parties to armed conflict must comply fully with the obligations applicable to them under international humanitarian law related to the protection of civilians in armed conflict and medical personnel.” US Optimistic About Pandemic Treaty Talks, But Timeline Remains Uncertain 29/05/2024 Kerry Cullinan US Secretary of Health and Human Services Xavier Becerra GENEVA – The United States believes a “good deal” is within reach on the pandemic agreement, with parties “close to consensus,” Secretary of Health and Human Services (HHS) Xavier Becerra told reporters at the US Mission in Geneva on Wednesday. “There is a clear consensus that we can’t let the status quo be upon us if another pandemic comes,” Becerra said, adding that the US believes it has given the talks their “best shot”. “We’re so optimistic because everyone gets it. It’s not just our health. It’s our economies. It’s our security that’s at stake.” Despite some disagreements, “the contours of the agreement are in place,” Becerra said, expressing optimism that countries would leave this week’s World Health Assembly (WHA) with “something” to show that the World Health Organization (WHO) is ready for the next pandemic. Spain’s Dr Fernando Simón (centre), flanked by Thiru Balasubramaniam of Knowledge Ecology International (left) and Dr YuanQiong Hu (right) of Médecins Sans Frontières. Key Spanish negotiator Dr Fernando Simón echoed the sentiment, stating that differences between countries are not significant. “Faster is the best. There is no perfect treaty, but if we don’t get this pandemic agreement, we risk getting a trade agreement, not a public health agreement,” Simón said at a meeting at the Médecins Sans Frontières headquarters. One or two-year delay? However, US Ambassador Pamela Hamamoto cautioned WHA delegates on Tuesday that the pandemic agreement might take one or two years to conclude, citing “fundamental differences” on “complex technical issues that require extensive deliberation and carefully crafted workable solutions.” US Ambassador Pamela Hamamoto at WHA77 The 47 African member states of the WHO are pushing for the pandemic agreement to be concluded and presented to a special WHA by year’s end. The upcoming US presidential election on November 5 could impact the negotiations, particularly given the high level of disinformation surrounding the pandemic agreement in the US. Should Donald Trump win the US election, his administration is likely to scupper the pandemic agreement – and possibly pull out of the WHO altogether. ‘We shouldn’t leave Geneva with nothing’ But Becerra and Loyce Pace, HHS Assistant Secretary for Global Affairs, were both upbeat, intimating that it was now up to other parties to pick up the pen and sign the deal. “If we can get this across the finish line, I think what we show – with the pandemic accord and improved International Health Regulations – that we’re ready to take on these challenges so that never again will we suffer a pandemic [like COVID-19],” said Becerra. Loyce Pace, US HHS Assistant Secretary for Global Affairs “Frankly, we shouldn’t be leaving Geneva and going home with nothing, not after all that’s been done,” Pace said. “The world needs us to update our global health security architecture. The world needs world leaders and public health leaders to truly commit to what’s required.” The US is also pushing hard for the amendments to the International Health Regulations (IHR) to be adopted this week. The IHR governs countries’ conduct during “public health emergencies of international concern”. “We don’t know how long it’s going to be before we get another type of COVID-kind of tragedy. We don’t want to wait,” Becerra said. “We made it unambiguous and clear what we could offer and also what we could accept. “The elements of a big deal are already on the table. And that’s why, again, we feel optimistic, because those are pretty good deals. It’s just a matter of now finally making sure everybody says: ‘We’re ready to sign on the dotted line’,” he added. A new WHA drafting committee met most of Wednesday to work out a process for adopting both measures and may report back to the WHA as early as Thursday. Some African countries have linked their support for the IHR amendments this week to their timetable for the pandemic agreement. But this position is not monolithic. Botswana, for example, supports the IHR’s adoption this week. Russia indicated on Tuesday that it opposed the adoption of the IHR this week, so the issue might go to a vote. Additional reporting by Elaine Fletcher. Cardiometabolic Diseases Threaten Life Expectancy Gains, Even in Young Countries 29/05/2024 Sophia Samantaroy Panelists Catherine Priestley, Jo Jewell, Monika Arora, Francesco Branca, and Ad Adams, with moderator Shiulie Ghosh (far right) at the IFPMA-World Heart Federation- World Obesity Federation side event in Geneva. GENEVA – Cardiometabolic diseases, a group of non-communicable diseases (NCDs) including cardiovascular disease, stroke, diabetes, and non-alcoholic fatty liver disease, are on the rise globally, threatening life expectancy gains and burdening vulnerable economies with excess healthcare costs. These diseases already contribute to over 30% of global deaths each year. With one billion people now living with obesity, projections suggest that by 2035, 50% of the world’s population will be affected, leading to premature deaths and a growing economic burden. “Non-communicable diseases are only going in one direction. They are increasing,” Dr Christopher Tufton, Jamaican Minister of Health, remarked at a World Heart Federation (WHF) and World Obesity Federation (WOF) event in Geneva on Monday. “It is at a catastrophic level. It concerns all of us wherever we are.” Low- and middle-income countries, despite their relatively young populations, are driving the alarming rise in global obesity. Obesity rates in these countries are expected to soon match those in high-income countries, a significant shift from the trend observed just a decade ago, said Francesco Branca, director of the Department of Nutrition and Food Safety at the World Health Organization. Cardiometabolic diseases pose a particularly severe threat to low- and middle-income countries, not only jeopardizing hard-fought life expectancy gains but also burdening their already fragile economies with excessive healthcare costs, endangering the sustainability of their health systems and diverting funds from other crucial areas of healthcare. “The data suggests that we’re seeing a reversal of the gains that we’ve made in life expectancy,” Tufton said, highlighting the impact on his home country Jamaica. “The opportunity to live up to an average of 75 years is now under serious threat.” Non-communicable diseases accounted for 77% of all deaths in Jamaica in 2020, with age-standardized mortality rates showing significant increases in deaths from diabetes, hypertension, and heart disease over the past decade. Rise of cardiometabolic diseases in children and adolescents, fueled by targeted advertising The increased rate of deaths from cardiometabolic diseases in countries like Jamaica is not just a consequence of an ageing population. It is also the result of a progressive rise in deaths across all age groups, from children and adolescents to adults. Dr Monika Arora, Vice President of Research and Health Promotion at the Public Health Foundation of India (PHFI), argued that much of the reason for the rise of obesity in younger children stems from advertising and hidden additives. “Advertisements for foods high in fat, salt, and sugar — the exposure was much higher in children’s [TV] channels than young adult channels, meaning the industry very clearly wants them to be hooked on to their products early on,” she said. India, a country that struggles with both undernutrition and overnutrition, now has the third-highest number of people living with obesity globally, largely due to aggressive advertising targeting children and the rise of ultra-processed foods (UPF). The urban poor are the hardest hit, as cheap food options often come in the form of ultra-processed foods, while fresh fruits and vegetables remain too costly. “They don’t have any means for physical activity, and they don’t have [access to] food which is healthy and cost-effective,” said Arora. Urban air pollution further compounds the barriers to exercise, as the air quality is often too dangerous for walking or running outdoors, she added, in an interview with Health Policy Watch. Ultra-processed foods can be deceptively hidden, such as the additives found in milk products marketed for children. “There’s a whole culture about feeding children milk. The milk additives are claiming 20% better growth, better height, and better immunity, and nobody’s checking where these studies are published — these are filled with high-sugar products,” Arora explained. “These are all hidden calories. So even in urban settings where people are cutting down on sugar, they don’t realize that these are ultra-processed foods, and they continue to feed children with products that are harmful.” The long-term consequences of childhood obesity and the predatory tactics that fuel it are staggering for individuals and health systems alike. A 2015 National Institutes of Health study of over 200,000 US children found that obese children and adolescents were nearly five times more likely to be obese as adults compared to their non-obese peers. The study showed that 55% of obese children become obese adolescents, 80% of obese adolescents remain obese in adulthood, and 70% will continue to be obese beyond age 30. “These young people are going to have a life-long exposure to this condition,” Branca warned. Growing economic burdens globally Lower and middle-income countries are seeing rising economic impacts due to obesity, according to data from the World Obesity Atlas. As more low- and middle-income countries struggle with obesity and other cardiometabolic diseases, the economic impact of these conditions continues to grow. In Jamaica, for example, the total economic impact of obesity is projected to reach $524 million by 2025, with the burden on GDP expected to be 3.9% by 2035, according to Tufton. The global economic impact of overweight and obesity will reach $4.32 trillion annually by 2035 if prevention and treatment measures do not improve, according to the World Obesity Federation’s World Obesity Atlas 2023. The report notes that at almost 3% of global GDP, this cost is “comparable to that of COVID-19 in 2020.” “It’s also about framing the societal value for patients, healthcare systems, and economies of taking action and avoiding those costs, which for obesity alone is estimated to be $4 trillion if we don’t take action,” said Jo Jewell, Novo Nordisk Director of Cities for Better Health & Head of Obesity Health Equity. Comprehensive prevention, treatment, and management are crucial, Jewell noted, with partnerships between the private sector, healthcare sector, and governments to reach those most in need within communities. Basic screening for conditions like hypertension, blood pressure, and diabetes is essential, and governments should work to bring screening to the people, Tufton added. Knowing these numbers provides a basis for healthcare providers to give meaningful advice and “encourage” behaviour change. “It is about taking screening to the people,” Tufton said, “as opposed to encouraging people to come to the health centres or the clinics or your private practitioners to get screening.” “Children live what they learn” Jamaica Minister of Health Christopher Tufton speaks at an IFPMA-World Heart Federation-World Obesity Federation event. Government policies targeting individual behaviour are a core component of plans to tackle the obesity epidemic. However, reflecting on the power of targeted advertising and hidden additives in ultra-processed foods, Branca noted that individuals are not solely responsible for obesity. This marks a paradigm shift in how the disease is perceived, as an individual’s obesity was previously viewed predominantly as a personal failing. Policies that only target individual behaviours are “clearly” not sufficient, Branca said, and must be paired with policies that create environments allowing people to make healthy choices, such as controlling marketing, eliminating trans fats, and lowering food prices. This approach extends to helping children make good decisions about nutrition from early childhood onward. The “captive environment” of schools and the educational programs they provide have the potential to influence community-level change through nutrition and exercise initiatives, multiple experts on the panel noted. The success of these childhood education programs depends on working closely with school authorities to provide a supportive environment, including less unhealthy food, physical education, and empowerment to make healthy food choices. “When we work with children in school settings, we are definitely able to influence their behaviours, whether it is healthy eating and being more physically active,” said Arora. Including children and young adults in decision-making plans around nutrition, she added, is key to ensuring “sustainable behaviour” and empowers them not to “go back home and resort to unhealthy food.” “We believe that our youngsters could be great teachers of the adults by making an impression on them in schools,” Tufton added. “If we were to modify what they consume, and encourage them to consume in a more balanced way, combined with physical activity, then they will grow hopefully to follow that pattern and become a healthier adult over time.” Image Credits: S. Samantaroy/HPW, World Obesity Federation. The Power of Partnerships in Advancing Global Health 29/05/2024 Maayan Hoffman IFPMA Director-General David Reddy (right) in an interview with journalist Shiulie Ghosh on Tuesday, May 28. GENEVA – Partnerships between industry, multilateral organizations, and other stakeholders are essential to overcoming challenges and improving access to innovations. This was the key message at an International Federation of Pharmaceutical Manufacturers (IFPMA) event on Tuesday evening, held on the sidelines of the World Health Assembly in Geneva. The gathering brought together representatives from the World Health Organization (WHO), Gavi, government officials, and industry leaders to discuss how these partnerships can be enhanced to deliver meaningful impact for people and healthcare systems worldwide. The event featured an interview with David Reddy, the newly appointed Director-General of IFPMA and former CEO of Medicines for Malaria Ventures who took over from Thomas Cueni in April. IFPMA, the global pharmaceutical trade organization, works with the WHO and other UN bodies, representing over 90 companies and associations, including industry giants like Johnson & Johnson, Novartis, Pfizer, Eli Lilly and AstraZeneca. Reddy, who has been in his new role for fewer than two months, described drug development as a process of “assembling information that wraps around a molecule,” from animal safety studies to patient behaviour, infection treatment and manufacturing quality. This information then undergoes regulatory review to ensure the drug’s efficacy. The complex nature of drug development means pharmaceutical companies must work closely with multilateral organizations to ensure their drugs are distributed and accessible, particularly in low- and middle-income countries. However, there is often tension between the high cost of developing innovative medicines and vaccines and the basic health needs of populations that may be unable to afford them. This is where partnerships are crucial. “It’s really important just to underscore that it’s not something that we, as an industry, can do alone. We can only do it in partnership.” Reddy quoted WHO Deputy Director-General Mike Ryan, who said that industry and the UN health body agree on 80% of things in global health and may differ on 20%. Ryan has urged focusing on the 80% agreement to make progress. “It doesn’t mean we should ignore the areas of difference. We should debate them,” Reddy said. “But don’t forget that we are so aligned in so many ways.” The monoclonal antibody revolution Covid-19 monoclonal antibodies Reddy also spoke about drug and vaccine innovation, using the mRNA COVID-19 vaccines as an example. “They were there just when they were needed, but they were there because of two decades of work. Companies were able to partner together and really accelerate getting them to people to prevent them from becoming patients,” Reddy explained. Innovation, he said, “just takes a long time” and costs money. Looking to the future, Reddy sees great potential in monoclonal antibodies, conjugated antibodies, mRNA technology, and individualized therapy, all underpinned by artificial intelligence. “We’re living in the monoclonal [antibody] revolution if you like,” he said. “Not globally yet. In terms of access, that is something this industry is really working on at this time.” AI could revolutionize drug development by enabling researchers to precisely select molecules that have the potential to become medicines, chart more efficient pathways, and significantly compress development timelines, Reddy added. Gavi: Partnerships crucial as health budgets tighten From left: Shiulie Ghosh, journalist; Minister Ong Ye Kung, minister of health of Singapore; Dr. Catharina Boehme, assistant director-general of External Relations and Governance for WHO; and Deborah Waterhouse, the CEO of ViiV Healthcare and the president of Global Health for GSK. Dr Sania Nishtar, the recently appointed CEO of Gavi, the Vaccine Alliance, also spoke about the importance of partnerships from her perspective, especially in the current climate, which she described as “a very resource-restrained time for global health”. Between competing priorities and ongoing conflicts in different parts of the world, the G7 is stretched,” Nishtar said. “We in the global health space must hear this loud and clear.” Nishtar’s remarks took place against the backdrop of the WHO’s new “Investment Round” initiative, aiming to raise $7 billion to make the organization’s funding more predictable, flexible, and sustainable. The total contributions of WHO member states are just $4 billion annually. Public health expenditure across OECD countries surged by an average of 17% in real terms between 2019 and 2021, as governments rapidly allocated resources to tackle the crisis. Prevention spending more than doubled due to extensive testing and vaccination efforts. In 2022, however, health spending across OECD countries declined by an average of 1.5%. With inflation expected to remain above 5% in 2024, compared to less than 2% in 2019, nominal increases will be considerably reduced. The pandemic led to increased health spending as a percentage of GDP in low- and middle-income countries, but not as much as in advanced economies. A recent Center for Global Development report suggests this increase is unlikely to be sustained due to the pandemic’s impact on revenues and budgets. Slow domestic revenue growth has already made achieving health-related Sustainable Development Goals (SDGs) by 2030 unlikely, and without new funding sources, meeting these goals will be further delayed. “We had 40 countries decrease their healthcare spending last year. Healthcare budgets are going down instead of up,” said Dr Catharina Boehme, assistant director-general of External Relations and Governance for WHO. “To harness the promise of science and innovation, we have to focus on creating capacity and making sure health funding remains intact.” Partnerships, Nishtar added, are in Gavi’s DNA, working closely with WHO, UNICEF, and industry to build synergies. “Solutions can be found when we work together,” she continued. “And we can only work together when we let go of ego, turf, rivalries and small thinking.” Image Credits: Raisa/Flickr. Push for International Health Regulation Changes to Be Passed This Week – But Disagreement About Future of Pandemic Agreement Talks 28/05/2024 Kerry Cullinan The crowded WHA meeting room where the pandemic discussions are taking place GENEVA – A powerful lobby, including the US, Germany and New Zealand, are pushing for the amendments to the International Health Regulations (IHR) to be adopted by the close of the World Health Assembly (WHA) on Saturday. Weaknesses in the IHR, the only global rules guiding countries’ conduct in international public health emergencies, were exposed during the pandemic, prompting a two-year process to amend them. Agreement is close, with some outstanding issues particularly on definitions, according to the report on the IHR negotiations to the WHA by World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus. “My appeal here is let us focus on the IHR so we have this success as this is already providing much better protection for the world,” said Germany’s Health Minister Karl Lauterbach. Strong positive signal The European Union (EU) echoed this sentiment, describing progress on IHR amendments as “remarkable”. “The adoption of these amendments within the very short timeframe of only two years will send a very positive signal to the outside world about the ability of the WHO and its membership to take concrete action to improve the global health architecture,” said the EU. “Such adoption will also send very positive signal for the future of the INB [Intergovernmental Negotiating Body] process.” The INB was charged with negotiating a pandemic agreement but member states have failed to reach agreement by the WHA deadline. The most recent pandemic agreement draft shows significant areas of disagreement remain. The EU acknowledged that some IHR amendments still need to be resolved and urged all partners to “redouble efforts” to finalise the work and adopt the changes by 1 June. Dr Ashley Bloomfield, co-chair of the Working Group on amendments to the IHR, told the WHA that the committee is “very close to completing an agreed package of amendments”. “There is both momentum and an aspiration among states parties to complete the task,” said Bloomfield. “Adopting a package of IHR amendments during this assembly would be a significant milestone and achievement and we believe in a very important stepping stone to successfully concluding the pandemic agreement negotiations later.” France, Indonesia, Kenya, New Zealand and Saudi Arabia have prepared a resolution to adopt the IHR amendments in anticipation of agreement being reached in the next few days. Pandemic agreement process unclear It is unclear whether the African region will support completing the IHR amendments this week if its demand for the speedy conclusion of the pandemic agreement by the end of this year is not accepted. At a packed WHA meeting of Committee A on Tuesday afternoon, there was intense discussion and some disagreements over the way forward for the INB process on a pandemic agreement. First off, there were two resolutions on the floor, one from the 47 WHO African member states and another from a group of countries that have often played a conciliatory role in talks – Australia, Brunei, Canada, Norway and Pakistan. Both spoke to the time frames for further talks, while the second resolution called for a new structure to take forward the pandemic agreement negotiations. South Africa’s Ambassador Mxolisi Nkosi. Expressing disappointment on behalf of the African region that a pandemic agreement was not agreed on, South Africa’s Ambassador Mxolisi Nkosi called for negotiations to be completed by the end of this year, followed by a special WHA. Botswana expressed its support for the speedy resolution of the IHR during the session, but Kenya – on behalf of the Africa region – linked the IHR amendments and the pandemic agreement, and simply said the region was ready to reach consensus. However, US Ambassador Pamela Hamamoto called for an extension of “one to two years”, explaining that “fundamental differences remain on core issues central to the agreement”. She described these differences as “complex technical issues that require extensive deliberation and carefully crafted workable solutions, inspired by a common vision and supported by all member states”. Ironically, if Donald Trump wins the US presidential election at the end of the year, his administration is unlikely to support the pandemic negotiations – or even the WHO. The WHA’s Committee A resolved that a single drafting group co-chaired by one INB member and one WGIHR member, will convene on Wednesday morning. It will be open to all member states and its task will be to consider all three draft resolutions and propose a process for adopting the IHR amendments and the timing, format and process to conclude the pandemic agreement. These proposals will have to be submitted to the WHA as the mandates for both the WGIHR and the INB have expired. Climate Change to Be Major Focus for WHO in Coming Years 28/05/2024 Disha Shetty The 77th session of World Health Assembly underway in Geneva, Switzerland. The World Health Organization plans to make climate change and its impact on health a major focus in the coming years, along with strengthening health systems, improving health equity and access, and preventing disease, according to the organization’s plan for its general program of work from 2025 to 2028. The four-year plan, known as GPW-14, also prioritizes mental health, gender equality, migrant health, food safety, digital health, and artificial intelligence. It was developed through an extensive 10-month consultation process involving member countries, UN organizations, and civil society organizations. “This document will act as our canvas, articulating our collective aspirations and strategic priorities in global health for the coming four years,” said Dr Saia Ma’u Piukala, the WHO’s regional director for the Western Pacific, as discussions on the plan concluded Tuesday morning, the second day of the ongoing 77th World Health Assembly. Dr Piukala added that the plan “reflects the learning from the Covid-19 pandemic and response to shared issues like climate change, ageing, migration, evolving geopolitics, increasing spillover events and rapidly advancing science and technology.” The World Health Assembly approved the draft GPW-14 following Tuesday’s discussions, but funding remains a concern. The GPW-14 program has a price tag of $11.1 billion, with WHO member states’ assessed contributions covering just over a third of the cost at $4 billion. The WHO is still looking for $7 billion in flexible funding, which it will attempt to raise at an investment conference in late 2024. Focus on Climate Change In recent years, the impact of climate change on health, particularly non-communicable diseases, has become increasingly clear. The WHO has warned that severe weather events, pollution, and climate-sensitive diseases are becoming more frequent worldwide, with vulnerable areas like small island developing states bearing a disproportionate impact. The GPW-14 also notes that human migration and displacement have reached unprecedented levels, with an estimated one billion people choosing to migrate or being forcibly displaced due to various factors, including economic, environmental, political, and conflict-related issues – with dire consequences for health. “The pace of climate change and environmental degradation has accelerated, emerging as a major threat to human health in the 21st century,” the GPW-14 warns. “Increasing inequities within and between countries, which were exacerbated by the COVID-19 pandemic, are leading to a growing divide in health, social and economic outcomes between those with financial resources and those without.” Countries like Japan and the United States praised the WHO for its growing focus on climate and health. Member states acknowledged that health-related Sustainable Development Goals are not on track, and Turkey drew attention to attacks on health facilities and disruptions to essential health services, calling it a “man-made crisis.” “GPW-14 includes the measures to address climate change in the primary objective,” the representative from Japan said. “Now, the world is facing a huge impact of climate change on health. And we affirm the importance of disaster management, especially in the healthcare field.” Dr Saia Ma’u Piukala, Regional Director for WHO’s Western Pacific region. Civil Society Warns WHO Plan is Incomplete Civil society groups have pointed out several shortcomings in the WHO’s GPW-14 plan, despite its ambitious goals to address climate change and health equity. The NCD Alliance, an organization focused on fighting non-communicable diseases (NCDs), criticized the plan for not adequately addressing NCDs, which account for 74% of global deaths. The lack of specificity on NCDs in the GPW-14 comes despite the increasing burden of disease from climate and environmental factors like heat and air pollution. “We regret the missed opportunity to ensure comprehensive outcome indicators for NCDs,” said a representative for the NCD Alliance. “The absence of answers to indicators hinders prioritization for achieving agreed targets.” Other civil society groups noted the plan’s lack of specific references to maternal health indicators and provisions to address the vulnerability of women in the health workforce, despite women constituting 70% of healthcare professionals globally. However, the healthcare workforce and ways to improve equity were mentioned in the plan several times. “Integrating gender-responsive approaches into health workforce planning and management can help address gender disparities in health outcomes and advance progress towards achieving universal healthcare,” said a representative from the Global Health Council in a constituent statement. The absence of gender-responsive provisions in the GPW-14 is likely due to opposition from conservative countries to the terminology. Countries like Russia, Egypt, and Iran objected to any references to “gender” on religious and political grounds during closed-door negotiations, Health Policy Watch reported. Despite these criticisms, several member states thanked the WHO for the extensive consultations carried out before finalizing the draft plan. “We particularly applaud the Secretariat for extensive and inclusive consultation through various platforms with member states, various organizations and partners in the drafting process,” the representative from Botswana said. Image Credits: Twitter, Twitter. Can Technology Help Address Global Migrant Crisis? Experts Weigh In 28/05/2024 Maayan Hoffman A panel discussion at the “Ensuring continuity of care at different stages of the migration process” session of the Gevena Health Forum. From left to right: Alexios Georgalis of the National and Kapodistrian University of Athens, Reinaldo Ortuno Gutierrez of Médecins Sans Frontières, Rebecca Marcussen-Lewis of SOS Méditerranée and Sanjula Weerasinghe, a representative of the International Federation of Red Cross. As the world grapples with a migrant and refugee crisis of unprecedented scale, with 281m international migrants and 3.5m refugees globally, according to UN agencies, experts are turning to technology, particularly artificial intelligence, in search of solutions. The potential for AI and technology to foster a more equitable and sustainable world has been recognised by international organisations. Last year, the World Health Organization, World Intellectual Property Organization, and International Telecommunication Union formed the Global Initiative on AI for Health to facilitate the implementation of AI in healthcare. During the 2024 World Economic Forum, specialists underscored both AI’s transformative potential and the associated risks, emphasising the necessity of cooperation and ethical guidelines to harness its benefits responsibly. With record numbers of people on the move worldwide, can technology help tackle the migrant and refugee crises? Four experts addressed the question at the Geneva Health Forum on Monday during a day focused on migration and health equity. The Geneva Health Forum, convened by the University of Geneva and partners on the first three days of the 2024 World Health Assembly, brings together key global health scientists and policymakers with medical practitioners and other field actors. Here are their insights. Alexios Georgalis, who co-authored the Boys on the Move life skills curriculum – a UNICEF initiative that guides unaccompanied male adolescents displaced by conflict and poverty – believes that although AI cannot fully resolve the refugee crisis, digitalizing and gamifying interventional packages could have a substantial impact. His work focuses on educating young male migrants about exploitation and trafficking, as well as providing mental health support. “Almost every refugee has a smartphone,” Georgalis noted, indicating that digital tools could serve as a “gateway into their psyches and their hands.” Reinaldo Ortuno Gutierrez of Médecins Sans Frontières (MSF) recommended developing geotargeted technologies to help migrants find healthcare wherever they are. MSF already uses QR codes that can be scanned with a smartphone to provide a map of care sites, from primary care to psychiatric care. Gutierrez also mentioned secure referral systems that allow patient files to travel safely via smartphone, ensuring continuity of care. “It would be ideal to have some kind of passport for everyone, but at the moment, it is very limited,” he said. Sanjula Weerasinghe, a representative of the International Federation of Red Cross (IFRC), highlighted the potential benefits of digitally-carried medical records, allowing migrants to “take responsibility and control of their own data.” However, she noted that while efforts to generate this type of record-keeping are underway, no such technology currently exists. Weerasinghe, like Gutierrez, pointed out that some international organisations have developed apps to help migrants locate and access services. Rebecca Marcussen-Lewis, SOS Méditerranée. In contrast, Rebecca Marcussen-Lewis of SOS Méditerranée, a search and rescue NGO operating boats tasked with rescuing drowning migrant vessels, highlighted the challenges of digitalization in her work on the Mediterranean Sea. “We don’t have connectivity, so everything being digital and online is not so easy for us, and if everything moves in that direction, we run the risk of losing the ability to do our work,” she said. However, Marcussen-Lewis acknowledged that telemedicine could be helpful, allowing her team to reach out to a network of experts when faced with unfamiliar medical situations at sea. With a team of four serving over 630 people on a 69-meter boat, “being able to have a network that we can reach out to when we have a presentation that none of us has come across before is fantastic,” she said. Image Credits: Maayan Hoffman, Courtesy of Geneva Health Forum, Geneva Health Forum. Pollution’s Silent Killers: New Research Links Lead Exposure to Millions of Cardiovascular Deaths 28/05/2024 Elaine Ruth Fletcher & Sophia Samantaroy Lead has been found in contaminated turmeric and other spices, creating another route of exposure to the heavy metal Four well-known heavy metals and chemical pollutants – lead, asbestos, arsenic and cadmium- continue exact a heavy toll on the lives of those in low- and middle-income countries – with lead named a factor in as much as 5 million premature deaths annually from cardiovascular disease, according to one recent estimate. Asbestos, arsenic, and cadmium round out the top four, claiming hundreds of thousands of lives every year. While much recent media attention has been focused on the health impacts of newer industrial compounds such as dioxins, phthalates, and endocrine disruptors, these heavy metal “silent killers” need renewed attention in the environmental health arena, experts say. This was one key message from a day-long session on Health and Environment, the featured theme on the opening day of this year’s Geneva Health Forum, 27-29 May. The session highlighted the pressing threats of environmental pollution from plastics and lead to endocrine disruptors and ambient air pollution. The Geneva Health Forum, organized by the University of Geneva on the sidelines of the World Health Assembly brings together the global scientific community with health practitioners and field actors from around the world. Migration, health and equity and malaria are other key themes The Geneva Health Forum highlighted three key themes on opening day. This year’s Forum, running on the sidelines of the World Health Assembly, brings together hundreds of scientists, policy experts and member state representatives on three key themes – including migration, health and equity; and malaria elimination – each the focus of a full-day session. There are also a host of side events on issues ranging from One Health to Climate resilience and elimination of neglected tropical diseases such as Chagas disease and Noma. While panellists highlighted the higher profile of air pollution in recent years and successes with air quality regulation in higher-income countries, air pollution remains a serious and even growing problem in low- and middle-income regions. Focus on pollutants with the highest impacts on death and disease A recent study implicated lead with 5.5 million premature deaths Meanwhile, age-old problems of heavy metal and mineral pollutants such as lead and asbestos also need much more attention, also in LMICs. “We need to deal with key priorities, country by country, of what’s causing the most damage,” said Richard Fuller, founder and former chair of the Global Alliance on Health and Pollution, who recently participated in an assessment ranking the burden of disease from key WHO “chemicals of concern.” “There was one chemical issue that caused millions of deaths – and then four issues that caused hundreds of thousands of deaths,” he said, referring to lead, asbestos, highly hazardous pesticides, arsenic, and cadmium. “The one that caused the majority of deaths was our old friend lead, which is responsible for 1.5 -2 million deaths per year.” Lead may account for as many as 5.5 million premature deaths from CVD A man melts lead metallic wastes used in the production of cooking pots, at a recycling warehouse in Koumassi, Abidjan, Ivory Coast. A 2023 paper published in The Lancet, supported by the World Bank, estimated that lead exposure may cause up to 5.5 million premature deaths annually, with 95 per cent of those deaths attributed to cardiovascular diseases. The analysis draws on emerging evidence linking lead exposure to atherosclerosis, alongside its known effects on reduced IQ, the central nervous system, and other organs. Mr. Fuller noted that the “lead problem,” once associated with pipes, paint, and gasoline, has evolved in affected low-income regions, but its impact remains just as devastating. “It turns out to be all sorts of activities going on in low- and middle-income countries, including [fabrication of] pots and pans and [contamination] of turmeric,” he explained. “The ones that are less impactful … are things like dioxins, phthalates, brominated flame retardants, PFAS, endocrine disruptors, PCBs, and PAHs,” Mr. Fuller noted, emphasizing that these pollutants are “simply the noisier part of the agenda, but not necessarily the most impactful part of the agenda.” “Should we be focusing on the ones that have the most impact, not just the most noise?” he added. John Ji, an environmental epidemiologist at the Tsinghua University Vanke School of Public Health, told the forum he initially thought his 2013 dissertation on lead would be one of the last. “Then