The WHO stresses that there is no safe level of alcohol consumption.

Romania, Georgia and Czechia have the highest alcohol consumption rates in the world while, in the best-case scenario, only 14% of those who abuse alcohol have access to treatment.

These are some of the insights from the World Health Organization’s (WHO) global status report on alcohol and substance use disorders, based on 2019 data from 154 countries. 


Around 400 million people lived with alcohol and drug use disorders, with 209 million of these being people with alcohol dependence.

Those living in the vast WHO European region, which includes Russia, consumed the most alcohol – 9.2 litres of pure alcohol per person annually. The Region of the Americas, which includes North and South America and the Caribbean, followed with 7.5 litres.

In Romania, the average daily pure alcohol consumption per capita was a staggering 36.9 grammes, the highest in the world. Georgia (31.1g), Czechia (28.8) and Latvia (28.4) – all in the European region – were not far behind.

Despite Australia’s hard-drinking image, its drinkers averaged 21.9 g per capita per day, the third highest in the West Pacific region after Laos (25) and the Cook Islands (22.9). 

In the region of the Americas, Canada (21.5) and the USA (20.8) topped the list. In Africa, South Africa (19) had the highest alcohol consumption, while Thailand (17) was the highest in the South East Asia region. Alcohol consumption was low in the Muslim-dominated Eastern Mediterranean region, topped by the United Arab Emirates (5).

Severe harms; ‘No safe level’

“Substance use severely harms individual health, increasing the risk of chronic diseases, mental health conditions, and tragically resulting in millions of preventable deaths every year. It places a heavy burden on families and communities, increasing exposure to accidents, injuries, and violence,” wrote WHO Director-General Dr Tedros Adhanom Ghebreyesus in the report’s foreword. 

Dr Vladimir Pozniak, WHO’s head of alcohol, drugs and addictive behaviours

“The level of alcohol consumption per capita among drinkers amounts to an average of 27 grammes of pure alcohol per day, which is roughly equivalent to two glasses of wine, two bottles of beer or two servings of spirits,” Dr Vladimir Pozniak, WHO’s head of alcohol, drugs and addictive behaviours, told a media briefing this week.

Of all deaths attributable to alcohol in 2019, an estimated 1.6 million deaths were from non-communicable diseases (NCDs), including 474,000 deaths from cardiovascular diseases and 401,000 from cancer.

Some 724 000 deaths were due to injuries, such as those from traffic crashes, self-harm and interpersonal violence. 

Another 284 000 deaths were linked to communicable diseases. For example, alcohol consumption has been shown to increase the risk of HIV/AIDS as people are more likely to have unprotected sex, and increase tuberculosis and lower respiratory infections by suppressing a wide range of immune responses.

The highest proportion (13%) of alcohol-attributable deaths in 2019 were young people aged 20-39 years.

Globally, almost a quarter (23.5%) of all 15 to 19 year olds were current drinkers, with the highest rates in the European region (45.9%) followed by the Americas (43.9%).

Pozniak stressed that “there is no risk free levels of alcohol consumption”.

“The WHO has not produced guidelines [on safe alcohol consumption] because the diversity of countries, the diversity of populations, their exposure to alcohol, are so different, that to come up with universal levels of risks would be an unmanageable task,” said Pozniak.

“It’s advisable to consult with a health professionals on the risks associated with level or pattern of consumption, taking into consideration the individual characteristics of a person [such as] pre-existing disorders or current health conditions because the risks varies substantially, depending on all these factors.”

Lack of treatment options

The total alcohol per capita consumption decreased slightly from 5.7 litres in 2010 to 5.5 litres in 2019. But the world is far from reaching the Sustainable Development Goal (SDG) target 3.5 by 2030 of reducing alcohol and drug consumption and improving access to quality treatment for substance use disorders.

Although effective treatment options for substance use disorders exists, treatment coverage is incredibly low. 

The proportion of people in contact with substance use treatment services ranged from less than 1% to a maximum of 35% in 2019. This was even lower for alcohol-related treatment, with up to 14% of people who needed it, accessing treatment.

