Almost half of the world’s population suffers from a neurological condition, yet in low-income countries, most lack access to medicines needed for treatment.

Nearly half of the world’s population suffers from some form of neurological condition ranging from simple migraines to Alzheimers. And yet in low-income countries, more than 75% of people needing neurological treatment cannot access care, according to a new World Health Organization report released on Tuesday, World Brain Day.  

The treatment gap – the difference between the number of people with a condition and those receiving treatment for it – is the combined result of misconceptions about neurological diseases, low diagnostic capacity and limited access to medicines.

“Most people with neurological disorders struggle to access the treatment they need for their conditions because these medicines do not reach them or are too expensive,” said Dévora Kestel, Director of WHO’s Department of Mental Health, Brain Health and Substance Use in a press statement. 

Should that change, “the impact of neurological disorders can be significantly decreased and quality of life improved.”

Using epilepsy and Parkinson’s disease as tracer conditions, the new WHO report identifies bottlenecks in existing treatments, particularly access to care in remote and rural areas.  

Affordability, procurement and availability of specialists are among the main barriers of access to neurological treatment.

The report also advocates for more education about neurological disorders to reduce stigma. And it recommends that neurological treatments  be integrated more completely into the essential medicines lists (EMLs) of national authorities as well as WHO’s own recommended essential medicines listing.

Finally, local healthcare systems need to budget for procurement of such medications – while international donors and agencies consider how to make treatments more affordable – including through donor-supported funding. 

Treatment access, but also prevention programmes, “will take a whole of society approach, especially given that the whole of society is impacted either directly or indirectly by these diseases,” said Dr David Dodick, co-chair of World Brain Day, at a briefing Monday, just ahead of the WHO report launch.

Nearly half of the world’s population suffers from a neurological condition 

In 2021, almost half of the world’s population, or 3.4 billion individuals suffered from a neurological condition, including side effects from a stroke, Alzheimer’s disease, neonatal brain injury, or chronic migraines, according to the Institute for Health Metrics and Evaluation (IHME) data. 

But the burden is distributed unevenly, with over 80% of the deaths related to neurological conditions, as well as losses in healthy life years, occurring in low- and middle-income countries.

Burden of neurological disorders amount for a total of 443 million years of healthy life years lost globally.

Neurological conditions are a leading cause of healthy life years lost (disability-adjusted life years, or DALYs) in 2021, ahead of cardiovascular diseases. In 2021, that amounted to a total of 443 million healthy life years lost due to a  chronic  illness, disability, or premature death.

Over the last three decades, DALYs associated with neurological conditions rose by 18% – and that is likely to increase further as a result of aging populations as well as lifestyle and environmental risks.

Over 80% of premature deaths from neurological conditions occurs in low- and middle-income countries – which have only 0.1 neurologist, on average, per 100,000 people. 

That is in comparison to 7.1 neurologists per 100,000 people in high-income countries, said Dodick.

On a more positive note, when diagnosis and treatment are available, then some 90% of strokes, 40% of dementia cases, and 30% of epilepsies are preventable. 

“We know what the modifiable risk factors are for some of the most prevalent and disabling neurological conditions, like stroke and Alzheimer’s disease, for example,” Dodick said.

Barriers to reaching global goals set out by WHA in 2022

The report identifies barriers limiting attainment of goals set by the World Health Assembly in 2022 to improve access to neurological care and treatment by 2031. 

The goals, laid out in the Intersectional global plan on epilepsy (IGAP), aim to have four out of five countries providing essential medicines and technologies to manage neurological disorders in primary health care settings within the coming decade. 

Disability-adjusted life years (DALYs) lost to neurological conditions: 80% of the global DALYs occur in low- and middle-income countries.

Even when treatment methods for neurological conditions are theoretically available, patients face many obstacles to accessing care. 

In African and Eastern Mediterranean regions, for instance, children with epilepsy are less likely to attend school because of the stigma surrounding the disorder. As the report shows, lack of knowledge about Parkinson’s and epilepsy, and exclusionary practices around people with those conditions, are common issues.

More regional manufacturing of medicines can bolster supply chains

The paucity of medicines available in pharmacies and clinics also was highlighted by country-level surveys included in the WHO report. 

In Ghana, for instance, out of 180 drug stores surveyed, levitiracetam, which is used to treat epilepsy, was available in only 50% of urban pharmacies and not at all in rural areas. Similarly, another epilepsy medicine, phenobarbital, was only available in roughly every second urban drug stores and in one in three rural pharmacies.

The report highlights the need for regional manufacturing of such medicines as well as more robust supply chains, overall, to ensure that such essential drugs are accessible. 

Consistent regulatory authorization of essential neurological medicines and ensuring their inclusion in national essential medicines lists, could also lead to more state financing support, improving treatment affordability.

Finally, the report also identifies the need for more specialised healthcare staff, particularly in rural areas, as well as more systematic data collection to improve surveillance. 

Neurological health access should be “inclusive and equitable”, also on the prevention level, said Prof. Tissa Wijeratne, Co-Chair, World Brain Day, during the webinar. “Access to preventative measures at community level, grassroot level, individual level, […] should be available to everybody across the world.”

Image Credits: WHO, IHME.

Bavarian troupe of gay traditional folk dancers provide entertainment at the opening of the International AIDS Conference.

MUNICH – German Chancellor Olaf Scholz reaffirmed his government’s commitment to the global campaign against AIDS, including the Global Fund, at the opening of the international AIDS Conference – and appealed to other global powers to do the same.

The Ukraine war is draining Germany’s resources, and on the far right, the substantial and growing influence of the anti-immigrant, anti-global Alternative for Germany (AfD) party is also influencing German spending and policies.

The budget of the government’s development ministry (BMZ), largely responsible for overseas development aid, was cut by 7% earlier this year sparking fears that Germany may retreat from its leading role in global health.

“As one of the largest donors, Germany contributes €1.3 billion to the Global Fund to Fight AIDS, Tuberculosis and Malaria,” Scholz told the packed conference, which is being attended by over 10,000 delegates.

“And we will continue to support it because programmes sponsored by the Global Fund have saved 59 million lives,” he added to applause.

“We also support UNAIDS and the World Health Organization and will continue to be a reliable partner. Together with France and Norway, Germany supports the WHO Replenishment Round as a co-host for the European Union. Because the WHO needs more support. It is the chain that holds different threads of global health together.

“I would like to call on other donors for stronger support,” Scholz added. 

German Chancellor Olaf Scholz speaking at the Opening Session.

PEPFAR jitters

As Russia’s war on Ukraine drains European resources, the possibility of a victory by Donald Trump in the US presidential campaign is triggering fears that a drastic reduction in the US President’s Emergency Plan for AIDS Relief (PEPFAR) could then follow. Through PEPFAR, the US has been the world’s largest single historical sponsor of antiretroviral medication in Africa, and other game-changing innovations in HIV/AIDS prevention and treatment since 2003.  