Flint happened,” he said, referring to the water crisis in Flint, Michigan, which brought the issue of lead contamination back into the spotlight. Air pollution remains a driver of poor health From left: Mexican Ambassador to Geneva Fernando Espinosa; Nino Kuenzli of the Swiss Tropical Instiute and John Ji of China’s Vanke School of Public Health. With the World Health Organization attributing 13.7 million deaths to chemical and pollutant exposures, the Forum called attention to the need for global collaboration, research, and policy to tackle pollution-related health effects. “Clean air is possible, yet in some cities in the Asian and African continents, air pollution is getting worse,” said Nino Kuenzli, former Swiss Tropical and Public Health Institute professor. He acknowledged that air pollution regulation is part of a broader environmental health success story, citing the significant increase in air quality in Europe and North America in the past decades. “The Swiss mountain town I grew up in had worse air quality than the Swiss urban centres today,” said Kuenzli, adding that this drastic improvement was built upon decades of scientific victories. “We cannot just call for action and policy without a knowledge [of the science] and it is really fascinating to see how the science to understand the health effects of air pollution has evolved over the last 35 years. It’s incredible. Progress is enormous.” Advances in environmental epidemiology, and newfound ways for collaboration among basic scientists and toxicologists, have paved the way for these air quality improvements. Addressing global air pollution inequalities and replicating much of the successes of higher-income countries means “leapfrogging” intermediate policies and technologies, argued Ji. For example, one of the largest sources of indoor air pollution comes from burning biomass fuels, yet countries often transition to gas stoves, which still produce air pollutants. Instead, countries could support a transition directly from biomass to electric, he said. Air pollution levels have continued to go up in most countries across the world despite rising awareness of its harms. Plastic pollution: a new and growing threat Plastics, now ubiquitous in the environment, are another kind of new, and growing pollution concern for soils, waterways, and air, when incinerated. “By 2050, there will be more plastic than fish in the oceans,” remarked Fernando Espinosa, the Mexican Ambassador to Switzerland. Plastic pollution got a brief nod on opening day following last month’s fourth Intergovernmental Negotiating Body in Ottowa, Canada to develop an international legally binding instrument on plastic pollution, including in the marine environment. While the negotiations did reach some conclusions, like developing a list of chemicals of concern, they did not agree to reduce the production of new plastics, most likely due to ongoing pressure from the fossil fuel lobby and their state backers, such as Saudi Arabia, Russia and the United States. Climate adaptation and resilience in the healthcare system The Forum also brought together experts to discuss the often negative environmental contributions of healthcare systems in lower- and middle-income countries. The sector has increasingly produced contaminated waste, greenhouse gas emissions, and other pollutants – causing upwards of five per cent of global greenhouse gas emissions. These emissions come from hospitals themselves, but also from the manufacturing of medical products. Yet remarks from panellist Habib N’Konou, founder of an innovative biomedical waste company, during a later session demonstrated the disproportionate environmental impacts of the health sector in lower-and-middle-income countries. Senegal, he noted, produces upwards of 21,000 tonnes of medical waste per year, much of which is inadequately processed. “It’s an alarming situation. When I came back to Senegal, there was waste on the coasts, in neighbourhoods.” Looking to the successes of other countries could pave the way for better biomedical waste management, N’Konou noted. Morocco and Tunisia both have government-mediated partnerships between waste facilities and hospitals, something N’Konou champions for Senegal and surrounding countries. Even when regulations exist, they are hard to enforce. Despite the environmental challenges facing LMICs, the climate crisis is an opportunity to rethink how healthcare systems operate, according to Sonia Roschnik, executive director of the Geneva Sustainability Centre. “This is where I really hope that some of what we do to respond to climate change is going to help us leverage more innovative ways of looking at healthcare that actually deliver better population health, but also help the planet.” Image Credits: Prchi Palwe , EPA/L. Koula, Geneva Health Forum, Geneva Health Forum. Conservative Member States Balk at References to ‘Gender’ in WHA Resolutions 28/05/2024 Kerry Cullinan The World Health Assembly in progress. GENEVA – Conservative countries have objected to the use of the terms “gender responsive” and “advancing gender mainstreaming” in behind-the-scenes negotiations on several resolutions before the World Health Assembly (WHA), according to a wide variety of sources. There have also been some objections to the use of “gender equality” and “sexual” in some instances – alongside a long-standing objection to the use of “rights” when referring to sexual and reproductive health. “Gender” references have already been stripped from the World Health Organization’s (WHO) draft pandemic agreement. At least five other resolutions have become bogged down by objectives from conservative member states, particularly Russia, Egypt, Iran and Nigeria. These include resolutions on mental health, emergency preparedness, the economics of health, climate and social participation. In the case of the economics of health resolution, Nigeria initially objected to the use of both “gender equality” and “advancing gender mainstreaming”, one source said. Another source told Health Policy Watch that Russia even wants “sexual” to be removed from the standard term, “sexual and reproductive health”. In the resolution on climate and health, for example, there was an impasse over the use of “gender-responsive” policies – apparently because conservatives believe that this opens the door to engagement with LGBTQ groups although they have never unpacked their objection. Countries have eventually settled on a reference to “gender equality”. Objecting to these particular phrases is new. All UN member states including Russia agreed by consensus to the language of the global Sustainable Development Goals (SDGs), which refer to sexual health and gender. Concerned parties close to the talks stressed the importance of “stopping the backsliding” against established terms and rights for women and other groups in the face of the relentless campaign. Experts call for SRHR space to be protected A few days ago, 43 of the foremost global experts in sexual and reproductive health and rights (SRHR) in the UN called on the WHA to protect advance in this hard-won space in an article published by Health Policy Watch. The experts, who work in various UN expert committees, described progress on SRHR as “fundamental for human rights and dignity, national economies, sustainable development, and a healthier planet”. They added that while SRHR includes “services needed to prevent unwanted pregnancies, unsafe births and avoidable sexual or reproductive illness, injury or dysfunction, it is much broader. “Vitally, it includes the positive enjoyment of consensual sexual intimacy and pleasure, the development of mutually respectful and loving relationships, as well as the affirmation of individuals and families in all their diversity,” they added. “Sexual and reproductive health and rights flourish only where its emotional, mental, and social dimensions are also enabled, free of coercion, discrimination, and violence.” A repeat of 2022? The Saudi delegate in heated WHA debate over sexual rights and terminology at the WHA in 2022. Two years ago, the entire WHA was delayed for days over conflict related to a global strategy on HIV, hepatitis B and sexually transmitted infections, primarily because of a glossary on sexual health and target populations for HIV treatment. While the language was standard for HIV treatment and care, the Saudi Arabian delegate – speaking for WHO’s 22-member state Eastern Mediterranean Region (EMRO) – objected to the terms “sexuality”, “sexual orientation”, “sexual rights”. He also objected to “men who have sex with men” being designated as a target population for HIV treatment. Although the WHO works by consensus, the strategy eventually went to a vote late on the last night of an extended WHA, and narrowly passed with many absentions. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... 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BREAKING – Israel Wins WHA Approval of Hostage Reference in Draft Decision on Health in Occupied Palestinian Territories 29/05/2024 Elaine Ruth Fletcher Israel scored a tactical victory Wednesday evening when World Health Organization (WHO) member states agreed in a vote of 50-44 to amend a draft decision denouncing the health situation in the Occupied Palestinian Territories, with a reference calling for the release of some 125 Israeli hostages still held by Hamas. Another 83 member states were absent or abstained from the politically-charged vote. The original draft WHA decision was led by Algeria and supported by some 35 member states, including Russia, Egypt, Colombia, Cuba, Venezuela, and Iran. The decision denounces “acts of violence,” the “use of starvation of civilians” and the “wanton destruction of health facilities” – and calls upon the “occupying power” to fulfill its obligations under international law,” including replenishment of medical supplies, safe passage of fuel and health supplies and additional humanitarian assistance. WHA debate on issue adjourns while member states debate next moves South Africa’s delegate speaks on behalf of the original resolution condemning the health situation in Gaza, and other Israeli-occupied territories. As of publication, it was unclear if the draft decision, with the amendment referring to Israeli hostages, would indeed be brought to a vote. Immediately following the vote on the amendment, Egypt, on behalf of the co-sponsors, requested that it be withdrawn altogether. However, WHO rules would require Israel’s agreement to withdraw the Algerian-led resolution, now that Israel’s amendment has been approved. Ultimately, the WHA debate on the draft decision was adjourned until later Friday. That leaves both Israeli delegates and the resolution’s supporters, including sworn enemies such as Iran, unsure of what to do next. Neither side will want to cede more diplomatic points to the other. At the debate preceeding the vote on the amendment, dozens of member states, from Africa, Latin America, Asia and Europe, as well as Palestine that holds observer status, deplored the humanitarian situation that has been created by Israel’s war on Hamas in Gaza, including the interruptions in humanitarian aid, destruction of health facilities, and the recent deaths of displaced Palestinian civilians sheltering in a supposedly safe zone near Rafah from a nearby Israeli aerial bombing. “The international community should exert all efforts through the various instruments at our disposal to improve the ongoing humanitarian catastrophe in the occupied Palestinian territory, including Gaza,” said South Africa’s delegate to the Assembly, referring to South Africa’s case against Israel for alleged genocide before the International Court of Justice. Israeli Ambassador to Israel, Meirav Eilon Shahar calls for a vote over an amendment on Israeli hostages held by Hamas. Speaking to the assembly, Israeli Ambassador Meirav Eilon Shahar said “a decision that does not also condemn the militarization of health facilities by terrorists in Gaza has no intention of improving the health conditions on the ground… A decision on health that does not demand the immediate and unconditional release of all hostages – who are held by a terrorist organization, raped and tortured – is an unforgivable moral failure.” Wednesday’s debate was only the first of two scheduled by the assembly on the war in Gaza and its humanitarian fallout, which has led to the displacement of over 1 million Palestinians, and over 34,000 deaths, along with severe hunger and malnutrition in parts of Gaza. Some 1,200 Israelis died and more than 250 were taken hostage during the October 7 Hamas incursion into Israeli communities that triggered Israel’s invasion of Gaza. While an estimated 125 hostages, including over a dozen sick and elderly people, young women, and several young children are still being held in Gaza, it’s unclear how many are still alive. Second Gaza resolution has wider support A second draft resolution on Gaza, to be considered tomorrow, has much wider WHA suport and is likely to be adopted by consensus. It makes a call on “all parties to fully comply with their obligations” under the 1949 Geneva conventions, and ensure “unimpeded, safe, and unobstructed” passage for medical personnel.” That resolution, which was the focus of a special session of WHO’s Executive Board on 10 December, was approved by consensus, including with support from the United States, Israel’s closest ally, in what was then a first such vote in the UN system. That draft resolution to be considered Friday, makes no direct mention of either the Israeli hostages or Palestinian prisoners held by Israel. But Article 2 “reaffirms that all parties to armed conflict must comply fully with the obligations applicable to them under international humanitarian law related to the protection of civilians in armed conflict and medical personnel.” US Optimistic About Pandemic Treaty Talks, But Timeline Remains Uncertain 29/05/2024 Kerry Cullinan US Secretary of Health and Human Services Xavier Becerra GENEVA – The United States believes a “good deal” is within reach on the pandemic agreement, with parties “close to consensus,” Secretary of Health and Human Services (HHS) Xavier Becerra told reporters at the US Mission in Geneva on Wednesday. “There is a clear consensus that we can’t let the status quo be upon us if another pandemic comes,” Becerra said, adding that the US believes it has given the talks their “best shot”. “We’re so optimistic because everyone gets it. It’s not just our health. It’s our economies. It’s our security that’s at stake.” Despite some disagreements, “the contours of the agreement are in place,” Becerra said, expressing optimism that countries would leave this week’s World Health Assembly (WHA) with “something” to show that the World Health Organization (WHO) is ready for the next pandemic. Spain’s Dr Fernando Simón (centre), flanked by Thiru Balasubramaniam of Knowledge Ecology International (left) and Dr YuanQiong Hu (right) of Médecins Sans Frontières. Key Spanish negotiator Dr Fernando Simón echoed the sentiment, stating that differences between countries are not significant. “Faster is the best. There is no perfect treaty, but if we don’t get this pandemic agreement, we risk getting a trade agreement, not a public health agreement,” Simón said at a meeting at the Médecins Sans Frontières headquarters. One or two-year delay? However, US Ambassador Pamela Hamamoto cautioned WHA delegates on Tuesday that the pandemic agreement might take one or two years to conclude, citing “fundamental differences” on “complex technical issues that require extensive deliberation and carefully crafted workable solutions.” US Ambassador Pamela Hamamoto at WHA77 The 47 African member states of the WHO are pushing for the pandemic agreement to be concluded and presented to a special WHA by year’s end. The upcoming US presidential election on November 5 could impact the negotiations, particularly given the high level of disinformation surrounding the pandemic agreement in the US. Should Donald Trump win the US election, his administration is likely to scupper the pandemic agreement – and possibly pull out of the WHO altogether. ‘We shouldn’t leave Geneva with nothing’ But Becerra and Loyce Pace, HHS Assistant Secretary for Global Affairs, were both upbeat, intimating that it was now up to other parties to pick up the pen and sign the deal. “If we can get this across the finish line, I think what we show – with the pandemic accord and improved International Health Regulations – that we’re ready to take on these challenges so that never again will we suffer a pandemic [like COVID-19],” said Becerra. Loyce Pace, US HHS Assistant Secretary for Global Affairs “Frankly, we shouldn’t be leaving Geneva and going home with nothing, not after all that’s been done,” Pace said. “The world needs us to update our global health security architecture. The world needs world leaders and public health leaders to truly commit to what’s required.” The US is also pushing hard for the amendments to the International Health Regulations (IHR) to be adopted this week. The IHR governs countries’ conduct during “public health emergencies of international concern”. “We don’t know how long it’s going to be before we get another type of COVID-kind of tragedy. We don’t want to wait,” Becerra said. “We made it unambiguous and clear what we could offer and also what we could accept. “The elements of a big deal are already on the table. And that’s why, again, we feel optimistic, because those are pretty good deals. It’s just a matter of now finally making sure everybody says: ‘We’re ready to sign on the dotted line’,” he added. A new WHA drafting committee met most of Wednesday to work out a process for adopting both measures and may report back to the WHA as early as Thursday. Some African countries have linked their support for the IHR amendments this week to their timetable for the pandemic agreement. But this position is not monolithic. Botswana, for example, supports the IHR’s adoption this week. Russia indicated on Tuesday that it opposed the adoption of the IHR this week, so the issue might go to a vote. Additional reporting by Elaine Fletcher. Cardiometabolic Diseases Threaten Life Expectancy Gains, Even in Young Countries 29/05/2024 Sophia Samantaroy Panelists Catherine Priestley, Jo Jewell, Monika Arora, Francesco Branca, and Ad Adams, with moderator Shiulie Ghosh (far right) at the IFPMA-World Heart Federation- World Obesity Federation side event in Geneva. GENEVA – Cardiometabolic diseases, a group of non-communicable diseases (NCDs) including cardiovascular disease, stroke, diabetes, and non-alcoholic fatty liver disease, are on the rise globally, threatening life expectancy gains and burdening vulnerable economies with excess healthcare costs. These diseases already contribute to over 30% of global deaths each year. With one billion people now living with obesity, projections suggest that by 2035, 50% of the world’s population will be affected, leading to premature deaths and a growing economic burden. “Non-communicable diseases are only going in one direction. They are increasing,” Dr Christopher Tufton, Jamaican Minister of Health, remarked at a World Heart Federation (WHF) and World Obesity Federation (WOF) event in Geneva on Monday. “It is at a catastrophic level. It concerns all of us wherever we are.” Low- and middle-income countries, despite their relatively young populations, are driving the alarming rise in global obesity. Obesity rates in these countries are expected to soon match those in high-income countries, a significant shift from the trend observed just a decade ago, said Francesco Branca, director of the Department of Nutrition and Food Safety at the World Health Organization. Cardiometabolic diseases pose a particularly severe threat to low- and middle-income countries, not only jeopardizing hard-fought life expectancy gains but also burdening their already fragile economies with excessive healthcare costs, endangering the sustainability of their health systems and diverting funds from other crucial areas of healthcare. “The data suggests that we’re seeing a reversal of the gains that we’ve made in life expectancy,” Tufton said, highlighting the impact on his home country Jamaica. “The opportunity to live up to an average of 75 years is now under serious threat.” Non-communicable diseases accounted for 77% of all deaths in Jamaica in 2020, with age-standardized mortality rates showing significant increases in deaths from diabetes, hypertension, and heart disease over the past decade. Rise of cardiometabolic diseases in children and adolescents, fueled by targeted advertising The increased rate of deaths from cardiometabolic diseases in countries like Jamaica is not just a consequence of an ageing population. It is also the result of a progressive rise in deaths across all age groups, from children and adolescents to adults. Dr Monika Arora, Vice President of Research and Health Promotion at the Public Health Foundation of India (PHFI), argued that much of the reason for the rise of obesity in younger children stems from advertising and hidden additives. “Advertisements for foods high in fat, salt, and sugar — the exposure was much higher in children’s [TV] channels than young adult channels, meaning the industry very clearly wants them to be hooked on to their products early on,” she said. India, a country that struggles with both undernutrition and overnutrition, now has the third-highest number of people living with obesity globally, largely due to aggressive advertising targeting children and the rise of ultra-processed foods (UPF). The urban poor are the hardest hit, as cheap food options often come in the form of ultra-processed foods, while fresh fruits and vegetables remain too costly. “They don’t have any means for physical activity, and they don’t have [access to] food which is healthy and cost-effective,” said Arora. Urban air pollution further compounds the barriers to exercise, as the air quality is often too dangerous for walking or running outdoors, she added, in an interview with Health Policy Watch. Ultra-processed foods can be deceptively hidden, such as the additives found in milk products marketed for children. “There’s a whole culture about feeding children milk. The milk additives are claiming 20% better growth, better height, and better immunity, and nobody’s checking where these studies are published — these are filled with high-sugar products,” Arora explained. “These are all hidden calories. So even in urban settings where people are cutting down on sugar, they don’t realize that these are ultra-processed foods, and they continue to feed children with products that are harmful.” The long-term consequences of childhood obesity and the predatory tactics that fuel it are staggering for individuals and health systems alike. A 2015 National Institutes of Health study of over 200,000 US children found that obese children and adolescents were nearly five times more likely to be obese as adults compared to their non-obese peers. The study showed that 55% of obese children become obese adolescents, 80% of obese adolescents remain obese in adulthood, and 70% will continue to be obese beyond age 30. “These young people are going to have a life-long exposure to this condition,” Branca warned. Growing economic burdens globally Lower and middle-income countries are seeing rising economic impacts due to obesity, according to data from the World Obesity Atlas. As more low- and middle-income countries struggle with obesity and other cardiometabolic diseases, the economic impact of these conditions continues to grow. In Jamaica, for example, the total economic impact of obesity is projected to reach $524 million by 2025, with the burden on GDP expected to be 3.9% by 2035, according to Tufton. The global economic impact of overweight and obesity will reach $4.32 trillion annually by 2035 if prevention and treatment measures do not improve, according to the World Obesity Federation’s World Obesity Atlas 2023. The report notes that at almost 3% of global GDP, this cost is “comparable to that of COVID-19 in 2020.” “It’s also about framing the societal value for patients, healthcare systems, and economies of taking action and avoiding those costs, which for obesity alone is estimated to be $4 trillion if we don’t take action,” said Jo Jewell, Novo Nordisk Director of Cities for Better Health & Head of Obesity Health Equity. Comprehensive prevention, treatment, and management are crucial, Jewell noted, with partnerships between the private sector, healthcare sector, and governments to reach those most in need within communities. Basic screening for conditions like hypertension, blood pressure, and diabetes is essential, and governments should work to bring screening to the people, Tufton added. Knowing these numbers provides a basis for healthcare providers to give meaningful advice and “encourage” behaviour change. “It is about taking screening to the people,” Tufton said, “as opposed to encouraging people to come to the health centres or the clinics or your private practitioners to get screening.” “Children live what they learn” Jamaica Minister of Health Christopher Tufton speaks at an IFPMA-World Heart Federation-World Obesity Federation event. Government policies targeting individual behaviour are a core component of plans to tackle the obesity epidemic. However, reflecting on the power of targeted advertising and hidden additives in ultra-processed foods, Branca noted that individuals are not solely responsible for obesity. This marks a paradigm shift in how the disease is perceived, as an individual’s obesity was previously viewed predominantly as a personal failing. Policies that only target individual behaviours are “clearly” not sufficient, Branca said, and must be paired with policies that create environments allowing people to make healthy choices, such as controlling marketing, eliminating trans fats, and lowering food prices. This approach extends to helping children make good decisions about nutrition from early childhood onward. The “captive environment” of schools and the educational programs they provide have the potential to influence community-level change through nutrition and exercise initiatives, multiple experts on the panel noted. The success of these childhood education programs depends on working closely with school authorities to provide a supportive environment, including less unhealthy food, physical education, and empowerment to make healthy food choices. “When we work with children in school settings, we are definitely able to influence their behaviours, whether it is healthy eating and being more physically active,” said Arora. Including children and young adults in decision-making plans around nutrition, she added, is key to ensuring “sustainable behaviour” and empowers them not to “go back home and resort to unhealthy food.” “We believe that our youngsters could be great teachers of the adults by making an impression on them in schools,” Tufton added. “If we were to modify what they consume, and encourage them to consume in a more balanced way, combined with physical activity, then they will grow hopefully to follow that pattern and become a healthier adult over time.” Image Credits: S. Samantaroy/HPW, World Obesity Federation. The Power of Partnerships in Advancing Global Health 29/05/2024 Maayan Hoffman IFPMA Director-General David Reddy (right) in an interview with journalist Shiulie Ghosh on Tuesday, May 28. GENEVA – Partnerships between industry, multilateral organizations, and other stakeholders are essential to overcoming challenges and improving access to innovations. This was the key message at an International Federation of Pharmaceutical Manufacturers (IFPMA) event on Tuesday evening, held on the sidelines of the World Health Assembly in Geneva. The gathering brought together representatives from the World Health Organization (WHO), Gavi, government officials, and industry leaders to discuss how these partnerships can be enhanced to deliver meaningful impact for people and healthcare systems worldwide. The event featured an interview with David Reddy, the newly appointed Director-General of IFPMA and former CEO of Medicines for Malaria Ventures who took over from Thomas Cueni in April. IFPMA, the global pharmaceutical trade organization, works with the WHO and other UN bodies, representing over 90 companies and associations, including industry giants like Johnson & Johnson, Novartis, Pfizer, Eli Lilly and AstraZeneca. Reddy, who has been in his new role for fewer than two months, described drug development as a process of “assembling information that wraps around a molecule,” from animal safety studies to patient behaviour, infection treatment and manufacturing quality. This information then undergoes regulatory review to ensure the drug’s efficacy. The complex nature of drug development means pharmaceutical companies must work closely with multilateral organizations to ensure their drugs are distributed and accessible, particularly in low- and middle-income countries. However, there is often tension between the high cost of developing innovative medicines and vaccines and the basic health needs of populations that may be unable to afford them. This is where partnerships are crucial. “It’s really important just to underscore that it’s not something that we, as an industry, can do alone. We can only do it in partnership.” Reddy quoted WHO Deputy Director-General Mike Ryan, who said that industry and the UN health body agree on 80% of things in global health and may differ on 20%. Ryan has urged focusing on the 80% agreement to make progress. “It doesn’t mean we should ignore the areas of difference. We should debate them,” Reddy said. “But don’t forget that we are so aligned in so many ways.” The monoclonal antibody revolution Covid-19 monoclonal antibodies Reddy also spoke about drug and vaccine innovation, using the mRNA COVID-19 vaccines as an example. “They were there just when they were needed, but they were there because of two decades of work. Companies were able to partner together and really accelerate getting them to people to prevent them from becoming patients,” Reddy explained. Innovation, he said, “just takes a long time” and costs money. Looking to the future, Reddy sees great potential in monoclonal antibodies, conjugated antibodies, mRNA technology, and individualized therapy, all underpinned by artificial intelligence. “We’re living in the monoclonal [antibody] revolution if you like,” he said. “Not globally yet. In terms of access, that is something this industry is really working on at this time.” AI could revolutionize drug development by enabling researchers to precisely select molecules that have the potential to become medicines, chart more efficient pathways, and significantly compress development timelines, Reddy added. Gavi: Partnerships crucial as health budgets tighten From left: Shiulie Ghosh, journalist; Minister Ong Ye Kung, minister of health of Singapore; Dr. Catharina Boehme, assistant director-general of External Relations and Governance for WHO; and Deborah Waterhouse, the CEO of ViiV Healthcare and the president of Global Health for GSK. Dr Sania Nishtar, the recently appointed CEO of Gavi, the Vaccine Alliance, also spoke about the importance of partnerships from her perspective, especially in the current climate, which she described as “a very resource-restrained time for global health”. Between competing priorities and ongoing conflicts in different parts of the world, the G7 is stretched,” Nishtar said. “We in the global health space must hear this loud and clear.” Nishtar’s remarks took place against the backdrop of the WHO’s new “Investment Round” initiative, aiming to raise $7 billion to make the organization’s funding more predictable, flexible, and sustainable. The total contributions of WHO member states are just $4 billion annually. Public health expenditure across OECD countries surged by an average of 17% in real terms between 2019 and 2021, as governments rapidly allocated resources to tackle the crisis. Prevention spending more than doubled due to extensive testing and vaccination efforts. In 2022, however, health spending across OECD countries declined by an average of 1.5%. With inflation expected to remain above 5% in 2024, compared to less than 2% in 2019, nominal increases will be considerably reduced. The pandemic led to increased health spending as a percentage of GDP in low- and middle-income countries, but not as much as in advanced economies. A recent Center for Global Development report suggests this increase is unlikely to be sustained due to the pandemic’s impact on revenues and budgets. Slow domestic revenue growth has already made achieving health-related Sustainable Development Goals (SDGs) by 2030 unlikely, and without new funding sources, meeting these goals will be further delayed. “We had 40 countries decrease their healthcare spending last year. Healthcare budgets are going down instead of up,” said Dr Catharina Boehme, assistant director-general of External Relations and Governance for WHO. “To harness the promise of science and innovation, we have to focus on creating capacity and making sure health funding remains intact.” Partnerships, Nishtar added, are in Gavi’s DNA, working closely with WHO, UNICEF, and industry to build synergies. “Solutions can be found when we work together,” she continued. “And we can only work together when we let go of ego, turf, rivalries and small thinking.” Image Credits: Raisa/Flickr. Push for International Health Regulation Changes to Be Passed This Week – But Disagreement About Future of Pandemic Agreement Talks 28/05/2024 Kerry Cullinan The crowded WHA meeting room where the pandemic discussions are taking place GENEVA – A powerful lobby, including the US, Germany and New Zealand, are pushing for the amendments to the International Health Regulations (IHR) to be adopted by the close of the World Health Assembly (WHA) on Saturday. Weaknesses in the IHR, the only global rules guiding countries’ conduct in international public health emergencies, were exposed during the pandemic, prompting a two-year process to amend them. Agreement is close, with some outstanding issues particularly on definitions, according to the report on the IHR negotiations to the WHA by World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus. “My appeal here is let us focus on the IHR so we have this success as this is already providing much better protection for the world,” said Germany’s Health Minister Karl Lauterbach. Strong positive signal The European Union (EU) echoed this sentiment, describing progress on IHR amendments as “remarkable”. “The adoption of these amendments within the very short timeframe of only two years will send a very positive signal to the outside world about the ability of the WHO and its membership to take concrete action to improve the global health architecture,” said the EU. “Such adoption will also send very positive signal for the future of the INB [Intergovernmental Negotiating Body] process.” The INB was charged with negotiating a pandemic agreement but member states have failed to reach agreement by the WHA deadline. The most recent pandemic agreement draft shows significant areas of disagreement remain. The EU acknowledged that some IHR amendments still need to be resolved and urged all partners to “redouble efforts” to finalise the work and adopt the changes by 1 June. Dr Ashley Bloomfield, co-chair of the Working Group on amendments to the IHR, told the WHA that the committee is “very close to completing an agreed package of amendments”. “There is both momentum and an aspiration among states parties to complete the task,” said Bloomfield. “Adopting a package of IHR amendments during this assembly would be a significant milestone and achievement and we believe in a very important stepping stone to successfully concluding the pandemic agreement negotiations later.” France, Indonesia, Kenya, New Zealand and Saudi Arabia have prepared a resolution to adopt the IHR amendments in anticipation of agreement being reached in the next few days. Pandemic agreement process unclear It is unclear whether the African region will support completing the IHR amendments this week if its demand for the speedy conclusion of the pandemic agreement by the end of this year is not accepted. At a packed WHA meeting of Committee A on Tuesday afternoon, there was intense discussion and some disagreements over the way forward for the INB process on a pandemic agreement. First off, there were two resolutions on the floor, one from the 47 WHO African member states and another from a group of countries that have often played a conciliatory role in talks – Australia, Brunei, Canada, Norway and Pakistan. Both spoke to the time frames for further talks, while the second resolution called for a new structure to take forward the pandemic agreement negotiations. South Africa’s Ambassador Mxolisi Nkosi. Expressing disappointment on behalf of the African region that a pandemic agreement was not agreed on, South Africa’s Ambassador Mxolisi Nkosi called for negotiations to be completed by the end of this year, followed by a special WHA. Botswana expressed its support for the speedy resolution of the IHR during the session, but Kenya – on behalf of the Africa region – linked the IHR amendments and the pandemic agreement, and simply said the region was ready to reach consensus. However, US Ambassador Pamela Hamamoto called for an extension of “one to two years”, explaining that “fundamental differences remain on core issues central to the agreement”. She described these differences as “complex technical issues that require extensive deliberation and carefully crafted workable solutions, inspired by a common vision and supported by all member states”. Ironically, if Donald Trump wins the US presidential election at the end of the year, his administration is unlikely to support the pandemic negotiations – or even the WHO. The WHA’s Committee A resolved that a single drafting group co-chaired by one INB member and one WGIHR member, will convene on Wednesday morning. It will be open to all member states and its task will be to consider all three draft resolutions and propose a process for adopting the IHR amendments and the timing, format and process to conclude the pandemic agreement. These proposals will have to be submitted to the WHA as the mandates for both the WGIHR and the INB have expired. Climate Change to Be Major Focus for WHO in Coming Years 28/05/2024 Disha Shetty The 77th session of World Health Assembly underway in Geneva, Switzerland. The World Health Organization plans to make climate change and its impact on health a major focus in the coming years, along with strengthening health systems, improving health equity and access, and preventing disease, according to the organization’s plan for its general program of work from 2025 to 2028. The four-year plan, known as GPW-14, also prioritizes mental health, gender equality, migrant health, food safety, digital health, and artificial intelligence. It was developed through an extensive 10-month consultation process involving member countries, UN organizations, and civil society organizations. “This document will act as our canvas, articulating our collective aspirations and strategic priorities in global health for the coming four years,” said Dr Saia Ma’u Piukala, the WHO’s regional director for the Western Pacific, as discussions on the plan concluded Tuesday morning, the second day of the ongoing 77th World Health Assembly. Dr Piukala added that the plan “reflects the learning from the Covid-19 pandemic and response to shared issues like climate change, ageing, migration, evolving geopolitics, increasing spillover events and rapidly advancing science and technology.” The World Health Assembly approved the draft GPW-14 following Tuesday’s discussions, but funding remains a concern. The GPW-14 program has a price tag of $11.1 billion, with WHO member states’ assessed contributions covering just over a third of the cost at $4 billion. The WHO is still looking for $7 billion in flexible funding, which it will attempt to raise at an investment conference in late 2024. Focus on Climate Change In recent years, the impact of climate change on health, particularly non-communicable diseases, has become increasingly clear. The WHO has warned that severe weather events, pollution, and climate-sensitive diseases are becoming more frequent worldwide, with vulnerable areas like small island developing states bearing a disproportionate impact. The GPW-14 also notes that human migration and displacement have reached unprecedented levels, with an estimated one billion people choosing to migrate or being forcibly displaced due to various factors, including economic, environmental, political, and conflict-related issues – with dire consequences for health. “The pace of climate change and environmental degradation has accelerated, emerging as a major threat to human health in the 21st century,” the GPW-14 warns. “Increasing inequities within and between countries, which were exacerbated by the COVID-19 pandemic, are leading to a growing divide in health, social and economic outcomes between those with financial resources and those without.” Countries like Japan and the United States praised the WHO for its growing focus on climate and health. Member states acknowledged that health-related Sustainable Development Goals are not on track, and Turkey drew attention to attacks on health facilities and disruptions to essential health services, calling it a “man-made crisis.” “GPW-14 includes the measures to address climate change in the primary objective,” the representative from Japan said. “Now, the world is facing a huge impact of climate change on health. And we affirm the importance of disaster management, especially in the healthcare field.” Dr Saia Ma’u Piukala, Regional Director for WHO’s Western Pacific region. Civil Society Warns WHO Plan is Incomplete Civil society groups have pointed out several shortcomings in the WHO’s GPW-14 plan, despite its ambitious goals to address climate change and health equity. The NCD Alliance, an organization focused on fighting non-communicable diseases (NCDs), criticized the plan for not adequately addressing NCDs, which account for 74% of global deaths. The lack of specificity on NCDs in the GPW-14 comes despite the increasing burden of disease from climate and environmental factors like heat and air pollution. “We regret the missed opportunity to ensure comprehensive outcome indicators for NCDs,” said a representative for the NCD Alliance. “The absence of answers to indicators hinders prioritization for achieving agreed targets.” Other civil society groups noted the plan’s lack of specific references to maternal health indicators and provisions to address the vulnerability of women in the health workforce, despite women constituting 70% of healthcare professionals globally. However, the healthcare workforce and ways to improve equity were mentioned in the plan several times. “Integrating gender-responsive approaches into health workforce planning and management can help address gender disparities in health outcomes and advance progress towards achieving universal healthcare,” said a representative from the Global Health Council in a constituent statement. The absence of gender-responsive provisions in the GPW-14 is likely due to opposition from conservative countries to the terminology. Countries like Russia, Egypt, and Iran objected to any references to “gender” on religious and political grounds during closed-door negotiations, Health Policy Watch reported. Despite these criticisms, several member states thanked the WHO for the extensive consultations carried out before finalizing the draft plan. “We particularly applaud the Secretariat for extensive and inclusive consultation through various platforms with member states, various organizations and partners in the drafting process,” the representative from Botswana said. Image Credits: Twitter, Twitter. Can Technology Help Address Global Migrant Crisis? Experts Weigh In 28/05/2024 Maayan Hoffman A panel discussion at the “Ensuring continuity of care at different stages of the migration process” session of the Gevena Health Forum. From left to right: Alexios Georgalis of the National and Kapodistrian University of Athens, Reinaldo Ortuno Gutierrez of Médecins Sans Frontières, Rebecca Marcussen-Lewis of SOS Méditerranée and Sanjula Weerasinghe, a representative of the International Federation of Red Cross. As the world grapples with a migrant and refugee crisis of unprecedented scale, with 281m international migrants and 3.5m refugees globally, according to UN agencies, experts are turning to technology, particularly artificial intelligence, in search of solutions. The potential for AI and technology to foster a more equitable and sustainable world has been recognised by international organisations. Last year, the World Health Organization, World Intellectual Property Organization, and International Telecommunication Union formed the Global Initiative on AI for Health to facilitate the implementation of AI in healthcare. During the 2024 World Economic Forum, specialists underscored both AI’s transformative potential and the associated risks, emphasising the necessity of cooperation and ethical guidelines to harness its benefits responsibly. With record numbers of people on the move worldwide, can technology help tackle the migrant and refugee crises? Four experts addressed the question at the Geneva Health Forum on Monday during a day focused on migration and health equity. The Geneva Health Forum, convened by the University of Geneva and partners on the first three days of the 2024 World Health Assembly, brings together key global health scientists and policymakers with medical practitioners and other field actors. Here are their insights. Alexios Georgalis, who co-authored the Boys on the Move life skills curriculum – a UNICEF initiative that guides unaccompanied male adolescents displaced by conflict and poverty – believes that although AI cannot fully resolve the refugee crisis, digitalizing and gamifying interventional packages could have a substantial impact. His work focuses on educating young male migrants about exploitation and trafficking, as well as providing mental health support. “Almost every refugee has a smartphone,” Georgalis noted, indicating that digital tools could serve as a “gateway into their psyches and their hands.” Reinaldo Ortuno Gutierrez of Médecins Sans Frontières (MSF) recommended developing geotargeted technologies to help migrants find healthcare wherever they are. MSF already uses QR codes that can be scanned with a smartphone to provide a map of care sites, from primary care to psychiatric care. Gutierrez also mentioned secure referral systems that allow patient files to travel safely via smartphone, ensuring continuity of care. “It would be ideal to have some kind of passport for everyone, but at the moment, it is very limited,” he said. Sanjula Weerasinghe, a representative of the International Federation of Red Cross (IFRC), highlighted the potential benefits of digitally-carried medical records, allowing migrants to “take responsibility and control of their own data.” However, she noted that while efforts to generate this type of record-keeping are underway, no such technology currently exists. Weerasinghe, like Gutierrez, pointed out that some international organisations have developed apps to help migrants locate and access services. Rebecca Marcussen-Lewis, SOS Méditerranée. In contrast, Rebecca Marcussen-Lewis of SOS Méditerranée, a search and rescue NGO operating boats tasked with rescuing drowning migrant vessels, highlighted the challenges of digitalization in her work on the Mediterranean Sea. “We don’t have connectivity, so everything being digital and online is not so easy for us, and if everything moves in that direction, we run the risk of losing the ability to do our work,” she said. However, Marcussen-Lewis acknowledged that telemedicine could be helpful, allowing her team to reach out to a network of experts when faced with unfamiliar medical situations at sea. With a team of four serving over 630 people on a 69-meter boat, “being able to have a network that we can reach out to when we have a presentation that none of us has come across before is fantastic,” she said. Image Credits: Maayan Hoffman, Courtesy of Geneva Health Forum, Geneva Health Forum. Pollution’s Silent Killers: New Research Links Lead Exposure to Millions of Cardiovascular Deaths 28/05/2024 Elaine Ruth Fletcher & Sophia Samantaroy Lead has been found in contaminated turmeric and other spices, creating another route of exposure to the heavy metal Four well-known heavy metals and chemical pollutants – lead, asbestos, arsenic and cadmium- continue exact a heavy toll on the lives of those in low- and middle-income countries – with lead named a factor in as much as 5 million premature deaths annually from cardiovascular disease, according to one recent estimate. Asbestos, arsenic, and cadmium round out the top four, claiming hundreds of thousands of lives every year. While much recent media attention has been focused on the health impacts of newer industrial compounds such as dioxins, phthalates, and endocrine disruptors, these heavy metal “silent killers” need renewed attention in the environmental health arena, experts say. This was one key message from a day-long session on Health and Environment, the featured theme on the opening day of this year’s Geneva Health Forum, 27-29 May. The session highlighted the pressing threats of environmental pollution from plastics and lead to endocrine disruptors and ambient air pollution. The Geneva Health Forum, organized by the University of Geneva on the sidelines of the World Health Assembly brings together the global scientific community with health practitioners and field actors from around the world. Migration, health and equity and malaria are other key themes The Geneva Health Forum highlighted three key themes on opening day. This year’s Forum, running on the sidelines of the World Health Assembly, brings together hundreds of scientists, policy experts and member state representatives on three key themes – including migration, health and equity; and malaria elimination – each the focus of a full-day session. There are also a host of side events on issues ranging from One Health to Climate resilience and elimination of neglected tropical diseases such as Chagas disease and Noma. While panellists highlighted the higher profile of air pollution in recent years and successes with air quality regulation in higher-income countries, air pollution remains a serious and even growing problem in low- and middle-income regions. Focus on pollutants with the highest impacts on death and disease A recent study implicated lead with 5.5 million premature deaths Meanwhile, age-old problems of heavy metal and mineral pollutants such as lead and asbestos also need much more attention, also in LMICs. “We need to deal with key priorities, country by country, of what’s causing the most damage,” said Richard Fuller, founder and former chair of the Global Alliance on Health and Pollution, who recently participated in an assessment ranking the burden of disease from key WHO “chemicals of concern.” “There was one chemical issue that caused millions of deaths – and then four issues that caused hundreds of thousands of deaths,” he said, referring to lead, asbestos, highly hazardous pesticides, arsenic, and cadmium. “The one that caused the majority of deaths was our old friend lead, which is responsible for 1.5 -2 million deaths per year.” Lead may account for as many as 5.5 million premature deaths from CVD A man melts lead metallic wastes used in the production of cooking pots, at a recycling warehouse in Koumassi, Abidjan, Ivory Coast. A 2023 paper published in The Lancet, supported by the World Bank, estimated that lead exposure may cause up to 5.5 million premature deaths annually, with 95 per cent of those deaths attributed to cardiovascular diseases. The analysis draws on emerging evidence linking lead exposure to atherosclerosis, alongside its known effects on reduced IQ, the central nervous system, and other organs. Mr. Fuller noted that the “lead problem,” once associated with pipes, paint, and gasoline, has evolved in affected low-income regions, but its impact remains just as devastating. “It turns out to be all sorts of activities going on in low- and middle-income countries, including [fabrication of] pots and pans and [contamination] of turmeric,” he explained. “The ones that are less impactful … are things like dioxins, phthalates, brominated flame retardants, PFAS, endocrine disruptors, PCBs, and PAHs,” Mr. Fuller noted, emphasizing that these pollutants are “simply the noisier part of the agenda, but not necessarily the most impactful part of the agenda.” “Should we be focusing on the ones that have the most impact, not just the most noise?” he added. John Ji, an environmental epidemiologist at the Tsinghua University Vanke School of Public Health, told the forum he initially thought his 2013 dissertation on lead would be one of the last. “Then Flint happened,” he said, referring to the water crisis in Flint, Michigan, which brought the issue of lead contamination back into the spotlight. Air pollution remains a driver of poor health From left: Mexican Ambassador to Geneva Fernando Espinosa; Nino Kuenzli of the Swiss Tropical Instiute and John Ji of China’s Vanke School of Public Health. With the World Health Organization attributing 13.7 million deaths to chemical and pollutant exposures, the Forum called attention to the need for global collaboration, research, and policy to tackle pollution-related health effects. “Clean air is possible, yet in some cities in the Asian and African continents, air pollution is getting worse,” said Nino Kuenzli, former Swiss Tropical and Public Health Institute professor. He acknowledged that air pollution regulation is part of a broader environmental health success story, citing the significant increase in air quality in Europe and North America in the past decades. “The Swiss mountain town I grew up in had worse air quality than the Swiss urban centres today,” said Kuenzli, adding that this drastic improvement was built upon decades of scientific victories. “We cannot just call for action and policy without a knowledge [of the science] and it is really fascinating to see how the science to understand the health effects of air pollution has evolved over the last 35 years. It’s incredible. Progress is enormous.” Advances in environmental epidemiology, and newfound ways for collaboration among basic scientists and toxicologists, have paved the way for these air quality improvements. Addressing global air pollution inequalities and replicating much of the successes of higher-income countries means “leapfrogging” intermediate policies and technologies, argued Ji. For example, one of the largest sources of indoor air pollution comes from burning biomass fuels, yet countries often transition to gas stoves, which still produce air pollutants. Instead, countries could support a transition directly from biomass to electric, he said. Air pollution levels have continued to go up in most countries across the world despite rising awareness of its harms. Plastic pollution: a new and growing threat Plastics, now ubiquitous in the environment, are another kind of new, and growing pollution concern for soils, waterways, and air, when incinerated. “By 2050, there will be more plastic than fish in the oceans,” remarked Fernando Espinosa, the Mexican Ambassador to Switzerland. Plastic pollution got a brief nod on opening day following last month’s fourth Intergovernmental Negotiating Body in Ottowa, Canada to develop an international legally binding instrument on plastic pollution, including in the marine environment. While the negotiations did reach some conclusions, like developing a list of chemicals of concern, they did not agree to reduce the production of new plastics, most likely due to ongoing pressure from the fossil fuel lobby and their state backers, such as Saudi Arabia, Russia and the United States. Climate adaptation and resilience in the healthcare system The Forum also brought together experts to discuss the often negative environmental contributions of healthcare systems in lower- and middle-income countries. The sector has increasingly produced contaminated waste, greenhouse gas emissions, and other pollutants – causing upwards of five per cent of global greenhouse gas emissions. These emissions come from hospitals themselves, but also from the manufacturing of medical products. Yet remarks from panellist Habib N’Konou, founder of an innovative biomedical waste company, during a later session demonstrated the disproportionate environmental impacts of the health sector in lower-and-middle-income countries. Senegal, he noted, produces upwards of 21,000 tonnes of medical waste per year, much of which is inadequately processed. “It’s an alarming situation. When I came back to Senegal, there was waste on the coasts, in neighbourhoods.” Looking to the successes of other countries could pave the way for better biomedical waste management, N’Konou noted. Morocco and Tunisia both have government-mediated partnerships between waste facilities and hospitals, something N’Konou champions for Senegal and surrounding countries. Even when regulations exist, they are hard to enforce. Despite the environmental challenges facing LMICs, the climate crisis is an opportunity to rethink how healthcare systems operate, according to Sonia Roschnik, executive director of the Geneva Sustainability Centre. “This is where I really hope that some of what we do to respond to climate change is going to help us leverage more innovative ways of looking at healthcare that actually deliver better population health, but also help the planet.” Image Credits: Prchi Palwe , EPA/L. Koula, Geneva Health Forum, Geneva Health Forum. Conservative Member States Balk at References to ‘Gender’ in WHA Resolutions 28/05/2024 Kerry Cullinan The World Health Assembly in progress. GENEVA – Conservative countries have objected to the use of the terms “gender responsive” and “advancing gender mainstreaming” in behind-the-scenes negotiations on several resolutions before the World Health Assembly (WHA), according to a wide variety of sources. There have also been some objections to the use of “gender equality” and “sexual” in some instances – alongside a long-standing objection to the use of “rights” when referring to sexual and reproductive health. “Gender” references have already been stripped from the World Health Organization’s (WHO) draft pandemic agreement. At least five other resolutions have become bogged down by objectives from conservative member states, particularly Russia, Egypt, Iran and Nigeria. These include resolutions on mental health, emergency preparedness, the economics of health, climate and social participation. In the case of the economics of health resolution, Nigeria initially objected to the use of both “gender equality” and “advancing gender mainstreaming”, one source said. Another source told Health Policy Watch that Russia even wants “sexual” to be removed from the standard term, “sexual and reproductive health”. In the resolution on climate and health, for example, there was an impasse over the use of “gender-responsive” policies – apparently because conservatives believe that this opens the door to engagement with LGBTQ groups although they have never unpacked their objection. Countries have eventually settled on a reference to “gender equality”. Objecting to these particular phrases is new. All UN member states including Russia agreed by consensus to the language of the global Sustainable Development Goals (SDGs), which refer to sexual health and gender. Concerned parties close to the talks stressed the importance of “stopping the backsliding” against established terms and rights for women and other groups in the face of the relentless campaign. Experts call for SRHR space to be protected A few days ago, 43 of the foremost global experts in sexual and reproductive health and rights (SRHR) in the UN called on the WHA to protect advance in this hard-won space in an article published by Health Policy Watch. The experts, who work in various UN expert committees, described progress on SRHR as “fundamental for human rights and dignity, national economies, sustainable development, and a healthier planet”. They added that while SRHR includes “services needed to prevent unwanted pregnancies, unsafe births and avoidable sexual or reproductive illness, injury or dysfunction, it is much broader. “Vitally, it includes the positive enjoyment of consensual sexual intimacy and pleasure, the development of mutually respectful and loving relationships, as well as the affirmation of individuals and families in all their diversity,” they added. “Sexual and reproductive health and rights flourish only where its emotional, mental, and social dimensions are also enabled, free of coercion, discrimination, and violence.” A repeat of 2022? The Saudi delegate in heated WHA debate over sexual rights and terminology at the WHA in 2022. Two years ago, the entire WHA was delayed for days over conflict related to a global strategy on HIV, hepatitis B and sexually transmitted infections, primarily because of a glossary on sexual health and target populations for HIV treatment. While the language was standard for HIV treatment and care, the Saudi Arabian delegate – speaking for WHO’s 22-member state Eastern Mediterranean Region (EMRO) – objected to the terms “sexuality”, “sexual orientation”, “sexual rights”. He also objected to “men who have sex with men” being designated as a target population for HIV treatment. Although the WHO works by consensus, the strategy eventually went to a vote late on the last night of an extended WHA, and narrowly passed with many absentions. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... 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US Optimistic About Pandemic Treaty Talks, But Timeline Remains Uncertain 29/05/2024 Kerry Cullinan US Secretary of Health and Human Services Xavier Becerra GENEVA – The United States believes a “good deal” is within reach on the pandemic agreement, with parties “close to consensus,” Secretary of Health and Human Services (HHS) Xavier Becerra told reporters at the US Mission in Geneva on Wednesday. “There is a clear consensus that we can’t let the status quo be upon us if another pandemic comes,” Becerra said, adding that the US believes it has given the talks their “best shot”. “We’re so optimistic because everyone gets it. It’s not just our health. It’s our economies. It’s our security that’s at stake.” Despite some disagreements, “the contours of the agreement are in place,” Becerra said, expressing optimism that countries would leave this week’s World Health Assembly (WHA) with “something” to show that the World Health Organization (WHO) is ready for the next pandemic. Spain’s Dr Fernando Simón (centre), flanked by Thiru Balasubramaniam of Knowledge Ecology International (left) and Dr YuanQiong Hu (right) of Médecins Sans Frontières. Key Spanish negotiator Dr Fernando Simón echoed the sentiment, stating that differences between countries are not significant. “Faster is the best. There is no perfect treaty, but if we don’t get this pandemic agreement, we risk getting a trade agreement, not a public health agreement,” Simón said at a meeting at the Médecins Sans Frontières headquarters. One or two-year delay? However, US Ambassador Pamela Hamamoto cautioned WHA delegates on Tuesday that the pandemic agreement might take one or two years to conclude, citing “fundamental differences” on “complex technical issues that require extensive deliberation and carefully crafted workable solutions.” US Ambassador Pamela Hamamoto at WHA77 The 47 African member states of the WHO are pushing for the pandemic agreement to be concluded and presented to a special WHA by year’s end. The upcoming US presidential election on November 5 could impact the negotiations, particularly given the high level of disinformation surrounding the pandemic agreement in the US. Should Donald Trump win the US election, his administration is likely to scupper the pandemic agreement – and possibly pull out of the WHO altogether. ‘We shouldn’t leave Geneva with nothing’ But Becerra and Loyce Pace, HHS Assistant Secretary for Global Affairs, were both upbeat, intimating that it was now up to other parties to pick up the pen and sign the deal. “If we can get this across the finish line, I think what we show – with the pandemic accord and improved International Health Regulations – that we’re ready to take on these challenges so that never again will we suffer a pandemic [like COVID-19],” said Becerra. Loyce Pace, US HHS Assistant Secretary for Global Affairs “Frankly, we shouldn’t be leaving Geneva and going home with nothing, not after all that’s been done,” Pace said. “The world needs us to update our global health security architecture. The world needs world leaders and public health leaders to truly commit to what’s required.” The US is also pushing hard for the amendments to the International Health Regulations (IHR) to be adopted this week. The IHR governs countries’ conduct during “public health emergencies of international concern”. “We don’t know how long it’s going to be before we get another type of COVID-kind of tragedy. We don’t want to wait,” Becerra said. “We made it unambiguous and clear what we could offer and also what we could accept. “The elements of a big deal are already on the table. And that’s why, again, we feel optimistic, because those are pretty good deals. It’s just a matter of now finally making sure everybody says: ‘We’re ready to sign on the dotted line’,” he added. A new WHA drafting committee met most of Wednesday to work out a process for adopting both measures and may report back to the WHA as early as Thursday. Some African countries have linked their support for the IHR amendments this week to their timetable for the pandemic agreement. But this position is not monolithic. Botswana, for example, supports the IHR’s adoption this week. Russia indicated on Tuesday that it opposed the adoption of the IHR this week, so the issue might go to a vote. Additional reporting by Elaine Fletcher. Cardiometabolic Diseases Threaten Life Expectancy Gains, Even in Young Countries 29/05/2024 Sophia Samantaroy Panelists Catherine Priestley, Jo Jewell, Monika Arora, Francesco Branca, and Ad Adams, with moderator Shiulie Ghosh (far right) at the IFPMA-World Heart Federation- World Obesity Federation side event in Geneva. GENEVA – Cardiometabolic diseases, a group of non-communicable diseases (NCDs) including cardiovascular disease, stroke, diabetes, and non-alcoholic fatty liver disease, are on the rise globally, threatening life expectancy gains and burdening vulnerable economies with excess healthcare costs. These diseases already contribute to over 30% of global deaths each year. With one billion people now living with obesity, projections suggest that by 2035, 50% of the world’s population will be affected, leading to premature deaths and a growing economic burden. “Non-communicable diseases are only going in one direction. They are increasing,” Dr Christopher Tufton, Jamaican Minister of Health, remarked at a World Heart Federation (WHF) and World Obesity Federation (WOF) event in Geneva on Monday. “It is at a catastrophic level. It concerns all of us wherever we are.” Low- and middle-income countries, despite their relatively young populations, are driving the alarming rise in global obesity. Obesity rates in these countries are expected to soon match those in high-income countries, a significant shift from the trend observed just a decade ago, said Francesco Branca, director of the Department of Nutrition and Food Safety at the World Health Organization. Cardiometabolic diseases pose a particularly severe threat to low- and middle-income countries, not only jeopardizing hard-fought life expectancy gains but also burdening their already fragile economies with excessive healthcare costs, endangering the sustainability of their health systems and diverting funds from other crucial areas of healthcare. “The data suggests that we’re seeing a reversal of the gains that we’ve made in life expectancy,” Tufton said, highlighting the impact on his home country Jamaica. “The opportunity to live up to an average of 75 years is now under serious threat.” Non-communicable diseases accounted for 77% of all deaths in Jamaica in 2020, with age-standardized mortality rates showing significant increases in deaths from diabetes, hypertension, and heart disease over the past decade. Rise of cardiometabolic diseases in children and adolescents, fueled by targeted advertising The increased rate of deaths from cardiometabolic diseases in countries like Jamaica is not just a consequence of an ageing population. It is also the result of a progressive rise in deaths across all age groups, from children and adolescents to adults. Dr Monika Arora, Vice President of Research and Health Promotion at the Public Health Foundation of India (PHFI), argued that much of the reason for the rise of obesity in younger children stems from advertising and hidden additives. “Advertisements for foods high in fat, salt, and sugar — the exposure was much higher in children’s [TV] channels than young adult channels, meaning the industry very clearly wants them to be hooked on to their products early on,” she said. India, a country that struggles with both undernutrition and overnutrition, now has the third-highest number of people living with obesity globally, largely due to aggressive advertising targeting children and the rise of ultra-processed foods (UPF). The urban poor are the hardest hit, as cheap food options often come in the form of ultra-processed foods, while fresh fruits and vegetables remain too costly. “They don’t have any means for physical activity, and they don’t have [access to] food which is healthy and cost-effective,” said Arora. Urban air pollution further compounds the barriers to exercise, as the air quality is often too dangerous for walking or running outdoors, she added, in an interview with Health Policy Watch. Ultra-processed foods can be deceptively hidden, such as the additives found in milk products marketed for children. “There’s a whole culture about feeding children milk. The milk additives are claiming 20% better growth, better height, and better immunity, and nobody’s checking where these studies are published — these are filled with high-sugar products,” Arora explained. “These are all hidden calories. So even in urban settings where people are cutting down on sugar, they don’t realize that these are ultra-processed foods, and they continue to feed children with products that are harmful.” The long-term consequences of childhood obesity and the predatory tactics that fuel it are staggering for individuals and health systems alike. A 2015 National Institutes of Health study of over 200,000 US children found that obese children and adolescents were nearly five times more likely to be obese as adults compared to their non-obese peers. The study showed that 55% of obese children become obese adolescents, 80% of obese adolescents remain obese in adulthood, and 70% will continue to be obese beyond age 30. “These young people are going to have a life-long exposure to this condition,” Branca warned. Growing economic burdens globally Lower and middle-income countries are seeing rising economic impacts due to obesity, according to data from the World Obesity Atlas. As more low- and middle-income countries struggle with obesity and other cardiometabolic diseases, the economic impact of these conditions continues to grow. In Jamaica, for example, the total economic impact of obesity is projected to reach $524 million by 2025, with the burden on GDP expected to be 3.9% by 2035, according to Tufton. The global economic impact of overweight and obesity will reach $4.32 trillion annually by 2035 if prevention and treatment measures do not improve, according to the World Obesity Federation’s World Obesity Atlas 2023. The report notes that at almost 3% of global GDP, this cost is “comparable to that of COVID-19 in 2020.” “It’s also about framing the societal value for patients, healthcare systems, and economies of taking action and avoiding those costs, which for obesity alone is estimated to be $4 trillion if we don’t take action,” said Jo Jewell, Novo Nordisk Director of Cities for Better Health & Head of Obesity Health Equity. Comprehensive prevention, treatment, and management are crucial, Jewell noted, with partnerships between the private sector, healthcare sector, and governments to reach those most in need within communities. Basic screening for conditions like hypertension, blood pressure, and diabetes is essential, and governments should work to bring screening to the people, Tufton added. Knowing these numbers provides a basis for healthcare providers to give meaningful advice and “encourage” behaviour change. “It is about taking screening to the people,” Tufton said, “as opposed to encouraging people to come to the health centres or the clinics or your private practitioners to get screening.” “Children live what they learn” Jamaica Minister of Health Christopher Tufton speaks at an IFPMA-World Heart Federation-World Obesity Federation event. Government policies targeting individual behaviour are a core component of plans to tackle the obesity epidemic. However, reflecting on the power of targeted advertising and hidden additives in ultra-processed foods, Branca noted that individuals are not solely responsible for obesity. This marks a paradigm shift in how the disease is perceived, as an individual’s obesity was previously viewed predominantly as a personal failing. Policies that only target individual behaviours are “clearly” not sufficient, Branca said, and must be paired with policies that create environments allowing people to make healthy choices, such as controlling marketing, eliminating trans fats, and lowering food prices. This approach extends to helping children make good decisions about nutrition from early childhood onward. The “captive environment” of schools and the educational programs they provide have the potential to influence community-level change through nutrition and exercise initiatives, multiple experts on the panel noted. The success of these childhood education programs depends on working closely with school authorities to provide a supportive environment, including less unhealthy food, physical education, and empowerment to make healthy food choices. “When we work with children in school settings, we are definitely able to influence their behaviours, whether it is healthy eating and being more physically active,” said Arora. Including children and young adults in decision-making plans around nutrition, she added, is key to ensuring “sustainable behaviour” and empowers them not to “go back home and resort to unhealthy food.” “We believe that our youngsters could be great teachers of the adults by making an impression on them in schools,” Tufton added. “If we were to modify what they consume, and encourage them to consume in a more balanced way, combined with physical activity, then they will grow hopefully to follow that pattern and become a healthier adult over time.” Image Credits: S. Samantaroy/HPW, World Obesity Federation. The Power of Partnerships in Advancing Global Health 29/05/2024 Maayan Hoffman IFPMA Director-General David Reddy (right) in an interview with journalist Shiulie Ghosh on Tuesday, May 28. GENEVA – Partnerships between industry, multilateral organizations, and other stakeholders are essential to overcoming challenges and improving access to innovations. This was the key message at an International Federation of Pharmaceutical Manufacturers (IFPMA) event on Tuesday evening, held on the sidelines of the World Health Assembly in Geneva. The gathering brought together representatives from the World Health Organization (WHO), Gavi, government officials, and industry leaders to discuss how these partnerships can be enhanced to deliver meaningful impact for people and healthcare systems worldwide. The event featured an interview with David Reddy, the newly appointed Director-General of IFPMA and former CEO of Medicines for Malaria Ventures who took over from Thomas Cueni in April. IFPMA, the global pharmaceutical trade organization, works with the WHO and other UN bodies, representing over 90 companies and associations, including industry giants like Johnson & Johnson, Novartis, Pfizer, Eli Lilly and AstraZeneca. Reddy, who has been in his new role for fewer than two months, described drug development as a process of “assembling information that wraps around a molecule,” from animal safety studies to patient behaviour, infection treatment and manufacturing quality. This information then undergoes regulatory review to ensure the drug’s efficacy. The complex nature of drug development means pharmaceutical companies must work closely with multilateral organizations to ensure their drugs are distributed and accessible, particularly in low- and middle-income countries. However, there is often tension between the high cost of developing innovative medicines and vaccines and the basic health needs of populations that may be unable to afford them. This is where partnerships are crucial. “It’s really important just to underscore that it’s not something that we, as an industry, can do alone. We can only do it in partnership.” Reddy quoted WHO Deputy Director-General Mike Ryan, who said that industry and the UN health body agree on 80% of things in global health and may differ on 20%. Ryan has urged focusing on the 80% agreement to make progress. “It doesn’t mean we should ignore the areas of difference. We should debate them,” Reddy said. “But don’t forget that we are so aligned in so many ways.” The monoclonal antibody revolution Covid-19 monoclonal antibodies Reddy also spoke about drug and vaccine innovation, using the mRNA COVID-19 vaccines as an example. “They were there just when they were needed, but they were there because of two decades of work. Companies were able to partner together and really accelerate getting them to people to prevent them from becoming patients,” Reddy explained. Innovation, he said, “just takes a long time” and costs money. Looking to the future, Reddy sees great potential in monoclonal antibodies, conjugated antibodies, mRNA technology, and individualized therapy, all underpinned by artificial intelligence. “We’re living in the monoclonal [antibody] revolution if you like,” he said. “Not globally yet. In terms of access, that is something this industry is really working on at this time.” AI could revolutionize drug development by enabling researchers to precisely select molecules that have the potential to become medicines, chart more efficient pathways, and significantly compress development timelines, Reddy added. Gavi: Partnerships crucial as