 “Most of the 145 countries that reported data did not have a specific budget line or data on governmental expenditures for treatment of substance use disorders. Although mutual help and peer support groups are useful resources for people with substance use disorders, almost half of responding countries reported that they do not offer such support groups for substance use disorders,” according to the WHO.

“Stigma, discrimination and misconceptions about the efficacy of treatment contribute to these critical gaps in treatment provision, as well as the continued low prioritisation of substance use disorders by health and development agencies.”

A significant number of countries reported interference from the alcohol industry in their efforts to develop effective alcohol policies, according to the report. Industry interference was highest in countries that were effectively increasing the price of alcohol.

“Industry interference was most frequently reported in the African Region (62.1%). However, across all income groups, between 42% and 50% of countries pointed to this interference as a barrier to move forward,” it notes.

Actions for progress

To accelerate progress towards achievement of SDG target 3.5 and reduce the health and social burden attributable to substance use, the WHO recommends action in eight areas.

These include increased awareness through a coordinated global advocacy campaign, and the re-commitment to implement the Global Alcohol Action Plan 2022-2030 with a focus on the SAFER package.

It also calls for increased capacity of health and social care systems to deal with substance abuse, more training of health professionals, better monitoring and research and more engagement with civil society organisations, professional associations and people with lived experience.

Image Credits: Stanislav Ivanitskiy/ Unsplash.

Breast cancer screening in Nigeria
Breast cancer is among the many non-communicable diseases growing in lower-and-middle-income countries, where funding for prevention is often diverted to other health concerns.

When Felicia Knaul met Tonya Rosa, a Mexican woman undergoing chemotherapy for breast cancer, “she was there with a big smile on her face…even though her cancer had recurred.” 

But Rosa told Knaul that her first round of treatment had impoverished her family, “they had to sell their business, their home, their assets to be able to pay for her care.”

But now, she had a card that gives her access to Mexico’s public insurance to cover her treatments.

Rosa’s story was one of many shared at a two-day international financing dialogue for NCDs and mental health hosted by the World Health Organization (WHO) and the World Bank in Washington, DC. The meeting convened as part of the preparation for the United Nations High-Level on these issues in 2025.  

For Knaul, a global health economist, cancer researcher and advocate, providing care for NCDs and mental health patients requires “a health system that could deal with the whole gamut of issues that go through, from primary prevention all the way through to end-of-life care.”

Representatives from over 30 countries reiterated this call for strengthened, affordable health coverage as the means to address NCDs and bolster mental health. 

Adriana Alfonso, Director of Health Surveillance with Uruguay’s Ministry of Health, credits the country’s recent mental health successes to its decree in making psychiatric care obligatory in an affordable and universal manner at health centers. These interventions were only possible through concerted government cooperation and willpower. 

Primary care financing as a sustainable solution

Graphic on NCD financing
Health and finance leaders from over 30 countries met to discuss a path forward to sustainable NCDs and mental health financing.

“In the past, when we prepared annual budgets, we didn’t really take into account the mental health issues. In the case of Uruguay, we have a yearly budget that is discussed at the parliament level, and we needed to make sure that we had a mental health budget that was sustainable,” Alfonso noted. 

Providing dedicated funds for mental health has translated into co-payment reductions and increases in beds in mental health facilities and halfway homes. 

Lester Tan, director of Health Policy, Development, and Planning at the Department of Health in the Philippines, echoed this sentiment in describing the economics of mental health in the Philippines. 

In 2021, mental health conditions cost the Philippine economy an estimated $1.37 billion dollars, equivalent to 0.4% of GDP.  Yet, investing in more treatment of epilepsy and depression would have an incredibly high return on investment – 6.6 and 5.3 times respectively. 

“This evidence, together with the implementation of a mental health law passed in 2018 have contributed to the scaling up of mental health services in the country. There are now 362 mental health access sites nationwide, which have served 124,000 users in 2022,” said Tan.

