monkeypox
A patient participating in a clinical trial of Tpoxx, an antiviral treatment for the mpox virus, in the Central African Republic.

At a time when the world is negotiating the best way forward for sustained preparedness to address pandemics, it is still exhibiting collective failure to learn from past outbreaks and a glaring gap in global health security. Mpox is one case in point – and a test case for global intent on pandemic preparedness. 

In a remote village in Niger Delta Region of Nigeria, a 55-year-old man’s life was forever changed by mpox. For weeks, he suffered alone, his body and face ravaged by extensive lesions. 

Shunned by local health clinics and stigmatized by his community, he endured not just the physical agony of mpox but also its profound psychological toll. By the time he reached a hospital willing to treat him, it was too late to save his vision, permanently impaired by keratitis.

In the Democratic Republic of the Congo (DRC), a mother in the Mongala province faced the agony of watching her three children suffer from mpox. The eldest child, aged seven, was the first to contract the disease. As all the children shared clothes, the younger siblings, aged four and five, fell ill too, weaving a tapestry of shared suffering.

Human cost of inaction 

These heart-wrenching stories are a stark reminder of the human cost of inaction. Far from being isolated incidents, they painfully illustrate the dire consequences of global neglect in addressing mpox, particularly in Africa. 

For over 50 years, this African disease has been neglected by the international community with limited or no investments in surveillance.

Despite the growing threat posed by the disease, almost no mpox vaccines and few therapeutics have reached Nigeria, DRC or other West African countries at the epicenter of the epidemic. 

Moreover, critical funding for research and the development of more effective, affordable and accessible diagnostic tools, vaccines, and treatments remains woefully insufficient.

Caused by the monkeypox virus (MPXV), mpox has been endemic in most parts of central and western Africa since the 1970s, after first being discovered in 1958 when two outbreaks of a pox-like disease occurred in colonies of monkeys kept for research.

Until very recently, the more pathogenic clade I strain of the MPXV was restricted to a few Central African countries, particularly the DRC. Infants, children and young adults, mostly in rural settings and in close contact with the animal reservoir, experienced stigma, and excruciating pain due to mpox skin lesions and frequently severe disease that led to deaths. 

The clade II strain, which is common in West Africa, causes less severe disease but also negatively impacts on the health and socioeconomic livelihoods of affected patients and their families.

In Africa, the disease was largely spread from animal-human spillover events, with only a few, limited cases of human-to-human transmission within households, before transmission would ‘burn out’ locally. 

Unfortunately, due to poverty, weak health systems and other resource-constraints, countries, communities and families facing the challenge of mpox were unable to adequately respond and contain the disease. But the virus continued to evolve and mutate so as to be more effective in transmission to humans, including sexual transmission.  

More dangerous Clade 1 infections spreading rapidly 

Men queuing for the mpox vaccine in Chicago in the US. Many African countries have yet to receive mpox vaccines despite the disease being endemic in parts of central and west Africa.

In July 2022, the World Health Organization (WHO) declared mpox a public health emergency of international concern (PHEIC) on account of the global spread of the disease to over 100 countries in all continents of the world. For the first time in history, many countries outside Africa were reporting community transmission of mpox without any travel link to previously endemic African countries. 

Whereas prior outbreaks of mpox in Africa were largely zoonotic related, in 2022, mpox was unusually spreading mostly among gay, bisexual and men who have sex with men (GBMSM) by sexual contact.

The declaration of mpox as a PHEIC was intended to foster immediate and coordinated international action to contain the virus and prevent its further spread. The WHO external situation report of the 2022 multi-country outbreak has continually emphasized the significant knowledge gaps regarding route of transmission and risk factors for mpox among affected African countries. 

Although mpox now seems to have been contained in most high-income countries, little has changed in West and Central Africa where the disease is endemic. The story of neglect remains largely the same.

The DRC, meanwhile, remains in the throes of its largest outbreak ever. Since January 2023, over 12,000 suspected cases have  been reported in the DRC, only 9% of which were definitively laboratory tested due to resource-constraints. 

In November 2023, the WHO announced the detection of clusters of mpox cases linked to sexual contact among GBMSM in the DRC, the first reports of sexual transmission of the clade I strain in history. 

