For many, access to assistive technology can enable independent everyday life.

Only one in five of the people in need of hearing aids and prostheses worldwide can access them, according to a new report by ATscale, a global partnership for assistive technologies and the Clinton Health Access Initiative (CHAI).

Assistive technology (AT) is any device and related systems that can help with everyday activities, improving or restoring the capabilities of a person’s body, ranging from eyeglasses, access ramps, prostheses or smartphones for functionalities such as the text-to-speech option.

The report, issued on the first-ever Day for Assistive Technology, aims to make assistive technology markets more transparent and easier to navigate for the public sector and producers. 

The hope is that comprehensive information will facilitate the choice of quality products, especially for governments in low- and middle-income countries, and encourage companies to expand their reach to new regions of operation, explained Pascal Bijleveld, CEO of ATscale in an interview for Health Policy Watch.

“It’s really about addressing one of the bottlenecks to access, which is the lack of transparency in the markets about what products are available, what are the price ranges, what’s the quality, and so on and so forth,” Bijleveld said.

Many governments lack the capacity to analyse and understand each of the markets and may make sub-optimal product choices.

It is also essential to raise awareness about the benefits of assistive technology and to start public and private initiatives to ensure more people, especially in low-income countries, can attain the AT they need. 

Large gap in access

Getting a AT of need is often the key to a more independent, full life for people with disabilities, unlocking a possibility to live independently, meet with family and friends, study, or work.

Globally, 2.5 billion people need at least one assistive product with the number expected to reach 3.5 billion by 2050 as the world population ages, WHO’s and UNICEF’s report shows. Even though 90% of people in need of an AT in high-income countries can access it, the number drops drastically to only 10% in low- and middle-income countries.

There is a nine-to-one return on investment from providing AT, thanks to unlocked educational outcomes, better paid employment and lower longer-term healthcare costs, an ATscale study from 2022 highlights.

The report systematically analyses markets for several most popular technologies: wheelchairs, glasses, augmentative communication, screen readers, and smartphones. 

Hearing aids, glasses and other assistive technologies can be prohibitively expensive. Taken for granted in wealthy countries, these simple technologies are out of reach for millions globally.

It lists the product types available, describes market specifics and enumerates some of the most important features. For hearing aids, for example, approximately 20 million units are sold annually, with the main market drivers being the ageing population. 

When picking the right device, it’s important to consider its ability to manage background noise and acoustic loops, its resilience against mild shocks, dust or rain, volume control and overall design. Those and other features are tested by several control agencies; to help navigate the market, the report provides a comprehensive list of producers and certificates held by their devices.

The report is only the first step, Bijleveld said and will be changed over the next couple of months into “a web-based platform that will be continuously updated”.

 Producers themselves will want to keep this interactive source of information up to date as a potential advertisement for their products and a guide to the overall market situation.

Raising awareness about the benefits of ATs is on the top of ATscale’s agenda. ”People need to get the word out there,” Bijleveld stressed.

Image Credits: CC.

Drug-resistant bacteria have developed from years of over-prescription of antibiotics.

With less than four months to the United Nations High-Level Meeting (HLM) on Antimicrobial Resistance (AMR), global leaders have proposed a variety of measures to address the growing threat of pathogens that are resistant to antibiotics.

The recently published zero draft of the political declaration for the meeting aims to reduce global deaths caused by bacterial AMR by 10% by 2030 (using 2019 as the baseline).

Mia Mottley, Prime Minister of Barbados and chairperson of the Global Leaders Group on AMR, called for “adequate, predictable and sustainable financing” to address the problem,  including financing for research and development for new antibiotics and the implementation of national action plans on AMR, especially in low- and middle-income countries. 

“Fundamentally, we must focus on prevention across all sectors – clean water, safe and effective sanitation, food security, infection prevention and control in all settings,” Mottley told a lunchtime roundtable during last week’s World Health Assembly.

Prime Minister of Barbados Mia Mottley, who chairs the Global Leaders Group on AMR

“I believe that we should establish an independent panel to monitor and report on the science and the evidence to facilitate collaborative and coordinated action against AMR,” She also called for the quadripartite joint secretariat on AMR to be formalised and adequately resourced. This is made up of the World Health Organization (WHO), the UN Food and Agriculture Organisation (FAO), UN Environment Programme (UNEP), and the World Organisation for Animal Health (WOAH).

The agricultural sector is responsible for the vast majority of antibiotic overuse, leading to drug resistance. 

Threatens to ‘unwind century of medical progress’

“In 2019, 1.3 million deaths resulted directly from bacterial AMR, more than two every minute,” WHO Director-General Dr Tedros Adhanom Ghebreyesus told the meeting.

“AMR threatens to unwind the century of medical progress and also threatens animal health, global food production, food security, and the environment.”

Dr Jean Kaseya, Director-General of Africa CDC, noted over one million deaths in Africa were associated with AMR and 250,000 caused by ARM. 

“Only 1.3% of our labs in Africa are able to perform bacterial resistance testing. It means this data that I’m sharing with you is an underrepresentation of the reality in Africa,” said Kaseya.

Four years ago, the African Union Assembly established a task force to control AMR and recommended that all member states implement national action plans.

“But less than 10% of a member states have national action plans that are fully funded and implemented,” he added.

Kaseya appealed to The Global Fund to expand its mandate from HIV, TB, and malaria to include AMR.

Professor Sally Davies, UK Special Envoy on AMR

Professor Sally Davies, the UK Special Envoy on AMR and a member of the Global Leaders Group, called for the high-level meeting to “truly address the needs of the most vulnerable communities, offering clear support to low and middle-income countries” that carry the greatest burden of this antibiotic emergency and need fair and equitable access to antibiotics and diagnostics.

Surviving AMR

Vanessa Carter developed a drug-resistant infection after a car crash cost her an eye.

South African Vanessa Carter, chair of WHO Taskforce of AMR Survivors, shared her nightmare of being unable to shake an infection after being seriously injured in a car crash in Johannesburg and losing her right eye. 

The infection turned out to be the drug-resistant Methicillin-resistant Staphylococcus aureus (MRSA). Hospital patients, people with wounds, and those who have surgery and medical devices implanted in their bodies are particularly at risk of MRSA.

Carter, who spent a month in hospital, had a prosthetic eye inserted and a number of surgeries.

“In my sixth year of surgeries, and my fourth prosthetic [eye], I went out shopping one day, I came back to the car and I felt moisture on my face. When I pulled down the rearview mirror, I saw this pus seeping out of the cheek of the prosthetic,” Carter told the roundtable meeting.

Her doctor told her she needed emergency surgery, but two weeks’ later the infection came back again.

“I was under the care of different types of specialists, an ENT surgeon, ophthalmologist, plastic surgeon, maxillofacial surgeon, each of them prescribing antibiotics during surgeries,” she added.

After almost a year of continued infections, doctors removed the prosthetic eye and sent it for testing and it was found to be contaminated with MRSA. What followed was a long and harrowing process during which the infection got into Carter’s bones before she was finally cured.

“I’ve been an advocate for the last 11 years and, most recently, we’ve established the WHO Task Force of AMR Survivors,” said Carter.

“Our biggest objective is to bring the human impact. When policy makers and members of the public understand exactly what it is, we can we can empower them. One of the documents we have worked on is a strategic technical guidance document for meaningful patient involvement. I would encourage you to go take a look at it.”

World reaches record high for annual temperatures over past 12 months – as 1.5°C tipping point approaches.

‘Extortion level’ capital costs put renewables out of reach in most developing economies; fossil fuel companies rake in record profits; and world reels from record heat, freak floods and drought, says UN Secretary General. 

New climate data released Wednesday shows virtually all key global warming parameters, including land and sea temperatures at all time record high levels for May, as well as for the past year. 