These mental health successes hinge on expanded financing of primary health care, the “how” of NCDs and mental health care, as a panelist noted.

Tan notes that the Philippines benefitted from expanding the number of health professionals trained in mental health at the primary care level. “This capacity building prioritized depression, epilepsy, self harm and psychosis.”

A multi-sectoral approach to overcome ‘fragmentation’

School girls with caption on primary health care and mental health
Increased primary health care investment has the potential to reduce the global burden of NCDs through prevention, treatment, and care.

Other panelists noted the urgency for multisectoral approaches to financing NCDs and mental health care – working across government institutions and ministries. An NCD expert from the Tunisia Ministry of Health, noted that her ministry recruited the help of the Ministry of Youth, Sport, and Heritage to organize a national day of exercise. 

“During this National Day, everybody was invited to exercise, and we talked about the importance of physical activity. The Ministry of Health decided to do screenings for hypertension and diabetes on this day, and we, of course, had a very large media campaign and awareness raising campaign in the entirety of the country,” she said. 

Beyond the more straightforward partnerships between adjacent ministries, the health sector must work more closely with ministries of finance, noted Aleksandra Altievska, head of fund budgets at North Macedonia’s Ministry of Finance. “I recommend that every Ministry of Health always keep in mind that the Minister of Finance has other priorities.”

Working with ministries of finance to fund NCDs and mental health interventions is critical because, as Joanna Ralston of the World Obesity Federation explained, NCDs are challenges that “can’t be targeted by one sector.”

“We have a global health system that really was built around single vector diseases, just to oversimplify, and yet, now we’re coming in with something that has these commercial elements, [environmental] elements, all these factors, this great level of complexity that that has to be respected,” Ralston said. 

Obesity, as just one example, continues to impact nations across all age levels, because of the fragmentation of the response, said Ralston. “The increase of obesity is around 100% in the past couple of years, when the goal was a 0% increase.” Fragmented, under-resourced responses undermine progress on NCDs and mental health – something that advocates hope can be overcome by renewed multi-sectorial frameworks and partnerships. 

Leveraging patient experiences 

NCD finance conference in Washington, DC June 2024
Several panelists shared their own experiences living with an NCD at the Washington, D.C conference.

Knaul, who founded the Mexico-based breast cancer advocacy organization Cancer de mama: Tomatelo a Pecho, notes that the numbers alone won’t sway policymakers – bringing in patient narratives is paramount to the future of non-communicable disease prevention, treatment, and care. “Health systems repeatedly fail patients with cancer and other NCDs,” she said.

Engaging people with lived experiences of NCDs or mental health challenges bolsters local and international support, argued Charity Muturi, an NCDs and mental health policy advocate in Kenya. 

“When a national task force on mental health was formed, we felt that, as patients, our voices needed to be on the table,” said Muturi, who discussed her own challenges navigating mental health care in Kenya. 

Ralston summed up the struggle with communicating the burden of NCDs and mental health. “Evidence and narrative are what are needed to be successful. We need to be rooted in evidence, but we need to have a way of communicating that story to decision makers, policy makers, and the wider public. And that has been a challenge with NCDs.”

Image Credits: Roche, WHO.

Dr Mamy Andrianirina Rakotondratsara (centre) distributing antimalarials in rural Madagascar.

Malaria has long been at the heart of public health efforts in Africa. As a preventable but potentially fatal disease, it is caused by a parasite transmitted by mosquitoes. In 2022, the WHO African Region accounted for about 94% of cases globally. WHO says 78% of deaths in the region are among children under 5 years of age.

That’s why Dr Mamy Andrianirina Rakotondratsara, a medical doctor and research technician for Madagascar’s National Institute of Public and Community Health (INSPC), wanted to dedicate his TDR-supported studies for a Masters in Public Health to malaria research.

Originally from an endemic region in eastern Madagascar, Rakotondratsara has been personally affected by malaria as he lost his older brother to the disease. 

“I lost someone close and beloved to me from this disease,” he told Health Policy Watch in an interview. That reinforced his determination to address the disease in the course of his studies. 