This unprecedented observation should be a wake-up call to re-examine investments and commitments to address the challenge of mpox in previously endemic countries, to avert another re-emergence of a global health emergency due to mpox.  

The first few months of 2024 reflect  an alarming surge in suspect cases and fatalities due to mpox, surpassing figures from the previous two years. 

WHO responses 

The WHO has developed a standing recommendation and a medium- to long-term mpox strategic response plan. To inform development and deployment of mpox-related medical countermeasures such as therapeutics and vaccines, the WHO published Target Product Profiles and developed a core protocol for the conduct of therapeutic clinical trials related to mpox. 

Affected countries, mostly high-income countries in Europe and America, have intensified risk communication and social mobilization, heightened surveillance and deployed existing smallpox-related vaccines and therapeutics (thought to be cross-protective against mpox) for use by the most at-risk social groups under an emergency use authorization.

These include MVA-BN, produced by the Belgium-based Bavarian Nordic and LC16 KMB, produced by Japanese firm KM Biologics. 

As clinical efficacy trials on mpox vaccines and therapeutics were lacking, many collaborative efforts were initiated or strengthened, to facilitate the conduct of mpox clinical trials. These coordinated international responses led to a sustained global decline in the number of new cases of mpox and the outbreak was effectively contained in most countries outside Africa by December 2022. In May 2023, the WHO declared an end to the mpox global emergency.

While declaring the end to the mpox emergency, the Mpox Emergency Committee indicated that “the gains in control of the multi-country outbreak of mpox have been achieved largely in the absence of outside funding support and that longer-term control and elimination are unlikely unless such support is provided”. 

‘Not one dollar’ to support mpox in endemic countries

And yet, as Dr Mike Ryan, Executive Director of the WHO Health Emergencies Programme, pointed out: “[mpox] is a neglected disease […]. In fact, WHO had to fund all of this international response purely on the basis of a contingency fund for emergencies. Not one dollar was received from donors to support this response and support countries.”

That means no donor funds have been available to strengthen mpox diagnosis, treatment, vaccination and control in the endemic countries like DRC, Nigeria and other neighboring countries in West Africa. Regardless of the risks posed to people in the region – or globally. 

Moreover, neither of the existing vaccines, both only available in limited supplies, are ideal for low- and middle income settings. The MVA-BN requires two jabs while the LC16 KMB is administered intradermally, a procedure unfamiliar to many rank-and-file health workers in low and middle-income countries (LMICs). There is a need to fund research for adapted, affordable and available medical countermeasures.

Today only tecovirimat, an oral treatment developed by SIGA, has received approval for use, based on animal data, in the European Union (EU) and US. 

When mpox cases rose, it was decided that a robust controlled clinical trial, confirming tecovirimat’s efficacy and safety in patients with mpox would be needed. 

Tecovirimat has to be administered twice daily after a solid food meal, and it is being investigated in the DRC in supervised, hospitalized patients. No data have yet been generated for any other African country where Clade II occurs, nor in an outpatient setting.  No other treatment has yet been investigated in patients. Tecovirimat is not approved in any African country and not yet available, even for compassionate use in Africa in clinical routine care.

Five clinical trials

Globally, there are currently only five randomized trials being conducted or planned on mpox treatments: UNITY (Switzerland, Brazil, Argentina), EPOXI (Europe), STOMP (USA, International), PALM007 (DRC) and MOSA (Benin, Cameroon, Central African Republic, Congo Republic, DRC, Ghana, Liberia and Nigeria). 

All the trials are testing tecovirimat as monotherapy. STOMP and PALM007 are funded through NIH/NIAID.  MOSA is a platform adaptive trial in Africa that could test other treatment arms, which is sponsored by PANdemic preparedness plaTform for Health and Emerging infectious Response (PANTHER) and receives partial support from the European Union.  

Horizon Europe is funding mainly the EPOXI trial in Europe, although it is also  providing some support to UNITY.

However, there is still a large funding gap to cover for the completion of those trials, especially in Africa. Furthermore, whereas various north south collaborations between African scientists and other researchers from across the globe are ongoing, there are still glaring gaps in investments in mpox surveillance, as well as available diagnostics and treatments in affected countries. 