However, Chris Collins, CEO of Friends of the Global Fight, said at a pre-conference media briefing that “bipartisan commitment to the program remains solid in the United States.”  That, despite the fact that what he described as “misinformation” held up the five-year reauthorization of PEPFAR by the US Congress in 2024 – with Congress ultimately agreeing only to a one year authorisation, until 2025. 

Addressing the same briefing, PEPFAR’s head, Ambassador John Nkengasong, warned that “now is not the time to sit back; we must sustain the gains we have all worked so hard to make against this pandemic and accelerate our efforts to end it.”

Sharon Lewin, IAS President and International Chair, opening the session.

International AIDS Society president and chair of the conference Sharon Lewin warned against “regressive policies, attacks on human rights, the spread of misinformation, cuts to global health funding, and waning trust in international institutions”.

 “We’ve seen incredible breakthroughs at AIDS 2024, including a new case of long-term HIV remission and a promising twice-yearly injection [lenacapavir] to prevent HIV,” added Lewin.

“To end HIV as a threat to public health and individual well-being, we need an evidence-based HIV response and a political climate that respects science.”

Debt relief call

UNAIDS executive director Winnie Byanyima.

UNAIDS Executive Director Winnie Byanyima called for debt relief for low-income countries that are unable to meet their citizens’ needs – including HIV prevention and treatment – and service their debt.

“In Angola, Kenya, Malawi, Rwanda, Uganda and Zambia, debt servicing is more than 60% of all the government revenue that is collected. Sierra Leone spends 15 times more on public debt servicing than on the health of its people,” said Byanyima.

“The choking debate must be restructured and restricted now.”

Appeal to Gilead to allow generic production of ‘miracle drug’ lenacapavir

She also called on Gilead, the manufacturer of the “miracle drug” lenacapavir – the twice-yearly injection that protected 100% of women from HIV infection in a recent trial – to “make history” by licensing generic manufacturers to produce it more affordably through mechanisms such as the Medicines Patent Pool (MPP).

“Gilead has an opportunity to take us closer to ending AIDS as a public health threat,” Byanyima told AFP in an interview at UNAIDS’ headquarters in Geneva.

“Those people hiding from the law — gay men, trans women — who could come out just twice a year to get their injection and be safe,” she said. So could young women in Africa, fearing stigma and domestic violence.

Lenacapavir was approved for use in 2022 for HIV patients in the United States and the European Union. But its cost of around $40,000 a year in the US currently puts it out of reach for most low- and middle-income countries.

Ukrainian leader urges action 

Ukraine’s Andrew Klepikov received a standing ovation at the opening session.

The AIDS 2024 conference includes a special focus on eastern Europe and central Asia, a region with one of the fastest-growing HIV epidemics in the world. 

“While most other regions around the globe have managed to stabilise their HIV epidemics, in eastern Europe and central Asia, it is rapidly increasing,” Andriy Klepikov, AIDS 2024 Regional Co-Chair, told delegates to the event.

“Only half of people living in our region are on antiretroviral therapy, nowhere near the global target of 95%. At the root of the region’s epidemic are drug use, stigma and harmful policies – exacerbated by violent conflict.”

Klepikov asked delegates to imagine the sound of air raid sirens, which he described as the background soundtrack of daily life in Ukraine.

“I would like to sound a siren today about the [HIV and AIDS] danger in eastern Europe and central Asia,” he added.

“Progress will require major change and innovation, removing policy barriers and respecting the rights of the communities most affected by HIV.”

Impact of Uganda’s anti-LGBTQ law

Trans man Jay Mulucha, head of Fem Alliance Uganda, speaking to delegates at the 2024 International AIDS conference.

Trans man Jay Mulucha, head of Fem Alliance Uganda, gave a moving address about the impact of Uganda’s 2023 Anti-Homosexuality Act, which introduces harsh penalties for a range of same-sex activities.

He said that being HIV positive and trans meant that “we are always discriminated against when we go for treatment” and face “corrective rape”.

His organisation’s Uganda office had been closed down, as has the homeless shelter it provided for trans people, “meaning that we are unable to supply HIV and social services for our community.”

Mulucha said his life is constantly in danger and Uganda’s LGBTQ community remains “isolated and vulnerable” – despite recent international pressure on the government of Yoweri Kaguta Museveni, who has now been in power since 1986.

“The sanctions and penalties being placed by the international community on the Ugandan government are working, but the lifting of these sanctions needs to be contingent not on changes in policy, but on evidence of changes in implementation,” said Mulucha. 

“You need to listen to the communities and hear what we are saying. We are still suffering and need your support more than ever. So the funding that is being denied to the government should be funnelled directly into LGBTIQ organizations and communities in Uganda.”

Image Credits: Steve Forrest / IAS, Steve Forrest / IAS, teve Forrest / IAS.

WHO’s Dr Prebo Barango at the NCD Alliance event at AIDS 2024

MUNICH – Despite a global commitment to cut deaths from non-communicable diseases (NCDs) by a third by 2030, virtually all countries are off-track  – and the NCD Alliance is appealing to allied organizations to help pressure governments to take action.

“NCDs cause three out of four deaths globally, and 80% of premature mortality from NCDs – deaths before the age of 70 – take place in low- and middle-income countries,” the World Health Organization’s (WHO) Dr Prebo Barango told an NCD Alliance satellite event shortly before the opening of the international AIDS conference in Munich.

“We also know that HIV mortality is worse in low and middle-income countries and that so there is a colliding epidemic of HIV and NCD,” added Barango.

Aside from the global goal to cut NCD deaths, which is one of the Social Development Goals (SDGs), global leaders made another commitment, NCD Alliance CEO Katie Dain said the meeting.

HIV High-Level Meeting

They committed at the 2021 United Nations High-Level Meeting on HIV and AIDS to ensure that “90% of people living with, and affected by, HIV have access to people-centred and context-specific, integrated services for HIV and other diseases, including NCDs and mental health by 2025,” said Dain.

“This, in many ways, is one of the real frontiers of the global HIV response, recognising that people living with HIV are living longer thanks to advancements in antiretroviral antiretroviral therapy,” she added.

But slow progress to achieve this 90% goal has prompted the NCD Alliance to issue a call for action to world leaders – and they have appealed to HIV organisations to sign the open letter.

The letter calls on all governments to “fulfil their commitments to tackle the NCD burden” by the time they attend the UN High-level Meeting on NCDs in September next year. They are calling for three key actions:  mobilising more investment, accelerating the implementation of policies to reduce NCDs and monitoring the progress made.