Dr Mamy Andrianirina Rakotondratsara lost his brother to malaria and is passionate about addressing the disease.

In 2021, during the course of his Masters studies at the Cheikh Anta Diop University of Dakar (UCAD), Rakotondratsara  also completed TDR’s Massive Open Online Course (MOOC) on implementation research. 

As part of this course, he designed a study around the relationship between the frequency of malaria episodes and mosquito bed net coverage, working with other researchers and doctors that specialize in malaria. This research is still ongoing and specifically targets the rural population of Madagascar’s Anosibe An’Ala district. 

Although results are still pending, designing such a study has laid the foundations for Rakotondratsara to put the research findings into practice in his home region and disease context, complementing his prior work on malnutrition. 

Sub-regional training centre for Francophone Africa

Students engaged in a field training in participatory epidemiology organised by the  National Institute of Public and Community Health Madagascar.

Rakotondratsara was able to undertake this research thanks to TDR’s global postgraduate training scheme – which focuses on building students’ skills to do interdisciplinary forms of research that look at barriers and opportunities for better uptake of available preventative and treatment methods.

For physicians, researchers and other professionals interested in local public health, the fellowships supported by TDR – the global research programme on diseases of poverty co-sponsored by UNICEF, UNDP, WHO and the World Bank – provides essential skills for health programme management and implementation. It is particularly important for addressing infectious diseases affecting vulnerable and underserved populations and promoting engagement in research from the local to global levels.

UCAD is one of the two universities in French-speaking West Africa to collaborate with TDR in the programme. It has been hosting students since 2021, to conduct research into how to control infectious diseases found across the region. In 2022, University of Sciences, Techniques and Technologies in Bamako, Mali, joined the programme with the support of Germany’s Deutsche Gesellschaft für Technische Zusammenarbeit.

“The TDR training allowed us to have a new vision of the health system,” Rakotondratsara  observes.  It changed my way of asking questions when faced with poor health indicators. Regarding my Master’s thesis, it gave me an idea of issues to be explored in the mosquito net distribution process, starting with the quantification of needs to end point use.”

He strives to integrate such lessons learnt into his current role with the INSPC. And he is also planning to pursue a PhD with a specialization in implementation research.  

“The INSPC is a public health training and research institution attached to the Ministry of Public Health,” he explains. “Given that it is a research institution, in collaboration with funding bodies, we are often called upon to carry out expert appraisals on their behalf. As a research technician, I accompany this research and bring my contributions to it,” he says.

“Based on my experience, it’s my intention to ensure that implementation research finds an important place both in the research and the teaching context.” 

Towards better management of Schistosomiasis

Although less well known, schistosomiasis, also known as bilharzia, is the second most prevalent disease after malaria both in Senegal and much of the rest of sub-Saharan Africa.

Its most common form – urogenital schistosomiasis – can result in damage to the bladder, urethra, and kidneys. It is a parasitic disease that occurs in tropical and subtropical regions where there is limited access to clean water, particularly in the Senegal River Basin, a hyper-endemic region for several species of the parasite that causes the disease. 

The different variants of the disease are classified by WHO according to the NTD principles for which a greater global response is needed, making it an important research target in the TDR program.

Oumy Kaltome Boh, a physician originally from Dakar, has been interested in the burden of NTDs in Senegal since her formative years, and hopes to see their eradication by 2030.

Dr Oumy Kaltome Boh

“Faced with the impact of these diseases on the health of the population,” she says, her main objective is to contribute to their management “through the implementation of innovative interventions.” 

This is what led Boh to undertake a Masters degree in management of health programmes at UCAD, as well as an International Inter-University Diploma in emerging infections.  

Benefiting from a TDR grant in December 2020, Boh was able to conduct a study examining the day-to-day lifestyle practices and environmental factors that make schistosomiasis transmission more likely in endemic areas of her home country.