health budgets tighten From left: Shiulie Ghosh, journalist; Minister Ong Ye Kung, minister of health of Singapore; Dr. Catharina Boehme, assistant director-general of External Relations and Governance for WHO; and Deborah Waterhouse, the CEO of ViiV Healthcare and the president of Global Health for GSK. Dr Sania Nishtar, the recently appointed CEO of Gavi, the Vaccine Alliance, also spoke about the importance of partnerships from her perspective, especially in the current climate, which she described as “a very resource-restrained time for global health”. Between competing priorities and ongoing conflicts in different parts of the world, the G7 is stretched,” Nishtar said. “We in the global health space must hear this loud and clear.” Nishtar’s remarks took place against the backdrop of the WHO’s new “Investment Round” initiative, aiming to raise $7 billion to make the organization’s funding more predictable, flexible, and sustainable. The total contributions of WHO member states are just $4 billion annually. Public health expenditure across OECD countries surged by an average of 17% in real terms between 2019 and 2021, as governments rapidly allocated resources to tackle the crisis. Prevention spending more than doubled due to extensive testing and vaccination efforts. In 2022, however, health spending across OECD countries declined by an average of 1.5%. With inflation expected to remain above 5% in 2024, compared to less than 2% in 2019, nominal increases will be considerably reduced. The pandemic led to increased health spending as a percentage of GDP in low- and middle-income countries, but not as much as in advanced economies. A recent Center for Global Development report suggests this increase is unlikely to be sustained due to the pandemic’s impact on revenues and budgets. Slow domestic revenue growth has already made achieving health-related Sustainable Development Goals (SDGs) by 2030 unlikely, and without new funding sources, meeting these goals will be further delayed. “We had 40 countries decrease their healthcare spending last year. Healthcare budgets are going down instead of up,” said Dr Catharina Boehme, assistant director-general of External Relations and Governance for WHO. “To harness the promise of science and innovation, we have to focus on creating capacity and making sure health funding remains intact.” Partnerships, Nishtar added, are in Gavi’s DNA, working closely with WHO, UNICEF, and industry to build synergies. “Solutions can be found when we work together,” she continued. “And we can only work together when we let go of ego, turf, rivalries and small thinking.” Image Credits: Raisa/Flickr. Push for International Health Regulation Changes to Be Passed This Week – But Disagreement About Future of Pandemic Agreement Talks 28/05/2024 Kerry Cullinan The crowded WHA meeting room where the pandemic discussions are taking place GENEVA – A powerful lobby, including the US, Germany and New Zealand, are pushing for the amendments to the International Health Regulations (IHR) to be adopted by the close of the World Health Assembly (WHA) on Saturday. Weaknesses in the IHR, the only global rules guiding countries’ conduct in international public health emergencies, were exposed during the pandemic, prompting a two-year process to amend them. Agreement is close, with some outstanding issues particularly on definitions, according to the report on the IHR negotiations to the WHA by World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus. “My appeal here is let us focus on the IHR so we have this success as this is already providing much better protection for the world,” said Germany’s Health Minister Karl Lauterbach. Strong positive signal The European Union (EU) echoed this sentiment, describing progress on IHR amendments as “remarkable”. “The adoption of these amendments within the very short timeframe of only two years will send a very positive signal to the outside world about the ability of the WHO and its membership to take concrete action to improve the global health architecture,” said the EU. “Such adoption will also send very positive signal for the future of the INB [Intergovernmental Negotiating Body] process.” The INB was charged with negotiating a pandemic agreement but member states have failed to reach agreement by the WHA deadline. The most recent pandemic agreement draft shows significant areas of disagreement remain. The EU acknowledged that some IHR amendments still need to be resolved and urged all partners to “redouble efforts” to finalise the work and adopt the changes by 1 June. Dr Ashley Bloomfield, co-chair of the Working Group on amendments to the IHR, told the WHA that the committee is “very close to completing an agreed package of amendments”. “There is both momentum and an aspiration among states parties to complete the task,” said Bloomfield. “Adopting a package of IHR amendments during this assembly would be a significant milestone and achievement and we believe in a very important stepping stone to successfully concluding the pandemic agreement negotiations later.” France, Indonesia, Kenya, New Zealand and Saudi Arabia have prepared a resolution to adopt the IHR amendments in anticipation of agreement being reached in the next few days. Pandemic agreement process unclear It is unclear whether the African region will support completing the IHR amendments this week if its demand for the speedy conclusion of the pandemic agreement by the end of this year is not accepted. At a packed WHA meeting of Committee A on Tuesday afternoon, there was intense discussion and some disagreements over the way forward for the INB process on a pandemic agreement. First off, there were two resolutions on the floor, one from the 47 WHO African member states and another from a group of countries that have often played a conciliatory role in talks – Australia, Brunei, Canada, Norway and Pakistan. Both spoke to the time frames for further talks, while the second resolution called for a new structure to take forward the pandemic agreement negotiations. South Africa’s Ambassador Mxolisi Nkosi. Expressing disappointment on behalf of the African region that a pandemic agreement was not agreed on, South Africa’s Ambassador Mxolisi Nkosi called for negotiations to be completed by the end of this year, followed by a special WHA. Botswana expressed its support for the speedy resolution of the IHR during the session, but Kenya – on behalf of the Africa region – linked the IHR amendments and the pandemic agreement, and simply said the region was ready to reach consensus. However, US Ambassador Pamela Hamamoto called for an extension of “one to two years”, explaining that “fundamental differences remain on core issues central to the agreement”. She described these differences as “complex technical issues that require extensive deliberation and carefully crafted workable solutions, inspired by a common vision and supported by all member states”. Ironically, if Donald Trump wins the US presidential election at the end of the year, his administration is unlikely to support the pandemic negotiations – or even the WHO. The WHA’s Committee A resolved that a single drafting group co-chaired by one INB member and one WGIHR member, will convene on Wednesday morning. It will be open to all member states and its task will be to consider all three draft resolutions and propose a process for adopting the IHR amendments and the timing, format and process to conclude the pandemic agreement. These proposals will have to be submitted to the WHA as the mandates for both the WGIHR and the INB have expired. Climate Change to Be Major Focus for WHO in Coming Years 28/05/2024 Disha Shetty The 77th session of World Health Assembly underway in Geneva, Switzerland. The World Health Organization plans to make climate change and its impact on health a major focus in the coming years, along with strengthening health systems, improving health equity and access, and preventing disease, according to the organization’s plan for its general program of work from 2025 to 2028. The four-year plan, known as GPW-14, also prioritizes mental health, gender equality, migrant health, food safety, digital health, and artificial intelligence. It was developed through an extensive 10-month consultation process involving member countries, UN organizations, and civil society organizations. “This document will act as our canvas, articulating our collective aspirations and strategic priorities in global health for the coming four years,” said Dr Saia Ma’u Piukala, the WHO’s regional director for the Western Pacific, as discussions on the plan concluded Tuesday morning, the second day of the ongoing 77th World Health Assembly. Dr Piukala added that the plan “reflects the learning from the Covid-19 pandemic and response to shared issues like climate change, ageing, migration, evolving geopolitics, increasing spillover events and rapidly advancing science and technology.” The World Health Assembly approved the draft GPW-14 following Tuesday’s discussions, but funding remains a concern. The GPW-14 program has a price tag of $11.1 billion, with WHO member states’ assessed contributions covering just over a third of the cost at $4 billion. The WHO is still looking for $7 billion in flexible funding, which it will attempt to raise at an investment conference in late 2024. Focus on Climate Change In recent years, the impact of climate change on health, particularly non-communicable diseases, has become increasingly clear. The WHO has warned that severe weather events, pollution, and climate-sensitive diseases are becoming more frequent worldwide, with vulnerable areas like small island developing states bearing a disproportionate impact. The GPW-14 also notes that human migration and displacement have reached unprecedented levels, with an estimated one billion people choosing to migrate or being forcibly displaced due to various factors, including economic, environmental, political, and conflict-related issues – with dire consequences for health. “The pace of climate change and environmental degradation has accelerated, emerging as a major threat to human health in the 21st century,” the GPW-14 warns. “Increasing inequities within and between countries, which were exacerbated by the COVID-19 pandemic, are leading to a growing divide in health, social and economic outcomes between those with financial resources and those without.” Countries like Japan and the United States praised the WHO for its growing focus on climate and health. Member states acknowledged that health-related Sustainable Development Goals are not on track, and Turkey drew attention to attacks on health facilities and disruptions to essential health services, calling it a “man-made crisis.” “GPW-14 includes the measures to address climate change in the primary objective,” the representative from Japan said. “Now, the world is facing a huge impact of climate change on health. And we affirm the importance of disaster management, especially in the healthcare field.” Dr Saia Ma’u Piukala, Regional Director for WHO’s Western Pacific region. Civil Society Warns WHO Plan is Incomplete Civil society groups have pointed out several shortcomings in the WHO’s GPW-14 plan, despite its ambitious goals to address climate change and health equity. The NCD Alliance, an organization focused on fighting non-communicable diseases (NCDs), criticized the plan for not adequately addressing NCDs, which account for 74% of global deaths. The lack of specificity on NCDs in the GPW-14 comes despite the increasing burden of disease from climate and environmental factors like heat and air pollution. “We regret the missed opportunity to ensure comprehensive outcome indicators for NCDs,” said a representative for the NCD Alliance. “The absence of answers to indicators hinders prioritization for achieving agreed targets.” Other civil society groups noted the plan’s lack of specific references to maternal health indicators and provisions to address the vulnerability of women in the health workforce, despite women constituting 70% of healthcare professionals globally. However, the healthcare workforce and ways to improve equity were mentioned in the plan several times. “Integrating gender-responsive approaches into health workforce planning and management can help address gender disparities in health outcomes and advance progress towards achieving universal healthcare,” said a representative from the Global Health Council in a constituent statement. The absence of gender-responsive provisions in the GPW-14 is likely due to opposition from conservative countries to the terminology. Countries like Russia, Egypt, and Iran objected to any references to “gender” on religious and political grounds during closed-door negotiations, Health Policy Watch reported. Despite these criticisms, several member states thanked the WHO for the extensive consultations carried out before finalizing the draft plan. “We particularly applaud the Secretariat for extensive and inclusive consultation through various platforms with member states, various organizations and partners in the drafting process,” the representative from Botswana said. Image Credits: Twitter, Twitter. Can Technology Help Address Global Migrant Crisis? Experts Weigh In 28/05/2024 Maayan Hoffman A panel discussion at the “Ensuring continuity of care at different stages of the migration process” session of the Gevena Health Forum. From left to right: Alexios Georgalis of the National and Kapodistrian University of Athens, Reinaldo Ortuno Gutierrez of Médecins Sans Frontières, Rebecca Marcussen-Lewis of SOS Méditerranée and Sanjula Weerasinghe, a representative of the International Federation of Red Cross. As the world grapples with a migrant and refugee crisis of unprecedented scale, with 281m international migrants and 3.5m refugees globally, according to UN agencies, experts are turning to technology, particularly artificial intelligence, in search of solutions. The potential for AI and technology to foster a more equitable and sustainable world has been recognised by international organisations. Last year, the World Health Organization, World Intellectual Property Organization, and International Telecommunication Union formed the Global Initiative on AI for Health to facilitate the implementation of AI in healthcare. During the 2024 World Economic Forum, specialists underscored both AI’s transformative potential and the associated risks, emphasising the necessity of cooperation and ethical guidelines to harness its benefits responsibly. With record numbers of people on the move worldwide, can technology help tackle the migrant and refugee crises? Four experts addressed the question at the Geneva Health Forum on Monday during a day focused on migration and health equity. The Geneva Health Forum, convened by the University of Geneva and partners on the first three days of the 2024 World Health Assembly, brings together key global health scientists and policymakers with medical practitioners and other field actors. Here are their insights. Alexios Georgalis, who co-authored the Boys on the Move life skills curriculum – a UNICEF initiative that guides unaccompanied male adolescents displaced by conflict and poverty – believes that although AI cannot fully resolve the refugee crisis, digitalizing and gamifying interventional packages could have a substantial impact. His work focuses on educating young male migrants about exploitation and trafficking, as well as providing mental health support. “Almost every refugee has a smartphone,” Georgalis noted, indicating that digital tools could serve as a “gateway into their psyches and their hands.” Reinaldo Ortuno Gutierrez of Médecins Sans Frontières (MSF) recommended developing geotargeted technologies to help migrants find healthcare wherever they are. MSF already uses QR codes that can be scanned with a smartphone to provide a map of care sites, from primary care to psychiatric care. Gutierrez also mentioned secure referral systems that allow patient files to travel safely via smartphone, ensuring continuity of care. “It would be ideal to have some kind of passport for everyone, but at the moment, it is very limited,” he said. Sanjula Weerasinghe, a representative of the International Federation of Red Cross (IFRC), highlighted the potential benefits of digitally-carried medical records, allowing migrants to “take responsibility and control of their own data.” However, she noted that while efforts to generate this type of record-keeping are underway, no such technology currently exists. Weerasinghe, like Gutierrez, pointed out that some international organisations have developed apps to help migrants locate and access services. Rebecca Marcussen-Lewis, SOS Méditerranée. In contrast, Rebecca Marcussen-Lewis of SOS Méditerranée, a search and rescue NGO operating boats tasked with rescuing drowning migrant vessels, highlighted the challenges of digitalization in her work on the Mediterranean Sea. “We don’t have connectivity, so everything being digital and online is not so easy for us, and if everything moves in that direction, we run the risk of losing the ability to do our work,” she said. However, Marcussen-Lewis acknowledged that telemedicine could be helpful, allowing her team to reach out to a network of experts when faced with unfamiliar medical situations at sea. With a team of four serving over 630 people on a 69-meter boat, “being able to have a network that we can reach out to when we have a presentation that none of us has come across before is fantastic,” she said. Image Credits: Maayan Hoffman, Courtesy of Geneva Health Forum, Geneva Health Forum. Pollution’s Silent Killers: New Research Links Lead Exposure to Millions of Cardiovascular Deaths 28/05/2024 Elaine Ruth Fletcher & Sophia Samantaroy Lead has been found in contaminated turmeric and other spices, creating another route of exposure to the heavy metal Four well-known heavy metals and chemical pollutants – lead, asbestos, arsenic and cadmium- continue exact a heavy toll on the lives of those in low- and middle-income countries – with lead named a factor in as much as 5 million premature deaths annually from cardiovascular disease, according to one recent estimate. Asbestos, arsenic, and cadmium round out the top four, claiming hundreds of thousands of lives every year. While much recent media attention has been focused on the health impacts of newer industrial compounds such as dioxins, phthalates, and endocrine disruptors, these heavy metal “silent killers” need renewed attention in the environmental health arena, experts say. This was one key message from a day-long session on Health and Environment, the featured theme on the opening day of this year’s Geneva Health Forum, 27-29 May. The session highlighted the pressing threats of environmental pollution from plastics and lead to endocrine disruptors and ambient air pollution. The Geneva Health Forum, organized by the University of Geneva on the sidelines of the World Health Assembly brings together the global scientific community with health practitioners and field actors from around the world. Migration, health and equity and malaria are other key themes The Geneva Health Forum highlighted three key themes on opening day. This year’s Forum, running on the sidelines of the World Health Assembly, brings together hundreds of scientists, policy experts and member state representatives on three key themes – including migration, health and equity; and malaria elimination – each the focus of a full-day session. There are also a host of side events on issues ranging from One Health to Climate resilience and elimination of neglected tropical diseases such as Chagas disease and Noma. While panellists highlighted the higher profile of air pollution in recent years and successes with air quality regulation in higher-income countries, air pollution remains a serious and even growing problem in low- and middle-income regions. Focus on pollutants with the highest impacts on death and disease A recent study implicated lead with 5.5 million premature deaths Meanwhile, age-old problems of heavy metal and mineral pollutants such as lead and asbestos also need much more attention, also in LMICs. “We need to deal with key priorities, country by country, of what’s causing the most damage,” said Richard Fuller, founder and former chair of the Global Alliance on Health and Pollution, who recently participated in an assessment ranking the burden of disease from key WHO “chemicals of concern.” “There was one chemical issue that caused millions of deaths – and then four issues that caused hundreds of thousands of deaths,” he said, referring to lead, asbestos, highly hazardous pesticides, arsenic, and cadmium. “The one that caused the majority of deaths was our old friend lead, which is responsible for 1.5 -2 million deaths per year.” Lead may account for as many as 5.5 million premature deaths from CVD A man melts lead metallic wastes used in the production of cooking pots, at a recycling warehouse in Koumassi, Abidjan, Ivory Coast. A 2023 paper published in The Lancet, supported by the World Bank, estimated that lead exposure may cause up to 5.5 million premature deaths annually, with 95 per cent of those deaths attributed to cardiovascular diseases. The analysis draws on emerging evidence linking lead exposure to atherosclerosis, alongside its known effects on reduced IQ, the central nervous system, and other organs. Mr. Fuller noted that the “lead problem,” once associated with pipes, paint, and gasoline, has evolved in affected low-income regions, but its impact remains just as devastating. “It turns out to be all sorts of activities going on in low- and middle-income countries, including [fabrication of] pots and pans and [contamination] of turmeric,” he explained. “The ones that are less impactful … are things like dioxins, phthalates, brominated flame retardants, PFAS, endocrine disruptors, PCBs, and PAHs,” Mr. Fuller noted, emphasizing that these pollutants are “simply the noisier part of the agenda, but not necessarily the most impactful part of the agenda.” “Should we be focusing on the ones that have the most impact, not just the most noise?” he added. John Ji, an environmental epidemiologist at the Tsinghua University Vanke School of Public Health, told the forum he initially thought his 2013 dissertation on lead would be one of the last. “Then Flint happened,” he said, referring to the water crisis in Flint, Michigan, which brought the issue of lead contamination back into the spotlight. Air pollution remains a driver of poor health From left: Mexican Ambassador to Geneva Fernando Espinosa; Nino Kuenzli of the Swiss Tropical Instiute and John Ji of China’s Vanke School of Public Health. With the World Health Organization attributing 13.7 million deaths to chemical and pollutant exposures, the Forum called attention to the need for global collaboration, research, and policy to tackle pollution-related health effects. “Clean air is possible, yet in some cities in the Asian and African continents, air pollution is getting worse,” said Nino Kuenzli, former Swiss Tropical and Public Health Institute professor. He acknowledged that air pollution regulation is part of a broader environmental health success story, citing the significant increase in air quality in Europe and North America in the past decades. “The Swiss mountain town I grew up in had worse air quality than the Swiss urban centres today,” said Kuenzli, adding that this drastic improvement was built upon decades of scientific victories. “We cannot just call for action and policy without a knowledge [of the science] and it is really fascinating to see how the science to understand the health effects of air pollution has evolved over the last 35 years. It’s incredible. Progress is enormous.” Advances in environmental epidemiology, and newfound ways for collaboration among basic scientists and toxicologists, have paved the way for these air quality improvements. Addressing global air pollution inequalities and replicating much of the successes of higher-income countries means “leapfrogging” intermediate policies and technologies, argued Ji. For example, one of the largest sources of indoor air pollution comes from burning biomass fuels, yet countries often transition to gas stoves, which still produce air pollutants. Instead, countries could support a transition directly from biomass to electric, he said. Air pollution levels have continued to go up in most countries across the world despite rising awareness of its harms. Plastic pollution: a new and growing threat Plastics, now ubiquitous in the environment, are another kind of new, and growing pollution concern for soils, waterways, and air, when incinerated. “By 2050, there will be more plastic than fish in the oceans,” remarked Fernando Espinosa, the Mexican Ambassador to Switzerland. Plastic pollution got a brief nod on opening day following last month’s fourth Intergovernmental Negotiating Body in Ottowa, Canada to develop an international legally binding instrument on plastic pollution, including in the marine environment. While the negotiations did reach some conclusions, like developing a list of chemicals of concern, they did not agree to reduce the production of new plastics, most likely due to ongoing pressure from the fossil fuel lobby and their state backers, such as Saudi Arabia, Russia and the United States. Climate adaptation and resilience in the healthcare system The Forum also brought together experts to discuss the often negative environmental contributions of healthcare systems in lower- and middle-income countries. The sector has increasingly produced contaminated waste, greenhouse gas emissions, and other pollutants – causing upwards of five per cent of global greenhouse gas emissions. These emissions come from hospitals themselves, but also from the manufacturing of medical products. Yet remarks from panellist Habib N’Konou, founder of an innovative biomedical waste company, during a later session demonstrated the disproportionate environmental impacts of the health sector in lower-and-middle-income countries. Senegal, he noted, produces upwards of 21,000 tonnes of medical waste per year, much of which is inadequately processed. “It’s an alarming situation. When I came back to Senegal, there was waste on the coasts, in neighbourhoods.” Looking to the successes of other countries could pave the way for better biomedical waste management, N’Konou noted. Morocco and Tunisia both have government-mediated partnerships between waste facilities and hospitals, something N’Konou champions for Senegal and surrounding countries. Even when regulations exist, they are hard to enforce. Despite the environmental challenges facing LMICs, the climate crisis is an opportunity to rethink how healthcare systems operate, according to Sonia Roschnik, executive director of the Geneva Sustainability Centre. “This is where I really hope that some of what we do to respond to climate change is going to help us leverage more innovative ways of looking at healthcare that actually deliver better population health, but also help the planet.” Image Credits: Prchi Palwe , EPA/L. Koula, Geneva Health Forum, Geneva Health Forum. Conservative Member States Balk at References to ‘Gender’ in WHA Resolutions 28/05/2024 Kerry Cullinan The World Health Assembly in progress. GENEVA – Conservative countries have objected to the use of the terms “gender responsive” and “advancing gender mainstreaming” in behind-the-scenes negotiations on several resolutions before the World Health Assembly (WHA), according to a wide variety of sources. There have also been some objections to the use of “gender equality” and “sexual” in some instances – alongside a long-standing objection to the use of “rights” when referring to sexual and reproductive health. “Gender” references have already been stripped from the World Health Organization’s (WHO) draft pandemic agreement. At least five other resolutions have become bogged down by objectives from conservative member states, particularly Russia, Egypt, Iran and Nigeria. These include resolutions on mental health, emergency preparedness, the economics of health, climate and social participation. In the case of the economics of health resolution, Nigeria initially objected to the use of both “gender equality” and “advancing gender mainstreaming”, one source said. Another source told Health Policy Watch that Russia even wants “sexual” to be removed from the standard term, “sexual and reproductive health”. In the resolution on climate and health, for example, there was an impasse over the use of “gender-responsive” policies – apparently because conservatives believe that this opens the door to engagement with LGBTQ groups although they have never unpacked their objection. Countries have eventually settled on a reference to “gender equality”. Objecting to these particular phrases is new. All UN member states including Russia agreed by consensus to the language of the global Sustainable Development Goals (SDGs), which refer to sexual health and gender. Concerned parties close to the talks stressed the importance of “stopping the backsliding” against established terms and rights for women and other groups in the face of the relentless campaign. Experts call for SRHR space to be protected A few days ago, 43 of the foremost global experts in sexual and reproductive health and rights (SRHR) in the UN called on the WHA to protect advance in this hard-won space in an article published by Health Policy Watch. The experts, who work in various UN expert committees, described progress on SRHR as “fundamental for human rights and dignity, national economies, sustainable development, and a healthier planet”. They added that while SRHR includes “services needed to prevent unwanted pregnancies, unsafe births and avoidable sexual or reproductive illness, injury or dysfunction, it is much broader. “Vitally, it includes the positive enjoyment of consensual sexual intimacy and pleasure, the development of mutually respectful and loving relationships, as well as the affirmation of individuals and families in all their diversity,” they added. “Sexual and reproductive health and rights flourish only where its emotional, mental, and social dimensions are also enabled, free of coercion, discrimination, and violence.” A repeat of 2022? The Saudi delegate in heated WHA debate over sexual rights and terminology at the WHA in 2022. Two years ago, the entire WHA was delayed for days over conflict related to a global strategy on HIV, hepatitis B and sexually transmitted infections, primarily because of a glossary on sexual health and target populations for HIV treatment. While the language was standard for HIV treatment and care, the Saudi Arabian delegate – speaking for WHO’s 22-member state Eastern Mediterranean Region (EMRO) – objected to the terms “sexuality”, “sexual orientation”, “sexual rights”. He also objected to “men who have sex with men” being designated as a target population for HIV treatment. Although the WHO works by consensus, the strategy eventually went to a vote late on the last night of an extended WHA, and narrowly passed with many absentions. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... 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Cardiometabolic Diseases Threaten Life Expectancy Gains, Even in Young Countries 29/05/2024 Sophia Samantaroy Panelists Catherine Priestley, Jo Jewell, Monika Arora, Francesco Branca, and Ad Adams, with moderator Shiulie Ghosh (far right) at the IFPMA-World Heart Federation- World Obesity Federation side event in Geneva. GENEVA – Cardiometabolic diseases, a group of non-communicable diseases (NCDs) including cardiovascular disease, stroke, diabetes, and non-alcoholic fatty liver disease, are on the rise globally, threatening life expectancy gains and burdening vulnerable economies with excess healthcare costs. These diseases already contribute to over 30% of global deaths each year. With one billion people now living with obesity, projections suggest that by 2035, 50% of the world’s population will be affected, leading to premature deaths and a growing economic burden. “Non-communicable diseases are only going in one direction. They are increasing,” Dr Christopher Tufton, Jamaican Minister of Health, remarked at a World Heart Federation (WHF) and World Obesity Federation (WOF) event in Geneva on Monday. “It is at a catastrophic level. It concerns all of us wherever we are.” Low- and middle-income countries, despite their relatively young populations, are driving the alarming rise in global obesity. Obesity rates in these countries are expected to soon match those in high-income countries, a significant shift from the trend observed just a decade ago, said Francesco Branca, director of the Department of Nutrition and Food Safety at the World Health Organization. Cardiometabolic diseases pose a particularly severe threat to low- and middle-income countries, not only jeopardizing hard-fought life expectancy gains but also burdening their already fragile economies with excessive healthcare costs, endangering the sustainability of their health systems and diverting funds from other crucial areas of healthcare. “The data suggests that we’re seeing a reversal of the gains that we’ve made in life expectancy,” Tufton said, highlighting the impact on his home country Jamaica. “The opportunity to live up to an average of 75 years is now under serious threat.” Non-communicable diseases accounted for 77% of all deaths in Jamaica in 2020, with age-standardized mortality rates showing significant increases in deaths from diabetes, hypertension, and heart disease over the past decade. Rise of cardiometabolic diseases in children and adolescents, fueled by targeted advertising The increased rate of deaths from cardiometabolic diseases in countries like Jamaica is not just a consequence of an ageing population. It is also the result of a progressive rise in deaths across all age groups, from children and adolescents to adults. Dr Monika Arora, Vice President of Research and Health Promotion at the Public Health Foundation of India (PHFI), argued that much of the reason for the rise of obesity in younger children stems from advertising and hidden additives. “Advertisements for foods high in fat, salt, and sugar — the exposure was much higher in children’s [TV] channels than young adult channels, meaning the industry very clearly wants them to be hooked on to their products early on,” she said. India, a country that struggles with both undernutrition and overnutrition, now has the third-highest number of people living with obesity globally, largely due to aggressive advertising targeting children and the rise of ultra-processed foods (UPF). The urban poor are the hardest hit, as cheap food options often come in the form of ultra-processed foods, while fresh fruits and vegetables remain too costly. “They don’t have any means for physical activity, and they don’t have [access to] food which is healthy and cost-effective,” said Arora. Urban air pollution further compounds the barriers to exercise, as the air quality is often too dangerous for walking or running outdoors, she added, in an interview with Health Policy Watch. Ultra-processed foods can be deceptively hidden, such as the additives found in milk products marketed for children. “There’s a whole culture about feeding children milk. The milk additives are claiming 20% better growth, better height, and better immunity, and nobody’s checking where these studies are published — these are filled with high-sugar products,” Arora explained. “These are all hidden calories. So even in urban settings where people are cutting down on sugar, they don’t realize that these are ultra-processed foods, and they continue to feed children with products that are harmful.” The long-term consequences of childhood obesity and the predatory tactics that fuel it are staggering for individuals and health systems alike. A 2015 National Institutes of Health study of over 200,000 US children found that obese children and adolescents were nearly five times more likely to be obese as adults compared to their non-obese peers. The study showed that 55% of obese children become obese adolescents, 80% of obese adolescents remain obese in adulthood, and 70% will continue to be obese beyond age 30. “These young people are going to have a life-long exposure to this condition,” Branca warned. Growing economic burdens globally Lower and middle-income countries are seeing rising economic impacts due to obesity, according to data from the World Obesity Atlas. As more low- and middle-income countries struggle with obesity and other cardiometabolic diseases, the economic impact of these conditions continues to grow. In Jamaica, for example, the total economic impact of obesity is projected to reach $524 million by 2025, with the burden on GDP expected to be 3.9% by 2035, according to Tufton. The global economic impact of overweight and obesity will reach $4.32 trillion annually by 2035 if prevention and treatment measures do not improve, according to the World Obesity Federation’s World Obesity Atlas 2023. The report notes that at almost 3% of global GDP, this cost is “comparable to that of COVID-19 in 2020.” “It’s also about framing the societal value for patients, healthcare systems, and economies of taking action and avoiding those costs, which for obesity alone is estimated to be $4 trillion if we don’t take action,” said Jo Jewell, Novo Nordisk Director of Cities for Better Health & Head of Obesity Health Equity. Comprehensive prevention, treatment, and management are crucial, Jewell noted, with partnerships between the private sector, healthcare sector, and governments to reach those most in need within communities. Basic screening for conditions like hypertension, blood pressure, and diabetes is essential, and governments should work to bring screening to the people, Tufton added. Knowing these numbers provides a basis for healthcare providers to give meaningful advice and “encourage” behaviour change. “It is about taking screening to the people,” Tufton said, “as opposed to encouraging people to come to the health centres or the clinics or your private practitioners to get screening.” “Children live what they learn” Jamaica Minister of Health Christopher Tufton speaks at an IFPMA-World Heart Federation-World Obesity Federation event. Government policies targeting individual behaviour are a core component of plans to tackle the obesity epidemic. However, reflecting on the power of targeted advertising and hidden additives in ultra-processed foods, Branca noted that individuals are not solely responsible for obesity. This marks a paradigm shift in how the disease is perceived, as an individual’s obesity was previously viewed predominantly as a personal failing. Policies that only target individual behaviours are “clearly” not sufficient, Branca said, and must be paired with policies that create environments allowing people to make healthy choices, such as controlling marketing, eliminating trans fats, and lowering food prices. This approach extends to helping children make good decisions about nutrition from early childhood onward. The “captive environment” of schools and the educational programs they provide have the potential to influence community-level change through nutrition and exercise initiatives, multiple experts on the panel noted. The success of these childhood education programs depends on working closely with school authorities to provide a supportive environment, including less unhealthy food, physical education, and empowerment to make healthy food