“NCDs such as diabetes, cancer, cardiovascular diseases, chronic respiratory conditions, neurological conditions, and mental ill health, are the leading cause of death and disability worldwide,” the letter notes.

“We urge governments to fulfil their responsibility to protect current and future generations from the risk factors that cause NCDs and provide healthcare for those who need it.”

Image Credits: Marcus Rose/ IAS.

UNAIDS executive director Winnie Byanyima and IAS chair Sharon Lewin at the launch of the UNAIDS report in Munich.

MUNICH – While new HIV infections in 2023 plummeted globally to the level that they were in the late 1980s, they have surged by 20% in Eastern Europe and Central Asia since 2010, according to UNAIDS.

There were 140,000 new HIV infections across Eastern Europe and Central Asia in 2023, with 93% of new cases occurring in Russia, Ukraine, Uzbekistan, and Kazakhstan, according to the UNAIDS global report released on Monday ahead of the International AIDS Conference in Munich, Germany.

Since 2010, there has been a 20% rise in new HIV infections and a 34% increase in AIDS-related in Eastern Europe and Central Asia – while over the same period, 59% fewer people acquired HIV in sub-Saharan Africa – traditionally the worst affected region in the world.

Restrictive legal environments obstructing progress

“Restrictive legal environments and stigma are obstructing progress in the region,” said Eamonn Murphy, UNAIDS Regional Director for Eastern Europe and Central Asia.

“Restrictive laws, along with aggressive policing and stigma, push people away from medical care. If people are pushed underground, the HIV response will not succeed.”

Only half of the 2.1 million people living with HIV in Eastern Europe and Central Asia are on treatment, and only 42% of those living with HIV have suppressed viral load – the lowest rate globally. People with suppressed viral loads don’t pass the virus on to others.

Almost all new infections (94%) are in what AIDS researchers term “key populations” – men who have sex with men, people who inject drugs, and sex workers – and their sexual partners. Yet only 12% of resources are dedicated to prevention programmes for key populations.

All 16 countries in the region criminalise sex work, 13 criminalise the non-disclosure, exposure, or transmission of HIV, and seven criminalise small amounts of drug possession for personal use.

Only 43% of gay men, 52% of people who inject drugs, and 58% of sex workers get HIV prevention services. 

“The criminalisation of small amounts of drug possession for personal use, of sex work, and of HIV transmission and exposure, are driving the people most in need underground and out of reach of HIV services,” according to UNAIDS.

Nearly half the people surveyed who inject drugs in Kyrgyzstan and 32% of people living with HIV in Tajikistan reported avoiding medical care due to stigma and discrimination. 

“Supporting the leadership of communities is essential for reaching marginalised people and providing vital outreach services. Without community leadership and the integration of community services into the health system, reaching these groups is too difficult,” said Elena Rastokina, lead of the ‘Answer-Kazakhstan’ Association, which represents women with HIV.

HIV activists Ganna Dorbach and Elena Rostokina

“The shrinking of civic space and attacks on human rights threaten our response to HIV, which is based on community-led or civil society-provided services. Addressing these interconnected issues is essential for a sustainable response to the AIDS epidemic in our region,” said Ganna Dovbach, executive director of the Eurasian Harm Reduction Association.

Several governments in the region are trying to eliminate the space for civil society which would make it almost impossible to reach key populations, Dovbach told a media briefing in Munich on Monday.

Georgia, for example, is in the process of making all civil society organisations that get more than 20% of their funds form abroad to register as “foreign agents”.

‘Without respecting human rights, we cannot defeat AIDS’

Andriy Klepikov, AIDS 2024 Regional Co-Chair.

Speaking at a press briefing Monday at the opening of the 2024 conference, Andriy Klepikov, AIDS 2024 Regional Co-Chair, charged that Russia’s influence in the region is having ripple effects on stigmatization of LGBTQI populations and people who inject drugs – leaving them further than ever outside the circle of treatment.

“Eastern Europe and Central Asia have the least number, percentage, of people on treatment. Only 50%. This is a very worrisome signal,” he observed.

He called on other European governments and civil society groups to amplify calls to defend the rights of marginalized communities.   

“We have the Russian war against Ukraine. But actually what we have observed is a kind of hybrid war ….against evidence based science. We see that ideology stereotypes prevails over evidence based interventions,” he asserted.

“How many people are on opioid substitution therapy in Russia where 1 million people use drugs how many ? No one, not a single one. A WHO-recommended evidence based intervention is prohibited. How many people have access to clean needles and syringes? … Almost no one.”

“But why am I calling this a hybrid war? Look at what is happening in Central Asia where Uzbekistan, more recently Kyrgyzstan, and more recently in Georgia, where LGTBQI  populations are getting brutalized and criminalized. 

“In Russia, they say there are no transgenders. How you can treat people which not exist? 

“It’s very important to apply innnovations.. but without respecting human rights, we cannot defeat AIDS.”

 

However, Armenia is moving in a more positive direction, said the country’s health minister, Anahit Avanesyan.

“For us, an important change of pathway for the patients is to make more services affordable in primary health care. This means self testing. It means making ARV treatment affordable in the regions, not only in the capital,” said Avanesyan.

Armenian Health Minister Anahit Avanesyan and Eamonn Murphy, UNAIDS Regional Director for Eastern Europe and Central Asia.

However, Russia’s war on Ukraine has strained her country’s resources as it deals with an influx of refugees equal to around 3% of the country’s population.

Dr Hans Kluge, World Health Organization (WHO) regional director for Europe, called for the normalisation of testing for HIV and sexually transmitted infections to address the problem.

“I’m very, very concerned about the situation in my region, particularly in the sub-region, which we call Eastern Europe and Central Asia, where we saw an increase in new HIV infections,”  Kluge told Health Policy Watch. WHO Europe covers 50 countries including the EU, Russia and the Balkans.

“This is a big paradox because we have everything. We have a preventive treatment which works. We have rapid diagnostic tools. We have an effective treatment, one pill a day. The issue is not so much medical, but societal in the sense that stigma and discrimination.”

He called for a massive scale up of HIV testing and the “decriminalisation of a number of policies” 

New HIV infections have increased by a staggering 116% in the Middle East and North Africa, albeit off a very low base, and by 9% Latin America since 2010. However, both regions have reduced AIDS deaths during that time.

Many of the AIDS deaths in Eastern Europe are being fuelled by a high prevalence of multidrug-resistant (MDR) TB. 

A study of TB/HIV coinfection using data from clinics in Belarus, Georgia, Latvia, Poland, Romania and Russia found that 19% of people newly diagnosed with TB had MDR TB and there was a 14% rate of TB recurrence. Over half the people with recurrent TB died.