As part of this study, done in collaboration with Senegal’s national bilharziasis programme, she also aimed to verify the effectiveness of schistosomiasis treatment with praziquantel, the only available treatment option currently. A total of 287 children were followed over the course of three weeks, with ‘Day Zero’ representing the date of administration of a single praziquantel dose. Between days 14 and 21, both the effects of the drug on disease progression were assessed and a favourable efficacy profile was found, with a 98% reduction in parasite eggs by day 21.

Today, Boh holds the position of deputy chief medical officer in the health district of Saint-Louis, Senegal, and is mainly involved in care and prevention activities for people living with HIV or tuberculosis.

Recruited into this position by the Ministry of Health, she stresses that it was through the support of the TDR postgraduate training scheme that she acquired the skills she needed to manage the public health challenges in this district. In particular, learning about community-based approaches allowed her to better “understand the specific needs and problems” of the districts. 

New research and management approaches

As a key aspect of disease control, students supported by TDR can learn to apply new health research and management approaches previously unknown in Senegal, Boh says.

Among these is the One Health approach, which aims to assess how diseases emerge from a holistic and ecosystem-oriented perspective, taking into account the reciprocal role of humans, animals, plants, and microorganisms such as the aforementioned pests.

By combining scientific, strategic, and rigorous implementation training, the TDR grants offered through UCAD enable their recipients to evaluate and propose improvements to health interventions against poverty-related infectious diseases. 

These opportunities are game-changers for both UCAD students and the future of implementation research in French-speaking Africa. With the help of TDR grants, Boh emphasises, students can gain exposure to critical health programmes and “pool their skills in order to end the neglect of poverty-related diseases and to achieve the Sustainable Development Goals.”

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

None of the over 2,000 young women and girls injected twice a year with a new drug, lenacapavir, contracted HIV in one of the most important advances in HIV prevention.

Gilead Sciences announced these results last Friday, reporting that its Phase 3 PURPOSE 1 trial, conducted in South Africa and Uganda involving 2,134 women and girls aged 16-25, had been so successful that it was terminating early.

Its announcement has been widely hailed as a huge breakthrough in the HIV sector where a vaccine has been elusive, and a range of groups urged Gilead to priorise early access to lenacapavir.

The injectable was compared with Truvada and Descovy, two pills taken daily that have proven successful as pre-exposure HIV prophylaxis (PrEP). 

Sixteen of the 1,068 women in the Truvada group and 39 of the 2,136 women in the Descovy group contracted HIV during the trial. 

During a scheduled review of results, the trial’s independent data and safety monitoring board (DSMB) found the lenacapavir regimen was safe and highly effective. The trial, expected to run until September, was terminated early based on its success. Results of the trial have not been peer-reviewed yet.

The age group targeted by the trial is the worst affected by HIV in southern Africa. In 2022, over three-quarters of infections in 15 to 24-year-olds in the region were girls and women, according to UNAIDS.

“Every week, 4,000 adolescent girls and young women aged 15–24 years became infected with HIV globally in 2022, and 3,100 of these infections occurred in sub-Saharan Africa,” added UNAIDS.

One of the ‘most important results’

“This is one of the most important results we’ve seen to date in an HIV prevention study,” said Mitchell Warren, executive director of AVAC, a non-profit HIV prevention advocacy organisation.

“Adding additional HIV prevention options means more people may find an option that is right for them. Beyond expanded choice, a twice-yearly injection has the potential to transform the way we deliver HIV prevention to people who need and want it most – from an easier-to-follow regimen for individuals to a decreased burden on healthcare systems that are stretched to the limit.” 

Professor Linda-Gail Bekker, director of the Desmond Tutu HIV Centre in South Africa, said that the twice-a-year injectable could provide a “critical new choice” to prevent HIV.

“While we know traditional HIV prevention options are highly effective when taken as prescribed, twice-yearly lenacapavir for PrEP could help address the stigma and discrimination some people may face when taking or storing oral PrEP pills, as well as potentially help increase PrEP adherence and persistence given its twice-yearly dosing schedule,” added Bekker.