choices. “When we work with children in school settings, we are definitely able to influence their behaviours, whether it is healthy eating and being more physically active,” said Arora. Including children and young adults in decision-making plans around nutrition, she added, is key to ensuring “sustainable behaviour” and empowers them not to “go back home and resort to unhealthy food.” “We believe that our youngsters could be great teachers of the adults by making an impression on them in schools,” Tufton added. “If we were to modify what they consume, and encourage them to consume in a more balanced way, combined with physical activity, then they will grow hopefully to follow that pattern and become a healthier adult over time.” Image Credits: S. Samantaroy/HPW, World Obesity Federation. The Power of Partnerships in Advancing Global Health 29/05/2024 Maayan Hoffman IFPMA Director-General David Reddy (right) in an interview with journalist Shiulie Ghosh on Tuesday, May 28. GENEVA – Partnerships between industry, multilateral organizations, and other stakeholders are essential to overcoming challenges and improving access to innovations. This was the key message at an International Federation of Pharmaceutical Manufacturers (IFPMA) event on Tuesday evening, held on the sidelines of the World Health Assembly in Geneva. The gathering brought together representatives from the World Health Organization (WHO), Gavi, government officials, and industry leaders to discuss how these partnerships can be enhanced to deliver meaningful impact for people and healthcare systems worldwide. The event featured an interview with David Reddy, the newly appointed Director-General of IFPMA and former CEO of Medicines for Malaria Ventures who took over from Thomas Cueni in April. IFPMA, the global pharmaceutical trade organization, works with the WHO and other UN bodies, representing over 90 companies and associations, including industry giants like Johnson & Johnson, Novartis, Pfizer, Eli Lilly and AstraZeneca. Reddy, who has been in his new role for fewer than two months, described drug development as a process of “assembling information that wraps around a molecule,” from animal safety studies to patient behaviour, infection treatment and manufacturing quality. This information then undergoes regulatory review to ensure the drug’s efficacy. The complex nature of drug development means pharmaceutical companies must work closely with multilateral organizations to ensure their drugs are distributed and accessible, particularly in low- and middle-income countries. However, there is often tension between the high cost of developing innovative medicines and vaccines and the basic health needs of populations that may be unable to afford them. This is where partnerships are crucial. “It’s really important just to underscore that it’s not something that we, as an industry, can do alone. We can only do it in partnership.” Reddy quoted WHO Deputy Director-General Mike Ryan, who said that industry and the UN health body agree on 80% of things in global health and may differ on 20%. Ryan has urged focusing on the 80% agreement to make progress. “It doesn’t mean we should ignore the areas of difference. We should debate them,” Reddy said. “But don’t forget that we are so aligned in so many ways.” The monoclonal antibody revolution Covid-19 monoclonal antibodies Reddy also spoke about drug and vaccine innovation, using the mRNA COVID-19 vaccines as an example. “They were there just when they were needed, but they were there because of two decades of work. Companies were able to partner together and really accelerate getting them to people to prevent them from becoming patients,” Reddy explained. Innovation, he said, “just takes a long time” and costs money. Looking to the future, Reddy sees great potential in monoclonal antibodies, conjugated antibodies, mRNA technology, and individualized therapy, all underpinned by artificial intelligence. “We’re living in the monoclonal [antibody] revolution if you like,” he said. “Not globally yet. In terms of access, that is something this industry is really working on at this time.” AI could revolutionize drug development by enabling researchers to precisely select molecules that have the potential to become medicines, chart more efficient pathways, and significantly compress development timelines, Reddy added. Gavi: Partnerships crucial as health budgets tighten From left: Shiulie Ghosh, journalist; Minister Ong Ye Kung, minister of health of Singapore; Dr. Catharina Boehme, assistant director-general of External Relations and Governance for WHO; and Deborah Waterhouse, the CEO of ViiV Healthcare and the president of Global Health for GSK. Dr Sania Nishtar, the recently appointed CEO of Gavi, the Vaccine Alliance, also spoke about the importance of partnerships from her perspective, especially in the current climate, which she described as “a very resource-restrained time for global health”. Between competing priorities and ongoing conflicts in different parts of the world, the G7 is stretched,” Nishtar said. “We in the global health space must hear this loud and clear.” Nishtar’s remarks took place against the backdrop of the WHO’s new “Investment Round” initiative, aiming to raise $7 billion to make the organization’s funding more predictable, flexible, and sustainable. The total contributions of WHO member states are just $4 billion annually. Public health expenditure across OECD countries surged by an average of 17% in real terms between 2019 and 2021, as governments rapidly allocated resources to tackle the crisis. Prevention spending more than doubled due to extensive testing and vaccination efforts. In 2022, however, health spending across OECD countries declined by an average of 1.5%. With inflation expected to remain above 5% in 2024, compared to less than 2% in 2019, nominal increases will be considerably reduced. The pandemic led to increased health spending as a percentage of GDP in low- and middle-income countries, but not as much as in advanced economies. A recent Center for Global Development report suggests this increase is unlikely to be sustained due to the pandemic’s impact on revenues and budgets. Slow domestic revenue growth has already made achieving health-related Sustainable Development Goals (SDGs) by 2030 unlikely, and without new funding sources, meeting these goals will be further delayed. “We had 40 countries decrease their healthcare spending last year. Healthcare budgets are going down instead of up,” said Dr Catharina Boehme, assistant director-general of External Relations and Governance for WHO. “To harness the promise of science and innovation, we have to focus on creating capacity and making sure health funding remains intact.” Partnerships, Nishtar added, are in Gavi’s DNA, working closely with WHO, UNICEF, and industry to build synergies. “Solutions can be found when we work together,” she continued. “And we can only work together when we let go of ego, turf, rivalries and small thinking.” Image Credits: Raisa/Flickr. Push for International Health Regulation Changes to Be Passed This Week – But Disagreement About Future of Pandemic Agreement Talks 28/05/2024 Kerry Cullinan The crowded WHA meeting room where the pandemic discussions are taking place GENEVA – A powerful lobby, including the US, Germany and New Zealand, are pushing for the amendments to the International Health Regulations (IHR) to be adopted by the close of the World Health Assembly (WHA) on Saturday. Weaknesses in the IHR, the only global rules guiding countries’ conduct in international public health emergencies, were exposed during the pandemic, prompting a two-year process to amend them. Agreement is close, with some outstanding issues particularly on definitions, according to the report on the IHR negotiations to the WHA by World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus. “My appeal here is let us focus on the IHR so we have this success as this is already providing much better protection for the world,” said Germany’s Health Minister Karl Lauterbach. Strong positive signal The European Union (EU) echoed this sentiment, describing progress on IHR amendments as “remarkable”. “The adoption of these amendments within the very short timeframe of only two years will send a very positive signal to the outside world about the ability of the WHO and its membership to take concrete action to improve the global health architecture,” said the EU. “Such adoption will also send very positive signal for the future of the INB [Intergovernmental Negotiating Body] process.” The INB was charged with negotiating a pandemic agreement but member states have failed to reach agreement by the WHA deadline. The most recent pandemic agreement draft shows significant areas of disagreement remain. The EU acknowledged that some IHR amendments still need to be resolved and urged all partners to “redouble efforts” to finalise the work and adopt the changes by 1 June. Dr Ashley Bloomfield, co-chair of the Working Group on amendments to the IHR, told the WHA that the committee is “very close to completing an agreed package of amendments”. “There is both momentum and an aspiration among states parties to complete the task,” said Bloomfield. “Adopting a package of IHR amendments during this assembly would be a significant milestone and achievement and we believe in a very important stepping stone to successfully concluding the pandemic agreement negotiations later.” France, Indonesia, Kenya, New Zealand and Saudi Arabia have prepared a resolution to adopt the IHR amendments in anticipation of agreement being reached in the next few days. Pandemic agreement process unclear It is unclear whether the African region will support completing the IHR amendments this week if its demand for the speedy conclusion of the pandemic agreement by the end of this year is not accepted. At a packed WHA meeting of Committee A on Tuesday afternoon, there was intense discussion and some disagreements over the way forward for the INB process on a pandemic agreement. First off, there were two resolutions on the floor, one from the 47 WHO African member states and another from a group of countries that have often played a conciliatory role in talks – Australia, Brunei, Canada, Norway and Pakistan. Both spoke to the time frames for further talks, while the second resolution called for a new structure to take forward the pandemic agreement negotiations. South Africa’s Ambassador Mxolisi Nkosi. Expressing disappointment on behalf of the African region that a pandemic agreement was not agreed on, South Africa’s Ambassador Mxolisi Nkosi called for negotiations to be completed by the end of this year, followed by a special WHA. Botswana expressed its support for the speedy resolution of the IHR during the session, but Kenya – on behalf of the Africa region – linked the IHR amendments and the pandemic agreement, and simply said the region was ready to reach consensus. However, US Ambassador Pamela Hamamoto called for an extension of “one to two years”, explaining that “fundamental differences remain on core issues central to the agreement”. She described these differences as “complex technical issues that require extensive deliberation and carefully crafted workable solutions, inspired by a common vision and supported by all member states”. Ironically, if Donald Trump wins the US presidential election at the end of the year, his administration is unlikely to support the pandemic negotiations – or even the WHO. The WHA’s Committee A resolved that a single drafting group co-chaired by one INB member and one WGIHR member, will convene on Wednesday morning. It will be open to all member states and its task will be to consider all three draft resolutions and propose a process for adopting the IHR amendments and the timing, format and process to conclude the pandemic agreement. These proposals will have to be submitted to the WHA as the mandates for both the WGIHR and the INB have expired. Climate Change to Be Major Focus for WHO in Coming Years 28/05/2024 Disha Shetty The 77th session of World Health Assembly underway in Geneva, Switzerland. The World Health Organization plans to make climate change and its impact on health a major focus in the coming years, along with strengthening health systems, improving health equity and access, and preventing disease, according to the organization’s plan for its general program of work from 2025 to 2028. The four-year plan, known as GPW-14, also prioritizes mental health, gender equality, migrant health, food safety, digital health, and artificial intelligence. It was developed through an extensive 10-month consultation process involving member countries, UN organizations, and civil society organizations. “This document will act as our canvas, articulating our collective aspirations and strategic priorities in global health for the coming four years,” said Dr Saia Ma’u Piukala, the WHO’s regional director for the Western Pacific, as discussions on the plan concluded Tuesday morning, the second day of the ongoing 77th World Health Assembly. Dr Piukala added that the plan “reflects the learning from the Covid-19 pandemic and response to shared issues like climate change, ageing, migration, evolving geopolitics, increasing spillover events and rapidly advancing science and technology.” The World Health Assembly approved the draft GPW-14 following Tuesday’s discussions, but funding remains a concern. The GPW-14 program has a price tag of $11.1 billion, with WHO member states’ assessed contributions covering just over a third of the cost at $4 billion. The WHO is still looking for $7 billion in flexible funding, which it will attempt to raise at an investment conference in late 2024. Focus on Climate Change In recent years, the impact of climate change on health, particularly non-communicable diseases, has become increasingly clear. The WHO has warned that severe weather events, pollution, and climate-sensitive diseases are becoming more frequent worldwide, with vulnerable areas like small island developing states bearing a disproportionate impact. The GPW-14 also notes that human migration and displacement have reached unprecedented levels, with an estimated one billion people choosing to migrate or being forcibly displaced due to various factors, including economic, environmental, political, and conflict-related issues – with dire consequences for health. “The pace of climate change and environmental degradation has accelerated, emerging as a major threat to human health in the 21st century,” the GPW-14 warns. “Increasing inequities within and between countries, which were exacerbated by the COVID-19 pandemic, are leading to a growing divide in health, social and economic outcomes between those with financial resources and those without.” Countries like Japan and the United States praised the WHO for its growing focus on climate and health. Member states acknowledged that health-related Sustainable Development Goals are not on track, and Turkey drew attention to attacks on health facilities and disruptions to essential health services, calling it a “man-made crisis.” “GPW-14 includes the measures to address climate change in the primary objective,” the representative from Japan said. “Now, the world is facing a huge impact of climate change on health. And we affirm the importance of disaster management, especially in the healthcare field.” Dr Saia Ma’u Piukala, Regional Director for WHO’s Western Pacific region. Civil Society Warns WHO Plan is Incomplete Civil society groups have pointed out several shortcomings in the WHO’s GPW-14 plan, despite its ambitious goals to address climate change and health equity. The NCD Alliance, an organization focused on fighting non-communicable diseases (NCDs), criticized the plan for not adequately addressing NCDs, which account for 74% of global deaths. The lack of specificity on NCDs in the GPW-14 comes despite the increasing burden of disease from climate and environmental factors like heat and air pollution. “We regret the missed opportunity to ensure comprehensive outcome indicators for NCDs,” said a representative for the NCD Alliance. “The absence of answers to indicators hinders prioritization for achieving agreed targets.” Other civil society groups noted the plan’s lack of specific references to maternal health indicators and provisions to address the vulnerability of women in the health workforce, despite women constituting 70% of healthcare professionals globally. However, the healthcare workforce and ways to improve equity were mentioned in the plan several times. “Integrating gender-responsive approaches into health workforce planning and management can help address gender disparities in health outcomes and advance progress towards achieving universal healthcare,” said a representative from the Global Health Council in a constituent statement. The absence of gender-responsive provisions in the GPW-14 is likely due to opposition from conservative countries to the terminology. Countries like Russia, Egypt, and Iran objected to any references to “gender” on religious and political grounds during closed-door negotiations, Health Policy Watch reported. Despite these criticisms, several member states thanked the WHO for the extensive consultations carried out before finalizing the draft plan. “We particularly applaud the Secretariat for extensive and inclusive consultation through various platforms with member states, various organizations and partners in the drafting process,” the representative from Botswana said. Image Credits: Twitter, Twitter. Can Technology Help Address Global Migrant Crisis? Experts Weigh In 28/05/2024 Maayan Hoffman A panel discussion at the “Ensuring continuity of care at different stages of the migration process” session of the Gevena Health Forum. From left to right: Alexios Georgalis of the National and Kapodistrian University of Athens, Reinaldo Ortuno Gutierrez of Médecins Sans Frontières, Rebecca Marcussen-Lewis of SOS Méditerranée and Sanjula Weerasinghe, a representative of the International Federation of Red Cross. As the world grapples with a migrant and refugee crisis of unprecedented scale, with 281m international migrants and 3.5m refugees globally, according to UN agencies, experts are turning to technology, particularly artificial intelligence, in search of solutions. The potential for AI and technology to foster a more equitable and sustainable world has been recognised by international organisations. Last year, the World Health Organization, World Intellectual Property Organization, and International Telecommunication Union formed the Global Initiative on AI for Health to facilitate the implementation of AI in healthcare. During the 2024 World Economic Forum, specialists underscored both AI’s transformative potential and the associated risks, emphasising the necessity of cooperation and ethical guidelines to harness its benefits responsibly. With record numbers of people on the move worldwide, can technology help tackle the migrant and refugee crises? Four experts addressed the question at the Geneva Health Forum on Monday during a day focused on migration and health equity. The Geneva Health Forum, convened by the University of Geneva and partners on the first three days of the 2024 World Health Assembly, brings together key global health scientists and policymakers with medical practitioners and other field actors. Here are their insights. Alexios Georgalis, who co-authored the Boys on the Move life skills curriculum – a UNICEF initiative that guides unaccompanied male adolescents displaced by conflict and poverty – believes that although AI cannot fully resolve the refugee crisis, digitalizing and gamifying interventional packages could have a substantial impact. His work focuses on educating young male migrants about exploitation and trafficking, as well as providing mental health support. “Almost every refugee has a smartphone,” Georgalis noted, indicating that digital tools could serve as a “gateway into their psyches and their hands.” Reinaldo Ortuno Gutierrez of Médecins Sans Frontières (MSF) recommended developing geotargeted technologies to help migrants find healthcare wherever they are. MSF already uses QR codes that can be scanned with a smartphone to provide a map of care sites, from primary care to psychiatric care. Gutierrez also mentioned secure referral systems that allow patient files to travel safely via smartphone, ensuring continuity of care. “It would be ideal to have some kind of passport for everyone, but at the moment, it is very limited,” he said. Sanjula Weerasinghe, a representative of the International Federation of Red Cross (IFRC), highlighted the potential benefits of digitally-carried medical records, allowing migrants to “take responsibility and control of their own data.” However, she noted that while efforts to generate this type of record-keeping are underway, no such technology currently exists. Weerasinghe, like Gutierrez, pointed out that some international organisations have developed apps to help migrants locate and access services. Rebecca Marcussen-Lewis, SOS Méditerranée. In contrast, Rebecca Marcussen-Lewis of SOS Méditerranée, a search and rescue NGO operating boats tasked with rescuing drowning migrant vessels, highlighted the challenges of digitalization in her work on the Mediterranean Sea. “We don’t have connectivity, so everything being digital and online is not so easy for us, and if everything moves in that direction, we run the risk of losing the ability to do our work,” she said. However, Marcussen-Lewis acknowledged that telemedicine could be helpful, allowing her team to reach out to a network of experts when faced with unfamiliar medical situations at sea. With a team of four serving over 630 people on a 69-meter boat, “being able to have a network that we can reach out to when we have a presentation that none of us has come across before is fantastic,” she said. Image Credits: Maayan Hoffman, Courtesy of Geneva Health Forum, Geneva Health Forum. Pollution’s Silent Killers: New Research Links Lead Exposure to Millions of Cardiovascular Deaths 28/05/2024 Elaine Ruth Fletcher & Sophia Samantaroy Lead has been found in contaminated turmeric and other spices, creating another route of exposure to the heavy metal Four well-known heavy metals and chemical pollutants – lead, asbestos, arsenic and cadmium- continue exact a heavy toll on the lives of those in low- and middle-income countries – with lead named a factor in as much as 5 million premature deaths annually from cardiovascular disease, according to one recent estimate. Asbestos, arsenic, and cadmium round out the top four, claiming hundreds of thousands of lives every year. While much recent media attention has been focused on the health impacts of newer industrial compounds such as dioxins, phthalates, and endocrine disruptors, these heavy metal “silent killers” need renewed attention in the environmental health arena, experts say. This was one key message from a day-long session on Health and Environment, the featured theme on the opening day of this year’s Geneva Health Forum, 27-29 May. The session highlighted the pressing threats of environmental pollution from plastics and lead to endocrine disruptors and ambient air pollution. The Geneva Health Forum, organized by the University of Geneva on the sidelines of the World Health Assembly brings together the global scientific community with health practitioners and field actors from around the world. Migration, health and equity and malaria are other key themes The Geneva Health Forum highlighted three key themes on opening day. This year’s Forum, running on the sidelines of the World Health Assembly, brings together hundreds of scientists, policy experts and member state representatives on three key themes – including migration, health and equity; and malaria elimination – each the focus of a full-day session. There are also a host of side events on issues ranging from One Health to Climate resilience and elimination of neglected tropical diseases such as Chagas disease and Noma. While panellists highlighted the higher profile of air pollution in recent years and successes with air quality regulation in higher-income countries, air pollution remains a serious and even growing problem in low- and middle-income regions. Focus on pollutants with the highest impacts on death and disease A recent study implicated lead with 5.5 million premature deaths Meanwhile, age-old problems of heavy metal and mineral pollutants such as lead and asbestos also need much more attention, also in LMICs. “We need to deal with key priorities, country by country, of what’s causing the most damage,” said Richard Fuller, founder and former chair of the Global Alliance on Health and Pollution, who recently participated in an assessment ranking the burden of disease from key WHO “chemicals of concern.” “There was one chemical issue that caused millions of deaths – and then four issues that caused hundreds of thousands of deaths,” he said, referring to lead, asbestos, highly hazardous pesticides, arsenic, and cadmium. “The one that caused the majority of deaths was our old friend lead, which is responsible for 1.5 -2 million deaths per year.” Lead may account for as many as 5.5 million premature deaths from CVD A man melts lead metallic wastes used in the production of cooking pots, at a recycling warehouse in Koumassi, Abidjan, Ivory Coast. A 2023 paper published in The Lancet, supported by the World Bank, estimated that lead exposure may cause up to 5.5 million premature deaths annually, with 95 per cent of those deaths attributed to cardiovascular diseases. The analysis draws on emerging evidence linking lead exposure to atherosclerosis, alongside its known effects on reduced IQ, the central nervous system, and other organs. Mr. Fuller noted that the “lead problem,” once associated with pipes, paint, and gasoline, has evolved in affected low-income regions, but its impact remains just as devastating. “It turns out to be all sorts of activities going on in low- and middle-income countries, including [fabrication of] pots and pans and [contamination] of turmeric,” he explained. “The ones that are less impactful … are things like dioxins, phthalates, brominated flame retardants, PFAS, endocrine disruptors, PCBs, and PAHs,” Mr. Fuller noted, emphasizing that these pollutants are “simply the noisier part of the agenda, but not necessarily the most impactful part of the agenda.” “Should we be focusing on the ones that have the most impact, not just the most noise?” he added. John Ji, an environmental epidemiologist at the Tsinghua University Vanke School of Public Health, told the forum he initially thought his 2013 dissertation on lead would be one of the last. “Then Flint happened,” he said, referring to the water crisis in Flint, Michigan, which brought the issue of lead contamination back into the spotlight. Air pollution remains a driver of poor health From left: Mexican Ambassador to Geneva Fernando Espinosa; Nino Kuenzli of the Swiss Tropical Instiute and John Ji of China’s Vanke School of Public Health. With the World Health Organization attributing 13.7 million deaths to chemical and pollutant exposures, the Forum called attention to the need for global collaboration, research, and policy to tackle pollution-related health effects. “Clean air is possible, yet in some cities in the Asian and African continents, air pollution is getting worse,” said Nino Kuenzli, former Swiss Tropical and Public Health Institute professor. He acknowledged that air pollution regulation is part of a broader environmental health success story, citing the significant increase in air quality in Europe and North America in the past decades. “The Swiss mountain town I grew up in had worse air quality than the Swiss urban centres today,” said Kuenzli, adding that this drastic improvement was built upon decades of scientific victories. “We cannot just call for action and policy without a knowledge [of the science] and it is really fascinating to see how the science to understand the health effects of air pollution has evolved over the last 35 years. It’s incredible. Progress is enormous.” Advances in environmental epidemiology, and newfound ways for collaboration among basic scientists and toxicologists, have paved the way for these air quality improvements. Addressing global air pollution inequalities and replicating much of the successes of higher-income countries means “leapfrogging” intermediate policies and technologies, argued Ji. For example, one of the largest sources of indoor air pollution comes from burning biomass fuels, yet countries often transition to gas stoves, which still produce air pollutants. Instead, countries could support a transition directly from biomass to electric, he said. Air pollution levels have continued to go up in most countries across the world despite rising awareness of its harms. Plastic pollution: a new and growing threat Plastics, now ubiquitous in the environment, are another kind of new, and growing pollution concern for soils, waterways, and air, when incinerated. “By 2050, there will be more plastic than fish in the oceans,” remarked Fernando Espinosa, the Mexican Ambassador to Switzerland. Plastic pollution got a brief nod on opening day following last month’s fourth Intergovernmental Negotiating Body in Ottowa, Canada to develop an international legally binding instrument on plastic pollution, including in the marine environment. While the negotiations did reach some conclusions, like developing a list of chemicals of concern, they did not agree to reduce the production of new plastics, most likely due to ongoing pressure from the fossil fuel lobby and their state backers, such as Saudi Arabia, Russia and the United States. Climate adaptation and resilience in the healthcare system The Forum also brought together experts to discuss the often negative environmental contributions of healthcare systems in lower- and middle-income countries. The sector has increasingly produced contaminated waste, greenhouse gas emissions, and other pollutants – causing upwards of five per cent of global greenhouse gas emissions. These emissions come from hospitals themselves, but also from the manufacturing of medical products. Yet remarks from panellist Habib N’Konou, founder of an innovative biomedical waste company, during a later session demonstrated the disproportionate environmental impacts of the health sector in lower-and-middle-income countries. Senegal, he noted, produces upwards of 21,000 tonnes of medical waste per year, much of which is inadequately processed. “It’s an alarming situation. When I came back to Senegal, there was waste on the coasts, in neighbourhoods.” Looking to the successes of other countries could pave the way for better biomedical waste management, N’Konou noted. Morocco and Tunisia both have government-mediated partnerships between waste facilities and hospitals, something N’Konou champions for Senegal and surrounding countries. Even when regulations exist, they are hard to enforce. Despite the environmental challenges facing LMICs, the climate crisis is an opportunity to rethink how healthcare systems operate, according to Sonia Roschnik, executive director of the Geneva Sustainability Centre. “This is where I really hope that some of what we do to respond to climate change is going to help us leverage more innovative ways of looking at healthcare that actually deliver better population health, but also help the planet.” Image Credits: Prchi Palwe , EPA/L. Koula, Geneva Health Forum, Geneva Health Forum. Conservative Member States Balk at References to ‘Gender’ in WHA Resolutions 28/05/2024 Kerry Cullinan The World Health Assembly in progress. GENEVA – Conservative countries have objected to the use of the terms “gender responsive” and “advancing gender mainstreaming” in behind-the-scenes negotiations on several resolutions before the World Health Assembly (WHA), according to a wide variety of sources. There have also been some objections to the use of “gender equality” and “sexual” in some instances – alongside a long-standing objection to the use of “rights” when referring to sexual and reproductive health. “Gender” references have already been stripped from the World Health Organization’s (WHO) draft pandemic agreement. At least five other resolutions have become bogged down by objectives from conservative member states, particularly Russia, Egypt, Iran and Nigeria. These include resolutions on mental health, emergency preparedness, the economics of health, climate and social participation. In the case of the economics of health resolution, Nigeria initially objected to the use of both “gender equality” and “advancing gender mainstreaming”, one source said. Another source told Health Policy Watch that Russia even wants “sexual” to be removed from the standard term, “sexual and reproductive health”. In the resolution on climate and health, for example, there was an impasse over the use of “gender-responsive” policies – apparently because conservatives believe that this opens the door to engagement with LGBTQ groups although they have never unpacked their objection. Countries have eventually settled on a reference to “gender equality”. Objecting to these particular phrases is new. All UN member states including Russia agreed by consensus to the language of the global Sustainable Development Goals (SDGs), which refer to sexual health and gender. Concerned parties close to the talks stressed the importance of “stopping the backsliding” against established terms and rights for women and other groups in the face of the relentless campaign. Experts call for SRHR space to be protected A few days ago, 43 of the foremost global experts in sexual and reproductive health and rights (SRHR) in the UN called on the WHA to protect advance in this hard-won space in an article published by Health Policy Watch. The experts, who work in various UN expert committees, described progress on SRHR as “fundamental for human rights and dignity, national economies, sustainable development, and a healthier planet”. They added that while SRHR includes “services needed to prevent unwanted pregnancies, unsafe births and avoidable sexual or reproductive illness, injury or dysfunction, it is much broader. “Vitally, it includes the positive enjoyment of consensual sexual intimacy and pleasure, the development of mutually respectful and loving relationships, as well as the affirmation of individuals and families in all their diversity,” they added. “Sexual and reproductive health and rights flourish only where its emotional, mental, and social dimensions are also enabled, free of coercion, discrimination, and violence.” A repeat of 2022? The Saudi delegate in heated WHA debate over sexual rights and terminology at the WHA in 2022. Two years ago, the entire WHA was delayed for days over conflict related to a global strategy on HIV, hepatitis B and sexually transmitted infections, primarily because of a glossary on sexual health and target populations for HIV treatment. While the language was standard for HIV treatment and care, the Saudi Arabian delegate – speaking for WHO’s 22-member state Eastern Mediterranean Region (EMRO) – objected to the terms “sexuality”, “sexual orientation”, “sexual rights”. He also objected to “men who have sex with men” being designated as a target population for HIV treatment. Although the WHO works by consensus, the strategy eventually went to a vote late on the last night of an extended WHA, and narrowly passed with many absentions. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... 