Funding gap

A widening funding gap is holding back the HIV response. Approximately $19.8 billion was available in 2023 for HIV programmes in low- and middle-income countries (LMICs), almost  $9.5 billion short of the amount needed in 2025. 

Total resources available for HIV, adjusted for inflation, are at their lowest level in over a decade. The regions with the biggest funding gaps – eastern Europe and central Asia and the Middle East and North Africa – are making the least headway against their HIV epidemics.

“Countries in sub-Saharan Africa rely heavily on external funding for their HIV prevention programmes, whereas in eastern Europe and central Asia and Latin America, most of the funds spent on those programmes come from domestic coffers,” according to the report.

“World leaders pledged to end the AIDS pandemic as a public health threat by 2030, and they can uphold their promise, but only if they ensure that the HIV response has the resources it needs and that the human rights of everyone are protected,” said UNAIDS Executive Director, Winnie Byanyima.

“Leaders can save millions of lives, prevent millions of new HIV infections, and ensure that everyone living with HIV can live healthy, full lives.”

UNAIDS estimates the funding gap for Eastern Europe and Central Asia  to be 54%, 85% for the Middle East and North Africa; 65% in Asia and the Pacific and 16% in western and central Africa.

Around 59% of funding for HIV comes from countries’ own domestic budgets, but both international and domestic HIV funding are under stress, the report notes.

“Adjusted for inflation, domestic HIV funding declined in 2023 for the fourth year in a row, and international resources were almost 20% lower than at their peak in 2013. Financing support from bilateral donors has dwindled dramatically.”

Germany’s Dr Sabine Dittmer and Dr Nittaya Phanuphak, Executive Director of the Institute of HIV Research and Innovation in Thailand.

The Global Fund to Fight AIDS, Tuberculosis and Malaria and the US government development assistance for HIV are the key bulwarks against further regressions. However, many countries in Europe and Central Asia do not qualify for Global Fund or Gavi assistance because of their middle-income status.

Money is Europe is tight because of Russia’s war against Ukraine. German State Secretary to the Federal Minister of Health Dr Sabine Dittmar said that her country was committed to funding UNAIDS at the same level and that her health budget had not been cut, although the budget for the development ministry had been cut.

Progress in sub-Saharan Africa

Despite the setback in Eastern Europe and Central Asia, worldwide almost 31 million people were receiving lifesaving antiretroviral therapy (ART) in 2023.

The 39% decline in new HIV infections globally is due “primarily to progress achieved in sub-Saharan Africa”, according to the report. 

Between 2010 and 2023, there was a 59% reduction in new infections per annum in eastern and southern Africa and a 46% reduction in western and central Africa.

In sub-Saharan Africa, life expectancy has jumped from 56.3 years in 2010 to 61.1 years in 2023.

“For the first time in the history of the HIV pandemic, more new infections are occurring outside sub-Saharan Africa than in sub-Saharan Africa,” the report notes.

South Africa runs one of the biggest treatment campaigns in the world. Almost one-fifth (19%) of all people on ART worldwide are in South Africa. In 2023, the country’s HIV programme was providing treatment to 5.9 million people, about 77% of all people living with HIV in the country. 

Over 90% of the people receiving treatment in South Africa in 2023 had a suppressed viral load. 

“This massive treatment programme has led to a rebound in average all-person life expectancy, from 53.6 years in 2004, when the treatment rollout began, to 65.9 years in 2023,”notes UNAIDS.

However, HIV incidence in girls and young women aged 15–24 years is “extraordinarily high in parts of sub-Saharan Africa”, according to the report.

“Prevention programmes and efforts to reduce gender inequalities, violence against women and harmful gender norms are not having a big enough impact,” it notes.

People living with HIV and NCDs tell their stories at the last International AIDS Conference.

MUNICH – People living with HIV and non-communicable diseases (NCDs) often have to see different health providers for each condition, wait too long for their NCDs to be diagnosed and take medication that can interact with one another.

In addition, most were unaware that their HIV status increased their risk of some NCDs – and some health workers did not know how to manage their conditions. This is according to a collection of interviews with people living with HIV and NCDs launched in advance of the AIDS 2024 conference.

A Case for Integration: A Collection of Lived Experiences of People Living with NCDs and HIV has been published as part of the NCD Alliance’s “Our Views, Our Voices” initiative, dedicated to promoting the meaningful involvement of people living with NCDs in the NCD response.

Kenyan Domitilah Anyango Okeymo, 50, lives with HIV and hypertension. When she moved to a rural part of the country, she was told she had to go to two different clinics for her two conditions.

“Here, they have an HIV clinic, but I have to go to another facility for hypertension and then explain everything there again. It is not comfortable having to explain to different people and disclose my status each time. So, I check my blood pressure myself,” said Okeymo.

Serah Mbovi Makau, 58, has HIV, hypertension and diabetes.  Diagnosed with HIV back in 1996, Kenyan Makau shunned health care for 10 years until TB and other opportunistic infections forced her to seek help.

She first took TB treatment, then antiretroviral (ARVs) medicine in 2006.

‘All was fine until 2018 when I discovered that I was hypertensive. I went to a regular clinic, where they tested my blood pressure and, realising that it was high, they put me on medication,” said Makau.

“Now I had another medication, which I had to take daily, another appointment and another clinician I had to see. Taking both medications was not easy. The timings of the medication didn’t match. I also felt that each clinician had their own interest – HIV only or hypertension only.”

Makau wishes that her conditions “can be treated and monitored in one clinic, with one clinician, and one appointment”. 

“I want to be treated holistically, and to be given information about these conditions and my medications so that I am empowered to manage them,” she added.

People living with HIV have a much higher risk of getting certain NCDs

Mental health struggles

Many people living with HIV struggle with mental health, yet most are unaware that their HIV status makes them more vulnerable. 

Zambian Luthando was infected with HIV at birth but only found out at the age of 14 when she and her friends decided to have HIV tests.

“When the results came, my friends were given their status there and then. But the counsellor told me that they needed my mother to be present.”

When she returned with her mother, the counsellor told her that she was HIV positive. The and asked if she was sexually active.

“I didn’t know about mother-to-child transmission. At this time my mother disclosed her status to me and my older sister,” said Luthando.

Once she had completed high school, “the reality of my status hit me”, says Luthando, who is now 25. 

“Even if I seemed okay on the outside, inside I wasn’t okay. I would break down and cry, I didn’t talk to my mum some days and I became rude in our conversations. It took connections with people for me to make a change and come to terms with my status,” she says, adding that a support group and counsellor helped her.

“I would like to see all clinics give information to patients, in their languages, about mental health support. I also want to see healthcare providers asking their patients more questions about how they are coping and what their needs are. They should be trained to offer this support and information on mental health,” she stresses.

Lack of diagnosis

A number of people with HIV also reported that their other conditions were not promptly diagnosed by healthcare workers at HIV clinics.