In Africa, children worst affected 

While in the Clade II global health emergency, most of the victims were men, in Africa, the Clade I victims are now mostly children under the age of 16. 

The number of skin lesions that each person with Clade I experiences is much higher – up to several hundred in comparison with tens in Clade II. Bacterial infections and  underlying malnutrition can increase morbidity and the case fatality ratio is definitely higher in Africa than in high income countries. Those features are contextual and must be considered during drug development as they may significantly affect treatments’ strategies and overall efficacy.

At the same time, if mutations in Clade I mpox in the DRC are changing the pattern of infection and transmission, then new treatments are all the more critical to not only end the local outbreak but to prevent it from spreading more widely via sexual contact and other means.  

Test of humanity

The tardiness of action on mpox demands an immediate and concerted effort from the international community. By prioritizing research and vaccine development, enhancing international collaboration, and addressing stigmatization, we can strengthen our global preparedness for emerging health threats. As recently stated by Africa CDC, “vulnerable populations worldwide must have access to life-saving interventions”.

We stand at a crossroads between repeating past oversights and forging a new path of true equity and foresight. We cannot afford to repeat the mistakes we made over Ebola when funding was only made available when high-income countries were at risk.

It is time to harness the spirit of international collaboration. Building on positive initiatives like the UNITY trial, nations must come together to address the unique challenges posed by mpox and respond to the specific needs of  African patients.

Mpox isn’t just a test of our global intent on preparedness – it’s a test of our humanity. In honoring the memory of the young victims, like an eight-day-old baby girl in DRC, we must pledge to do better, act faster, and create a global health infrastructure that is as inclusive as it is effective.

Prof Jean-Jacques Muyembe Tamfum is the Director General of the DRC’s National Institute of Biomedical Research (INRB) in Kinshasa, Professor of Microbiology at the University of Kinshasa Medical and the inaugural president of the Congolese Academy of Science. He is co-discoverer of the Ebola virus in 1976 and co-inventor of the monoclonal antibody “ mAb114”, approved by FDA as an Ebola treatment, Ebanga, in December 2020. The INRB is conducting the PALM007 study on Tecovorimat in mpox patients.

Prof Dimie Ogoina is a Professor of Medicine and Infectious at the Niger Delta University Teaching Hospital in Nigeria. Ogoina’s team were the first to describe sexual transmission of mpox in Nigeria in 2017. He was a member of the World Health Organization IHR Emergency Committee on the multi-country outbreak of mpox.

Prof Francine Ntoumi is head of the Congolese Foundation for Medical Research, which she founded 15 years ago. She has over 20 years of experience in basic and clinical research in infectious diseases particularly malaria, HIV and tuberculosis, in endemic countries and Europe. 

Dr Nathalie Strub Wourgaft has been Delegate General for the PANdemic preparedness plaTform for Health and Emerging infectious Response (PANTHER) since its creation in 2022. Prior to that, she was Director of NTDs and later for COVID and pandemic preparedness at the Drugs for Neglected Diseases Initiative (DNDi) from 2009 to 2022. 

Prof Samba Sow is Director of CVD-Mali. A medical doctor and epidemiologist, Sow was Minister of Health and Public Hygiene for Mali between April 2017 and May 2019 and instituted a series of health sector reforms to provide free antenatal and maternal healthcare as well as free care for children under five years old. In 2020, he was appointed WHO Special Envoy for COVID-19 in West Africa.

Spring Gombe is the Strategic Policy Advisor to PANTHER, providing policy and program management support to entities working with vulnerable and marginalised groups with limited access to health technologies.

Jessica Ilunga is the Co-founder and Strategic Communication Partner of Galuni Consulting Associates, an Africa-focused advisory firm based in Brussels. She previously worked as Communications Director at the Ministry of Health in the DRC.

Image Credits: TRT World Now/Twitter .

Save Hands for Girls campaigns against female genital mutilation in The Gambia by working with schools, parents and organisations.

Global health and parliamentary leaders have offered to support The Gambia to maintain its  ban on female genital mutilation (FGM), expressing “profound concern” over a recent attempt to reverse the ban. 