Gilead expects results by early 2025 from the programme’s other trial, PURPOSE 2, which is assessing twice-yearly lenacapavir for PrEP in men who have sex with men, transgender and non-binary people, currently underway in Argentina, Brazil, Mexico, Peru, South Africa, Thailand and the US. 

Access to lenacapavir, marketed as Sunlenca in the US, still needs to be worked out once it is approved by regulatory authorities.

Cost of access?

Lenacapavir (marketed as Sunlenca) was approved in the US in 2022  for “heavily treatment-experienced adults with multi-drug resistant  HIV-1 infection and for treatment of people living with HIV who have been on other HIV treatment regimes which are currently failing”.

However, Gilead charges $40,000 per patient per year in the US, reports aidsmap. 

When announcing the PURPOSE 2 results, Gilead acknowledged  the “importance of helping to enable access in order for twice-yearly lenacapavir for PrEP, if approved by regulatory authorities, to achieve the broadest impact”. 

“In light of today’s milestone and the company’s ongoing commitment to communities affected by HIV, Gilead intends to brief community partners and provide a public statement regarding its planned access approach for high-incidence, resource-limited countries, which are primarily low- and lower-middle-income countries,” said the company.

Gilead’s statement was welcomed by African HIV medicines access group AfroCAB in an open letter to its CEO, Daniel O’Day.

“Replacing 365 pills of oral PrEP with just two injections is a life-changing transition and urgently needed option, as millions of our brothers and sisters, friends, and neighbours face challenges of stigma, pill burden, and adherence, leaving them unprotected against HIV acquisition,” said AfroCAB.

“To forge a new pathway forward for [lenacapavir], we call on stakeholders to act now. After thousands of our community members have taken part in clinical trials for LEN and other injectable PrEP products, it is time that pharmaceutical companies, governments, and donors play their part in driving access among the communities that supported the science.”

“We expect to see a timeline that takes into account a full analysis of PURPOSE 1 data and the coming data from PURPOSE 2 from Gilead as soon as possible, and we urge regulatory agencies to prepare to fast track regulatory review,” Warren added.

“We also call on [the World Health Organization] to be prepared to quickly include lenacapavir, if approved by regulatory agencies, in HIV prevention guidelines. There is no time to waste if we are to translate these exciting clinical trial results into actual public health impact and expand the toolbox of HIV prevention choices.”

Meanwhile, Unitaid urged Gilead to make access to lenacapavir a priority, calling for “the terms of their access strategies – including any voluntary licensing agreements – [to be] transparent, global health-oriented, and equitable”.

“Lack of prompt and broad action would jeopardise translating the clinical trial results into real-life impact,” said Unitaid, which offered to work with Gilead to enable access, including “quality-assured, low-cost generics”.

“Unitaid is dedicated to leveraging its recent investment through the Wits Reproductive Health and HIV Institute to facilitate market shaping interventions on long-acting PrEP options (in partnership with the Clinton Health Access Initiative), as well as its continued support to enabling elements such as the key work of WHO and the WHO Prequalification program, the Medicines Patent Pool and other intellectual property grants, to ensure access to this life-saving product is as broad as possible,” the organisation said in a statement last week.

Image Credits: Gilead, Diana Polekhina/ Unsplash.

A member of the ring vaccination team vaccinates a man in Bosolo village. Vaccines offered as part of Gavi’s portfolio now also include preventive Ebola vaccines for care workers.

Gavi, the Vaccine Alliance, announced last week that it will offer high risk countries the option of obtaining preventative Ebola vaccines, particularly for health workers, as part of the rollout of new vaccine offerings, which also include  meningitis, rabies and hepatitis B vaccines.

Plans to add the vaccines to the basket of available products were initially drawn up before the  COVID-19 pandemic, but put on hold due to lack of appropriate supply or regulations, with applications opening only now to eligible countries.

“Gavi’s ability as an alliance to protect health and save lives hinges on its ability to ensure vaccines are accessible, as quickly as possible, to those who need them the most,” said Gavi CEO Dr Sania Nishtar. “The new programmes launching today demonstrate the impact of this work.” 