Indian Mona Balani, 48, lives with HIV and hypertension, but feels that her health promblems have often been overlooked because health workers assume that they are all related to HIV.

“Every time I’ve sought treatment for health issues other than HIV, discrimination has been my constant companion,” recounts Balani.

“Stigma and discrimination contributed to further delay in diagnosing my extra-pulmonary TB in the abdomen, pushing me close to death,” she said.

“Beyond my own story, other people living with co-morbid conditions in my community also face similar challenges, including the fact that most of the NCDs are left undiagnosed, untreated or inadequately treated due to stigma and discrimination associated with HIV and TB,” Balani added.

“With my experience, I would like to emphasise the need for HIV-NCD service delivery integration.”

Her story is echoed by that of Ashleigh Bezuidenhout, who lives in South Africa.

“For three years, between 2018 and 2021, I suffered severe stomach cramps and constipation. Each time I told my [HIV] doctor, I was just given laxative medication and sent home,” says Bezuidenhout.

“The focus was on treating us for HIV and not on our overall health. It broke me all the time leaving the clinic or hospital and always being told that there was nothing serious, when each X-ray or scan showed lumps on my ovaries and all I got was numerous types of pain meds which helped just for a short time.”

Finally, in February 2021, she went to hospital after her HIV clinic had once again fobbed her off with laxatives.

“A scan detected a mass and the doctors had to put a draining tube through my nose to help relieve the swelling and pain in my stomach,” says Bezuidenhout.

“I needed an emergency operation which took place a few days later. They removed a big mass the size of an orange, 12 small tumours and 30cm of my small colon which was badly infected. I tested positive for cancer of the colon, and ended up with a stomah bag, which I still have today. My world shattered when I was given this diagnosis and told I needed to have chemotherapy.”

The NCD Alliance has developed 15 Transformative Solutions, which are recommendations for contextually appropriate, person-centred information about NCDs and their risk factors for people living with HIV. 

 

Administering oral polio vaccine – Gaza’s vaccination rates have plummeted since war began.

Variant type 2 poliovirus (VDPV) has been isolated from six environmental (sewage) samples in the Gaza Strip – collected from two different collection sites in the southern city of Khan Younis as well as Deir al Balah, further north,  WHO confirmed Friday.

The variant poliovirus strains detected in all six wastewater samples, collected in late June,  are genetically linked to each other, said the WHO-hosted Global Polio Eradication Initiative (GPEI), in a news release.

“It is important to note that virus has been isolated from the environment only at this time; no associated paralytic cases have been detected,” the GPEI statement noted. Even so, it added that, “WHO considers there to be a high risk of spread of this strain within Gaza, and internationally, particularly given the impact the current situation continues to have on public health services.”

The oral polio vaccine (OPV) that has brought the wild poliovirus to the brink of eradication provides better immunity in the gut, which is where polio replicates. But the vaccine virus is also excreted in the stool. And in communities with low-quality sanitation, this means that it can be spread from person to person and actually help protect the community.

However, in communities with low immunization rates, as the virus is spread from one unvaccinated child to another over the course of 12-18 months, it also can mutate and take on a form that can cause paralysis just like the wild poliovirus. This mutated poliovirus can then spread amongst undervaccinated children in the same communities – as cases of vaccine-derived poliovirus (VDPV).

Immunization rates have declined sharply in Gaza – while clean water is scarce and garbage piles up

Gazans struggle to obtain basic supplies of food and water amidst mounting piles of garbage and debris.

Routine immunization rates in the occupied Palestinian territory (oPt), including Gaza and the West Bank, were estimated at 99% before the start of the conflict on 7 October 2023, when Hamas forces invaded some two dozen Israeli communities, killing 1200 people mostly civilians and taking 240 people hostage.  By end 2023, vaccination rates had declined sharply to 89%, according to the latest WHO-UNICEF routine immunization estimates. But the data does not separately address Gaza, which has suffered widespread destruction of its health infrastructure, along with over 38,000 deaths and nearly 90,000 injuries over the course of the nine month war.

Inside Gaza, currently only 16 out of 36 hospitals are partially functional and 45 out of 105 primary health care facilities are operational, contributing to reduced immunization rates. In addition, garbage has piled up, drinking water sources have been damaged or destroyed by the war, and sewage water is pervasive across the enclave in the wake of the breakdown in the enclave’s sewage treatment plant.  And that is in addition to pervasive malnutrition and undernutrition – increasing infectious diseases of all kinds, including but not limited, to polio.

Virus crosses borders – and conflict zones

Responding to the alert, Gaza’s Hamas-controlled Ministry of Health called for “an immediate halt to the Israeli aggression, providing usable water, repairing sewage lines, and ending population crowding in places of displacement.”

Israel’s Ministry of Health also confirmed the presence of the virus in samples it had taken from Gaza. The samples “raise concerns about the presence of the virus in this region,” the Ministry said.

Vaccine-derived polio virus has also plagued Israeli communities in recent years, where it has been circulating widely in sewage for some time, occasionally striking in under-vaccinated communities. In March 2022, a four-year-old girl from Jerusalem was diagnosed with the paralytic disease – the first case in the country since 1989.  Her case was also determined to be a vaccine-derived form of the virus.  In March 2023, four more children in northern Israel were diagnosed with the asymptomatic cases of the virus – they, too, counted among the estimated 150,000 Israeli children who are unvaccinated – mostly living in ultra-Orthodox Jewish communities.

“Unfortunately, it is no surprise that there is polio in Gaza sewage,” Professor Nadav Davidovitch, director of the School of Public Health at Ben Gurion University, was quoted as saying in Israeli media.

“Concerted effort is needed to see that everyone is vaccinated in Gaza, including Israeli soldiers, hostages, and especially the babies born in Gaza,” he said. “We must have regional collaboration in order to stop the spread of the disease.”

Image Credits: Global Polio Eradication Initiative, UNRWA .

‘Respect my HIV’ protest in London, November 2021

WHO’s Regional Director for Europe reflects on why we haven’t been able to end AIDS despite having the tools to do so – as Germany hosts the 25th International AIDS conference.

Twenty-four years ago, Maria Godlevkskaya was in a coma in a hospital in Russia, her immune system having failed without treatment for her HIV. She had been diagnosed with the virus five years earlier. Fast forward to today, and not only is Maria leading a full and healthy life, she also hasn’t passed the virus on to her son.

Back when Maria was diagnosed, at the turn of the millennium, HIV treatment was still largely in its infancy and not widely available. For millions of people around the world HIV was a death sentence – and still remains life-threatening for millions more today. Since the beginning of the epidemic in the 1980s, HIV/AIDS has claimed more than 40 million lives, and that’s probably an underestimate.