There’s an 80% likelihood that in at least one of the next five years, the world will temporarily exceed the 1.5°C limit set by the 2015 Paris agreement, said the World Metereological Organization.  And at current emissions rates, the world will permanently breach the 1.5° C limit before 2030, warned UN Secretary General Antonio Guterres in a stark message on climate change, coinciding with World Environment Day. 

“New data from leading climate scientists released today shows the remaining carbon budget to limit long term warning to 1.5 C is now around 200 billion tons – that is the  maximum amount of carbon dioxide that the Earth’s atmosphere can take – if we are to have a fighting chance of staying within the limits,” Guterres said. His comments were based on projections released today by WMO and the European Union’s Copernicus climate observatory. 

“And the truth is, we are  burning through the budget at reckless speed, spewing out around 40 billion tons of carbon dioxide a year,” he said urging people “to do the math.”

“At this rate, the entire carbon budget will be passed before 2030,” he said in an address was delivered from New York City’s Museum of Natural History – to underline the point that the human species, like dinosaurs, faces a real extinction threat.   

World’s carbon ‘budget’ surpassed before 2030

UN Secretary General delivers a major address on climate Wednesday 5 June.

To avoid permanently breaching the 1.5°C tipping point,  global emissions need to fall by 9% every year until 2030, he said. “But they are heading in the wrong direction. Last year, they rose by 1%.

“Almost 10 years since the Paris Agreement was adopted, the target of limiting long term global warming to 1.5 degrees Celsius is hanging by a thread. Meanwhile, the godfathers of climate chaos, the fossil fuel industry, rake in record profits supported by a system of trillions [of dollars] in taxpayer funded subsidies.”

‘Extortion-level’ capital costs put green energy out of reach in developing countries

Hospital in Johannesburg, South Africa with solar panels: Investments in African renewables was a woeful 1% even as costs globally tumble.

It is money that is driving the world to “climate hell”, the UN Secretary General said, calling for a broad overhaul of finance priorities amongst G20 and G7 countries, as well as in private banks and multilaterals. 

Investments in African renewables represent just 1% of the world’s installed PV solar capacity – while oil and gas profiteers rake the continent for fossil fuels, he noted, citing recent data from the International Energy Agency.  

“Extortion level capital costs are putting renewables virtually out of reach for most developing and emerging economies – astoundingly and despite the renewables boom of recent years,” Guterres declared. 

“Clean energy investments in developed developing and emerging economies outside of China have been stuck at the same levels since 2015.   Last year, just 15% of new clean energy investment went to emerging markets and developing economies outside China, countries representing nearly two thirds of the world’s population.

“And Africa was less than 1% of [PV solar] installations – despite its wealth of natural resources, and vast renewables potential.”

All that is coming at a time when globally, clean energy investments reached a record high last year, with wind and solar power growing faster than any other electricity source in developed economies, he noted. 

Hottest month and year on record 

Record high sea temperatures are changing ocean and air currents, bleaching corals, threatening ice caps – all accelerating the approach of climate tipping points.

May 2024 also was the hottest day in recorded history – marking 12 consecutive months of the hottest weather for the planet ever on record, Guterres noted, citing the fallout that is also being felt from Delhi to the Americas – in terms of record temperatures on the Indian subcontinent, and fierce, unpredictable storms and flooding in southern Brazil. 

The new WMO report, also released Wednesday, backs that up with detailed data on the unprecedented levels of temperature rise on land as well as on the seas. The WMO report was led by the UK Met Service. Further data on global warming trends was released by the European Union’s Copernicus Climate Service. 

Based on that data, the global average temperature for the last 12 months (June 2023 – May 2024) is the highest ever on record, at 1.63°C above the 1850–1900 pre-industrial average. 

And crossing 1.5°C is not merely a matter of crossing a political target, Guterres stressed.  

“Scientists have alerted us that temperatures rising higher would likely mean the collapse of the Greenland Ice Sheet and the West Antarctic Ice Sheet with catastrophic sea level rise,” he said, 

And not only that, but also the “destruction of tropical coral reef systems and livelihoods of 300 million people; the collapse of the Labrador Sea currents that would further disrupt weather patterns in Europe; and widespread permafrost melt that will release devastating levels of methane – one of the most potent heat trapping gasses.” 

Health effects increasingly evident – impacting the poorest and vulnerable

Water shortage in Ethiopia. Droughts, flooding and heat waves all create acute health impacts, as well as exacerbating chronic diseases, like cardiovascular disease.

Even today, as humankind pushes planetary boundaries to the brink-  shattering global temperature records are being recorded around the world, he pointed out.  

“Already the brutal heatwave has baked Asia with record temperatures, shriveling crops, closing schools and killing people. Cities from New Delhi to Bamako to Mexico City are scorching. Here in the West severe storms have destroyed communities and lives. 

“We have seen drought and disaster declared across southern Africa and extreme rains flood the Arabian Peninsula, East Africa and Brazil. 

“And the mass global coral bleaching caused by unprecedented ocean temperatures – soaring past the worst predictions of scientists,” he said, noting that the cost of climate “chaos” could rise to at least $30 trillion by 2050.”

And while the rich can huddle inside air conditioned bubbles, at least much of the time, those least responsible for the crisis bear its brunt, he noted. 

“Extreme events turbocharged by climate change are piling up – destroying lives, families’ economies and hammering health, wracking sustainable development, forcing people from their homes and rocking the foundations of peace and security as people are displaced and vital resources are depleted.”

 Appeal to G7 and G20 to fix broken financial system 

‘Better, bigger and bolder’ commitments to green energy needed from multilateral development banks.

To reverse current trends, Guterres called on world leaders, and particularly G7 leaders meeting nexxt week in Italy, as well as the G20, in Rio in November, to commit to ending coal production by 2030 and reduce oil and gas production by 60% – as compared to trillions in fossil fuel subsidies.   

The world’s leading economies also should: 

  • Set up a “high integrity” system for carbon taxes and markets; 
  • Relieve the debt burden in developing economies so that investment can flow into green forms of energy; 
  • Commit to finally filling the coffers of the Green Energy Fund, with the  $100 billion in funds agreed to in previous Climate Conferences, for developing countries. 

He appealed to private financial institutions to stop funding coal, oil and gas projects – while the G7 and G20 countries should use their influence with multilateral development banks to make “better, bigger and bolder” commitments to green energy infrastructure. 

“The International Energy Agency reports that clean energy investments in developing and  emerging economies beyond China need to reach up to $1.7 trillion a year by the early 2030s. 

“In short, we need a massive expansion of affordable problem to public and private finance to fuel ambitious new climate plans and deliver clean, affordable energy for all,” he said, pointing to the UN Summit of the Future planned for September “to push reform of the international financial architecture.”

Meanwhile, private financial institutions should stop “”bankrolling fossil fuel destruction and start investing in a global renewable revolution,” while shareholders press for disclosure of engagements on fossil fuel multinationals – which have pressed on the gas, rather than releasing the pedal, investing a mere 2.5% in renewable projects, on average last year.  

Ban advertising of ‘unhealthy’ fossil fuels, as with tobacco 

Fossil fuels kill, like tobacco.

Business and government leaders, moveover, need to confront disinformation and “greenwashing” by the fossil fuel industry, more aggressively. 

“Many governments restrict or prohibit advertising for products that are dangerous to  human health like tobacco,” he pointed out.  Some are now doing the same for fossil fuels.

“I urge every country to ban advertising from fossil fuel companies. And I urge news media and tech companies to stop taking fossil fuel advertising. 

Embrace clean technologies  

polluted air
Cycling in Fortaleza, Brazil – the city strengthened its active transport system, which reduces carbon emissions from motor vehicles.

Meanwhile, he said, the general public can press on demand-side levers. 

“All of us can make a difference by embracing clean technology, phasing down fossil fuels in our own lives, and using our power as citizens to push for systemic change in the fight for a Livable Future. 

“People everywhere are far ahead of politicians. Make your voices and your choices count your friends. We do have a choice, creating tipping points for climate progress or gaining tipping points for climate disaster.” 