Ebola is a rare but dangerous viral disease, with a 50-60% mortality rate. Infections may be transmitted through close contact with infected animals – for instance, fruit bats – but also through human-to-human contact. 

Gavi first offered Ebola vaccine candidates to health workers and suspected Ebola contacts during the 2014-2016 West Africa outbreak as an outbreak response. 

Two vaccines subsequently received regulatory approval and in May 2024 WHO’s Strategic Advisory Group of Experts on Immunisation (SAGE) decided to recommend the vaccines for preventive use, as well, in high-risk groups, such as health care providers in areas of endemic transmission.

Meningitis vaccine rollout aims for elimination

Gavi will also roll out a newly-approved vaccine for five strains of meningitis: meningococcal serogroups A, C, W, Y, and X. 

Central and Western African countries most prone to meningitis infections in the so-called “meningitis belt”

The vaccine is a likely game-changer in the fight against the disease, experts say, noting that in the so-called “meningitis belt” of sub-Saharan African countries, the bacterial form of the diseases, regarded as the most dangerous, could potentially be eliminated. 

The product, MenFive, received WHO pre-qualification in July 2023 and has already been implemented in standard childhood immunisation programmes in Nigeria and Niger.

In 2019, there were about 236,000 meningitis deaths, with the greatest burden in children younger than five years, with 112,000 deaths.

Hepatitis B and rabies post-exposure jabs

Other new vaccines include hepatitis B vaccines for newborns, granting infants critical additional protection in their first months of life, when they are at high risk of infection: including from maternal transmission.

According to Gavi, nine out of ten infants infected with hepatitis B will develop chronic forms of the disease, while a quarter develop severe liver disease, which currently kills 884,000 people a year.

Human rabies post exposure prophylaxis (PEP) vaccines are the last of the new package. 

The initiative aims to build more stockpiles of the rabies vaccine, which are often scarce and inaccessible, especially in remote areas, for post-exposure use. 

Rabies, which has an almost 100% mortality rate, remains a serious health problem in some 150 countries, where it is transmitted by infected dogs.

But vaccines alone are not enough to stop the disease, experts underlined. 

“To stop human rabies deaths completely, we urgently need better data and surveillance, dog populations must be vaccinated, and people must be educated about what to do if bitten, and how to avoid being bitten in the first place,” said Professor Lucille Blumberg, Chair of United Against Rabies, pointing out to several blind spots of the human immunisation programme.

Image Credits: WHO/L. Mackenzie , CDC.

The latest episode of the Global Health Matters podcast, hosted by Dr Garry Aslanyan, delves into the extraordinary careers of two global health leaders and the crucial role that capacity development has played in their journeys.

This episode, produced to celebrate the 50th anniversary of TDR, the Special Programme for Research and Training in Tropical Diseases, features insights from Dr Wilfried Mutombo, Head of Clinical Operations at the Drugs for Neglected Diseases Initiative (DNDi) in the Democratic Republic of the Congo, and Dr Yasmine Belkaid, President of the Institut Pasteur in France. Both leaders share their experiences and the impact of TDR’s support on their professional growth.

Dr John Reeder, the Director of TDR, reflects on the importance of capacity development in fostering the potential of researchers in low- and middle-income countries. Reeder highlights his transition from hands-on research to global leadership, emphasising the value of putting research into action and nurturing talent at the grassroots level.

He underscores that effective capacity development goes beyond providing resources; it involves empowering individuals to fulfil their potential and significantly contribute to their fields.

“When you’re looking at science and laboratory science particularly, people get fixated on the expensive equipment and the fancy technology that surrounds this,” Reeder says. “But the most important investment in a laboratory is the scientist who is in that laboratory because, all other things aside, the ability to see the problem, think of innovative solutions to test them critically and to have the open mind to be able to see the discovery coming through that, you invest in that, and you’ve got great science.”