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The Power of Partnerships in Advancing Global Health 29/05/2024 Maayan Hoffman IFPMA Director-General David Reddy (right) in an interview with journalist Shiulie Ghosh on Tuesday, May 28. GENEVA – Partnerships between industry, multilateral organizations, and other stakeholders are essential to overcoming challenges and improving access to innovations. This was the key message at an International Federation of Pharmaceutical Manufacturers (IFPMA) event on Tuesday evening, held on the sidelines of the World Health Assembly in Geneva. The gathering brought together representatives from the World Health Organization (WHO), Gavi, government officials, and industry leaders to discuss how these partnerships can be enhanced to deliver meaningful impact for people and healthcare systems worldwide. The event featured an interview with David Reddy, the newly appointed Director-General of IFPMA and former CEO of Medicines for Malaria Ventures who took over from Thomas Cueni in April. IFPMA, the global pharmaceutical trade organization, works with the WHO and other UN bodies, representing over 90 companies and associations, including industry giants like Johnson & Johnson, Novartis, Pfizer, Eli Lilly and AstraZeneca. Reddy, who has been in his new role for fewer than two months, described drug development as a process of “assembling information that wraps around a molecule,” from animal safety studies to patient behaviour, infection treatment and manufacturing quality. This information then undergoes regulatory review to ensure the drug’s efficacy. The complex nature of drug development means pharmaceutical companies must work closely with multilateral organizations to ensure their drugs are distributed and accessible, particularly in low- and middle-income countries. However, there is often tension between the high cost of developing innovative medicines and vaccines and the basic health needs of populations that may be unable to afford them. This is where partnerships are crucial. “It’s really important just to underscore that it’s not something that we, as an industry, can do alone. We can only do it in partnership.” Reddy quoted WHO Deputy Director-General Mike Ryan, who said that industry and the UN health body agree on 80% of things in global health and may differ on 20%. Ryan has urged focusing on the 80% agreement to make progress. “It doesn’t mean we should ignore the areas of difference. We should debate them,” Reddy said. “But don’t forget that we are so aligned in so many ways.” The monoclonal antibody revolution Covid-19 monoclonal antibodies Reddy also spoke about drug and vaccine innovation, using the mRNA COVID-19 vaccines as an example. “They were there just when they were needed, but they were there because of two decades of work. Companies were able to partner together and really accelerate getting them to people to prevent them from becoming patients,” Reddy explained. Innovation, he said, “just takes a long time” and costs money. Looking to the future, Reddy sees great potential in monoclonal antibodies, conjugated antibodies, mRNA technology, and individualized therapy, all underpinned by artificial intelligence. “We’re living in the monoclonal [antibody] revolution if you like,” he said. “Not globally yet. In terms of access, that is something this industry is really working on at this time.” AI could revolutionize drug development by enabling researchers to precisely select molecules that have the potential to become medicines, chart more efficient pathways, and significantly compress development timelines, Reddy added. Gavi: Partnerships crucial as health budgets tighten From left: Shiulie Ghosh, journalist; Minister Ong Ye Kung, minister of health of Singapore; Dr. Catharina Boehme, assistant director-general of External Relations and Governance for WHO; and Deborah Waterhouse, the CEO of ViiV Healthcare and the president of Global Health for GSK. Dr Sania Nishtar, the recently appointed CEO of Gavi, the Vaccine Alliance, also spoke about the importance of partnerships from her perspective, especially in the current climate, which she described as “a very resource-restrained time for global health”. Between competing priorities and ongoing conflicts in different parts of the world, the G7 is stretched,” Nishtar said. “We in the global health space must hear this loud and clear.” Nishtar’s remarks took place against the backdrop of the WHO’s new “Investment Round” initiative, aiming to raise $7 billion to make the organization’s funding more predictable, flexible, and sustainable. The total contributions of WHO member states are just $4 billion annually. Public health expenditure across OECD countries surged by an average of 17% in real terms between 2019 and 2021, as governments rapidly allocated resources to tackle the crisis. Prevention spending more than doubled due to extensive testing and vaccination efforts. In 2022, however, health spending across OECD countries declined by an average of 1.5%. With inflation expected to remain above 5% in 2024, compared to less than 2% in 2019, nominal increases will be considerably reduced. The pandemic led to increased health spending as a percentage of GDP in low- and middle-income countries, but not as much as in advanced economies. A recent Center for Global Development report suggests this increase is unlikely to be sustained due to the pandemic’s impact on revenues and budgets. Slow domestic revenue growth has already made achieving health-related Sustainable Development Goals (SDGs) by 2030 unlikely, and without new funding sources, meeting these goals will be further delayed. “We had 40 countries decrease their healthcare spending last year. Healthcare budgets are going down instead of up,” said Dr Catharina Boehme, assistant director-general of External Relations and Governance for WHO. “To harness the promise of science and innovation, we have to focus on creating capacity and making sure health funding remains intact.” Partnerships, Nishtar added, are in Gavi’s DNA, working closely with WHO, UNICEF, and industry to build synergies. “Solutions can be found when we work together,” she continued. “And we can only work together when we let go of ego, turf, rivalries and small thinking.” Image Credits: Raisa/Flickr. Push for International Health Regulation Changes to Be Passed This Week – But Disagreement About Future of Pandemic Agreement Talks 28/05/2024 Kerry Cullinan The crowded WHA meeting room where the pandemic discussions are taking place GENEVA – A powerful lobby, including the US, Germany and New Zealand, are pushing for the amendments to the International Health Regulations (IHR) to be adopted by the close of the World Health Assembly (WHA) on Saturday. Weaknesses in the IHR, the only global rules guiding countries’ conduct in international public health emergencies, were exposed during the pandemic, prompting a two-year process to amend them. Agreement is close, with some outstanding issues particularly on definitions, according to the report on the IHR negotiations to the WHA by World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus. “My appeal here is let us focus on the IHR so we have this success as this is already providing much better protection for the world,” said Germany’s Health Minister Karl Lauterbach. Strong positive signal The European Union (EU) echoed this sentiment, describing progress on IHR amendments as “remarkable”. “The adoption of these amendments within the very short timeframe of only two years will send a very positive signal to the outside world about the ability of the WHO and its membership to take concrete action to improve the global health architecture,” said the EU. “Such adoption will also send very positive signal for the future of the INB [Intergovernmental Negotiating Body] process.” The INB was charged with negotiating a pandemic agreement but member states have failed to reach agreement by the WHA deadline. The most recent pandemic agreement draft shows significant areas of disagreement remain. The EU acknowledged that some IHR amendments still need to be resolved and urged all partners to “redouble efforts” to finalise the work and adopt the changes by 1 June. Dr Ashley Bloomfield, co-chair of the Working Group on amendments to the IHR, told the WHA that the committee is “very close to completing an agreed package of amendments”. “There is both momentum and an aspiration among states parties to complete the task,” said Bloomfield. “Adopting a package of IHR amendments during this assembly would be a significant milestone and achievement and we believe in a very important stepping stone to successfully concluding the pandemic agreement negotiations later.” France, Indonesia, Kenya, New Zealand and Saudi Arabia have prepared a resolution to adopt the IHR amendments in anticipation of agreement being reached in the next few days. Pandemic agreement process unclear It is unclear whether the African region will support completing the IHR amendments this week if its demand for the speedy conclusion of the pandemic agreement by the end of this year is not accepted. At a packed WHA meeting of Committee A on Tuesday afternoon, there was intense discussion and some disagreements over the way forward for the INB process on a pandemic agreement. First off, there were two resolutions on the floor, one from the 47 WHO African member states and another from a group of countries that have often played a conciliatory role in talks – Australia, Brunei, Canada, Norway and Pakistan. Both spoke to the time frames for further talks, while the second resolution called for a new structure to take forward the pandemic agreement negotiations. South Africa’s Ambassador Mxolisi Nkosi. Expressing disappointment on behalf of the African region that a pandemic agreement was not agreed on, South Africa’s Ambassador Mxolisi Nkosi called for negotiations to be completed by the end of this year, followed by a special WHA. Botswana expressed its support for the speedy resolution of the IHR during the session, but Kenya – on behalf of the Africa region – linked the IHR amendments and the pandemic agreement, and simply said the region was ready to reach consensus. However, US Ambassador Pamela Hamamoto called for an extension of “one to two years”, explaining that “fundamental differences remain on core issues central to the agreement”. She described these differences as “complex technical issues that require extensive deliberation and carefully crafted workable solutions, inspired by a common vision and supported by all member states”. Ironically, if Donald Trump wins the US presidential election at the end of the year, his administration is unlikely to support the pandemic negotiations – or even the WHO. The WHA’s Committee A resolved that a single drafting group co-chaired by one INB member and one WGIHR member, will convene on Wednesday morning. It will be open to all member states and its task will be to consider all three draft resolutions and propose a process for adopting the IHR amendments and the timing, format and process to conclude the pandemic agreement. These proposals will have to be submitted to the WHA as the mandates for both the WGIHR and the INB have expired. Climate Change to Be Major Focus for WHO in Coming Years 28/05/2024 Disha Shetty The 77th session of World Health Assembly underway in Geneva, Switzerland. The World Health Organization plans to make climate change and its impact on health a major focus in the coming years, along with strengthening health systems, improving health equity and access, and preventing disease, according to the organization’s plan for its general program of work from 2025 to 2028. The four-year plan, known as GPW-14, also prioritizes mental health, gender equality, migrant health, food safety, digital health, and artificial intelligence. It was developed through an extensive 10-month consultation process involving member countries, UN organizations, and civil society organizations. “This document will act as our canvas, articulating our collective aspirations and strategic priorities in global health for the coming four years,” said Dr Saia Ma’u Piukala, the WHO’s regional director for the Western Pacific, as discussions on the plan concluded Tuesday morning, the second day of the ongoing 77th World Health Assembly. Dr Piukala added that the plan “reflects the learning from the Covid-19 pandemic and response to shared issues like climate change, ageing, migration, evolving geopolitics, increasing spillover events and rapidly advancing science and technology.” The World Health Assembly approved the draft GPW-14 following Tuesday’s discussions, but funding remains a concern. The GPW-14 program has a price tag of $11.1 billion, with WHO member states’ assessed contributions covering just over a third of the cost at $4 billion. The WHO is still looking for $7 billion in flexible funding, which it will attempt to raise at an investment conference in late 2024. Focus on Climate Change In recent years, the impact of climate change on health, particularly non-communicable diseases, has become increasingly clear. The WHO has warned that severe weather events, pollution, and climate-sensitive diseases are becoming more frequent worldwide, with vulnerable areas like small island developing states bearing a disproportionate impact. The GPW-14 also notes that human migration and displacement have reached unprecedented levels, with an estimated one billion people choosing to migrate or being forcibly displaced due to various factors, including economic, environmental, political, and conflict-related issues – with dire consequences for health. “The pace of climate change and environmental degradation has accelerated, emerging as a major threat to human health in the 21st century,” the GPW-14 warns. “Increasing inequities within and between countries, which were exacerbated by the COVID-19 pandemic, are leading to a growing divide in health, social and economic outcomes between those with financial resources and those without.” Countries like Japan and the United States praised the WHO for its growing focus on climate and health. Member states acknowledged that health-related Sustainable Development Goals are not on track, and Turkey drew attention to attacks on health facilities and disruptions to essential health services, calling it a “man-made crisis.” “GPW-14 includes the measures to address climate change in the primary objective,” the representative from Japan said. “Now, the world is facing a huge impact of climate change on health. And we affirm the importance of disaster management, especially in the healthcare field.” Dr Saia Ma’u Piukala, Regional Director for WHO’s Western Pacific region. Civil Society Warns WHO Plan is Incomplete Civil society groups have pointed out several shortcomings in the WHO’s GPW-14 plan, despite its ambitious goals to address climate change and health equity. The NCD Alliance, an organization focused on fighting non-communicable diseases (NCDs), criticized the plan for not adequately addressing NCDs, which account for 74% of global deaths. The lack of specificity on NCDs in the GPW-14 comes despite the increasing burden of disease from climate and environmental factors like heat and air pollution. “We regret the missed opportunity to ensure comprehensive outcome indicators for NCDs,” said a representative for the NCD Alliance. “The absence of answers to indicators hinders prioritization for achieving agreed targets.” Other civil society groups noted the plan’s lack of specific references to maternal health indicators and provisions to address the vulnerability of women in the health workforce, despite women constituting 70% of healthcare professionals globally. However, the healthcare workforce and ways to improve equity were mentioned in the plan several times. “Integrating gender-responsive approaches into health workforce planning and management can help address gender disparities in health outcomes and advance progress towards achieving universal healthcare,” said a representative from the Global Health Council in a constituent statement. The absence of gender-responsive provisions in the GPW-14 is likely due to opposition from conservative countries to the terminology. Countries like Russia, Egypt, and Iran objected to any references to “gender” on religious and political grounds during closed-door negotiations, Health Policy Watch reported. Despite these criticisms, several member states thanked the WHO for the extensive consultations carried out before finalizing the draft plan. “We particularly applaud the Secretariat for extensive and inclusive consultation through various platforms with member states, various organizations and partners in the drafting process,” the representative from Botswana said. Image Credits: Twitter, Twitter. Can Technology Help Address Global Migrant Crisis? Experts Weigh In 28/05/2024 Maayan Hoffman A panel discussion at the “Ensuring continuity of care at different stages of the migration process” session of the Gevena Health Forum. From left to right: Alexios Georgalis of the National and Kapodistrian University of Athens, Reinaldo Ortuno Gutierrez of Médecins Sans Frontières, Rebecca Marcussen-Lewis of SOS Méditerranée and Sanjula Weerasinghe, a representative of the International Federation of Red Cross. As the world grapples with a migrant and refugee crisis of unprecedented scale, with 281m international migrants and 3.5m refugees globally, according to UN agencies, experts are turning to technology, particularly artificial intelligence, in search of solutions. The potential for AI and technology to foster a more equitable and sustainable world has been recognised by international organisations. Last year, the World Health Organization, World Intellectual Property Organization, and International Telecommunication Union formed the Global Initiative on AI for Health to facilitate the implementation of AI in healthcare. During the 2024 World Economic Forum, specialists underscored both AI’s transformative potential and the associated risks, emphasising the necessity of cooperation and ethical guidelines to harness its benefits responsibly. With record numbers of people on the move worldwide, can technology help tackle the migrant and refugee crises? Four experts addressed the question at the Geneva Health Forum on Monday during a day focused on migration and health equity. The Geneva Health Forum, convened by the University of Geneva and partners on the first three days of the 2024 World Health Assembly, brings together key global health scientists and policymakers with medical practitioners and other field actors. Here are their insights. Alexios Georgalis, who co-authored the Boys on the Move life skills curriculum – a UNICEF initiative that guides unaccompanied male adolescents displaced by conflict and poverty – believes that although AI cannot fully resolve the refugee crisis, digitalizing and gamifying interventional packages could have a substantial impact. His work focuses on educating young male migrants about exploitation and trafficking, as well as providing mental health support. “Almost every refugee has a smartphone,” Georgalis noted, indicating that digital tools could serve as a “gateway into their psyches and their hands.” Reinaldo Ortuno Gutierrez of Médecins Sans Frontières (MSF) recommended developing geotargeted technologies to help migrants find healthcare wherever they are. MSF already uses QR codes that can be scanned with a smartphone to provide a map of care sites, from primary care to psychiatric care. Gutierrez also mentioned secure referral systems that allow patient files to travel safely via smartphone, ensuring continuity of care. “It would be ideal to have some kind of passport for everyone, but at the moment, it is very limited,” he said. Sanjula Weerasinghe, a representative of the International Federation of Red Cross (IFRC), highlighted the potential benefits of digitally-carried medical records, allowing migrants to “take responsibility and control of their own data.” However, she noted that while efforts to generate this type of record-keeping are underway, no such technology currently exists. Weerasinghe, like Gutierrez, pointed out that some international organisations have developed apps to help migrants locate and access services. Rebecca Marcussen-Lewis, SOS Méditerranée. In contrast, Rebecca Marcussen-Lewis of SOS Méditerranée, a search and rescue NGO operating boats tasked with rescuing drowning migrant vessels, highlighted the challenges of digitalization in her work on the Mediterranean Sea. “We don’t have connectivity, so everything being digital and online is not so easy for us, and if everything moves in that direction, we run the risk of losing the ability to do our work,” she said. However, Marcussen-Lewis acknowledged that telemedicine could be helpful, allowing her team to reach out to a network of experts when faced with unfamiliar medical situations at sea. With a team of four serving over 630 people on a 69-meter boat, “being able to have a network that we can reach out to when we have a presentation that none of us has come across before is fantastic,” she said. Image Credits: Maayan Hoffman, Courtesy of Geneva Health Forum, Geneva Health Forum. Pollution’s Silent Killers: New Research Links Lead Exposure to Millions of Cardiovascular Deaths 28/05/2024 Elaine Ruth Fletcher & Sophia Samantaroy Lead has been found in contaminated turmeric and other spices, creating another route of exposure to the heavy metal Four well-known heavy metals and chemical pollutants – lead, asbestos, arsenic and cadmium- continue exact a heavy toll on the lives of those in low- and middle-income countries – with lead named a factor in as much as 5 million premature deaths annually from cardiovascular disease, according to one recent estimate. Asbestos, arsenic, and cadmium round out the top four, claiming hundreds of thousands of lives every year. While much recent media attention has been focused on the health impacts of newer industrial compounds such as dioxins, phthalates, and endocrine disruptors, these heavy metal “silent killers” need renewed attention in the environmental health arena, experts say. This was one key message from a day-long session on Health and Environment, the featured theme on the opening day of this year’s Geneva Health Forum, 27-29 May. The session highlighted the pressing threats of environmental pollution from plastics and lead to endocrine disruptors and ambient air pollution. The Geneva Health Forum, organized by the University of Geneva on the sidelines of the World Health Assembly brings together the global scientific community with health practitioners and field actors from around the world. Migration, health and equity and malaria are other key themes The Geneva Health Forum highlighted three key themes on opening day. This year’s Forum, running on the sidelines of the World Health Assembly, brings together hundreds of scientists, policy experts and member state representatives on three key themes – including migration, health and equity; and malaria elimination – each the focus of a full-day session. There are also a host of side events on issues ranging from One Health to Climate resilience and elimination of neglected tropical diseases such as Chagas disease and Noma. While panellists highlighted the higher profile of air pollution in recent years and successes with air quality regulation in higher-income countries, air pollution remains a serious and even growing problem in low- and middle-income regions. Focus on pollutants with the highest impacts on death and disease A recent study implicated lead with 5.5 million premature deaths Meanwhile, age-old problems of heavy metal and mineral pollutants such as lead and asbestos also need much more attention, also in LMICs. “We need to deal with key priorities, country by country, of what’s causing the most damage,” said Richard Fuller, founder and former chair of the Global Alliance on Health and Pollution, who recently participated in an assessment ranking the burden of disease from key WHO “chemicals of concern.” “There was one chemical issue that caused millions of deaths – and then four issues that caused hundreds of thousands of deaths,” he said, referring to lead, asbestos, highly hazardous pesticides, arsenic, and cadmium. “The one that caused the majority of deaths was our old friend lead, which is responsible for 1.5 -2 million deaths per year.” Lead may account for as many as 5.5 million premature deaths from CVD A man melts lead metallic wastes used in the production of cooking pots, at a recycling warehouse in Koumassi, Abidjan, Ivory Coast. A 2023 paper published in The Lancet, supported by the World Bank, estimated that lead exposure may cause up to 5.5 million premature deaths annually, with 95 per cent of those deaths attributed to cardiovascular diseases. The analysis draws on emerging evidence linking lead exposure to atherosclerosis, alongside its known effects on reduced IQ, the central nervous system, and other organs. Mr. Fuller noted that the “lead problem,” once associated with pipes, paint, and gasoline, has evolved in affected low-income regions, but its impact remains just as devastating. “It turns out to be all sorts of activities going on in low- and middle-income countries, including [fabrication of] pots and pans and [contamination] of turmeric,” he explained. “The ones that are less impactful … are things like dioxins, phthalates, brominated flame retardants, PFAS, endocrine disruptors, PCBs, and PAHs,” Mr. Fuller noted, emphasizing that these pollutants are “simply the noisier part of the agenda, but not necessarily the most impactful part of the agenda.” “Should we be focusing on the ones that have the most impact, not just the most noise?” he added. John Ji, an environmental epidemiologist at the Tsinghua University Vanke School of Public Health, told the forum he initially thought his 2013 dissertation on lead would be one of the last. “Then Flint happened,” he said, referring to the water crisis in Flint, Michigan, which brought the issue of lead contamination back into the spotlight. Air pollution remains a driver of poor health From left: Mexican Ambassador to Geneva Fernando Espinosa; Nino Kuenzli of the Swiss Tropical Instiute and John Ji of China’s Vanke School of Public Health. With the World Health Organization attributing 13.7 million deaths to chemical and pollutant exposures, the Forum called attention to the need for global collaboration, research, and policy to tackle pollution-related health effects. “Clean air is possible, yet in some cities in the Asian and African continents, air pollution is getting worse,” said Nino Kuenzli, former Swiss Tropical and Public Health Institute professor. He acknowledged that air pollution regulation is part of a broader environmental health success story, citing the significant increase in air quality in Europe and North America in the past decades. “The Swiss mountain town I grew up in had worse air quality than the Swiss urban centres today,” said Kuenzli, adding that this drastic improvement was built upon decades of scientific victories. “We cannot just call for action and policy without a knowledge [of the science] and it is really fascinating to see how the science to understand the health effects of air pollution has evolved over the last 35 years. It’s incredible. Progress is enormous.” Advances in environmental epidemiology, and newfound ways for collaboration among basic scientists and toxicologists, have paved the way for these air quality improvements. Addressing global air pollution inequalities and replicating much of the successes of higher-income countries means “leapfrogging” intermediate policies and technologies, argued Ji. For example, one of the largest sources of indoor air pollution comes from burning biomass fuels, yet countries often transition to gas stoves, which still produce air pollutants. Instead, countries could support a transition directly from biomass to electric, he said. Air pollution levels have continued to go up in most countries across the world despite rising awareness of its harms. Plastic pollution: a new and growing threat Plastics, now ubiquitous in the environment, are another kind of new, and growing pollution concern for soils, waterways, and air, when incinerated. “By 2050, there will be more plastic than fish in the oceans,” remarked Fernando Espinosa, the Mexican Ambassador to Switzerland. Plastic pollution got a brief nod on opening day following last month’s fourth Intergovernmental Negotiating Body in Ottowa, Canada to develop an international legally binding instrument on plastic pollution, including in the marine environment. While the negotiations did reach some conclusions, like developing a list of chemicals of concern, they did not agree to reduce the production of new plastics, most likely due to ongoing pressure from the fossil fuel lobby and their state backers, such as Saudi Arabia, Russia and the United States. Climate adaptation and resilience in the healthcare system The Forum also brought together experts to discuss the often negative environmental contributions of healthcare systems in lower- and middle-income countries. The sector has increasingly produced contaminated waste, greenhouse gas emissions, and other pollutants – causing upwards of five per cent of global greenhouse gas emissions. These emissions come from hospitals themselves, but also from the manufacturing of medical products. Yet remarks from panellist Habib N’Konou, founder of an innovative biomedical waste company, during a later session demonstrated the disproportionate environmental impacts of the health sector in lower-and-middle-income countries. Senegal, he noted, produces upwards of 21,000 tonnes of medical waste per year, much of which is inadequately processed. “It’s an alarming situation. When I came back to Senegal, there was waste on the coasts, in neighbourhoods.” Looking to the successes of other countries could pave the way for better biomedical waste management, N’Konou noted. Morocco and Tunisia both have government-mediated partnerships between waste facilities and hospitals, something N’Konou champions for Senegal and surrounding countries. Even when regulations exist, they are hard to enforce. Despite the environmental challenges facing LMICs, the climate crisis is an opportunity to rethink how healthcare systems operate, according to Sonia Roschnik, executive director of the Geneva Sustainability Centre. “This is where I really hope that some of what we do to respond to climate change is going to help us leverage more innovative ways of looking at healthcare that actually deliver better population health, but also help the planet.” Image Credits: Prchi Palwe , EPA/L. Koula, Geneva Health Forum, Geneva Health Forum. Conservative Member States Balk at References to ‘Gender’ in WHA Resolutions 28/05/2024 Kerry Cullinan The World Health Assembly in progress. GENEVA – Conservative countries have objected to the use of the terms “gender responsive” and “advancing gender mainstreaming” in behind-the-scenes negotiations on several resolutions before the World Health Assembly (WHA), according to a wide variety of sources. There have also been some objections to the use of “gender equality” and “sexual” in some instances – alongside a long-standing objection to the use of “rights” when referring to sexual and reproductive health. “Gender” references have already been stripped from the World Health Organization’s (WHO) draft pandemic agreement. At least five other resolutions have become bogged down by objectives from conservative member states, particularly Russia, Egypt, Iran and Nigeria. These include resolutions on mental health, emergency preparedness, the economics of health, climate and social participation. In the case of the economics of health resolution, Nigeria initially objected to the use of both “gender equality” and “advancing gender mainstreaming”, one source said. Another source told Health Policy Watch that Russia even wants “sexual” to be removed from the standard term, “sexual and reproductive health”. In the resolution on climate and health, for example, there was an impasse over the use of “gender-responsive” policies – apparently because conservatives believe that this opens the door to engagement with LGBTQ groups although they have never unpacked their objection. Countries have eventually settled on a reference to “gender equality”. Objecting to these particular phrases is new. All UN member states including Russia agreed by consensus to the language of the global Sustainable Development Goals (SDGs), which refer to sexual health and gender. Concerned parties close to the talks stressed the importance of “stopping the backsliding” against established terms and rights for women and other groups in the face of the relentless campaign. Experts call for SRHR space to be protected A few days ago, 43 of the foremost global experts in sexual and reproductive health and rights (SRHR) in the UN called on the WHA to protect advance in this hard-won space in an article published by Health Policy Watch. The experts, who work in various UN expert committees, described progress on SRHR as “fundamental for human rights and dignity, national economies, sustainable development, and a healthier planet”. They added that while SRHR includes “services needed to prevent unwanted pregnancies, unsafe births and avoidable sexual or reproductive illness, injury or dysfunction, it is much broader. “Vitally, it includes the positive enjoyment of consensual sexual intimacy and pleasure, the development of mutually respectful and loving relationships, as well as the affirmation of individuals and families in all their diversity,” they added. “Sexual and reproductive health and rights flourish only where its emotional, mental, and social dimensions are also enabled, free of coercion, discrimination, and violence.” A repeat of 2022? The Saudi delegate in heated WHA debate over sexual rights and terminology at the WHA in 2022. Two years ago, the entire WHA was delayed for days over conflict related to a global strategy on HIV, hepatitis B and sexually transmitted infections, primarily because of a glossary on sexual health and target populations for HIV treatment. While the language was standard for HIV treatment and care, the Saudi Arabian delegate – speaking for WHO’s 22-member state Eastern Mediterranean Region (EMRO) – objected to the terms “sexuality”, “sexual orientation”, “sexual rights”. He also objected to “men who have sex with men” being designated as a target population for HIV treatment. Although the WHO works by consensus, the strategy eventually went to a vote late on the last night of an extended WHA, and narrowly passed with many absentions. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... 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Push for International Health Regulation Changes to Be Passed This Week – But Disagreement About Future of Pandemic Agreement Talks 28/05/2024 Kerry Cullinan The crowded WHA meeting room where the pandemic discussions are taking place GENEVA – A powerful lobby, including the US, Germany and New Zealand, are pushing for the amendments to the International Health Regulations (IHR) to be adopted by the close of the World Health Assembly (WHA) on Saturday. Weaknesses in the IHR, the only global rules guiding countries’ conduct in international public health emergencies, were exposed during the pandemic, prompting a two-year process to amend them. Agreement is close, with some outstanding issues particularly on definitions, according to the report on the IHR negotiations to the WHA by World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus. “My appeal here is let us focus on the IHR so we have this success as this is already providing much better protection for the world,” said Germany’s Health Minister Karl Lauterbach. Strong positive signal The European Union (EU) echoed this sentiment, describing progress on IHR amendments as “remarkable”. “The adoption of these amendments within the very short timeframe of only two years will send a very positive signal to the outside world about the ability of the WHO and its membership to take concrete action to improve the global health architecture,” said the EU. “Such adoption will also send very positive signal for the future of the INB [Intergovernmental Negotiating Body] process.” The INB was charged with negotiating a pandemic agreement but member states have failed to reach agreement by the WHA deadline. The most recent pandemic agreement draft shows significant areas of disagreement remain. The EU acknowledged that some IHR amendments still need to be resolved and urged all partners to “redouble efforts” to finalise the work and adopt the changes by 1 June. Dr Ashley Bloomfield, co-chair of the Working Group on amendments to the IHR, told the WHA that the committee is “very close to completing an agreed package of amendments”. “There is both momentum and an aspiration among states parties to complete the task,” said Bloomfield. “Adopting a package of IHR amendments during this assembly would be a significant milestone and achievement and we believe in a very important stepping stone to successfully concluding the pandemic agreement negotiations later.” France, Indonesia, Kenya, New Zealand and Saudi Arabia have prepared a resolution to adopt the IHR amendments in anticipation of agreement being reached in the next few days. Pandemic agreement process unclear It is unclear whether the African region will support completing the IHR amendments this week if its demand for the speedy conclusion of the pandemic agreement by the end of this year is not accepted. At a packed WHA meeting of Committee A on Tuesday afternoon, there was intense discussion and some disagreements over the way forward for the INB process on a pandemic agreement. First off, there were two resolutions on the floor, one from the 47 WHO African member states and another from a group of countries that have often played a conciliatory role in talks – Australia, Brunei, Canada, Norway and Pakistan. Both spoke to the time frames for further talks, while the second resolution called for a new structure to take forward the pandemic agreement negotiations. South Africa’s Ambassador Mxolisi Nkosi. Expressing disappointment on behalf of the African region that a pandemic agreement was not agreed on, South Africa’s Ambassador Mxolisi Nkosi called for negotiations to be completed by the end of this year, followed by a special WHA. Botswana expressed its support for the speedy resolution of the IHR during the session, but Kenya – on behalf of the Africa region – linked the IHR amendments and the pandemic agreement, and simply said the region was ready to reach consensus. However, US Ambassador Pamela Hamamoto called for an extension of “one to two years”, explaining that “fundamental differences remain on core issues central to the agreement”. She described these differences as “complex technical issues that require extensive deliberation and carefully crafted workable solutions, inspired by a common vision and supported by all member states”. Ironically, if Donald Trump wins the US presidential election at the end of the year, his administration is unlikely to support the pandemic negotiations – or even the WHO. The WHA’s Committee A resolved that a single drafting group co-chaired by one INB member and one WGIHR member, will convene on Wednesday morning. It will be open to all member states and its task will be to consider all three draft resolutions and propose a process for adopting the IHR amendments and the timing, format and process to conclude the pandemic agreement. These proposals will have to be submitted to the WHA as the mandates for both the WGIHR and the INB have expired. Climate Change to Be Major Focus for WHO in Coming Years 28/05/2024 Disha Shetty The 77th session of World Health Assembly underway in Geneva, Switzerland. The World Health Organization plans to make climate change and its impact on health a major focus in the coming years, along with strengthening health systems, improving health equity and access, and preventing disease, according to the organization’s plan for its general program of work from 2025 to 2028. The four-year plan, known as GPW-14, also prioritizes mental health, gender equality, migrant health, food safety, digital health, and artificial intelligence. It was developed through an extensive 10-month consultation process involving member countries, UN organizations, and civil society organizations. “This document will act as our canvas, articulating our collective aspirations and strategic priorities in global health for the coming four years,” said Dr Saia Ma’u Piukala, the WHO’s regional director for the Western Pacific, as discussions on the plan concluded Tuesday morning, the second day of the ongoing 77th World Health Assembly. Dr Piukala added that the plan “reflects the learning from the Covid-19 pandemic and response to shared issues like climate change, ageing, migration, evolving geopolitics, increasing spillover events and rapidly advancing science and technology.” The World Health Assembly approved the draft GPW-14 following Tuesday’s discussions, but funding remains a concern. The GPW-14 program has a price tag of $11.1 billion, with WHO member states’ assessed contributions covering just over a third of the cost at $4 billion. The WHO is still looking for $7 billion in flexible funding, which it will attempt to raise at an investment conference in late 2024. Focus on Climate Change In recent years, the impact of climate change on health, particularly non-communicable diseases, has become increasingly clear. The WHO has warned that severe weather events, pollution, and climate-sensitive diseases are becoming more frequent worldwide, with vulnerable areas like small island developing states bearing a disproportionate impact. The GPW-14 also notes that human migration and displacement have reached unprecedented levels, with an estimated one billion people choosing to migrate or being forcibly displaced due to various factors, including economic, environmental, political, and conflict-related issues – with dire consequences for health. “The pace of climate change and environmental degradation has accelerated, emerging as a major threat to human health in the 21st century,” the GPW-14 warns. “Increasing inequities within and between countries, which were exacerbated by the COVID-19 pandemic, are leading to a growing divide in health, social and economic outcomes between those with financial resources and those without.” Countries like Japan and the United States praised the WHO for its growing focus on climate and health. Member states acknowledged that health-related Sustainable Development Goals are not on track, and Turkey drew attention to attacks on health facilities and disruptions to essential health services, calling it a “man-made crisis.” “GPW-14 includes the measures to address climate change in the primary objective,” the representative from Japan said. “Now, the world is facing a huge impact of climate change on health. And we affirm the importance of disaster management, especially in the healthcare field.” Dr Saia Ma’u Piukala, Regional Director for WHO’s Western Pacific region. Civil Society Warns WHO Plan is Incomplete Civil society groups have pointed out several shortcomings in the WHO’s GPW-14 plan, despite its ambitious goals to address climate change and health equity. The NCD Alliance, an organization focused on fighting non-communicable diseases (NCDs), criticized the plan for not adequately addressing NCDs, which account for 74% of global deaths. The lack of specificity on NCDs in the GPW-14 comes despite the increasing burden of disease from climate and environmental factors like heat and air pollution. “We regret the missed opportunity to ensure comprehensive outcome indicators for NCDs,” said a representative for the NCD Alliance. “The absence of answers to indicators hinders prioritization for achieving agreed targets.” Other civil society groups noted the plan’s lack of specific references to maternal health indicators and provisions to address the vulnerability of women in the health workforce, despite women constituting 70% of healthcare professionals globally. However, the healthcare workforce and ways to improve equity were mentioned in the plan several times. “Integrating gender-responsive approaches into health workforce planning and management can help address gender disparities in health outcomes and advance progress towards achieving universal healthcare,” said a representative from the Global Health Council in a constituent statement. The absence of gender-responsive provisions in the GPW-14 is likely due to opposition from conservative countries to the terminology. Countries like Russia, Egypt, and Iran objected to any references to “gender” on religious and political grounds during closed-door negotiations, Health Policy Watch reported. Despite these criticisms, several member states thanked the WHO for the extensive consultations carried out before finalizing the draft plan. “We particularly applaud the Secretariat for extensive and inclusive consultation through various platforms with member states, various organizations and partners in the drafting process,” the representative from Botswana said. Image Credits: Twitter, Twitter. Can Technology Help Address Global Migrant Crisis? Experts Weigh In 28/05/2024 Maayan Hoffman A panel discussion at the “Ensuring continuity of care at different stages of the migration process” session of the Gevena Health Forum. From left to right: Alexios Georgalis of the National and Kapodistrian University of Athens, Reinaldo Ortuno Gutierrez of Médecins Sans Frontières, Rebecca Marcussen-Lewis of SOS Méditerranée and Sanjula Weerasinghe, a representative of the International Federation of Red Cross. As the world grapples with a migrant and refugee crisis of unprecedented scale, with 281m international migrants and 3.5m refugees globally, according to UN agencies, experts are turning to technology, particularly artificial intelligence, in search of solutions. The potential for AI and technology to foster a more equitable and sustainable world has been recognised by international organisations. Last year, the World Health Organization, World Intellectual Property Organization, and International Telecommunication Union formed the Global Initiative on AI for Health to facilitate the implementation of AI in healthcare. During the 2024 World Economic Forum, specialists underscored both AI’s transformative potential and the associated risks, emphasising the necessity of cooperation and ethical guidelines to harness its benefits responsibly. With record numbers of people on the move worldwide, can technology help tackle the migrant and refugee crises? Four experts addressed the question at the Geneva Health Forum on Monday during a day focused on migration and health equity. The Geneva Health Forum, convened by the University of Geneva and partners on the first three days of the 2024 World Health Assembly, brings together key global health scientists and policymakers with medical practitioners and other field actors. Here are their insights. Alexios Georgalis, who co-authored the Boys on the Move life skills curriculum – a UNICEF initiative that guides unaccompanied male adolescents displaced by conflict and poverty – believes that although AI cannot fully resolve the refugee crisis, digitalizing and gamifying interventional packages could have a substantial impact. His work focuses on educating young male migrants about exploitation and trafficking, as well as providing mental health support. “Almost every refugee has a smartphone,” Georgalis noted, indicating that digital tools could serve as a “gateway into their psyches and their hands.” Reinaldo Ortuno Gutierrez of Médecins Sans Frontières (MSF) recommended developing geotargeted technologies to help migrants find healthcare wherever they are. MSF already uses QR codes that can be scanned with a smartphone to provide a map of care sites, from primary care to psychiatric care. Gutierrez also mentioned secure referral systems that allow patient files to travel safely via smartphone, ensuring continuity of care. “It would be ideal to have some kind of passport for everyone, but at the moment, it is very limited,” he said. Sanjula Weerasinghe, a representative of the International Federation of Red Cross (IFRC), highlighted the potential benefits of digitally-carried medical records, allowing migrants to “take responsibility and control of their own data.” However, she noted that while efforts to generate this type of record-keeping are underway, no such technology currently exists. Weerasinghe, like Gutierrez, pointed out that some international organisations have developed apps to help migrants locate and access services. Rebecca Marcussen-Lewis, SOS Méditerranée. In contrast, Rebecca Marcussen-Lewis of SOS Méditerranée, a search and rescue NGO operating boats tasked with rescuing drowning migrant vessels, highlighted the challenges of digitalization in her work on the Mediterranean Sea. “We don’t have connectivity, so everything being digital and online is not so easy for us, and if everything moves in that direction, we run the risk of losing the ability to do our work,” she said. However, Marcussen-Lewis acknowledged that telemedicine could be helpful, allowing her team to reach out to a network of experts when faced with unfamiliar medical situations at sea. With a team of four serving over 630 people on a 69-meter boat, “being able to have a network that we can reach out to when we have a presentation that none of us has come across before is fantastic,” she said. Image Credits: Maayan Hoffman, Courtesy of Geneva Health Forum, Geneva Health Forum. Pollution’s Silent Killers: New Research Links Lead Exposure to Millions of Cardiovascular Deaths 28/05/2024 Elaine Ruth Fletcher & Sophia Samantaroy Lead has been found in contaminated turmeric and other spices, creating another route of exposure to the heavy metal Four well-known heavy metals and chemical pollutants – lead, asbestos, arsenic and cadmium- continue exact a heavy toll on the lives of those in low- and middle-income countries – with lead named a factor in as much as 5 million premature deaths annually from cardiovascular disease, according to one recent estimate. Asbestos, arsenic, and cadmium round out the top four, claiming hundreds of thousands of lives every year. While much recent media attention has been focused on the health impacts of newer industrial compounds such as dioxins, phthalates, and endocrine disruptors, these heavy metal “silent killers” need renewed attention in the environmental health arena, experts say. This was one key message from a day-long session on Health and Environment, the featured theme on the opening day of this year’s Geneva Health Forum, 27-29 May. The session highlighted the pressing threats of environmental pollution from plastics and lead to endocrine disruptors and ambient air pollution. The Geneva Health Forum, organized by the University of Geneva on the sidelines of the World Health Assembly brings together the global scientific community with health practitioners and field actors from around the world. Migration, health and equity and malaria are other key themes The Geneva Health Forum highlighted three key themes on opening day. This year’s Forum, running on the sidelines of the World Health Assembly, brings together hundreds of scientists, policy experts and member state representatives on three key themes – including migration, health and equity; and malaria elimination – each the focus of a full-day session. There are also a host of side events on issues ranging from One Health to Climate resilience and elimination of neglected tropical diseases such as Chagas disease and Noma. While panellists highlighted the higher profile of air pollution in recent years and successes with air quality regulation in higher-income countries, air pollution remains a serious and even growing problem in low- and middle-income regions. Focus on pollutants with the highest impacts on death and disease A recent study implicated lead with 5.5 million premature deaths Meanwhile, age-old problems of heavy metal and mineral pollutants such as lead and asbestos also need much more attention, also in LMICs. “We need to deal with key priorities, country by country, of what’s causing the most damage,” said Richard Fuller, founder and former chair of the Global Alliance on Health and Pollution, who recently participated in an assessment ranking the burden of disease from key WHO “chemicals of concern.” “There was one chemical issue that caused millions of deaths – and then four issues that caused hundreds of thousands of deaths,” he said, referring to lead, asbestos, highly hazardous pesticides, arsenic, and cadmium. “The one that caused the majority of deaths was our old friend lead, which is responsible for 1.5 -2 million deaths per year.” Lead may account for as many as 5.5 million premature deaths from CVD A man melts lead metallic wastes used in the production of cooking pots, at a recycling warehouse in Koumassi, Abidjan, Ivory Coast. A 2023 paper published in The Lancet, supported by the World Bank, estimated that lead exposure may cause up to 5.5 million premature deaths annually, with 95 per cent of those deaths attributed to cardiovascular diseases. The analysis draws on emerging evidence linking lead exposure to atherosclerosis, alongside its known effects on reduced IQ, the central nervous system, and other organs. Mr. Fuller noted that the “lead problem,” once associated with pipes, paint, and gasoline, has evolved in affected low-income regions, but its impact remains just as devastating. “It turns out to be all sorts of activities going on in low- and middle-income countries, including [fabrication of] pots and pans and [contamination] of turmeric,” he explained. “The ones that are less impactful … are things like dioxins, phthalates, brominated flame retardants, PFAS, endocrine disruptors, PCBs, and PAHs,” Mr. Fuller noted, emphasizing that these pollutants are “simply the noisier part of the agenda, but not necessarily the most impactful part of the agenda.” “Should we be focusing on the ones that have the most impact, not just the most noise?” he added. John Ji, an environmental epidemiologist at the Tsinghua University Vanke School of Public Health, told the forum he initially thought his 2013 dissertation on lead would be one of the last. “Then Flint happened,” he said, referring to the water crisis in Flint, Michigan, which brought the issue of lead contamination back into the spotlight. Air pollution remains a driver of poor health From left: Mexican Ambassador to Geneva Fernando Espinosa; Nino Kuenzli of the Swiss Tropical Instiute and John Ji of China’s Vanke School of Public Health. With the World Health Organization attributing 13.7 million deaths to chemical and pollutant exposures, the Forum called attention to the need for global collaboration, research, and policy to tackle pollution-related health effects. “Clean air is possible, yet in some cities in the Asian and African continents, air pollution is getting worse,” said Nino Kuenzli, former Swiss Tropical and Public Health Institute professor. He acknowledged that air pollution regulation is part of a broader environmental health success story, citing the significant increase in air quality in Europe and North America in the past decades. “The Swiss mountain town I grew up in had worse air quality than the Swiss urban centres today,” said Kuenzli, adding that this drastic improvement was built upon decades of scientific victories. “We cannot just call for action and policy without a knowledge [of the science] and it is really fascinating to see how the science to understand the health effects of air pollution has evolved over the last 35 years. It’s incredible. Progress is enormous.” Advances in environmental epidemiology, and newfound ways for collaboration among basic scientists and toxicologists, have paved the way for these air quality improvements. Addressing global air pollution inequalities and replicating much of the successes of higher-income countries means “leapfrogging” intermediate policies and technologies, argued Ji. For example, one of the largest sources of indoor air pollution comes from burning biomass fuels, yet countries often transition to gas stoves, which still produce air pollutants. Instead, countries could support a transition directly from biomass to electric, he said. Air pollution levels have continued to go up in most countries across the world despite rising awareness of its harms. Plastic pollution: a new and growing threat Plastics, now ubiquitous in the environment, are another kind of new, and growing pollution concern for soils, waterways, and air, when incinerated. “By 2050, there will be more plastic than fish in the oceans,” remarked Fernando Espinosa, the Mexican Ambassador to Switzerland. Plastic pollution got a brief nod on opening day following last month’s fourth Intergovernmental Negotiating Body in Ottowa, Canada to develop an international legally binding instrument on plastic pollution, including in the marine environment. While the negotiations did reach some conclusions, like developing a list of chemicals of concern, they did not agree to reduce the production of new plastics, most likely due to ongoing pressure from the fossil fuel lobby and their state backers, such as Saudi Arabia, Russia and the United States. Climate adaptation and resilience in the healthcare system The Forum also brought together experts to discuss the often negative environmental contributions of healthcare systems in lower- and middle-income countries. The sector has increasingly produced contaminated waste, greenhouse gas emissions, and other pollutants – causing upwards of five per cent of global greenhouse gas emissions. These emissions come from hospitals themselves, but also from the manufacturing of medical products. Yet remarks from panellist Habib N’Konou, founder of an innovative biomedical waste company, during a later session demonstrated the disproportionate environmental impacts of the health sector in lower-and-middle-income countries. Senegal, he noted, produces upwards of 21,000 tonnes of medical waste per year, much of which is inadequately processed. “It’s an alarming situation. When I came back to Senegal, there was waste on the coasts, in neighbourhoods.” Looking to the successes of other countries could pave the way for better biomedical waste management, N’Konou noted. Morocco and Tunisia both have government-mediated partnerships between waste facilities and hospitals, something N’Konou champions for Senegal and surrounding countries. Even when regulations exist, they are hard to enforce. Despite the environmental challenges facing LMICs, the climate crisis is an opportunity to rethink how healthcare systems operate, according to Sonia Roschnik, executive director of the Geneva Sustainability Centre. “This is where I really hope that some of what we do to respond to climate change is going to help us leverage more innovative ways of looking at healthcare that actually deliver better population health, but also help the planet.” Image Credits: Prchi Palwe , EPA/L. Koula, Geneva Health Forum, Geneva Health Forum. Conservative Member States Balk at References to ‘Gender’ in WHA Resolutions 28/05/2024 Kerry Cullinan The World Health Assembly in progress. GENEVA – Conservative countries have objected to the use of the terms “gender responsive” and “advancing gender mainstreaming” in behind-the-scenes negotiations on several resolutions before the World Health Assembly (WHA), according to a wide variety of sources. There have also been some objections to the use of “gender equality” and “sexual” in some instances – alongside a long-standing objection to the use of “rights” when referring to sexual and reproductive health. “Gender” references have already been stripped from the World Health Organization’s (WHO) draft pandemic agreement. At least five other resolutions have become bogged down by objectives from conservative member states, particularly Russia, Egypt, Iran and Nigeria. These include resolutions on mental health, emergency preparedness, the economics of health, climate and social participation. In the case of the economics of health resolution, Nigeria initially objected to the use of both “gender equality” and “advancing gender mainstreaming”, one source said. Another source told Health Policy Watch that Russia even wants “sexual” to be removed from the standard term, “sexual and reproductive health”. In the resolution on climate and health, for example, there was an impasse over the use of “gender-responsive” policies – apparently because conservatives believe that this opens the door to engagement with LGBTQ groups although they have never unpacked their objection. Countries have eventually settled on a reference to “gender equality”. Objecting to these particular phrases is new. All UN member states including Russia agreed by consensus to the language of the global Sustainable Development Goals (SDGs), which refer to sexual health and gender. Concerned parties close to the talks stressed the importance of “stopping the backsliding” against established terms and rights for women and other groups in the face of the relentless campaign. Experts call for SRHR space to be protected A few days ago, 43 of the foremost global experts in sexual and reproductive health and rights (SRHR) in the UN called on the WHA to protect advance in this hard-won space in an article published by Health Policy Watch. The experts, who work in various UN expert committees, described progress on SRHR as “fundamental for human rights and dignity, national economies, sustainable development, and a healthier planet”. They added that while SRHR includes “services needed to prevent unwanted pregnancies, unsafe births and avoidable sexual or reproductive illness, injury or dysfunction, it is much broader. “Vitally, it includes the positive enjoyment of consensual sexual intimacy and pleasure, the development of mutually respectful and loving relationships, as well as the affirmation of individuals and families in all their diversity,” they added. “Sexual and reproductive health and rights flourish only where its emotional, mental, and social dimensions are also enabled, free of coercion, discrimination, and violence.” A repeat of 2022? The Saudi delegate in heated WHA debate over sexual rights and terminology at the WHA in 2022. Two years ago, the entire WHA was delayed for days over conflict related to a global strategy on HIV, hepatitis B and sexually transmitted infections, primarily because of a glossary on sexual health and target populations for HIV treatment. While the language was standard for HIV treatment and care, the Saudi Arabian delegate – speaking for WHO’s 22-member state Eastern Mediterranean Region (EMRO) – objected to the terms “sexuality”, “sexual orientation”, “sexual rights”. He also objected to “men who have sex with men” being designated as a target population for HIV treatment. Although the WHO works by consensus, the strategy eventually went to a vote late on the last night of an extended WHA, and narrowly passed with many absentions. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... 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Climate Change to Be Major Focus for WHO in Coming Years 28/05/2024 Disha Shetty The 77th session of World Health Assembly underway in Geneva, Switzerland. The World Health Organization plans to make climate change and its impact on health a major focus in the coming years, along with strengthening health systems, improving health equity and access, and preventing disease, according to the organization’s plan for its general program of work from 2025 to 2028. The four-year plan, known as GPW-14, also prioritizes mental health, gender equality, migrant health, food safety, digital health, and artificial intelligence. It was developed through an extensive 10-month consultation process involving member countries, UN organizations, and civil society organizations. “This document will act as our canvas, articulating our collective aspirations and strategic priorities in global health for the coming four years,” said Dr Saia Ma’u Piukala, the WHO’s regional director for the Western Pacific, as discussions on the plan concluded Tuesday morning, the second day of the ongoing 77th World Health Assembly. Dr Piukala added that the plan “reflects the learning from the Covid-19 pandemic and response to shared issues like climate change, ageing, migration, evolving geopolitics, increasing spillover events and rapidly advancing science and technology.” The World Health Assembly approved the draft GPW-14 following Tuesday’s discussions, but funding remains a concern. The GPW-14 program has a price tag of $11.1 billion, with WHO member states’ assessed contributions covering just over a third of the cost at $4 billion. The WHO is still looking for $7 billion in flexible funding, which it will attempt to raise at an investment conference in late 2024. Focus on Climate Change In recent years, the impact of climate change on health, particularly non-communicable diseases, has become increasingly clear. The WHO has warned that severe weather events, pollution, and climate-sensitive diseases are becoming more frequent worldwide, with vulnerable areas like small island developing states bearing a disproportionate impact. The GPW-14 also notes that human migration and displacement have reached unprecedented levels, with an estimated one billion people choosing to migrate or being forcibly displaced due to various factors, including economic, environmental, political, and conflict-related issues – with dire consequences for health. “The pace of climate change and environmental degradation has accelerated, emerging as a major threat to human health in the 21st century,” the GPW-14 warns. “Increasing inequities within and between countries, which were exacerbated by the COVID-19 pandemic, are leading to a growing divide in health, social and economic outcomes between those with financial resources and those without.” Countries like Japan and the United States praised the WHO for its growing focus on climate and health. Member states acknowledged that health-related Sustainable Development Goals are not on track, and Turkey drew attention to attacks on health facilities and disruptions to essential health services, calling it a “man-made crisis.” “GPW-14 includes the measures to address climate change in the primary objective,” the representative from Japan said. “Now, the world is facing a huge impact of climate change on health. And we affirm the importance of disaster management, especially in the healthcare field.” Dr Saia Ma’u Piukala, Regional Director for WHO’s Western Pacific region. Civil Society Warns WHO Plan is Incomplete Civil society groups have pointed out several shortcomings in the WHO’s GPW-14 plan, despite its ambitious goals to address climate change and health equity. The NCD Alliance, an organization focused on fighting non-communicable diseases (NCDs), criticized the plan for not adequately addressing NCDs, which account for 74% of global deaths. The lack of specificity on NCDs in the GPW-14 comes despite the increasing burden of disease from climate and environmental factors like heat and air pollution. “We regret the missed opportunity to ensure comprehensive outcome indicators for NCDs,” said a representative for the NCD Alliance. “The absence of answers to indicators hinders prioritization for achieving agreed targets.” Other civil society groups noted the plan’s lack of specific references to maternal health indicators and provisions to address the vulnerability of women in the health workforce, despite women constituting 70% of healthcare professionals globally. However, the healthcare workforce and ways to improve equity were mentioned in the plan several times. “Integrating gender-responsive approaches into health workforce planning and management can help address gender disparities in health outcomes and advance progress towards achieving universal healthcare,” said a representative from the Global Health Council in a constituent statement. The absence of gender-responsive provisions in the GPW-14 is likely due to opposition from conservative countries to the terminology. Countries like Russia, Egypt, and Iran objected to any references to “gender” on religious and political grounds during closed-door negotiations, Health Policy Watch reported. Despite these criticisms, several member states thanked the WHO for the extensive consultations carried out before finalizing the draft plan. “We particularly applaud the Secretariat for extensive and inclusive consultation through various platforms with member states, various organizations and partners in the drafting process,” the representative from Botswana said. Image Credits: Twitter, Twitter. Can Technology Help Address Global Migrant Crisis? Experts Weigh In 28/05/2024 Maayan Hoffman A panel discussion at the “Ensuring continuity of care at different stages of the migration process” session of the Gevena Health Forum. From left to right: Alexios Georgalis of the National and Kapodistrian University of Athens, Reinaldo Ortuno Gutierrez of Médecins Sans Frontières, Rebecca Marcussen-Lewis of SOS Méditerranée and Sanjula Weerasinghe, a representative of the International Federation of Red Cross. As the world grapples with a migrant and refugee crisis of unprecedented scale, with 281m international migrants and 3.5m refugees globally, according to UN agencies, experts are turning to technology, particularly artificial intelligence, in search of solutions. The potential for AI and technology to foster a more equitable and sustainable world has been recognised by international organisations. Last year, the World Health Organization, World Intellectual Property Organization, and International Telecommunication Union formed the Global Initiative on AI for Health to facilitate the implementation of AI in healthcare. During the 2024 World Economic Forum, specialists underscored both AI’s transformative potential and the associated risks, emphasising the necessity of cooperation and ethical guidelines to harness its benefits responsibly. With record numbers of people on the move worldwide, can technology help tackle the migrant and refugee crises? Four experts addressed the question at the Geneva Health Forum on Monday during a day focused on migration and health equity. The Geneva Health Forum, convened by the University of Geneva and partners on the first three days of the 2024 World Health Assembly, brings together key global health scientists and policymakers with medical practitioners and other field actors. Here are their insights. Alexios Georgalis, who co-authored the Boys on the Move life skills curriculum – a UNICEF initiative that guides unaccompanied male adolescents displaced by conflict and poverty – believes that although AI cannot fully resolve the refugee crisis, digitalizing and gamifying interventional packages could have a substantial impact. His work focuses on educating young male migrants about exploitation and trafficking, as well as providing mental health support. “Almost every refugee has a smartphone,” Georgalis noted, indicating that digital tools could serve as a “gateway into their psyches and their hands.” Reinaldo Ortuno Gutierrez of Médecins Sans Frontières (MSF) recommended developing geotargeted technologies to help migrants find healthcare wherever they are. MSF already uses QR codes that can be scanned with a smartphone to provide a map of care sites, from primary care to psychiatric care. Gutierrez also mentioned secure referral systems that allow patient files to travel safely via smartphone, ensuring continuity of care. “It would be ideal to have some kind of passport for everyone, but at the moment, it is very limited,” he said. Sanjula Weerasinghe, a representative of the International Federation of Red Cross (IFRC), highlighted the potential benefits of digitally-carried medical records, allowing migrants to “take responsibility and control of their own data.” However, she noted that while efforts to generate this type of record-keeping are underway, no such technology currently exists. Weerasinghe, like Gutierrez, pointed out that some international organisations have developed apps to help migrants locate and access services. Rebecca Marcussen-Lewis, SOS Méditerranée. In contrast, Rebecca Marcussen-Lewis of SOS Méditerranée, a search and rescue NGO operating boats tasked with rescuing drowning migrant vessels, highlighted the challenges of digitalization in her work on the Mediterranean Sea. “We don’t have connectivity, so everything being digital and online is not so easy for us, and if everything moves in that direction, we run the risk of losing the ability to do our work,” she said. However, Marcussen-Lewis acknowledged that telemedicine could be helpful, allowing her team to reach out to a network of experts when faced with unfamiliar medical situations at sea. With a team of four serving over 630 people on a 69-meter boat, “being able to have a network that we can reach out to when we have a presentation that none of us has come across before is fantastic,” she said. Image Credits: Maayan Hoffman, Courtesy of Geneva Health Forum, Geneva Health Forum. Pollution’s Silent Killers: New Research Links Lead Exposure to Millions of Cardiovascular Deaths 28/05/2024 Elaine Ruth Fletcher & Sophia Samantaroy Lead has been found in contaminated turmeric and other spices, creating another route of exposure to the heavy metal Four well-known heavy metals and chemical pollutants – lead, asbestos, arsenic and cadmium- continue exact a heavy toll on the lives of those in low- and middle-income countries – with lead named a factor in as much as 5 million premature deaths annually from cardiovascular disease, according to one recent estimate. Asbestos, arsenic, and cadmium round out the top four, claiming hundreds of thousands of lives every year. While much recent media attention has been focused on the health impacts of newer industrial compounds such as dioxins, phthalates, and endocrine disruptors, these heavy metal “silent killers” need renewed attention in the environmental health arena, experts say. This was one key message from a day-long session on Health and Environment, the featured theme on the opening day of this year’s Geneva Health Forum, 27-29 May. The session highlighted the pressing threats of environmental pollution from plastics and lead to endocrine disruptors and ambient air pollution. The Geneva Health Forum, organized by the University of Geneva on the sidelines of the World Health Assembly brings together the global scientific community with health practitioners and field actors from around the world. Migration, health and equity and malaria are other key themes The Geneva Health Forum highlighted three key themes on opening day. This year’s Forum, running on the sidelines of the World Health Assembly, brings together hundreds of scientists, policy experts and member state representatives on three key themes – including migration, health and equity; and malaria elimination – each the focus of a full-day session. There are also a host of side events on issues ranging from One Health to Climate resilience and elimination of neglected tropical diseases such as Chagas disease and Noma. While panellists highlighted the higher profile of air pollution in recent years and successes with air quality regulation in higher-income countries, air pollution remains a serious and even growing problem in low- and middle-income regions. Focus on pollutants with the highest impacts on death and disease A recent study implicated lead with 5.5 million premature deaths Meanwhile, age-old problems of heavy metal and mineral pollutants such as lead and asbestos also need much more attention, also in LMICs. “We need to deal with key priorities, country by country, of what’s causing the most damage,” said Richard Fuller, founder and former chair of the Global Alliance on Health and Pollution, who recently participated in an assessment ranking the burden of disease from key WHO “chemicals of concern.” “There was one chemical issue that caused millions of deaths – and then four issues that caused hundreds of thousands of deaths,” he said, referring to lead, asbestos, highly hazardous pesticides, arsenic, and cadmium. “The one that caused the majority of deaths was our old friend lead, which is responsible for 1.5 -2 million deaths per year.” Lead may account for as many as 5.5 million premature deaths from CVD A man melts lead metallic wastes used in the production of cooking pots, at a recycling warehouse in Koumassi, Abidjan, Ivory Coast. A 2023 paper published in The Lancet, supported by the World Bank, estimated that lead exposure may cause up to 5.5 million premature deaths annually, with 95 per cent of those deaths attributed to cardiovascular diseases. The analysis draws on emerging evidence linking lead exposure to atherosclerosis, alongside its known effects on reduced IQ, the central nervous system, and other organs. Mr. Fuller noted that the “lead problem,” once associated with pipes, paint, and gasoline, has evolved in affected low-income regions, but its impact remains just as devastating. “It turns out to be all sorts of activities going on in low- and middle-income countries, including [fabrication of] pots and pans and [contamination] of turmeric,” he explained. “The ones that are less impactful … are things like dioxins, phthalates, brominated flame retardants, PFAS, endocrine disruptors, PCBs, and PAHs,” Mr. Fuller noted, emphasizing that these pollutants are “simply the noisier part of the agenda, but not necessarily the most impactful part of the agenda.” “Should we be focusing on the ones that have the most impact, not just the most noise?” he added. John Ji, an environmental epidemiologist at the Tsinghua University Vanke School of Public Health, told the forum he initially thought his 2013 dissertation on lead would be one of the last. “Then Flint happened,” he said, referring to the water crisis in Flint, Michigan, which brought the issue of lead contamination back into the spotlight. Air pollution remains a driver of poor health From left: Mexican Ambassador to Geneva Fernando Espinosa; Nino Kuenzli of the Swiss Tropical Instiute and John Ji of China’s Vanke School of Public Health. With the World Health Organization attributing 13.7 million deaths to chemical and pollutant exposures, the Forum called attention to the need for global collaboration, research, and policy to tackle pollution-related health effects. “Clean air is possible, yet in some cities in the Asian and African continents, air pollution is getting worse,” said Nino Kuenzli, former Swiss Tropical and Public Health Institute professor. He acknowledged that air pollution regulation is part of a broader environmental health success story, citing the significant increase in air quality in Europe and North America in the past decades. “The Swiss mountain town I grew up in had worse air quality than the Swiss urban centres today,” said Kuenzli, adding that this drastic improvement was built upon decades of scientific victories. “We cannot just call for action and policy without a knowledge [of the science] and it is really fascinating to see how the science to understand the health effects of air pollution has evolved over the last 35 years. It’s incredible. Progress is enormous.” Advances in environmental epidemiology, and newfound ways for collaboration among basic scientists and toxicologists, have paved the way for these air quality improvements. Addressing global air pollution inequalities and replicating much of the successes of higher-income countries means “leapfrogging” intermediate policies and technologies, argued Ji. For example, one of the largest sources of indoor air pollution comes from burning biomass fuels, yet countries often transition to gas stoves, which still produce air pollutants. Instead, countries could support a transition directly from biomass to electric, he said. Air pollution levels have continued to go up in most countries across the world despite rising awareness of its harms. Plastic pollution: a new and growing threat Plastics, now ubiquitous in the environment, are another kind of new, and growing pollution concern for soils, waterways, and air, when incinerated. “By 2050, there will be more plastic than fish in the oceans,” remarked Fernando Espinosa, the Mexican Ambassador to Switzerland. Plastic pollution got a brief nod on opening day following last month’s fourth Intergovernmental Negotiating Body in Ottowa, Canada to develop an international legally binding instrument on plastic pollution, including in the marine environment. While the negotiations did reach some conclusions, like developing a list of chemicals of concern, they did not agree to reduce the production of new plastics, most likely due to ongoing pressure from the fossil fuel lobby and their state backers, such as Saudi Arabia, Russia and the United States. Climate adaptation and resilience in the healthcare system The Forum also brought together experts to discuss the often negative environmental contributions of healthcare systems in lower- and middle-income countries. The sector has increasingly produced contaminated waste, greenhouse gas emissions, and other pollutants – causing upwards of five per cent of global greenhouse gas emissions. These emissions come from hospitals themselves, but also from the manufacturing of medical products. Yet remarks from panellist Habib N’Konou, founder of an innovative biomedical waste company, during a later session demonstrated the disproportionate environmental impacts of the health sector in lower-and-middle-income countries. Senegal, he noted, produces upwards of 21,000 tonnes of medical waste per year, much of which is inadequately processed. “It’s an alarming situation. When I came back to Senegal, there was waste on the coasts, in neighbourhoods.” Looking to the successes of other countries could pave the way for better biomedical waste management, N’Konou noted. Morocco and Tunisia both have government-mediated partnerships between waste facilities and hospitals, something N’Konou champions for Senegal and surrounding countries. Even when regulations exist, they are hard to enforce. Despite the environmental challenges facing LMICs, the climate crisis is an opportunity to rethink how healthcare systems operate, according to Sonia Roschnik, executive director of the Geneva Sustainability Centre. “This is where I really hope that some of what we do to respond to climate change is going to help us leverage more innovative ways of looking at healthcare that actually deliver better population health, but also help the planet.” Image Credits: Prchi Palwe , EPA/L. Koula, Geneva Health Forum, Geneva Health Forum. Conservative Member States Balk at References to ‘Gender’ in WHA Resolutions 28/05/2024 Kerry Cullinan The World Health Assembly in progress. GENEVA – Conservative countries have objected to the use of the terms “gender responsive” and “advancing gender mainstreaming” in behind-the-scenes negotiations on several resolutions before the World Health Assembly (WHA), according to a wide variety of sources. There have also been some objections to the use of “gender equality” and “sexual” in some instances – alongside a long-standing objection to the use of “rights” when referring to sexual and reproductive health. “Gender” references have already been stripped from the World Health Organization’s (WHO) draft pandemic agreement. At least five other resolutions have become bogged down by objectives from conservative member states, particularly Russia, Egypt, Iran and Nigeria. These include resolutions on mental health, emergency preparedness, the economics of health, climate and social participation. In the case of the economics of health resolution, Nigeria initially objected to the use of both “gender equality” and “advancing gender mainstreaming”, one source said. Another source told Health Policy Watch that Russia even wants “sexual” to be removed from the standard term, “sexual and reproductive health”. In the resolution on climate and health, for example, there was an impasse over the use of “gender-responsive” policies – apparently because conservatives believe that this opens the door to engagement with LGBTQ groups although they have never unpacked their objection. Countries have eventually settled on a reference to “gender equality”. Objecting to these particular phrases is new. All UN member states including Russia agreed by consensus to the language of the global Sustainable Development Goals (SDGs), which refer to sexual health and gender. Concerned parties close to the talks stressed the importance of “stopping the backsliding” against established terms and rights for women and other groups in the face of the relentless campaign. Experts call for SRHR space to be protected A few days ago, 43 of the foremost global experts in sexual and reproductive health and rights (SRHR) in the UN called on the WHA to protect advance in this hard-won space in an article published by Health Policy Watch. The experts, who work in various UN expert committees, described progress on SRHR as “fundamental for human rights and dignity, national economies, sustainable development, and a healthier planet”. They added that while SRHR includes “services needed to prevent unwanted pregnancies, unsafe births and avoidable sexual or reproductive illness, injury or dysfunction, it is much broader. “Vitally, it includes the positive enjoyment of consensual sexual intimacy and pleasure, the development of mutually respectful and loving relationships, as well as the affirmation of individuals and families in all their diversity,” they added. “Sexual and reproductive health and rights flourish only where its emotional, mental, and social dimensions are also enabled, free of coercion, discrimination, and violence.” A repeat of 2022? The Saudi delegate in heated WHA debate over sexual rights and terminology at the WHA in 2022. Two years ago, the entire WHA was delayed for days over conflict related to a global strategy on HIV, hepatitis B and sexually transmitted infections, primarily because of a glossary on sexual health and target populations for HIV treatment. While the language was standard for HIV treatment and care, the Saudi Arabian delegate – speaking for WHO’s 22-member state Eastern Mediterranean Region (EMRO) – objected to the terms “sexuality”, “sexual orientation”, “sexual rights”. He also objected to “men who have sex with men” being designated as a target population for HIV treatment. Although the WHO works by consensus, the strategy eventually went to a vote late on the last night of an extended WHA, and narrowly passed with many absentions. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