The business committee of Gambia’s parliament is currently contemplating whether to allow the passage of a Private Members Bill which aims to reverse the landmark Women’s (Amendment) Act of 2015, which outlawed FGM.

The Bill was introduced by Almameh Gibba, an MP from the Alliance for the Patriotic Reorientation and Construction (APRC), with the support of Imam Abdoulie Fatty, a notorious proponent of FGM. The process involves the partial of total removal of external female genitalia – supposedly to “control” women’s sexuality – and is usually performed on girls under the age of 15.

But this attempt to reintroduce FGM has been condemned by the leadership of both the Partnership for Maternal, Newborn & Child Health (PMNCH), the world’s largest alliance for women’s, children’s, and adolescent’s health and well-being, which is hosted by World Health Organization (WHO), and the Inter-Parliamentary Union (IPU), the global organisation of national parliaments.

They urge the Members of the National Assembly to continue to protect the “hard-won” ban on FGM, warning in a statement issued over the weekend that repealing the ban “would not only undermine this progress but also perpetuate a cycle of discrimination and violence against women and girls”.

Despite the banning of FGM nine years ago, almost three-quarters of Gambian women are estimated to have been subjected to the practice, and almost half were cut before their 15th birthday.

There has only been one FGM-related conviction in the past nine years involving three women for cutting babies aged four to 12 months old, according to women’s rights activist Jama Jack. They received fines which were paid by Fatty via a public fundraising campaign, added Jack.

‘All possible support’

“We pledge all possible support to The Gambia in strengthening its efforts to prevent and address this harmful practice through multi-sectoral actions. This includes ensuring robust enforcement mechanisms, increasing access to quality healthcare services, and promoting gender equality and women’s empowerment initiatives,” according to the statement, which is signed by PMNCH leaders Helen Clark, Joy Phumaphi, Githinji Gitahi and Flavia Bustreo, and IPU Secretary General Martin Chungong.

“FGM is a grave violation of human rights and a harmful practice with severe health consequences, including physical, psychological, and reproductive and sexual health complications,” they add.

“FGM is associated with increased risks of postpartum hemorrhage, perinatal death, as well as urinary tract infections, menstrual difficulties and mental health conditions over the life course of women and girls.”

The PMNCH and the IPU emphasise the importance of upholding international human rights standards and commitments to protect women and girls from all forms of violence and discrimination.

“As a signatory to various international instruments, including the Convention on the Rights of the Child (CRC), Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), the African Charter on the Rights and Welfare of the Child (ACRWC) and the Protocol to the African Charter on Human and People’s Rights on the Rights of Women in Africa (Maputo Protocol), The Gambia has a duty to uphold its obligations to its people and prioritize the health and rights of its population,” they remind the country.

Domino effect?

“Combatting FGM requires partnership at all levels. Parliamentarians can develop and uphold comprehensive legal frameworks; opinion leaders, including faith leaders, are needed to speak out firmly against the practice; community members, including health workers, can carry out powerful awareness campaigns based on lived experience, ensuring that care and support for survivors are integrated into sexual, reproductive, maternal, newborn, child and adolescent health (SRMNCAH) services.”

Meanwhile, Bustreo, who chairs PMNCH’s governance and ethics committee, said that her organisation was concerned about potential copycat moves.

“The concern lies in the potential for a domino effect if an anti-FGM law is repealed, signaling to others that similar regressive steps are acceptable,” Bustreo told Health Policy Watch.

“This isn’t merely about changing legislation; it’s about preserving the progress made in safeguarding the rights and well-being of women and girls. Repealing such laws threatens to erase years of dedicated advocacy and community engagement.” 

Around 90% of women in Somalia, Guinea and Djibouti are subjected to FGM, and a range of organisations fear that The Gambia’s reversal will encourage other countries in West Africa to follow suit.

Over 230 million girls and women alive today have undergone female genital mutilation (FGM), according to a report from the UN children’s agency, UNICEF, released earlier this month. This is a 15% increase since eight years ago.

Image Credits: Safe Hands for Girls.

Zero-emission vehicles powered by renewable energy could most likely avoid 1.9 million premature deaths, going up as much 2.4 million by 2040.