Image Credits: World Metereological Organization, Health Care Without Harm , WMO , Oxfam East Africa, WHO FCTC, City of Fortaleza.

These children from Savai’i Island, Samoa, are protected by a mosquito net while they sleep.

Climate change is perhaps the greatest threat to human health. In a warming world, with changing and unpredictable weather patterns, its effects are all around us.

In 2022, Pakistan experienced the worst floods in the country’s history, placing much of the country under water and giving way to a fivefold increase in the country’s rate of malaria transmission.

 Earlier this year, Brazil declared a state of emergency as its national healthcare system buckled under the pressures of an outbreak of dengue, a neglected tropical disease (NTD) carried by mosquitoes. 

Cases continue to rise and the outbreak shows no sign of stopping. But Brazil is not alone. Over the past two decades, dengue cases have increased eightfold, with the mosquitoes that carry it thriving in areas where climate change has made temperatures higher and precipitation more abundant.

Despite these daily reminders, there is much we do not understand about the impact climate change is exacting on malaria and NTDs, both of which disproportionately impact low-income countries (LICs). An ongoing effort to rid the world of these debilitating diseases by understanding the impacts of climate change isn’t just important – it’s imperative.

Evidence gaps

 An unprecedented scoping review highlights significant gaps in evidence. It was conducted by the World Health Organization (WHO) Task Team on Climate Change, NTDs and Malaria, in partnership with Reaching the Last Mile, a portfolio of global health initiatives driven by the philanthropy of United Arab Emirates President Sheikh Mohamed bin Zayed Al Nahyan.

Spanning 42,693 articles from the past decade, the review correlates climate fluctuations with changing disease patterns, confirming that changing temperature and rainfall patterns will shift the transmission windows and geographies of malaria, dengue and chikungunya.

The research also reveals that, as our planet warms, the poorest and most vulnerable communities are poised to suffer even more. It also highlights that our research agenda is imbalanced, with studies historically focused on where disease burden is low and access to quality healthcare is high.

This is not merely a health issue but a profound injustice that compounds vulnerabilities among those least equipped to bear them.

Given the complex and nonlinear ways these diseases interact with changing climates, the importance of closing our gap in understanding is clear. As we already see with dengue in Brazil – and will continue to see in other areas for years to come – diseases are being transmitted faster and farther than before as vectors like mosquitoes expand to regions previously unexposed to these diseases.

This could lead to new outbreaks in populations without any natural resistance or existing health infrastructure to manage such diseases. It’s only further complicated by increased displacement and migration as a result of a changing climate.

Adaptation and mitigation

Health officials speak to community members in Tana River County, Kenya, about the ongoing oral cholera vaccination campaign.

Despite the clear risk, our understanding of how to mitigate or adapt to the impact of climate change on malaria and NTDs is limited. Adaptation and mitigation strategies were discussed in only a fraction of the scientific literature reviewed by the WHO Task Team. This needs to change.  

A new research agenda is crucial to inform evidence-based adaptation and mitigation strategies.

In a world acutely aware of the effects of climate change, this all matters immensely if we are to preserve our gains and investments. As global citizens and stakeholders in global health – whether policymakers or researchers, NGOs, funders, or community leaders— we must adapt our strategies and responses not just to the diseases as we’ve known them, but to how they will evolve in a changing climate.

This will require innovative approaches to our public health interventions as dynamic as the challenges they aim to counter.

 We must build resilient, climate-responsive health systems, surveillance programs and intervention strategies to mitigate against or adapt to the immediate-short-term and long-term effects of climate change on malaria and NTDs.

We must ensure communities have the resources to respond to health threats in the context of real-time challenges and changing dynamics, like rising temperatures, extended rainy seasons or drought – particularly in the ‘last mile.’

This will require us to reimagine and invest in a new research agenda driven by scientists on the frontlines of this climate-vector-borne disease nexus aimed at protecting those most vulnerable to its impact.

Stronger action on the ground

We need a committed, global push for research that not only tracks disease trends but actively explores robust intervention strategies that consider the full spectrum of climate impacts. 

This includes a holistic approach to hazard assessment, driven by research that examines the links between hazards, vulnerability and exposure so we can more accurately project the potential effects of climate change on malaria and NTDs.

The climate crisis will only continue to put strain and pressure on already fragile health systems, diverting precious resources from other budget lines, including malaria and NTDs. With more evidence, we can break this cycle and protect the resources needed for disease response.

Last week, the World Health Assembly adopted the WHO’s 14th Global Programme of Work, which prioritises the climate-health nexus. Member states also adopted the strongest resolution yet on climate change and health. 

Now we need to see even stronger action on the ground. Let’s marshal our collective resources and ingenuity to ensure that our responses are as adaptable as the diseases we’re striving to overcome.

The time to act is now. This new WHO paper is not just a summary of data; it’s a call to action. It’s a directive for all of us involved in the fight against malaria and NTDs to look beyond our current horizons and plan for a future where climate change reshapes the landscape of global health. For the sake of the millions at risk, we must heed this call and act swiftly and decisively.

It’s no small challenge, but one that we can overcome together.

Dr Ibrahima Socé Fall is the Director of WHO’s Global NTD Programme.

Dr Michael Adelkunle Charles is CEO of the RBM Partnership to End Malaria.

 

Image Credits: Yoshi Shimizu, Billy Miaron/ WHO.

Votes to move to a secret ballot broke down along almost the same geopolitical lines – with 14 opponents (voting here) versus 17 supporters.

The World Health Organization (WHO) Executive Board on Tuesday voted to recognize the US-based Center for Reproductive Rights (CRR) as a non-state actor “in official relations” with it, in a motion carried by a narrow 17-13 margin, with four abstentions.

After multiple rounds of voting, the final vote was by way of a secret ballot.

The decision to grant WHO recognition to the Center, which supports access to sexual and reproductive health services, including abortion, was a hard-won victory for European, Asian and Latin American countries.  But the victory may be  short-lived.

Egypt, backed by a coalition of Middle Eastern and Islamic nations, as well as the 47-member WHO African Group, pledged to  “escalate” the issue to the World Health Assembly (WHA), a promise that it reaffirmed shortly after the vote in the WHO governing body, calling the vote a “politicization” of the global health body.

Egypt’s delegate to the EB (back left) pledges “to pursue” the controversial issue at the World Health Assembly.

“We would like to repeat what we have mentioned yesterday,” said Egypt’s delegate. “That we will pursue reopening of the discussions on this agenda item within the wider quorum of the organization during the upcoming WHA”.

He added that, at the national level, the decision ” is of no weight…  we will not abide by it, and will not consider it in any means”.

“Also, we will join the Russian Federation on their query, which is ‘how could we avoid the repetition of such unpleasant situation?’.. We need the good offices of the WHO in order to avoid the politicization of this organization as it has been experienced frequently in the past few days. “

“The text that was adopted today will not be implemented in Senegal, unless it is compatible with our laws, traditions and values,” said Senegal’s delegate, echoing sentiments expressed by Yemen, Kuwait, Somalia, and other member states in the post-vote discussion. 

National context still prevails

The Netherlands: WHO recognition of non-state actors does not commit member states where, “the national context prevails.”

Member states that supported the move by the 34-member governing body noted that other nations are in no way obliged to cooperate with the Center, or with any other non-state actor, which they oppose.

They stressed that the recognition was being extended solely by the WHO Secretariat, which maintains a wide network of official relations with over 200 non-state actors from civil society, industry federations and professional associations in line with a Framework for Engagement with Non-State Actors (FENSA) approved by the World Health Assembly in 2016.

The vote also awarded WHO recognition to a second non-state actor, Rare Diseases International, whose candidacy was never opposed by member states.