From left: Dr John Reeder, the Director of TDR; Dr Yasmine Belkaid, President of the Institut Pasteur in France; and Dr Wilfried Mutombo, Head of Clinical Operations at the Drugs for Neglected Diseases Initiative (DNDi) in the Democratic Republic of the Congo
From left: Dr John Reeder, the Director of TDR; Dr Yasmine Belkaid, President of the Institut Pasteur in France; and Dr Wilfried Mutombo, Head of Clinical Operations at the Drugs for Neglected Diseases Initiative (DNDi) in the Democratic Republic of the Congo

Clinical Trials in Remote Areas: Three Challenges

Mutombo’s story is a testament to the transformative power of research capacity development. Starting as a medical doctor in a small village in the DRC, Mutombo faced the challenge of treating sleeping sickness with toxic drugs. His clinical research fellowship from TDR enabled him to lead the first clinical trial in the DRC for fexinidazole, a safer oral drug for sleeping sickness. He discusses the immense challenges of conducting high-quality clinical trials in remote areas with inadequate infrastructure and highlights the importance of sustained support and training for local health workers.

“The first challenge is to reach those areas because to perform a clinical trial, you need to go there in those areas, in those remote areas, and as you may know, we have bad roads, and sometimes this is not very safe,” Mutombo says. “The second challenge is, when you are in those areas, you can imagine in what state those health facilities are… So we had to improve these health facilities.”

Another challenge, he says, is the health workers.

“Health workers are there, but they are not aware of what a clinical trial is,” according to Mutombo. “To have a high-quality clinical trial, they needed to train them and have a very, very close supervision of their activities. So we organised all this.”

Finally, “We need our governments … to give more support and more money to maintain those facilities. This is very important for the government because the first and very important step has been done, but now we need to maintain them at that level.”

Building Research Capacity: Support is Crucial

In many ways, Belkaid’s journey from Algeria to leading the Institut Pasteur in France exemplifies the global impact of TDR’s fellowships. She speaks about the crucial support she received, which allowed her to pursue her PhD and establish a notable research career.

Belkaid emphasises creating environments that nurture talent and passion, enabling researchers to address pressing global health issues. Her vision as President of Institut Pasteur includes fostering international collaboration and continuing to build research capacities that can address future health challenges.

Belkaid says if there is anything she can do over the next few years, it will hopefully be helping in any way she can to grow and nurture the leaders of tomorrow internationally.

The episode underscores the ongoing need for international organisations like TDR and WHO to prioritise capacity building in low- and middle-income countries.

Reeder points out the shift towards in-country training and the importance of sustainable research systems driven by local needs and priorities. He says this approach helps ensure research capacity development and is not just about immediate results but about long-term, sustainable growth that empowers countries to tackle their health challenges effectively.

Read related Inside View by Dr John Reeder.

Listen to the Global Health Matters podcast on Health Policy Watch.

Visit the podcast website.

Image Credits: TDR.

Ted Herbosa, Health Secretary for the Philippines

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

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

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

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

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

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

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

Phased approach

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

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

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

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

Egypt’s Radwa Iman

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

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

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

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

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

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

Mental health out in the cold

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

Devora Kestel, WHO director of mental health.

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

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

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

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

The meeting continues on Friday.

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

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

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

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

 

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

Reaching zero-dose children and expanding vaccine portfolio

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

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

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

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

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

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

Decentralising vaccine production

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

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

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

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

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

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

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

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

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

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

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

Image Credits: Politico.

The Solomon Islands are facing severe climate threats.

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

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

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

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

Conference Lineup

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

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

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

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

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

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

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

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

Uniting to Combat NTDs

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

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

Leaders Forum

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

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

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

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

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

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

Image Credits: National Cancer Institute on Unsplash, UNEP.

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

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

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

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

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

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

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

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

Years of brain drain

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

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

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

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

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

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

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

Crippling effect on health

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

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

WHO data (2021)

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

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

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

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

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

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

Government withholds proof of qualification 

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

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

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

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

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

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

‘The heart belongs at home’

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

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

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

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

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

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

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

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

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

Image Credits: WHO.