The International Council on Clean Transportation (ICCT), famous for busting Volkswagen’s Dieselgate, has a new ambition: Taking immediate action to shift to zero-emissions vehicles, significantly cutting ozone (O3) nitrogen dioxide (NO2) and PM2.5 pollution, and avoiding millions of cases of early death and paediatric asthma. Business-as-usual vehicle scenarios will lead to an increase. 

Because they breathe faster than adults, children are particularly vulnerable to emissions from vehicles. Toddlers are worse off because their shorter height means they’re closer to exhaust pipes. A new report has attempted to measure this and model various scenarios of controlling pollution from vehicles that would best protect children from asthma, and older people from air pollution-related chronic illnesses and premature deaths. 

The report, Global Health Benefits of Policies to Reduce On-Road Vehicle Pollution Through 2040, is by 10 authors, mostly associated with the ICCT. The group is perhaps best known for exposing Volkswagen for fudging on the true level of emissions from its popular diesel vehicles – known as the Dieselgate scandal. That cost the German auto giant billions of dollars and shifting producers away from the most health-harmful vehicle fuel. Now, the ICCT has turned its attention to the world’s vehicle fleet – analysing what would it take to reduce cases of early deaths and paediatric asthma over the next two decades. 

The authors say that their study, published in March as a Lancet pre-print, is the first of its kind to provide a globally consistent evaluation of this issue. They examined the impact of vehicular pollution at a one-kilometre resolution across 186 countries and territories that cover 99% of the global population. Fifteen emissions scenarios were evaluated representing different policy combinations. 

At one end is what the study calls the BASE scenario, where emission controls and policies analysed are as of March 2023, the time of this analysis. At the other end is the ALLZG scenario, the most ambitious one where all the best current and future technologies (like Euro 7 emission standard), are adopted for all sales of new internal combustion engines (ICE) in the world’s countries and territories. The ALLZG scenario also includes expedited rollout of zero-emission vehicles (ZEV), with renewable energy sources powering most of that shift. It further assumes countries would phase out older ICE vehicles, which don’t meet the most recent standards.  

Act to avoid premature deaths, children’s asthma

Children breathe faster and also are closer to the ground – thus more exposed to tailpipe emissions – ICCT.

Its conclusion is that the most ambitious ALLZG scenario could avoid 1.9 million premature deaths – and as many as 2.4 million between 2023 and 2040. People over the age of 65 would gain the biggest benefit in terms of avoided premature deaths. But in terms of illness, children would also benefit in a big way, especially in developing countries and urban areas. About 1.4 million cases of paediatric asthma could be avoided, with the projection rising to 1.7 million children – as many as half of them toddlers under the age of five. 

Under the business-as-usual scenario i.e. if government policies as of March 2023 remain in place, then annual deaths from transport-related emissions would increase from 182,000 annually in 2020 to 210,000 in 2040. Chronic obstructive pulmonary disease (COPD) or chronic lung disease, is the leading cause of air-pollution related premature deaths with cardiovascular disease, hypertension and cancer as other leading causes. 

Global South has the most to gain

Ozone concentrations are highest in African and Asian parts of the global south.

The study is preliminary and not peer-reviewed, the publishers point out. However, its data is broadly in line with trends and reality already observed especially about vehicular pollution.

Much of the Global South is way behind in controls. Many countries haven’t even implemented Euro 6, a diesel emission standard for vehicles first introduced in 2014 in the European Union, and a reference point for major manufacturers globally. It is also a truism that urban areas are more affected given the concentration of vehicles. Two-thirds of over 1.8 million new cases of paediatric asthma globally in 2019 occurred in urban areas. 

The report says that regions and trade blocs that mainly consist of countries in the Global South – Middle East, ASEAN (Southeast Asia), SAARC (South Asia), and ECOWAS (Africa) – have the greatest potential for mitigating new paediatric asthma cases from road transport emissions. Disparities in road transport-attributable health burdens are projected to widen amongst countries with different levels of development, with populations in countries with lower social demographic indices (SDIs) experiencing the largest increases in road transport-attributable health burdens. 

In countries without Euro 6 equivalent standards, implementing these could achieve 64% and 71% of the total benefits of all emission control measures combined for avoidable premature deaths and new paediatric asthma cases respectively. 