“The Framework of Engagement with Non State Actors (FENSA) is one of WHO normative guidelines, which has been negotiated and agreed by all member states,” The Netherlands pointed out.  “Questioning any non-state actor about its eligibility for admission into an official relationship with WHO after the organization passed the Secretariat’s criteria, undermines a great procedure and sets a harmful precedent for the future agreements.

However “the national context prevails over WHO engagements with non state actors,” she emphasized. 

FENSA framework is supposed to be neutral

The FENSA framework sets out a set of generic criteria for organizations “in official relations” to engage in collaborations with WHO, serve on technical groups and be recognized as “observers” with the right to speak at the annual WHA.

The aim of FENSA, which took years to negotiate and approve, was to create an even playing field in the much-coveted “official relations” designation that would side-step vested interests, particularly of industry or lobbying groups, that contravened WHO aims and priniciples.

Since the approval of FENSA, the handful of recommendations made by WHO each year to the Executive Board, to approve new NSA’s in official relations with WHA, or renew the terms of others, are usually just a matter of protocol, following WHO review and due diligence.

But there is growing pressure on the UN from socially conservative nations to roll back its activities on sexual and reproductive health in a period where many conservative nations still ban abortions, limit access to contraceptives and  criminalize the LGBTQI community.

Proposed WHO Recognition of Center for Reproductive Rights Provokes Storm at WHO Executive Board

As member states pointed out, the CRR has long been recognized by the UN’s Economic and Social Council (ECOSOC),  highlighting how the controversy over its recognition by WHO is a sign of the times, with intensive pushback not only in major powers such as the US and Russia, but also in international forums against the recognition of reproductive health rights long taken for granted in many societies.

Multiple votes are worrisome precedent for WHO governing body

Poland pledges to uphold the “consensus” around the FENSA framework for engagement with non-state actors.

For the EB members, themselves, the repeated votes, including by secret ballot, was yet another worrisome sign of the growing fracture between WHO member states in Europe, the Americas and Asia, which tend to identify themselves as socially and politically liberal, and developing nations in Africa as well as Russia, and the Middle East – where more conservative worldviews prevail.

The result, most member states agree, is the creeping “politicization” of global health agendas and issues. And while everyone also has a different point of view about what is political, it’s clear that it is leading to fewer decisions by consensus and more by lengthy, and often bitter, rounds of votes.

“After a record number of votes in the last week, we are alarmed by the notion that this is now becoming the default way to solve difficult issue,” said Poland’s delegate. “We would like to remind everyone that we adopted the FENSA by consensus, and we should respect it subtle equilibrium for the sake of our collective interests.

Matthew Wilson (center): “What you did was democracy”

“It is essential to preserve the independent, transparent, technical and evidence based role of the World Health Organization. We highly appreciate the efforts of the direct chair and other member states in trying to find a solution we could have all subscribed to. Poland remains committed to decision-making by consensus in this organization, and rejects the notion that the voting is now mainstream. We will spare no effort in supporting effective multilateralism and fostering consensus – with all due respect for different contexts of different countries.”

New EB Chair, Matthew Wilson, who sought to strike a more consensual note after the vote, declared: “What you did was democracy, and that’s not a bad thing.”

Dr Franklin Asiedu Bekoe, Director Public Health, Ghana Health Service (right) and Dr Winfred Ofosu of Ghana Health Service (right standing) signing an MoU with Deepak Arora, Country President, African Cluster at AstraZeneca (left) and Ruud Dobber, Executive Vice-President, BioPharmaceuticals Business Unit of AstraZeneca (left standing).

On the sidelines of the 77th World Health Assembly last week, Healthy Heart Africa announced that it would be expanding its work to tackle the rising burden of non-communicable diseases (NCDs) in Africa. Starting this year, the program – which was launched by AstraZeneca in 2014 initially to address hypertension – will now also support countries in combating chronic kidney disease (CKD) and extend its reach into additional countries in North Africa.

We sat down with Deepak Arora, Country President for the African Cluster at AstraZeneca, to learn more about what this expansion means for the continent.

Deepak Arora, Country President, African Cluster, AstraZeneca.

How has Healthy Heart Africa helped address NCDs across Africa?

Partnering with governments, healthcare providers and local communities, AstraZeneca’s Healthy Heart Africa programme supports countries in addressing the growing social and economic burden of NCDs by targeting those in greatest need and improving equitable access to care.

The programme aims to challenge traditional thinking and advocate for policy changes in healthcare to improve outcomes for all individuals affected by NCDs, regardless of their demographic, geographic or socio-economic status. It also seeks to support health systems to embrace innovative health technologies, which have the potential to make screening more accessible, particularly in remote and underserved communities in Africa.

Since our founding 10 years ago, Healthy Heart Africa has trained more than 11,480 healthcare workers and screened more than 50 million people and achieved its aspiration of identifying over 10 million patients with elevated blood pressure across the continent. To date, HHA has been implemented in Kenya, Ethiopia, Tanzania, Ghana, Nigeria, Uganda, Côte d’Ivoire, Senegal, Rwanda, and now Egypt. We are so proud of this impact.

What is the significance of the Memorandums of Understanding (MoU) signed in Uganda and Ghana, and what impact will these have on the countries’ efforts to address the rising burden of NCDs?

In Uganda, chronic kidney disease (CKD) is increasing and is among the top 10 causes of death. This growing burden requires a multifaceted approach that incorporates early screening, diagnosis, and treatment at a primary care level.

The new MoU that we have signed with the Ministry of Health of Uganda will enable us to expand the Healthy Heart Africa programme in the country to tackle this disease. This includes increased education efforts on the symptoms and risks of hypertension and educating about healthy lifestyle choices; training providers and driving care to lower levels of the healthcare system; and offering health screening, and access to treatment and disease management.

 Similarly, in Ghana, the overall prevalence of CKD has been shown to range between 6.74% and 13.3% and is associated with increasing morbidity and mortality, which places significant financial burden on the health system.

AstraZeneca’s Healthy Heart Africa programme has been working with the Ministry of Health, Ghana Health Services, and our implementing partner, PATH, to address hypertension and cardiovascular disease in Ghana since 2019. Our shared commitment to address NCDs is reflected in the memorandum of understanding signed with Ghana Health Services.

We are expanding the HHA programme to address the growing and unmet need for chronic kidney disease. The expanded scope builds on HHA’s scientific legacy of collaborative partnerships to cardiovascular diseases in Africa. This memorandum of understanding outlines the terms and agreements of engagement and collaboration between HHA and Ghana Health Services in cardiorenal care in Ghana.

What unique role does a pharmaceutical company like AstraZeneca play in improving NCD care in Africa?

Pharmaceutical companies don’t only develop and provide health products. They also bring a depth of knowledge about the patient care journey, which can provide insights into what prevents people from getting screened and treated and in turn, strengthen health systems.

We also have extensive experience bringing together a range of stakeholders to address health challenges – from public health experts, researchers, and patients, to tech firms, government officials, and policymakers. Partnerships are central to the Healthy Heart Africa programme.

Working together, we’re able to maximise our impact by addressing the barriers that prevent access to care; increasing awareness of the symptoms and risks of hypertension and educating about healthy lifestyle choices; training providers and driving care to lower levels of the healthcare system, and offering health screening, and access to treatment and disease management.

A significant aspect of CKD is its strong interconnection with other non-communicable diseases such as diabetes and hypertension. These conditions often coexist, creating a complex interplay that exacerbates patient outcomes. For instance, a person with diabetes is at higher risk for cardiovascular issues, and vice versa.

Globally, the incidence of cardiovascular disease among patients with type 2 diabetes is two to three times higher than among those without type 2 diabetes. Similarly, hypertension can both result from and contribute to the progression of kidney diseases. This interconnection underscores the necessity of integrated healthcare approaches to manage CKD alongside other NCDs.

What impact do you hope to have by expanding Healthy Heart Africa?

NCDs, including heart and kidney diseases, are rapidly escalating in Africa. All too often, they are underdiagnosed, undertreated and their interconnections are under-recognised, affecting and claiming millions of lives every year.