Maria considers herself extremely lucky. She puts her survival down to two things: access to high-quality care and acceptance from her doctors, family, and friends.

Maria Godlevskaya turned her HIV diagnosis into a calling.

As the 25th International AIDS conference opens in Munich on Monday, the WHO European Region, covering 53 countries across Europe and Central Asia, has made significant progress in tackling HIV. Medically speaking, we have all the tools we need. Once a person accesses HIV testing, health systems in our region can diagnose (some faster than others) and get people onto treatment which is almost always available and offered free of charge.

Why then are only 72% of people living with HIV in our region aware of their status? 50% of them receive a late diagnosis. We are not managing to reach people in a timely way, and this trend has not changed for 10 years. In a highly developed Region with high clinical standards, what is going wrong?

The biggest barrier to ending AIDS is not medical

The sad truth is the biggest and most stubborn barrier to ending AIDS is not medical. It’s the persistent HIV-related stigma and discrimination and criminalization of HIV transmission and behaviours, that derails prevention efforts and prevents people from seeking diagnosis and care.

In the European Region, where advances in treatment and care have increased life expectancy for those living with HIV to a point where it’s effectively a chronic condition like diabetes or hypertension, we must urgently address the pervasive stigma that continues to prevent the Region – and indeed the world – from reaching the global target of ending AIDS as a public health threat by 2030.

Stigma and discrimination have long created barriers. For example, more than one in five (21%) people living with HIV report being denied healthcare in the past year. Meanwhile, stigmatizing attitudes contribute to physical and economic violence, affecting their education and employment opportunities.

Stand up to discrimination in all forms

Discrimination can come in many forms, devastating lives, and eroding the hard-won trust in health workers and the health system, which can take years to rebuild.

The LGBTQI+ community, sex workers and injecting drug users – key populations that remain at the heart of the epidemic – often bear the brunt of society’s intolerance.

I have heard countless stories.

In a country where same-sex relations are criminalized, an HIV-positive gay man was sent to jail rather than receiving the medical attention he so desperately needed.

In yet another country, a 19-year-old heterosexual woman, who was born with HIV, faced bullying from her community, often being ‘outed’ as HIV-positive without her consent.

Naming and shaming countries or governments or health workers is not helpful, because discrimination can – and does – rear its head in every country and society, even those perceived as open and liberal.

We must stand up for people living with HIV, and challenge the ingrained attitudes and structures that can make their lives so difficult. Change is possible, but only if we fight for it.

Six strategies to end AIDS by 2030

Protestors call for universal access to anti-retroviral treatment and against AIDS denial, in Cape Town, 2002. The struggle against stigma continues.

To end AIDS as a public health threat by 2030 we need to:

  • Put people first. We must make our health and community systems accessible and acceptable to those most marginalized.
  • Raise awareness and dispel lingering myths about HIV. Education remains our most potent weapon against stigma, including age-appropriate comprehensive sexuality education that provides young persons with a foundation for empathy, life, and love.
  • Advocate for policies that protect the rights of PLHIV and fully dismantle discriminatory laws and practices.
  • Create safe spaces where individuals can share their experiences without fear.
  • Encourage regular testing and early treatment. When we normalize HIV testing, along with testing for other sexually transmitted infections, we reduce stigma.
  • Highlight stories of courage, resilience, and triumph over stigma. Let us celebrate the strength of those who have overcome adversity and allow them to flourish as champions for change.

‘Attention, care and respect’

Not too long ago, I had the privilege to speak to Maria – who now lives in Germany – about serving as an advocate for people who live with HIV. She turned her HIV diagnosis of more than two decades ago into a calling, setting up Russia’s first network to support women affected by the virus.

Her strength and courage continue to inspire me, and her story – along with so many others – should give us all hope for a better future, even in the face of formidable challenges.

“My first visit to the AIDS center in Saint Petersburg was filled with attention, care, and sympathy. From those early days both my doctor and my family treated me with respect,” she told me.

“I would like it to be this way for every young person who joins our ranks. I want everyone who is scared, anxious and struggling to understand, to have access to a peer counselor, so that the path out of the darkness of fear, loneliness and uncertainty can be walked hand-in-hand together, towards the light of knowledge and self-confidence. An HIV diagnosis doesn’t make a person a mistake. And I wish this feeling and knowledge for everyone living with HIV.”

Keeping the promise of ending AIDS is not just a medical objective; it is a human rights imperative.

We can be the generation that eradicates HIV stigma, embraces compassion, ensures full access to diagnostics and treatment, and paves the way for a healthier, more inclusive world. Only then will we end AIDS – once and for all.

Dr Hans Henri P Kluge, director of the WHO European Region.WHO Euro

 

Image Credits: Ehimetalor Akhere Unuabona/ Unsplash, Louis George 2011 .

HIV Awareness ribbon

On the eve of the International AIDS conference in Munich, scientists report that another person has been cured of AIDS via a stem cell transplant and impressive success in HIV prevention via trials of long-action injectable pre-exposure medication – yet funding cuts threaten global HIV goals.

UNAIDS economist Erik Lamontagne said that HIV could cost low- and middle-income countries (LMICs) over $10,000 per person by 2050, with almost 35 million new HIV acquisitions and nearly 18 million AIDS-related deaths between 2021 and 2050 without “bold action”.

The projections are based on the failure of 114 key LMICs to meet the “95-95-95” targets – 95% of people who are living with HIV knowing their HIV status, 95% of these people on antiretroviral treatment, and 95% of those on treatment being virally suppressed.

Seventh AIDS cure via stem cell transplant

 

Scientists brief the media ahead of the AIDS conference

Christian Gaebler of Charité Universitätsmedizin Berlin told a media briefing on Thursday  that a seventh person had been cured of AIDS following a stem cell transplant with from a donor carrying genes that are partially resistant to HIV. 

The Berlin-based patient had leukaemia and HIV. and his doctors looked for a donor with the particular gene mutuation – referred to as double, CCR5-delta32 mutation – known to have cleared HIV in other patients.

“In 2015 when it became clear that our patient required the stem cell transplantation for his cancer treatment, the clinical team began searching for donors with this rare genetic mutation known as the homozygous CCR5-delta32 mutation, because we know that this mutation provides natural resistance to HIV, and it has been a crucial part in the successful HIV cure cases,” said Gaebler.

However, the clinical team was only able to find a donor carrying one functional as well as one copy of the CCR5-delta32 mutation, known as a heterozygous donor, he added.

The transplant went ahead and the patient, who has asked to be anonymous, has been AIDS free since 2018, almost six years.

This is the seventh recorded case of a person being cured of HIV via a stem cell transplant, the first being the “Berlin patient”, who later revealed himself as Timothy Brown.