Can Technology Help Address Global Migrant Crisis? Experts Weigh In 28/05/2024 Maayan Hoffman A panel discussion at the “Ensuring continuity of care at different stages of the migration process” session of the Gevena Health Forum. From left to right: Alexios Georgalis of the National and Kapodistrian University of Athens, Reinaldo Ortuno Gutierrez of Médecins Sans Frontières, Rebecca Marcussen-Lewis of SOS Méditerranée and Sanjula Weerasinghe, a representative of the International Federation of Red Cross. As the world grapples with a migrant and refugee crisis of unprecedented scale, with 281m international migrants and 3.5m refugees globally, according to UN agencies, experts are turning to technology, particularly artificial intelligence, in search of solutions. The potential for AI and technology to foster a more equitable and sustainable world has been recognised by international organisations. Last year, the World Health Organization, World Intellectual Property Organization, and International Telecommunication Union formed the Global Initiative on AI for Health to facilitate the implementation of AI in healthcare. During the 2024 World Economic Forum, specialists underscored both AI’s transformative potential and the associated risks, emphasising the necessity of cooperation and ethical guidelines to harness its benefits responsibly. With record numbers of people on the move worldwide, can technology help tackle the migrant and refugee crises? Four experts addressed the question at the Geneva Health Forum on Monday during a day focused on migration and health equity. The Geneva Health Forum, convened by the University of Geneva and partners on the first three days of the 2024 World Health Assembly, brings together key global health scientists and policymakers with medical practitioners and other field actors. Here are their insights. Alexios Georgalis, who co-authored the Boys on the Move life skills curriculum – a UNICEF initiative that guides unaccompanied male adolescents displaced by conflict and poverty – believes that although AI cannot fully resolve the refugee crisis, digitalizing and gamifying interventional packages could have a substantial impact. His work focuses on educating young male migrants about exploitation and trafficking, as well as providing mental health support. “Almost every refugee has a smartphone,” Georgalis noted, indicating that digital tools could serve as a “gateway into their psyches and their hands.” Reinaldo Ortuno Gutierrez of Médecins Sans Frontières (MSF) recommended developing geotargeted technologies to help migrants find healthcare wherever they are. MSF already uses QR codes that can be scanned with a smartphone to provide a map of care sites, from primary care to psychiatric care. Gutierrez also mentioned secure referral systems that allow patient files to travel safely via smartphone, ensuring continuity of care. “It would be ideal to have some kind of passport for everyone, but at the moment, it is very limited,” he said. Sanjula Weerasinghe, a representative of the International Federation of Red Cross (IFRC), highlighted the potential benefits of digitally-carried medical records, allowing migrants to “take responsibility and control of their own data.” However, she noted that while efforts to generate this type of record-keeping are underway, no such technology currently exists. Weerasinghe, like Gutierrez, pointed out that some international organisations have developed apps to help migrants locate and access services. Rebecca Marcussen-Lewis, SOS Méditerranée. In contrast, Rebecca Marcussen-Lewis of SOS Méditerranée, a search and rescue NGO operating boats tasked with rescuing drowning migrant vessels, highlighted the challenges of digitalization in her work on the Mediterranean Sea. “We don’t have connectivity, so everything being digital and online is not so easy for us, and if everything moves in that direction, we run the risk of losing the ability to do our work,” she said. However, Marcussen-Lewis acknowledged that telemedicine could be helpful, allowing her team to reach out to a network of experts when faced with unfamiliar medical situations at sea. With a team of four serving over 630 people on a 69-meter boat, “being able to have a network that we can reach out to when we have a presentation that none of us has come across before is fantastic,” she said. Image Credits: Maayan Hoffman, Courtesy of Geneva Health Forum, Geneva Health Forum. Pollution’s Silent Killers: New Research Links Lead Exposure to Millions of Cardiovascular Deaths 28/05/2024 Elaine Ruth Fletcher & Sophia Samantaroy Lead has been found in contaminated turmeric and other spices, creating another route of exposure to the heavy metal Four well-known heavy metals and chemical pollutants – lead, asbestos, arsenic and cadmium- continue exact a heavy toll on the lives of those in low- and middle-income countries – with lead named a factor in as much as 5 million premature deaths annually from cardiovascular disease, according to one recent estimate. Asbestos, arsenic, and cadmium round out the top four, claiming hundreds of thousands of lives every year. While much recent media attention has been focused on the health impacts of newer industrial compounds such as dioxins, phthalates, and endocrine disruptors, these heavy metal “silent killers” need renewed attention in the environmental health arena, experts say. This was one key message from a day-long session on Health and Environment, the featured theme on the opening day of this year’s Geneva Health Forum, 27-29 May. The session highlighted the pressing threats of environmental pollution from plastics and lead to endocrine disruptors and ambient air pollution. The Geneva Health Forum, organized by the University of Geneva on the sidelines of the World Health Assembly brings together the global scientific community with health practitioners and field actors from around the world. Migration, health and equity and malaria are other key themes The Geneva Health Forum highlighted three key themes on opening day. This year’s Forum, running on the sidelines of the World Health Assembly, brings together hundreds of scientists, policy experts and member state representatives on three key themes – including migration, health and equity; and malaria elimination – each the focus of a full-day session. There are also a host of side events on issues ranging from One Health to Climate resilience and elimination of neglected tropical diseases such as Chagas disease and Noma. While panellists highlighted the higher profile of air pollution in recent years and successes with air quality regulation in higher-income countries, air pollution remains a serious and even growing problem in low- and middle-income regions. Focus on pollutants with the highest impacts on death and disease A recent study implicated lead with 5.5 million premature deaths Meanwhile, age-old problems of heavy metal and mineral pollutants such as lead and asbestos also need much more attention, also in LMICs. “We need to deal with key priorities, country by country, of what’s causing the most damage,” said Richard Fuller, founder and former chair of the Global Alliance on Health and Pollution, who recently participated in an assessment ranking the burden of disease from key WHO “chemicals of concern.” “There was one chemical issue that caused millions of deaths – and then four issues that caused hundreds of thousands of deaths,” he said, referring to lead, asbestos, highly hazardous pesticides, arsenic, and cadmium. “The one that caused the majority of deaths was our old friend lead, which is responsible for 1.5 -2 million deaths per year.” Lead may account for as many as 5.5 million premature deaths from CVD A man melts lead metallic wastes used in the production of cooking pots, at a recycling warehouse in Koumassi, Abidjan, Ivory Coast. A 2023 paper published in The Lancet, supported by the World Bank, estimated that lead exposure may cause up to 5.5 million premature deaths annually, with 95 per cent of those deaths attributed to cardiovascular diseases. The analysis draws on emerging evidence linking lead exposure to atherosclerosis, alongside its known effects on reduced IQ, the central nervous system, and other organs. Mr. Fuller noted that the “lead problem,” once associated with pipes, paint, and gasoline, has evolved in affected low-income regions, but its impact remains just as devastating. “It turns out to be all sorts of activities going on in low- and middle-income countries, including [fabrication of] pots and pans and [contamination] of turmeric,” he explained. “The ones that are less impactful … are things like dioxins, phthalates, brominated flame retardants, PFAS, endocrine disruptors, PCBs, and PAHs,” Mr. Fuller noted, emphasizing that these pollutants are “simply the noisier part of the agenda, but not necessarily the most impactful part of the agenda.” “Should we be focusing on the ones that have the most impact, not just the most noise?” he added. John Ji, an environmental epidemiologist at the Tsinghua University Vanke School of Public Health, told the forum he initially thought his 2013 dissertation on lead would be one of the last. “Then Flint happened,” he said, referring to the water crisis in Flint, Michigan, which brought the issue of lead contamination back into the spotlight. Air pollution remains a driver of poor health From left: Mexican Ambassador to Geneva Fernando Espinosa; Nino Kuenzli of the Swiss Tropical Instiute and John Ji of China’s Vanke School of Public Health. With the World Health Organization attributing 13.7 million deaths to chemical and pollutant exposures, the Forum called attention to the need for global collaboration, research, and policy to tackle pollution-related health effects. “Clean air is possible, yet in some cities in the Asian and African continents, air pollution is getting worse,” said Nino Kuenzli, former Swiss Tropical and Public Health Institute professor. He acknowledged that air pollution regulation is part of a broader environmental health success story, citing the significant increase in air quality in Europe and North America in the past decades. “The Swiss mountain town I grew up in had worse air quality than the Swiss urban centres today,” said Kuenzli, adding that this drastic improvement was built upon decades of scientific victories. “We cannot just call for action and policy without a knowledge [of the science] and it is really fascinating to see how the science to understand the health effects of air pollution has evolved over the last 35 years. It’s incredible. Progress is enormous.” Advances in environmental epidemiology, and newfound ways for collaboration among basic scientists and toxicologists, have paved the way for these air quality improvements. Addressing global air pollution inequalities and replicating much of the successes of higher-income countries means “leapfrogging” intermediate policies and technologies, argued Ji. For example, one of the largest sources of indoor air pollution comes from burning biomass fuels, yet countries often transition to gas stoves, which still produce air pollutants. Instead, countries could support a transition directly from biomass to electric, he said. Air pollution levels have continued to go up in most countries across the world despite rising awareness of its harms. Plastic pollution: a new and growing threat Plastics, now ubiquitous in the environment, are another kind of new, and growing pollution concern for soils, waterways, and air, when incinerated. “By 2050, there will be more plastic than fish in the oceans,” remarked Fernando Espinosa, the Mexican Ambassador to Switzerland. Plastic pollution got a brief nod on opening day following last month’s fourth Intergovernmental Negotiating Body in Ottowa, Canada to develop an international legally binding instrument on plastic pollution, including in the marine environment. While the negotiations did reach some conclusions, like developing a list of chemicals of concern, they did not agree to reduce the production of new plastics, most likely due to ongoing pressure from the fossil fuel lobby and their state backers, such as Saudi Arabia, Russia and the United States. Climate adaptation and resilience in the healthcare system The Forum also brought together experts to discuss the often negative environmental contributions of healthcare systems in lower- and middle-income countries. The sector has increasingly produced contaminated waste, greenhouse gas emissions, and other pollutants – causing upwards of five per cent of global greenhouse gas emissions. These emissions come from hospitals themselves, but also from the manufacturing of medical products. Yet remarks from panellist Habib N’Konou, founder of an innovative biomedical waste company, during a later session demonstrated the disproportionate environmental impacts of the health sector in lower-and-middle-income countries. Senegal, he noted, produces upwards of 21,000 tonnes of medical waste per year, much of which is inadequately processed. “It’s an alarming situation. When I came back to Senegal, there was waste on the coasts, in neighbourhoods.” Looking to the successes of other countries could pave the way for better biomedical waste management, N’Konou noted. Morocco and Tunisia both have government-mediated partnerships between waste facilities and hospitals, something N’Konou champions for Senegal and surrounding countries. Even when regulations exist, they are hard to enforce. Despite the environmental challenges facing LMICs, the climate crisis is an opportunity to rethink how healthcare systems operate, according to Sonia Roschnik, executive director of the Geneva Sustainability Centre. “This is where I really hope that some of what we do to respond to climate change is going to help us leverage more innovative ways of looking at healthcare that actually deliver better population health, but also help the planet.” Image Credits: Prchi Palwe , EPA/L. Koula, Geneva Health Forum, Geneva Health Forum. Conservative Member States Balk at References to ‘Gender’ in WHA Resolutions 28/05/2024 Kerry Cullinan The World Health Assembly in progress. GENEVA – Conservative countries have objected to the use of the terms “gender responsive” and “advancing gender mainstreaming” in behind-the-scenes negotiations on several resolutions before the World Health Assembly (WHA), according to a wide variety of sources. There have also been some objections to the use of “gender equality” and “sexual” in some instances – alongside a long-standing objection to the use of “rights” when referring to sexual and reproductive health. “Gender” references have already been stripped from the World Health Organization’s (WHO) draft pandemic agreement. At least five other resolutions have become bogged down by objectives from conservative member states, particularly Russia, Egypt, Iran and Nigeria. These include resolutions on mental health, emergency preparedness, the economics of health, climate and social participation. In the case of the economics of health resolution, Nigeria initially objected to the use of both “gender equality” and “advancing gender mainstreaming”, one source said. Another source told Health Policy Watch that Russia even wants “sexual” to be removed from the standard term, “sexual and reproductive health”. In the resolution on climate and health, for example, there was an impasse over the use of “gender-responsive” policies – apparently because conservatives believe that this opens the door to engagement with LGBTQ groups although they have never unpacked their objection. Countries have eventually settled on a reference to “gender equality”. Objecting to these particular phrases is new. All UN member states including Russia agreed by consensus to the language of the global Sustainable Development Goals (SDGs), which refer to sexual health and gender. Concerned parties close to the talks stressed the importance of “stopping the backsliding” against established terms and rights for women and other groups in the face of the relentless campaign. Experts call for SRHR space to be protected A few days ago, 43 of the foremost global experts in sexual and reproductive health and rights (SRHR) in the UN called on the WHA to protect advance in this hard-won space in an article published by Health Policy Watch. The experts, who work in various UN expert committees, described progress on SRHR as “fundamental for human rights and dignity, national economies, sustainable development, and a healthier planet”. They added that while SRHR includes “services needed to prevent unwanted pregnancies, unsafe births and avoidable sexual or reproductive illness, injury or dysfunction, it is much broader. “Vitally, it includes the positive enjoyment of consensual sexual intimacy and pleasure, the development of mutually respectful and loving relationships, as well as the affirmation of individuals and families in all their diversity,” they added. “Sexual and reproductive health and rights flourish only where its emotional, mental, and social dimensions are also enabled, free of coercion, discrimination, and violence.” A repeat of 2022? The Saudi delegate in heated WHA debate over sexual rights and terminology at the WHA in 2022. Two years ago, the entire WHA was delayed for days over conflict related to a global strategy on HIV, hepatitis B and sexually transmitted infections, primarily because of a glossary on sexual health and target populations for HIV treatment. While the language was standard for HIV treatment and care, the Saudi Arabian delegate – speaking for WHO’s 22-member state Eastern Mediterranean Region (EMRO) – objected to the terms “sexuality”, “sexual orientation”, “sexual rights”. He also objected to “men who have sex with men” being designated as a target population for HIV treatment. Although the WHO works by consensus, the strategy eventually went to a vote late on the last night of an extended WHA, and narrowly passed with many absentions. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... 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Pollution’s Silent Killers: New Research Links Lead Exposure to Millions of Cardiovascular Deaths 28/05/2024 Elaine Ruth Fletcher & Sophia Samantaroy Lead has been found in contaminated turmeric and other spices, creating another route of exposure to the heavy metal Four well-known heavy metals and chemical pollutants – lead, asbestos, arsenic and cadmium- continue exact a heavy toll on the lives of those in low- and middle-income countries – with lead named a factor in as much as 5 million premature deaths annually from cardiovascular disease, according to one recent estimate. Asbestos, arsenic, and cadmium round out the top four, claiming hundreds of thousands of lives every year. While much recent media attention has been focused on the health impacts of newer industrial compounds such as dioxins, phthalates, and endocrine disruptors, these heavy metal “silent killers” need renewed attention in the environmental health arena, experts say. This was one key message from a day-long session on Health and Environment, the featured theme on the opening day of this year’s Geneva Health Forum, 27-29 May. The session highlighted the pressing threats of environmental pollution from plastics and lead to endocrine disruptors and ambient air pollution. The Geneva Health Forum, organized by the University of Geneva on the sidelines of the World Health Assembly brings together the global scientific community with health practitioners and field actors from around the world. Migration, health and equity and malaria are other key themes The Geneva Health Forum highlighted three key themes on opening day. This year’s Forum, running on the sidelines of the World Health Assembly, brings together hundreds of scientists, policy experts and member state representatives on three key themes – including migration, health and equity; and malaria elimination – each the focus of a full-day session. There are also a host of side events on issues ranging from One Health to Climate resilience and elimination of neglected tropical diseases such as Chagas disease and Noma. While panellists highlighted the higher profile of air pollution in recent years and successes with air quality regulation in higher-income countries, air pollution remains a serious and even growing problem in low- and middle-income regions. Focus on pollutants with the highest impacts on death and disease A recent study implicated lead with 5.5 million premature deaths Meanwhile, age-old problems of heavy metal and mineral pollutants such as lead and asbestos also need much more attention, also in LMICs. “We need to deal with key priorities, country by country, of what’s causing the most damage,” said Richard Fuller, founder and former chair of the Global Alliance on Health and Pollution, who recently participated in an assessment ranking the burden of disease from key WHO “chemicals of concern.” “There was one chemical issue that caused millions of deaths – and then four issues that caused hundreds of thousands of deaths,” he said, referring to lead, asbestos, highly hazardous pesticides, arsenic, and cadmium. “The one that caused the majority of deaths was our old friend lead, which is responsible for 1.5 -2 million deaths per year.” Lead may account for as many as 5.5 million premature deaths from CVD A man melts lead metallic wastes used in the production of cooking pots, at a recycling warehouse in Koumassi, Abidjan, Ivory Coast. A 2023 paper published in The Lancet, supported by the World Bank, estimated that lead exposure may cause up to 5.5 million premature deaths annually, with 95 per cent of those deaths attributed to cardiovascular diseases. The analysis draws on emerging evidence linking lead exposure to atherosclerosis, alongside its known effects on reduced IQ, the central nervous system, and other organs. Mr. Fuller noted that the “lead problem,” once associated with pipes, paint, and gasoline, has evolved in affected low-income regions, but its impact remains just as devastating. “It turns out to be all sorts of activities going on in low- and middle-income countries, including [fabrication of] pots and pans and [contamination] of turmeric,” he explained. “The ones that are less impactful … are things like dioxins, phthalates, brominated flame retardants, PFAS, endocrine disruptors, PCBs, and PAHs,” Mr. Fuller noted, emphasizing that these pollutants are “simply the noisier part of the agenda, but not necessarily the most impactful part of the agenda.” “Should we be focusing on the ones that have the most impact, not just the most noise?” he added. John Ji, an environmental epidemiologist at the Tsinghua University Vanke School of Public Health, told the forum he initially thought his 2013 dissertation on lead would be one of the last. “Then Flint happened,” he said, referring to the water crisis in Flint, Michigan, which brought the issue of lead contamination back into the spotlight. Air pollution remains a driver of poor health From left: Mexican Ambassador to Geneva Fernando Espinosa; Nino Kuenzli of the Swiss Tropical Instiute and John Ji of China’s Vanke School of Public Health. With the World Health Organization attributing 13.7 million deaths to chemical and pollutant exposures, the Forum called attention to the need for global collaboration, research, and policy to tackle pollution-related health effects. “Clean air is possible, yet in some cities in the Asian and African continents, air pollution is getting worse,” said Nino Kuenzli, former Swiss Tropical and Public Health Institute professor. He acknowledged that air pollution regulation is part of a broader environmental health success story, citing the significant increase in air quality in Europe and North America in the past decades. “The Swiss mountain town I grew up in had worse air quality than the Swiss urban centres today,” said Kuenzli, adding that this drastic improvement was built upon decades of scientific victories. “We cannot just call for action and policy without a knowledge [of the science] and it is really fascinating to see how the science to understand the health effects of air pollution has evolved over the last 35 years. It’s incredible. Progress is enormous.” Advances in environmental epidemiology, and newfound ways for collaboration among basic scientists and toxicologists, have paved the way for these air quality improvements. Addressing global air pollution inequalities and replicating much of the successes of higher-income countries means “leapfrogging” intermediate policies and technologies, argued Ji. For example, one of the largest sources of indoor air pollution comes from burning biomass fuels, yet countries often transition to gas stoves, which still produce air pollutants. Instead, countries could support a transition directly from biomass to electric, he said. Air pollution levels have continued to go up in most countries across the world despite rising awareness of its harms. Plastic pollution: a new and growing threat Plastics, now ubiquitous in the environment, are another kind of new, and growing pollution concern for soils, waterways, and air, when incinerated. “By 2050, there will be more plastic than fish in the oceans,” remarked Fernando Espinosa, the Mexican Ambassador to Switzerland. Plastic pollution got a brief nod on opening day following last month’s fourth Intergovernmental Negotiating Body in Ottowa, Canada to develop an international legally binding instrument on plastic pollution, including in the marine environment. While the negotiations did reach some conclusions, like developing a list of chemicals of concern, they did not agree to reduce the production of new plastics, most likely due to ongoing pressure from the fossil fuel lobby and their state backers, such as Saudi Arabia, Russia and the United States. Climate adaptation and resilience in the healthcare system The Forum also brought together experts to discuss the often negative environmental contributions of healthcare systems in lower- and middle-income countries. The sector has increasingly produced contaminated waste, greenhouse gas emissions, and other pollutants – causing upwards of five per cent of global greenhouse gas emissions. These emissions come from hospitals themselves, but also from the manufacturing of medical products. Yet remarks from panellist Habib N’Konou, founder of an innovative biomedical waste company, during a later session demonstrated the disproportionate environmental impacts of the health sector in lower-and-middle-income countries. Senegal, he noted, produces upwards of 21,000 tonnes of medical waste per year, much of which is inadequately processed. “It’s an alarming situation. When I came back to Senegal, there was waste on the coasts, in neighbourhoods.” Looking to the successes of other countries could pave the way for better biomedical waste management, N’Konou noted. Morocco and Tunisia both have government-mediated partnerships between waste facilities and hospitals, something N’Konou champions for Senegal and surrounding countries. Even when regulations exist, they are hard to enforce. Despite the environmental challenges facing LMICs, the climate crisis is an opportunity to rethink how healthcare systems operate, according to Sonia Roschnik, executive director of the Geneva Sustainability Centre. “This is where I really hope that some of what we do to respond to climate change is going to help us leverage more innovative ways of looking at healthcare that actually deliver better population health, but also help the planet.” Image Credits: Prchi Palwe , EPA/L. Koula, Geneva Health Forum, Geneva Health Forum. Conservative Member States Balk at References to ‘Gender’ in WHA Resolutions 28/05/2024 Kerry Cullinan The World Health Assembly in progress. GENEVA – Conservative countries have objected to the use of the terms “gender responsive” and “advancing gender mainstreaming” in behind-the-scenes negotiations on several resolutions before the World Health Assembly (WHA), according to a wide variety of sources. There have also been some objections to the use of “gender equality” and “sexual” in some instances – alongside a long-standing objection to the use of “rights” when referring to sexual and reproductive health. “Gender” references have already been stripped from the World Health Organization’s (WHO) draft pandemic agreement. At least five other resolutions have become bogged down by objectives from conservative member states, particularly Russia, Egypt, Iran and Nigeria. These include resolutions on mental health, emergency preparedness, the economics of health, climate and social participation. In the case of the economics of health resolution, Nigeria initially objected to the use of both “gender equality” and “advancing gender mainstreaming”, one source said. Another source told Health Policy Watch that Russia even wants “sexual” to be removed from the standard term, “sexual and reproductive health”. In the resolution on climate and health, for example, there was an impasse over the use of “gender-responsive” policies – apparently because conservatives believe that this opens the door to engagement with LGBTQ groups although they have never unpacked their objection. Countries have eventually settled on a reference to “gender equality”. Objecting to these particular phrases is new. All UN member states including Russia agreed by consensus to the language of the global Sustainable Development Goals (SDGs), which refer to sexual health and gender. Concerned parties close to the talks stressed the importance of “stopping the backsliding” against established terms and rights for women and other groups in the face of the relentless campaign. Experts call for SRHR space to be protected A few days ago, 43 of the foremost global experts in sexual and reproductive health and rights (SRHR) in the UN called on the WHA to protect advance in this hard-won space in an article published by Health Policy Watch. The experts, who work in various UN expert committees, described progress on SRHR as “fundamental for human rights and dignity, national economies, sustainable development, and a healthier planet”. They added that while SRHR includes “services needed to prevent unwanted pregnancies, unsafe births and avoidable sexual or reproductive illness, injury or dysfunction, it is much broader. “Vitally, it includes the positive enjoyment of consensual sexual intimacy and pleasure, the development of mutually respectful and loving relationships, as well as the affirmation of individuals and families in all their diversity,” they added. “Sexual and reproductive health and rights flourish only where its emotional, mental, and social dimensions are also enabled, free of coercion, discrimination, and violence.” A repeat of 2022? The Saudi delegate in heated WHA debate over sexual rights and terminology at the WHA in 2022. Two years ago, the entire WHA was delayed for days over conflict related to a global strategy on HIV, hepatitis B and sexually transmitted infections, primarily because of a glossary on sexual health and target populations for HIV treatment. While the language was standard for HIV treatment and care, the Saudi Arabian delegate – speaking for WHO’s 22-member state Eastern Mediterranean Region (EMRO) – objected to the terms “sexuality”, “sexual orientation”, “sexual rights”. He also objected to “men who have sex with men” being designated as a target population for HIV treatment. Although the WHO works by consensus, the strategy eventually went to a vote late on the last night of an extended WHA, and narrowly passed with many absentions. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy
Conservative Member States Balk at References to ‘Gender’ in WHA Resolutions 28/05/2024 Kerry Cullinan The World Health Assembly in progress. GENEVA – Conservative countries have objected to the use of the terms “gender responsive” and “advancing gender mainstreaming” in behind-the-scenes negotiations on several resolutions before the World Health Assembly (WHA), according to a wide variety of sources. There have also been some objections to the use of “gender equality” and “sexual” in some instances – alongside a long-standing objection to the use of “rights” when referring to sexual and reproductive health. “Gender” references have already been stripped from the World Health Organization’s (WHO) draft pandemic agreement. At least five other resolutions have become bogged down by objectives from conservative member states, particularly Russia, Egypt, Iran and Nigeria. These include resolutions on mental health, emergency preparedness, the economics of health, climate and social participation. In the case of the economics of health resolution, Nigeria initially objected to the use of both “gender equality” and “advancing gender mainstreaming”, one source said. Another source told Health Policy Watch that Russia even wants “sexual” to be removed from the standard term, “sexual and reproductive health”. In the resolution on climate and health, for example, there was an impasse over the use of “gender-responsive” policies – apparently because conservatives believe that this opens the door to engagement with LGBTQ groups although they have never unpacked their objection. Countries have eventually settled on a reference to “gender equality”. Objecting to these particular phrases is new. All UN member states including Russia agreed by consensus to the language of the global Sustainable Development Goals (SDGs), which refer to sexual health and gender. Concerned parties close to the talks stressed the importance of “stopping the backsliding” against established terms and rights for women and other groups in the face of the relentless campaign. Experts call for SRHR space to be protected A few days ago, 43 of the foremost global experts in sexual and reproductive health and rights (SRHR) in the UN called on the WHA to protect advance in this hard-won space in an article published by Health Policy Watch. The experts, who work in various UN expert committees, described progress on SRHR as “fundamental for human rights and dignity, national economies, sustainable development, and a healthier planet”. They added that while SRHR includes “services needed to prevent unwanted pregnancies, unsafe births and avoidable sexual or reproductive illness, injury or dysfunction, it is much broader. “Vitally, it includes the positive enjoyment of consensual sexual intimacy and pleasure, the development of mutually respectful and loving relationships, as well as the affirmation of individuals and families in all their diversity,” they added. “Sexual and reproductive health and rights flourish only where its emotional, mental, and social dimensions are also enabled, free of coercion, discrimination, and violence.” A repeat of 2022? The Saudi delegate in heated WHA debate over sexual rights and terminology at the WHA in 2022. Two years ago, the entire WHA was delayed for days over conflict related to a global strategy on HIV, hepatitis B and sexually transmitted infections, primarily because of a glossary on sexual health and target populations for HIV treatment. While the language was standard for HIV treatment and care, the Saudi Arabian delegate – speaking for WHO’s 22-member state Eastern Mediterranean Region (EMRO) – objected to the terms “sexuality”, “sexual orientation”, “sexual rights”. He also objected to “men who have sex with men” being designated as a target population for HIV treatment. Although the WHO works by consensus, the strategy eventually went to a vote late on the last night of an extended WHA, and narrowly passed with many absentions. Posts navigation Older postsNewer posts