Most of the savings in lives from ozone (O3) would be in the global south, according to the analysis, published in preprint.

Overall, more than nine out of 10 fatalities are attributable to air pollution and the majority of the associated economic losses are concentrated in low-income and middle-income countries, and disproportionally affect children, the elderly, and socially vulnerable individuals.

One child’s death by vehicular pollution

Ella Roberta Adoo Kissi Debrah, who died on 15 February 2013 of a fatal asthma attack. She was the first air pollution victim to have that written as a cause on her death certificate, posthumously.

While the awareness about the links between air pollution and asthma has grown significantly, it has remained a more marginal issue in the air pollution debate, at least until the case of nine-year-old Ella Roberta Adoo Kissi Debrah who suffered from chronic asthma and died in 2013. Hers became the world’s first case where a death was officially attributed to air pollution. Initially, her death was merely attributed to acute respiratory failure. But  following a public campaign led by her mother, Rosamund Kissi-Debrah, a 2020 court ruling determined that her death should be attributed to levels of NO2 above the legal limits in her south-east London neighbourhood.

“The principal source of her exposure was traffic emissions.” The Coroner informed the court that “excess levels of nitrogen dioxide and particulate matter, PM10 and PM2.5, were a health risk, especially to children with asthma. Kissi-Debrah went on to found the Ella Roberta Foundation, campaigning against air pollution in the name of her late daughter. 

Still need an integrated approach 

Sadiq Khan, Mayor of London, has led a high-profile campaign to cut air pollution.

Bolstered by growing public awareness, London’s Mayor Sadiq Khan, who took office in 2016, has led a dramatic policy shift leading to sharp reductions in vehicular pollution. 

In March 2024, the mayor’s office announced that the roadside nitrogen dioxide (NO2) concentration levels had fallen by 49% between 2016 and 2023. NO2 levels were lower than even the first year of the COVID lockdown. The pandemic, moreover, vividly demonstrated to the public how a drastic reduction in traffic could reduce NO2, PM10, sulphur dioxide and carbon monoxide emissions, which are a direct or indirect result of burning fossil fuels for transport. 

As part of the shift, London has, of course, electrified vast chunks of its transport and tightened emission norms in lines with many of the recommendations of the new ICCT-led report.  However, the UK city also has created and expanded an ultra-low emission zone in the central city, greened public spaces, and created more cycling and pedestrian routes to encourage shifts to non-motorized transport along with improving public transport.

So while the London experience demonstrates that changes in vehicle emission policies can make a big difference, it also illustrates that an integrated approach remains critical – although the benefits of greener transport, mode shift, and greener urban planning remain to be quantified at a global level.

Not only that, but the climate impacts of reducing emissions also need to be considered along with the direct air quality benefits, as demonstrated in another report by ICCT, published late last year. That report focused on how reducing greenhouse gas emissions from vehicles could help limit global warming exceeding the 1.5° Celsius target climate scientists say needs to be reached to avoid greater catastrophic fallouts from extreme weather to the destruction of delicate coral reefs. Globally, road vehicles currently account for more than 20% of the carbon emissions from human activities, considering both fuel production and combustion. 

But both reports are clear.  To cut air pollutants from vehicles, policy action needs to be very ambitious and needs to start immediately, especially in the Global South. The Global North, as decades of climate negotiations have shown, needs to step up and transfer both green tech and money to the effort as fast as possible. Lives are at stake. 

Image Credits: Climateone.org , ICCT , ICCT , ICCT/The Lancet , Mayor of London .

CoViNet – The new network includes nearly 3 dozen research laboratories across the world with an expanded mandate.

The World Health Organization (WHO) has launched a new network, CoViNet, aimed at identifying, monitoring, and evaluating SARS-CoV-2, MERS-CoV, and emerging coronaviruses that pose significant public health risks.

The program expands on the WHO COVID-19 reference laboratory network, established in January 2020, in the early days of the pandemic.

Originally, the network’s primary goal was to offer confirmatory testing to countries lacking the capacity for testing SARS-CoV-2, including new variants. Over time, the requirements related to SARS-CoV-2 have changed. As such, CoViNet, with its “enhanced epidemiological and laboratory capacities,” according to WHO, will focus on tracking the virus’s evolution and the spread of variants and evaluating how these variants affect public health. The network brings together experts in animal health and environmental surveillance, other existing coronaviruses, and the identification of novel coronaviruses that could negatively affect human health. 