NCDs are also exacerbated by climate change, with extreme heat adding stress to the human body and impairing the function of these vital organs. For instance, the carbon intensity of chronic kidney disease treatments, such as dialysis, contributes significantly to carbon emissions, further stressing the need for sustainable healthcare solutions. The detrimental effects underscore the urgent need to integrate broader health strategies to combat these diseases more effectively.

That’s why Healthy Heart Africa is stepping up its efforts. Building on a decade of impact, the programme is tackling the growing burden by broadening its scope to include both heart and kidney diseases. This expansion underscores the importance AstraZeneca places on education and awareness programmes, screening and early diagnosis and sustainable healthcare that aim to improve the resiliency and sustainability of health systems in Africa, and ultimately enhance the well-being of all people across the continent.

By prioritizing access to care for underserved populations, the initiative aims to improve the resiliency and sustainability of health systems in Africa, ensuring that everyone, regardless of their socioeconomic status, has the opportunity to achieve better health outcomes and ultimate enhance the well-being of all people across the continent.

This Q&A is supported by AstraZeneca

Image Credits: Fred Merz.

A baby gets vaccinated against polio thanks to su

With the first-ever malaria vaccines rolling out across Africa and a next-generation tuberculosis (TB) vaccine in testing, scientific advances are driving an unparalleled expansion of vaccine development. But vaccines in development don’t become immunizations that protect our health without concerted efforts by global initiatives like Gavi, the vaccine alliance, that help bring these life-saving products to the world’s poorest countries.

Next month, Gavi will kick-off a campaign to raise several billion dollars to deliver on its new strategy. The stakes are high: falling short of its target could delay delivery of vaccines to those most in need.

But amidst a rapidly changing global landscape, Gavi’s leadership and board must look inwards and seize the opportunity to reform by adjusting its operational model, addressing how it delivers vaccines in humanitarian and conflict settings, sustaining the impact of its investments, and aligning with other global health initiatives to respond to country priorities.

By Gavi’s own count, it has helped immunize more than a billion children since its launch in 2000. But underlying this remarkable impact is a stark reality: millions of women and children continue to miss out on vaccines. Perhaps most staggering is the fact that close to 15 million children around the world still do not receive basic childhood vaccines, leaving the poorest and most vulnerable susceptible to preventable diseases.

Significant gaps in accessing newer vaccines also exist. Only 20% of girls worldwide have received the human papillomavirus (HPV) vaccine, which protects against the leading cause of cervical cancer.

As Gavi’s leadership and board finalize a new strategy that will cement its priorities over the next five years, we urge attention to three areas to ensure that every child, everywhere, has access to vaccines. 

Rethink criteria for selecting countries

First, Gavi should update how it deems which countries receive support. Since its early days, Gavi has channeled financial support for immunization, based on national income per capita, to the poorest countries that also showed the biggest gaps in immunization access. The model is simple: if national income per capita is below the eligibility line, a country can receive full Gavi support; if it is above the line, then no support is given. But almost 25 years later, it’s time to refine how this works. 

 As a growing number of countries face economic headwinds and stagnating vaccination rates in the post-COVID era, Gavi needs to better match support with a country’s ability to pay for vaccines. And as new vaccines – including for TB – become available, Gavi’s model needs to align with the burden of leading infectious killers. 

As one case in point: four of the highest TB burden countries – India, Indonesia, China, and the Philippines – are no longer or were never eligible for Gavi support. But ironically, they are eligible for financial support for TB diagnosis and treatment from Gavi’s sister organization, The Global Fund for AIDS, TB, and Malaria. This policy mismatch could limit the impact of a new vaccine against a major infectious killer.

Invest more in vaccine delivery innovation

Second, Gavi should play a bigger role in scaling innovations to address the barriers that deter vaccine delivery. COVID-19 laid bare just how critical health systems infrastructure is to stopping disease outbreaks in their tracks. It also proved how useful innovations like digital immunization records can be in boosting vaccine uptake.

 With dedicated resources, Gavi can support partner countries to scale proven innovations for immunization systems they want and need. This could include solar panels for electrification of health clinics, unmanned drones for vaccine delivery, and digital immunization records.

While each of these innovations has been proven to work, Gavi’s investments would fill a critical gap in providing financing to scale, thereby leveraging at-risk early funding by other partners. Gavi’s track record in innovation, including financing mechanisms to scale new vaccine introductions, makes it well placed to do so.

Pilot new financing to ensure country control

Lastly, Gavi should pilot new ways to channel financing to partner countries that puts them in the driver’s seat and respond to national priorities. This is especially timely amidst growing calls to shift the center of gravity for decision-making to countries. 

How can this be achieved? One idea is for Gavi to test a new approach that provides a consolidated envelope of resources to each country, scaled to specific criteria including population size.

One portion could be dedicated to vaccine purchasing, enabling countries to base decisions on their own priorities. The second portion could be carved out for technical support and grants for health systems strengthening. With the 2030 deadline of the Sustainable Development Goals in sight, now is the time to experiment. 

Our collective ability to end the scourge of vaccine-preventable diseases is within reach. And Gavi – provided it is able to reform – remains one of our best bets to get there. At this crucial juncture, its leadership, board, and donors must ensure that Gavi has a fit-for-purpose model with adequate resources to deliver on the unfinished immunization agenda in a shifting global landscape.

Janeen Madan Keller is deputy director of the Global Health Policy Program and a Policy Fellow at the Center for Global Development (CGD), where she leads policy-oriented research focused on the economics of global health challenges. 

Orin Levine has worked to accelerate the introduction of, and access to, vaccines and other proven health interventions in low- and middle-income countries for the past 30 years. He served as a member of Gavi’s board for almost nine years, representing the Bill & Melinda Gates Foundation. He currently serves as a member of the Board on Global Health for the US National Academy of Medicine, and on the Board of Directors for the National Foundation for Infectious Diseases.

 

 

Image Credits: Gavi/Karel Prinsloo 2017, Gavi, the Vaccine Alliance.

Egypt [portayed here] and Qatar threaten to “escalate” issue of Center’s recognition to World Health Assembly.
A  bitter debate over proposed WHO recognition of a non-profit center for reproductive health rights, erupted in full force at the WHO Executive Board on Monday – after a tumultuous week of the World Health Assembly where member states largely skirted the increasingly contentious issue of sexual and reproductive health rights.

The proposal by the WHO Secretariat the US-based Center for Reproductive Rights be designated as a non-state actor in “official relations” with WHO – drew fierce opposition from member state blocs of the Eastern Mediterranean and African region – with Qatar threatening to escalate the issue and potentially the criteria for admitting non-state actors into official relations to the World Health Assembly if the WHO recognition of official relations with the organization is approved by the EB.

Qatar, speaking on behalf of the Eastern Mediterranean Region, which extends from Tunisia to Afghanistan, also rejected a compromise proposal by WHO Director General Dr Tedros Adhanom Ghebreyesus to admit the Center on a one-year trial basis – pitched by the DG as the deadlocked session drew to a close, and postponing a decision until Tuesday.

“We are against the introduction of official relations with the Center for Reproductive Rights, with all means give the controversial concepts they promote. And regardless of the decision of the esteemed executive members in this regard, we will seek further discussions on this matter within the wider quora of the WHA,” said Qatar’s representative.

His remarks were echoed by Egypt, Tunisia, Iran, Morocco, Pakistan, Yemen and Senegal, speaking on behalf of 47 African member states, as well as the Russian Federation.

“We firmly stand against the introduction of official relations with the Center for Reproductive Rights due to the controversial concepts they promote,” Egypt said, warning that: “Regardless of the outcome of the decision by the board today, we will seek to escalate this matter to further discussion within wider quorum of the World Health Assembly.”

Some 217 non-state actors, ranging from non-profits advocacy groups to professional associations of doctors, nurses and other health workers, as well as agro- and pharma industry-backed federations, are currently recognized as being “in official WHO relations.”