“The next Berlin Patient’s experience suggests that we can broaden the donor pool for these kinds of cases, although stem cell transplantation is only used in people who have another illness, such as leukaemia. This is also promising for future HIV cure strategies based on gene therapy, because it suggests that we don’t have to eliminate every single piece of CCR5 to achieve remission,” said Sharon Lewin, President of the International AIDS Society, and co-director of the conference, which begins in Munich on Monday.

Prevention advances with PrEP

Last month, news broke that none of the over 2,000 young women and girls injected twice a year with a new drug, lenacapavir, had contracted HIV in one of the most important advances in HIV prevention ever.

Gilead Sciences announced the preliminary results of its Phase 3 PURPOSE 1 trial of lenacapavir as pre-exposure prophylaxis (PrEP) conducted in South Africa and Uganda involving 2,134 women and girls aged 16-25.

The trial was so successful that it was stopped early, and details of the trial will be released at the AIDS conference next week.

Results of another, smaller PrEP study of the antiretrovial cabotegravir – where participants were given a choice between pills or an injection  – showed that many participants preferred a long-acting injection rather than daily pills.

The study recruited young men and women aged 15 and older in rural Uganda and Kenya who were vulnerable to HIV infection.

Ugandan scientist Jane Kabani told the media briefing that participants two-thirds of participants opted for the long-acting injection as they did not want to be questioned about why they were taking pills. Some also feared the side effects of pills.

“Long-acting PrEP has the potential to strengthen HIV prevention progress worldwide. I hope these results will accelerate efforts to make long-acting injectable cabotegravir available and accessible to all those who can benefit,” Lewin said.

PrEP to prevent STIs

Another study using the antibiotic doxycycline to prevent sexually transmitted diseases (STIs) showed impressive results in a small study in Canada, as presented by Tony Grennan of the British Columbia Centre for Disease Control.

The study recruited 52 gay, bisexual and other men who have sex with men living with HIV in Vancouver and Toronto. Half took 100 milligrams of doxycycline daily for the prevention of STIs and the other took a placebo for 48 week. 

“There was an 80% reduction in any of the three STIs we were looking” said Grennan. “Breaking it down by specific infection, there was a 79% reduction in syphilis, a 92% reduction in chlamydia and a 68% reduction in gonorrhea in the Doxy PrEP arm.”

He added that there was “no signal of concern” about antibiotic resistance “but the numbers were very, very small, so it’s really hard to draw any definitive conclusions”.

“We’re seeing impressive innovation across the entire spectrum of HIV research,” noted 

Lewin. “For these advances to have a real-world impact, we must put people first and keep delivery and access concerns front and centre.”

Image Credits: UNICEF Zimbabwe, NIAID/Flickr.

David Laborde, Director of the Agrifood Economics Division of the Food and Agriculture Organization, presents the most recent report on nutrition and food security.

Food security and nutrition initiatives often fail due to fragmentation, a lack of consensus on priorities, and the prevalence of numerous actors delivering mostly small, short-term projects, according to this year’s State of Food Security and Nutrition in the World (SOFI) report, due to be released next week.

More targeted and less risk-averse finance, as well as better alignment and synergy amongst different funding sources, is critical to scaling up assistance more effectively in hunger-stricken areas of the world, said Qu Dongyu, Director-General of the UN Food and Agriculture Organisation. 

He was speaking this week during an event on Finance to End Hunger and Food Insecurity, held on the sidelines of the UN Economic and Social Council (ECOSOC) High-Level Political Forum in New York City.

“I call on funders and partners across agri-food systems to enhance coordination and consensus on what and where it is essential to finance and to better target financing for the ones most in need,” said the FAO Director-General in a video-taped address. 

The annual report, a collaboration of FAO, the World Health Organization (WHO) and other UN agencies, analyses the progress made in addressing SDG2, No Hunger. The full document is due to be launched July 24 at a G20 ministerial task force meeting.

“Every year we report on progress towards the SDG targets towards ending hunger, food insecurity, and malnutrition,” said WHO Director General, Dr Tedros Adhanom Ghebreyesus. “And every year we report that progress has been insufficient.”

There were between 691 and 783 million people facing hunger in 2022, according to the State of Food Security and Nutrition in the World report – an increase of 122 million people compared to 2019.

Blurry definitions impede action

Different financial estimates for fighting food insecurity vary greatly.

Counting people who lack reliable and sufficient nutrition is easier than estimating the costs to address their needs, raising funds and delivering aid that makes a difference long-term and not only in emergencies, according to FAO’s preview of key SOFI report findings. 

Depending on the definitions and scope of planned interventions, the sum needed to ‘feed the world’ could amount to anything between $77 and $15,400 billion, one of the report’s authors, David Laborde, noted at the side event.

No clear definition is “obviously […] a bad starting point,” Laborde pointed out, especially as it obscures accountability. “It’s not that we’re lacking progress, it’s that we’re moving in the wrong direction,” he added. As per the SOFI report, despite continuing efforts, countries that face the most acute malnutrition are also the ones that have the least access to funding.

Need to tackle root drivers of hunger

Funding is also aimed too narrowly, addressing core needs like emergency food supplies – but failing to tackle the roots of the problem and improve the situation in the long run. The current structure is also at fault. Fragmented and dispersed, mostly consisting of small, short-term projects of varying priorities, the funding remains ineffective, Maximo Torero Cullen, FAO Chief Economist assessed at the ECOSOC Forum event.

The report proposes a common definition for food support programmes and encourages agencies to work together and ensure they are communicating about mapping areas of progress.

Electricity or vaccines are also food interventions

A more holistic view on food security could be key to achieving the “no hunger” SDG goal, the Forum’s speakers also highlighted. “Nutrition is a smart investment with significant health and economic returns,” Tedros said, stressing also the economic benefits to resilient food systems. And building those requires diverse funding in various fields.

Dr Qu Dongyu, Director-General of the Food and Agriculture Organisation, during an event presenting this year’s nutrition report results.

Rather than a stand-alone problem, malnutrition is a result of several health factors caused by structural problems, Laborde reminded, and as such, needs a broader problem-solving vision.

Expanding energy access in a rural area can be a boost for the local farmers, now able to use electricity-powered irrigation equipment or access food cleaning and cooling technologies.

Investment in community-based animal health services and livestock vaccinations can also serve as a driver for a stronger food system, as demonstrated in areas of conflict in South Sudan and Sudan.

Overcoming uncertainty

The main improvements needed to achieve SDG2 are better coordination – also in terms of targeting and definitions – increased donor risk tolerance and more blended finance, FAO’s Director-General Dr Qu Dongyu said.

Interventions strengthening local food production, for instance enabling electricity-powered irrigation, can effectively combat food insecurity.