One Health focus 

The network will emphasize the significance of adopting a “OneHealth” strategy, the agency also added in a press release. The COVID-19 pandemic underscored the need for a comprehensive health approach that considers interactions among various species. The virus likely originated from a bat and was transmitted to humans through infected mammals kept and processed under unhygienic conditions at a market in Wuhan, China.

Finally, CoViNet will contribute to shaping WHO policies regarding public health and medical interventions. The data collected by CoViNet will inform the decisions of WHO’s Technical Advisory Groups on Viral Evolution and Vaccine Composition, among others. This will help ensure global health strategies and tools are grounded in the most up-to-date scientific insights.

“Coronaviruses have time and again demonstrated their epidemic and pandemic risk. We thank our partners from around the world who are working to better understand high-threat coronaviruses like SARS, MERS, and COVID-19 and to detect novel coronaviruses,” said Dr Maria Van Kerkhove, acting Director of WHO’s Department of Epidemic and Pandemic Preparedness and Prevention. “This new global network for coronaviruses will ensure timely detection, monitoring, and assessment of coronaviruses of public health importance.”

So far, 36 laboratories from 21 countries are involved in the network – from FIOCRUZ in Brazil to Geneva University Hospitals, Institut Pasteur in Dakar, Senegal, and Pakistan’s National Institute of Health.  Representatives from the labs met last week in Geneva to finalize an action plan for the next 12 months.

WHO has reported 6,932,591 coronavirus deaths and 766,440,796 cases since the pandemic began – although the real number of deaths worldwide is presumed to have been far higher. The pandemic was declared over last year, while the number of people dying from the disease has declined since the Omicron variant first detected in the fall of 2021 in southern Africa became dominant.  But WHO has continued to encourage countries to report weekly aggregate indicators of COVID-19 morbidity and mortality and variant surveillance data, warning that new variants of the virus, or other related emerging viruses could still pose a global health risk. 

Image Credits: WHO .

Al Shifa Hospital’s Surgery wing Monday April 1, 2024 after Israeli forces withdrew from the compound.

Israel said Monday that its forces had withdrawn from Shifa Hospital, Gaza’s largest health facility, after two weeks of fierce fighting with Hamas gunmen barricaded inside that destroyed large parts of the facility, including the surgery, maternity and emergency wards.  

WHO Director General Tedros Adhanom Ghebreyesus said Sunday evening that some 21 patients had died during the fighting. Around 107 patients trapped in the compound had been moved multiple times, lacking adequate food, medicines and access to clean water and sanitation for basic hygiene and wound care, he stressed.  

He added that a mission to Gaza, originally scheduled for Saturday, had to be postponed and urged Israel to “facilitate a safe humanitarian corridor and a better deconfliction system for WHO and partners to support patient transfers. 

Israel re-entered Shifa in a surprise attack early Monday morning, 18 March, saying that key Hamas leaders had regrouped inside following Israel’s first raid on the hospital in November. 

Israel said it had killed some 400 Hamas operatives in the two week operation, including the heads of the organization’s rocket unit and supplies, as well as senior intelligence figures. It detained 900 more people, of which it said 500 were found to be affiliated with Hamas or its ally, Palestinian Islamic Jihad. The army also released footage of weapons caches seized in the raids, reportedly from patient beds, drop ceilings and walls, saying other “valuable intelligence” had also been recovered.   

The Hamas-controlled Health Ministry in Gaza said some 400 people had been killed at Shifa hospital, including a female doctor and her son. Following Israel’s withdrawal, WAFA, the official Palestinian Authority news agency, said “hundreds of bodies of slain civilians” were strewn on the hospital grounds. The hospital’s few remaining patients were being moved to Al Ahli Hospital about two kilometres to the south-east, Reuters reported. 

Over 6,000 people had been sheltering on the hospital grounds when Israel first entered the compound, those who were not killed or detained fled in the first days of fighting. 