Raises broader questions over WHO’s entire process for engaging with NSAs

Chile, along with seven other Latin American countries supported the Center’s recognition by WHO.

The designation, which allows the NSAs to participate as observers at the WHA, as well as opening a door to WHO technical and working groups, is only granted after a proven track record of collaborations with the global health agency. The designation is granted in accordance with a strict criteria, known as the Framework for Engagement with Non-State Actors (FENSA), intended to protect the organization from vested interests, especially industry influence.

The FENSA framework was painstakingly negotiated and approved by member states nearly a decade ago, so as to create an even playing field for organizations to work with the global health agency. It includes a lengthy and rigorous trial period, and agreement with a WHO technical unit on a collaboration plan, so that in fact, only a handful or less of new non-state actors are approved every year. Member state review of new, proposed NSA actors, has therefore been largely perfunctory – following the recommendations set by the WHO administration.

Rejecting WHO’s recommendation would set a dangerous precedent

Mexico speaks out in favor of recognition of the Center, saying rejection would set an “unhelpful” precedent.

A large number of European Union member states, as well as the USA, Canada, Australia and a broad non-EU group of member states led by Mexico, expressed concern that the divisive debate could also rip across the entire FENSA process, paintstakingly developed over a number of years by WHA together with legal advisors. It could make any new organization’s candidacy  for the treasured “in official relations” designation, subject to a diverse range of political pressure and influences – rather than technical criteria, they warned.

“We share concerns regarding the negative precedent it would set, we would say if the EB decided to reopen that recommendation in any way,” Mexico’s delegate said. “We member states negotiated and agreed to it by consensus having a robust framework of this nature provides value to the organization, but only if we use it. We are therefore deeply concerned that despite the non state actors having fulfilled the necessary requirements… the EB in January, did not agree.

” We agreed to postpone the decision until this session. Five months have passed, during which the EB  chair conducted extensive and inclusive consultations to find a solution… which resulted in an adequate, good faith proposal,” she said, apparently referring to Tedros’ compromise proposal for a one-year trial period of recognition – as compared to the normal multi-year term.

“‘We regret that this proposal has not been accepted,” added Mexico’s delegate. “We acknowledge the concerns of some allegations on the work of this particular NSA.

“It is worth recalling that ultimately, it is the state-led WHO governing bodies which direct the work of this organization. Therefore, applying a selective approach to the work of single entities undermines well-established and effective governance procedures. It risks setting an unhelpful precedent negatively impacting the efficient and effective, effective governance of the organization –  and politicizing routine decisions that we should trust the Secretary to make in the framework of its mandate,” Mexico said, in a statement supported by other non-EU European countries as well as a seven other Latin American countries including Chile,  the Dominican Republic, Ecuador, Panama, Peru, Uruguay – and echoed separately by Brazil.

Morocco sounds softer note – Thailand and Israel also support

Thailand says recognition of the Center, would expand social inclusion – in line with a WHA resolution approved just last week.

Israel, whose appointment to the EB was bitterly denounced last week, and again this morning by rival states, including Palestine, also expressed support for admitting the Center, saying “We regret the exclusion of important stakeholders, and we believe that a dialogue with all relevant stakeholders is essential.”

Thailand, meanwhile, pointed to a new WHO resolution approved only last week promoting “social inclusion” and said that recognizing the Center would walk the talk on that issue:  “Approving the Center of Reproductive Rights as an entity in official relations would be a concrete example of expanding social participation in WHO’s work, or commitment to involve non state actors in meaningful ways and showing the broader perspective, a more comprehensive approach in global health.”

Morocco, meanwhile, appeared to break ranks with other Arab and African states, appealing for consensus around the WHO Secretariat’s proposal to extend official relations to the Center.

While “there are national laws and concerns to be considered, my delegation would like to reiterate its  trust in the application of eligibility criteria and due diligence when it comes to collaboration of NSAs with the WHO,” Morocco’s delegate stated.

“I note that collaboration between the WHO and the Center has been established and for years work has been carried out on the ground. That’s the reality. Our discussions today are a second stage, we’re opening up new prospects when it comes to artificial relations, in processes led by member states.

“So my delegation is strongly attached, and promoting, the consensus based adoption of this proposal, noting similar cases, with a view to strengthening the credibility of our work and the constructive cooperation spirit that has always prevailed within our Executive Board.”

Tedros proposes a one-year trial period for Center

WHO’s Dr Tedros Adhanom Ghebreyesus appeals to the EB to recognize the Center for Reproductive Rights, even for a one-year trial.

In a late afternoon intervention, Tedros proposed to the EB that opponents of recognition consider a one-year trial period for the Center, as a recognized WHO NSA – rather than the usual multi-year term. But as of early evening, that compromise proposal also seemed doomed to failure. Meanwhile, the EB suspended its discussion until Tuesday, with members on both sides  loathe to continue debating after a string of late nights at last week’s WHA.

Tedros, speaking before critics of the Center’s recognition, said that WHO member states that WHO’s work needs to “stick to science and evidence.”  And according to that evidence, efforts to repress access to abortion only leads to more maternal and newborn deaths, he said, also citing his own experience as Minister of Health in Ethiopia.

“The Ethiopian Parliament passed a law on abortion when I was Minister of Health,” Tedros related.  “That law was passed because of practical problems we were facing. The maternal mortality rate was very, very high. And two of the leading causes of death were postpartum hemorrhage and unsafe abortion. Of course there were other reasons. But the Parliament was very courageous, and since the bill was passed, the maternal mortality rate has declined.”

Two decades later, the very same drivers remain an issue in many countries today, he said, citing a meeting with ministers of health last week on the sidelines of the World Health Assembly, on their high maternal mortality rates, “And in many of the countries, the two leading cause of deaths for mothers are postpartum hemorrhage and unsafe abortion,” he related, noting that even if women are not supported by legal abortion frameworks, “they will do it [seek abortions] anyway. That’s a real problem in some countries.”

Ultimately, it  is poor women, not the rich, who die from illegal abortions, Tedros pointed out, adding: “when a mother is dying, and when we know that why they are dying, we cannot just look the other way.”

WHA delegates spend hours debating and voting on two measures addressing the crisis in Gaza.

WHA delegates spent over 10 hours in diplomatic maneuvers, debates and painful rollcount votes Friday, finally approving two measures that decried the humanitarian crisis in Gaza in sharply different, and sometimes  contradictory terms.  

One motion co-sponsored by a coalition of Algeria, Russia, China, Cuba, Iran, Egypt and other Middle Eastern allies, condemns “indiscriminate attacks” by Israel on medical and humanitarian facilities “used exclusively for humanitarian purposes.”  A second resolution approved in December at a special meeting of WHO’s 34-member Executive Board, including EU countries and the United States, called for a “humanitarian ceasefire”, using more neutral language. 

Both measures ultimately passed with large majorities – but with a raft of abstentions as well as objections on all sides of the aisle. 

The bitter, 10-hour long debate over Gaza, Palestine and Israel, followed a mere two hours of attacks and accusations around a new draft resolution over the Ukraine humanitarian and refugee crisis, with a title referencing “the Russian Federation’s aggression”.   The new Ukraine resolution proposed by European states, with United States support, won WHA approval by a vote of 72-10.  A  counter resolution proposed by the Russian Federation, Syria, North Korea and Belarus, failed to pass, garnering only 13 votes.  

It also came on a day when Palestine was awarded quasi-member state status by the World Health Assembly – in all regards except the right to vote and hold positions on the governing board or other governance instruments. [see related story]

Palestine Granted Quasi WHO Member State Status – Without Voting Rights  

First OPT decision, subject to numerous amendments by bitter rivals

The first Gaza measure, was built around a perennial, stand-alone “decision” on the “Health Conditions of the Occupied Palestinian Territory (OPT), including East Jerusalem and the Occupied Syrian Golan” that is voted on, and approved, every year by the WHA.  The long and rambling text, in fact, addresses a very mixed bag of settings, populations and health conditions.  