Agrifood systems operate under risk by definition, he highlighted, and the uncertainty is even rising with climate-change-induced extreme weather conditions and irregular rainfall. Donors need to understand the nature of the sector and invest despite the risks.

It’s still a bet worth taking, and “financing zero hunger today is investing in a better future tomorrow,” Qu said.

SOFI 2024 estimates that achieving SDG2 “could amount to several trillion USD,” though it is difficult to calculate the exact cost. The sum is beyond the scope achievable for the public sector, which then points to the need for blended, private-public financing.

Depending on the country’s access to financial flows, different instruments are most appropriate. The report recommends grants and concessional loans for those with limited access, domestic tax revenue, especially linked to food security and nutrition outcomes for those with moderate access. High-access countries can use bonds or similar instruments to embed specific food security and nutrition objectives.

Dr Tedros Adhanom Ghebreyesus during the forum in New York.

“It’s time to rethink financing food security and nutrition,” Tedros said. The change needs to be treated “as an investment in a healthier, safer, and fairer world.”

Food crises also aggravated by conflict 

Along with the longer-term solutions, conflicts in numerous regional hotspots continue to fuel hunger crises, the WHO has underlined over and again. 

More than one million children are at risk from acute malnutrition in Democratic Republic of Congo as rising violence drives up needs amongst millions of displaced people, WHO said on Friday.

The DRC now had the highest number of people in need of humanitarian aid in the entire world, with 25.4 million people affected, Dr Adelheid Marschang, WHO Senior Emergency Officer, said at the press briefing. Despite this, the situation in DRC remains one of the world’s most underfunded and forgotten crises.

In the most affected provinces, Ituri, North Kivu and South Kivu, 5.4 million people are food insecure, while almost three million children across the country are severely malnourished, according to the WFP. With floods destroying crops, the prospect for next year is even more severe food insecurity. Unless immediate action is taken, over one million children will suffer from acute malnutrition, the WHO alarms.

Conflicts, climate change, economic crises and inequality are amongst the main drivers of food insecurity.

In Sudan, 26.6 million people, more than half of the population, are food insecure, according to the World Food Programme (WFP) data. Continued fighting between the country’s army and paramilitary Rapid Support Forces (RSF), going on since April 2023, continue to impede the operations of aid organisations. Over 10 million people are internally displaced and 2 million abroad – the largest number in the world, according to a WHO update this week.  

In Khartoum, free kitchens operating there announced July 13 they were forced to shut down due to a lack of funding and food supplies.

In Gaza, where Israel continues its nine-month military campaign to crush the Islamic Hamas organisation following Hamas’ deadly October 7 2023 raids on Israel, WHO officials have warned that one in four people faces starvation risks – even if previous forecasts of widespread famine by July did not yet materialise. Some 96% of the enclave’s 2 million residents are facing crisis levels of hunger – or worse – according to the World Food Programme. 

Israel’s closure of the Rafah crossing into Gaza in mid-May has paralysed the flow of health supplies and humanitarian aid from Egypt – forcing exclusive reliance on Israeli aid crossing points.  Meanwhile, the World Food Programme (WFP) said Wednesday that it had been forced to reduce food rations in Gaza City to ensure broader coverage for people who have been newly displaced after new Israeli incursions in the North and South. In July so far, WFP has provided more than 600,000 people in Gaza with food assistance, and more than 500,000 people with food parcels and wheat flour.

INB co-chairs Anne-Claire Amprou and Precious Matsoso

As delegates at this week’s Intergovernmental Negotiating Body (INB) worked to nail down a day-by-day agenda for negotiating a pandemic agreement for the next few months, it appears increasingly unlikely that the talks will be concluded by year-end. 

The detailed work plan – an indication that the Bureau has heard criticism that it has given member states too little notice in the past – underscores that there is so much to do in so little time.

As US Ambassador Pamela Hamamoto noted on the first day of the meeting, the work proposal for the next INB meeting in September “assumes we can reach consensus on at least one article per day, which may be overly ambitious”.

Delegates have also resolved to include consultation with experts as part of the process. This is high time, given that the structures and processes they agree on should be workable for frontline pandemic ‘responders’: scientists studying pathogens, pharmaceutical companies making medicines, health workers and government officials trying to contain outbreaks. But it will mean more time is needed.

New co-chair Anne-Claire Amprou also told delegates on Wednesday that they would need to decide by 11 November – not 15th, as assumed the previous day – if there was sufficient agreement to call a World Health Assembly (HWA) special session in December to adopt a pandemic agreement.

The US wants a “stocktake” by the end of the next INB meeting on 20 September to see how realistic this is, while the Bureau proposed such a stocktake at the INB meeting in early November.

Part of the proposed agenda for the next INB meeting from 9-20 September.

Debate over experts and stakeholders

Delegates were divided on which experts should be consulted. Several countries – including China, Russia and Nigeria – proposed including only those in official relations with the WHO in terms of its Framework of Engagement with Non-State Actors (FENSA)

Others, such as Colombia, wanted more diversity. Nonetheless, countries have until 26 July to submit their proposals on experts to the Bureau.

The INB circled around whether to allow groups with official stakeholders status to sit in on closed drafting sessions. Initially, it appeared stakeholders would be allowed into closed meetings as observers, but by the end of the meeting, delegates settled on closed talks and daily information sessions at the start of each day with stakeholders.

This prompted the European Union’s Americo Zampetti to comment that such sessions should not simply serve as information giving but also solicit the inputs and opinions of the stakeholders, which range from patient advocacy organisations to pharmacuetical companies.

WHO Assistant Director General Mike Ryan stressed at the close of the INB that political agreement was essential and appealed to delegates not to become mired in technical issues and lose the momentum they had gained by the end of the talks in May.

“I would just say to you as negotiators, to separate what is technical from what is ultimately political, and not to delve too far back into technical discussions,” said Ryan.

“A better understanding of the technical issue will not resolve political issues,” he stressed.

“Do not look for answers to what are essentially political trust and other issues in the land of technical explanation. You will find some answers and some reassurance there, but you will not find resolution of what are essentially political issues

Ryan warned that the world’s biome is becoming more volatile and unpredictable, making other pandemics more likely.

“The pandemic agreement will not itself stop the next pandemic. The pandemic agreement will not in itself directly save lives, but without a pandemic agreement, the chaos, the lack of coherence, the lack of equity, the lack of efficiency that we had in the last pandemic will continue and probably increase giving our given our geopolitical differences.

“So this is not an academic exercise. It’s not even a political exercise. This is an exercise in saving human lives. And I just hope that that energy you had when you finished the last time, the disappointment you put to the side, and the commitment to get this done as quickly as possible, is still there.”

The next INB meeting will be from 9-20 September, with further sessions set for November and December – as well as February and April if agreement is not reached in November.