This year’s version called out Israel as the occupying power to address “the threat of famine” water and sanitation, and ensure adequate supplies of fuel, medicines and humanitarian aid to Gaza.  A raft of other provisions  mandate WHO to report on “wanton destruction of health facilities”; “acts of violence against the wounded and the sick and medical personnel”, and “results from the use of starvation of civilians.”  

The decision also calls on WHO and Israel to ensure “unhindered access” for Palestinians in the occupied territory including East Jerusalem, to a full range of health products and services. In fact, East Jerusalem Palestinians, are typically enroled in, and served by, Israeli health funds – although if they are not formally registered by Israeli authorities as Jerusalem residents, then access to medial services can be hampered.

However, along with the acute crisis in Gaza, West Bank Palestinians have suffered from oft-serious problems accessing services due to a tough Israeli military crackdown since the war in Gaza began. That has hindered travel to West Bank Palestinian hospitals, private or public, as well as to Jerusalem-based Israeli and Palestinian facilities that are common destinations for more advanced services, like cancer treatment.

Finally, the decision calls upon the WHO to conduct an assessment of health conditions in what it describes as the the “Occupied Syrian Golan”, where communities of Druse, an ancient Middle Eastern religious minority, have lived under civilian law, with access to Israeli health funds, since 1981.  Those Golan communities, like other Jewish, Druse and Palestinian communities in pre-1967  northern Israel, are however, facing physical risks, stress and economic disruptions from the low-level war raging in the north between Israel and the Hamas-aligned Hizbullah, based in southern Lebanon.

Technical or political?

US delegate votes “No” on the first of two WHA measures addressing Gaza – the US abstained on the second measure, a resolution approved at a special December Executive Board session.

Described by supporters as a “technical” measure, the decision was criticized by the US and some European member states, and Israel, as a largely political instrument, singling out one WHO member state amongst 194, and mixing the dire realities faced by Palestinians in Gaza and the West Bank with rhetoric unique to a single conflict.

“The decision before us today has been presented year after year since 1968. Since then, Palestinians and Syrians have used this annual ritual to attack Israel and to absolve the Palestinian Authority of its responsibility for governance,” said Israel’s delegate to the WHA.  

“It has also been used to divert attention from decades of atrocities committed by the Syrian government. This decision has never been about health. If this decision was about health, it would address the systematic and deliberate militarization of health facilities in Gaza by Hamas and by the Islamic Jihad. Health facilities in Gaza are used as hideouts and launch sites for terrorism…. Hamas is deliberately putting the safety of patients at risk. Everyone in this room is well aware of it. Evidence of this militarization was found in every hospital in Gaza and Shifa Hospital for example, there were more terrorists than patients; Israeli forces apprehended some 500 terrorist and eliminated hundreds more.” 

The decision ultimately passed but with the addition of four amendments tacked on by diametrically opposed geopolitical blocs of member states. 

Firstly, an amendment proposed by Israel, which won approval 50-54 in the surprise outcome of a member state vote Wednesday, called for the Hamas release of hostages, as well as condemning the militarization of Gaza’s health facilities.  

In response, Bahrain and 18 other co-sponsors proposed and won approval Friday for three new amendments, including one directly condemning Israel’s  “indiscriminate attacks on medical and humanitarian facilities”.  

Sponsors like Iran abstained because of a mention of hostages

Qatar disassociated itself from an amendment added by Israel, which denounces Hamas militarization of health facilities and calls for the release of Israeli hostages and

As a result of Israel’s amendment, some co-sponsors of the original measure, such as Iran and Libya, ultimately abstained from the final vote on the decision, which passed 102-6.  

“Recent gross violations of international humanitarian law, particularly war crimes, crimes against humanity, genocide, ethnic cleansing, mass disruption of health infrastructure us and enforced displacement committed in Gaza demonstrates as an absolutely unleashed nature of this regime in committing atrocities in an unprecedented manner,” said Iran’s delegate. 

Others, including Mediterranean and Gulf powers, such as Egypt, Turkiye, Tunisia, and Qatar, voted for the measure but explicitly “disassociated” themselves from the Israeli-added reference to Hamas holding of hostages and militarization of health facilities.  Oman complained that the reference to calling for the releease of hostages failed to also refer to the conditions of thousands of Palestinian prisoners who have been detained by Israel before and during the Gaza war – “and are held in inhumane conditions where international representatives are not allowed to visit them.” 

European states distance from some of the decision’s provisions 

Argentina: nothing justifies violence, but if you ignore what happened on October 7, you will have an unbalanced picture.

Meanwhile, a number of European nations and allies that ultimately voted for the Algerian-sponsored measure, or abstained, later sought to distance themselves from some of the stronger language condemning Israel unilaterally for the crisis in Gaza, and particularly for the destruction of health infrastructure.  

Norway, which recently recognized the state of Palestine, called both out “the misuse of hospitals for military purposes” on the one hand, a clear reference to Hamas, as well as “indiscriminate attacks on hospitals” on the other, referring to Israel. 

“Such facilities, for medical purposes, must be respected and protected in all circumstances and by all the parties to the conflict,” Norway’s delegate said.  

The United States, Israel’s staunchest ally, opposed the first, Algerian-sponsored measure, outright.

“We believe the current draft decision does not help advance the cause of a lasting and comprehensive peace between the Israelis and the Palestinians,” the US delegate said in the  debate. 

“Nothing justifies violence on any side, in any part of the world… but we are only going to get to the truth if people start speaking it,” said Argentina. 

 “If you ignore what happened on the seventh of October in Israel. If you ignore the fact that hostages were taken as a result of that, you will be politicizing a situation. You will be giving a distorted, unbalanced picture of what happened – and that will also lead to a complete and utter loss of impartiality.” he said, referring to the Hamas incursion into Israeli border communities that killed some 1200 Israelis, mostly civilians.  

‘Gazans and the people of Israel have both suffered’ 

US votes no on the first of two measures addressing Gaza – and abstains on the second measure.

The late evening WHA session saw the final vote on the second resolution decrying the Gazan humanitarian crisis – this one the product of a consensus reached between G-77 nations, the European Union, the United States and its allies at the December Executive Board meeting.  

But in a surprise move, the United States also abstained from voting on the EB-approved measure, due to what it said was a continuing “lack of balance” with reference to the absence of a reference there to Hamas-held  hostages. 

 “Citizens in Gaza and the people of Israel have both suffered in this conflict. Our top priority is a ceasefire agreement that leads to the release of hostages and creates conditions to facilitate a surge of additional humanitarian assistance into Gaza,” said the US delegate to the WHA in the debate that took place just as  President Joe Biden was anouncing a new US proposal for a Gaza cease-fire and hostage exchange deal.

Allegations of genocide and concerns about hostage release

Belgium, on behalf of the European Union, reaffirms commitment to the release of hostages held by Hamas.

In a debate that preceded a roll call vote, Turkiye, Egypt, Cuba and other bitter critics of Israel, decried what some described as a genocide in Gaza, and others, “war crimes against humanity” in the words of Cuba. 

Meanwhile, European Union delegates and allies, led by Belgium, “urged the Israeli Government not to undertake a ground operation in Rafah, which would worsen the already catastrophic humanitarian situation.”

And they stressed the importance of “respecting and implementing the orders of the International Court of Justice,” which are legally binding. 

The EU also expressed “grave concern” over the “safety and well-being of hostages held by Hamas, calling for their “unconditional release.”

Situation on the ground

An esetimated 1 million displaced Palestinians have now fled Rafah, due to the Israeli operation there, said WHO’s Mike Ryan.

Late Friday evening, and only after hours of bitter member state political sparring, did WHO’s Executive Mike Ryan, provided a brief update of the actual situation in Gaza on the ground. 

“An estimated 1 million people have left Rafah in search of safety that does not exist anywhere in Gaza,” he said, adding the recent Israeli evacuation order affects 17 hospitals including three field hospitals to the north and the loss of more than 600 hospital beds.”

 The flow of health supplies and humanitarian aid remains paralyzed due to the closure of the Rafah crossing into Gaza, following Israels take over of the area. WHO missions to embattled hospitals, particularly in northern Gaza, continue to be cancelled, impeding the flow of health aid within the enclave. 

“The health system degradation continues. The system is winding towards zero humanitarian access,” Ryan warned.

No time left for discussion of other humanitarian crises 

Grade 3 emergencies in late 2022 – before the crisis in Gaza erupted. Most are still ongoing.

Aside from the discussion of Ukraine, the day-long debate left no time for discussion of more than a dozen other  acute crises and conflicts raging in the world today, defined by WHO as Grade 3 emergencies  – and the increased burden of emergency health and humanitarian needs that they have generated. Observed Slovenia’s delegate as the evening discussion on Gaza continued into the late night hours:  

“Slovenia is deeply concerned about the increasing frequency complexity and duration of health emergencies, resulting from conflicts which have led to a significant rise in global humanitarian health needs, affecting people in Afghanistan, Haiti, Somalia, Ukraine, Sudan, Gaza. And elsewhere. The growing number of attacks on healthcare facilities and personnel is unacceptable.”

Gaza transfixes WHA 

WHO Director General Dr Tedros Adhanom Ghebreyesus appeals for a cease-fire – saying it’s good for Israel and the Palestinians.

If it proved anything, the long-winding debate demonstrated the unique and enduring ability of the Israeli-Palestinian conflict to transfix diplomats, defy solutions and polarize WHO member states more than almost any other conflict in the world – captivating the hearts and minds of countries thousands of miles away from the war’s epicenter.  

Said the representative from Cook Island, the dicussion continued towards midnight, “We ae a small island state, and our primary fight is against climate change. We are17,000 kilometers away from Gaza. However, we cannot and won’t ignore the dire humanitarian crisis affecting our fellow human beings, civilians and hostages. And we will support all genuine efforts to address these issues as well.” 

In an emotional late night statement, close to midnight, and just prior to the final vote on a secod resolution, WHO Director General Dr Tedros Adhanom Ghebreyesus, directly appealed to Israel, who he said “held the keys” to a ceasefire call. 

“I ask Israel and appeal to Israel to stop this war,” said Tedros, in a voice hoarse from speaking throughout the week. “For the sake of humanity, I think the key holder should stop the war. 

“It’s in the interest of Palestine in the interest of Israel to go for a political solution,” Tedros  added, while also calling for the  “safety of the hostages, support of medical care, and of course their release.” 

Correction- The correct vote count on the amendment calling for release of Hamas held hostages was 50-44, not 54-50. 

Image Credits: OHCHR , https://cdn.who.int/media/docs/default-source/documents/emergencies/who_ghea-2022_grade3-emergencies-map.pdf?sfvrsn=7215a303_7.

WGIHR co-chairs Dr Ashley Bloomfield and Dr Abdullah Asiri and INB co-chair Precious Matsoso.

After two years of intensive negotiations – including long nights this week – the World Health Assembly (WHA) finally passed amendments to the International Health Regulations (IHR)  and committed to completing pandemic agreement talks within a year. 

After failing to agree on the amendments before WHA opened on Monday, member states have been racing to the finish in a drafting committee during this week in meetings that often went into the early hours.

“Tonight we have all won and the world has won. You have made the world safer,” said a hoarse WHO Director-General Dr Tedros Adhanom Ghebreyesus, who lost his voice during the late-night sessions.

The IHR is a legally binding international instrument aimed at preventing the international spread of disease, and requires countries to conduct surveillance for potential international health threats of all kinds and report those to WHO.

The COVID-19 pandemic showed weaknesses in the IHR, including that it did not mention “pandemic”. Member states submitted over 300 proposed amendments to the Working Group on Amendments to the IHR (WGIHR), chaired by New Zealand’s Dr Ashley Bloomfield and Dr Abdullah Asiri of Saudi Arabia.

“The amendments to the International Health Regulations will bolster countries’ ability to detect and respond to future outbreaks and pandemics by strengthening their own national capacities, and coordination between fellow states, on disease surveillance, information sharing and response,” said Tedros. 

WHI Director-General Dr Tedros Adhanom Ghebreyesus: Hoarse but happy

New ‘pandemic emergency’ defined

The amendments include the definition of a “pandemic emergency” – the highest level of alarm – that will trigger more effective international collaboration in response to a disease outbreak that may become a pandemic. 

“Solidarity and equity on strengthening access to medical products and financing” will be strengthened by a “coordinating financial mechanism” to help to “equitably address the needs and priorities of developing countries” to prevent, prepare and respond to pandemics

A States Parties Committee will be set up to facilitate the effective implementation of the amended Regulations, including the creation of National IHR Authorities to improve coordination of implementation of the Regulations within and among countries.

WHA President Dr Edwin Dikoloti strikes the gavel to indicate the passing of the IHR amendments and extension of the INB’s mandate.

“The experience of epidemics and pandemics, from Ebola and Zika to COVID-19 and mpox, showed us where we needed better public health surveillance, response and preparedness mechanisms around the world,” said Bloomfield, who also co-chaired the drafting group.

Countries also agreed to extend the mandate of the Intergovernmental Negotiating Body (INB) established in December 2021, to finish its work to negotiate a pandemic agreement by the World Health Assembly in 2025, or earlier if possible at a special session of the Health Assembly in 2024.

“There was a clear consensus amongst all member states on the need for a further instrument to help the world better fight a full-blown pandemic,” said Precious Matsoso of South Africa, co-chair of the INB and drafting group.

Credit to multilateralism

Member states generally expressed satisfaction with the final agreement, with the European Union and China describing it as proof of the success of multilateralism.

Ethiopian Health Minister Mekdes Daba, on behalf of Africa group, supports the IHR amendments and urges speedy adoption of pandemic agreement

However, Ethiopia’s Health Minister, Mekdes Daba – representing the 47 African member states and Egypt – urged all countries to use the momentum from the adoption of the IHR amendments to propel agreement on the pandemic accord. The INB meets again in July.

When parallel negotiations on a new pandemic agreement sailed into heavy water, there was a risk that the IHR amendments might become a casualty in the bargaining process – particularly from African member states pursuing equitable access to health products in the pandemic agreement.

They feared that the powerful Western countries pushing for the IHR to be passed – the US, European Union, Japan and the UK – would be less inclined to continue negotiating in good faith on the pandemic agreement once the IHR amendments have been passed. 

Meanwhile, Slovakia dissociated itself from the resolution, and Russia and Argentina said they reserved the right to implement amendments – or not – according to their national sovereignty. Costa Rica also expressed reservations about the extension of the INB’s mandate.

Reactions to amendments

Former Prime Minister of New Zealand Helen Clark, who chaired the Independent Panel for Pandemic Preparedness and Response, welcomed the adoption of the amendments.

“These amended International Health Regulations, if fully implemented, can result in a system that can better detect health threats and stop them before they become international emergencies,” said Clark.

“I congratulate WHO member states for agreeing to regulations intended to improve information-sharing about outbreaks, and action to ensure that countries have access to health products to contain outbreaks, including to the financing required. It’s excellent that a pandemic emergency is now defined in the IHRs.

“The world must now urgently make the investments needed to implement them, including in low- and middle-income countries, with the objective of stopping pandemic threats in their tracks.”

However, Nina Schwalbe, CEO of Spark Street Advisors and an independent observer of the pandemic negotiations, expressed “deep disappointment” that all references to compliance have been dropped in the IHR.

“The amendments do not include any provisions for a compliance mechanism. How can countries be held accountable to their commitments with a compliance mechanism?”

This story was edited to add reactions.