Al Aqsa Hospital compound hit by another attack  

Further south in Gaza’s middle region, WHO’s Tedros said that Al-Aqsa Hospital had been hit Sunday by an Israeli airstrike while a WHO team was on a needs assessment mission there, including the collection of incubators to be sent to northern Gaza. 

Tedros said that four people were killed in the attack, which hit a tent camp inside the hospital compound. But the WHO mission officers were unharmed.  Israel said that it had launched “a precision strike” at an “operational Islamic Jihad command centre” positioned in the hospital courtyard. It said that the hospital building was undamaged. The BBC said, meanwhile, that seven journalists including one BBC freelancer, were amongst those injured in the Israeli strike that hit a group of makeshift tents on the hospital grounds.   

Al-Aqsa Hospital is the only hospital located in the middle area of the Gaza Strip in Deir al-Balah and was founded in 2001. As of 2018, this hospital is one of 15 public hospitals in the Gaza Strip and is managed by the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA).

“We again call for protection of patients, health personnel and humanitarian missions. The ongoing attacks and militarisation of hospitals must stop. International humanitarian law must be respected,” Tedros said.

The fact that Israel decided to re-occupy Shifa reflects the success of Hamas regrouping in Gaza City, despite Israel’s ostensible control of the area since late last year, experts on the conflict have observed. 

Northern Gaza has been cut off militarily by Israel from southern Gaza for weeks during the fighting, complicating aid deliveries to the area from the southern part of the strip, including the border town of Rafah, while the grinding conflict continues over the month of Ramadan. Negotiations over an Israeli-Hamas ceasefire, including the release of some of the 100 Israeli hostages still held in Gaza, have progressed only in fits and starts.

UN agencies have sounded repeated warnings of increasing hunger and risks of famine, particularly in the north where food aid deliveries are perilous. Scenes of people being killed by food parcels parachuted from the sky or shot or run over by aid trucks further underline the chaos surrounding the logistics of aid delivery. 

The International Court of Justice last week ordered Israel to allow unimpeded access of food aid to Gaza, saying that “famine is setting in.” Israel has said that it will no longer cooperate with the UNRWA personnel in aid deliveries due to UNRWA’s alleged complicity in the Hamas 7 October attacks on Israel, complicating the logistics of food deliveries.  

Meanwhile, WHO and other international relief agencies face an uphill challenge in maintaining basic functionality, let alone rebuilding, Gaza’s damaged health system, while fierce fighting continues and the threat of an invasion of Rafah looms. Only nine out of 36 Gaza hospitals continue to function, and most of those are concentrated in the southern or middle part of the enclave.  They are complemented by several emergency field hospitals, set up and run by international donors, also in the south.   

INB co-chairs Roland Driece and Precious Matsoso.

The fractious pandemic agreement talks – supposed to end with an agreement on Thursday (28 March) – have limped into extra time, with World Health Organization (WHO) member states resolving to hold an additional intergovernmental negotiating body (INB) meeting from 29 April to 10 May.

The World Health Assembly (WHA), which begins on 27 May, is supposed to adopt the agreement, intended to be a global guide on how to prevent, prepare for, and respond to, pandemics.

But the best case scenario is for the WHA to adopt an “instrument of essentials”, a bare-bones text that will be fleshed out over the next 12 to 24 months in advance of the proposed Conference of Parties, according to people close to the talks.

At the briefing at the end of Thursday’s talks, which started almost four hours later than scheduled, INB co-chair Roland Driece said that “there is no champagne”.

“We had long intensive discussions, but we have not succeeded in concluding this meeting,” added Driece. 

Consensus text

Instead, the INB Bureau would get a revised text to member states by no later than 18 April.

However, this text would be different from the previous one as it would aim to draw out consensus points rather than provide a shopping list of issues.

“That text will be building on the current one but also be different in focus and in level of detail, like we discussed before, but still trying to operationalise equity as much as we can,” said Driece. “We will build on the consensus already identified. Consensus is an important word.”

Extract from the INB 9 reportback

The INB drafting group will focus on “agreeing text”, and member states were also urged to “provide the Bureau with any convergence text resulting from informal consultations, as soon as possible”.

Meanwhile, when the INB resumes, there will be space for “structured informal meetings or working groups, as needed, to progress the work”.

At the start of the two-week negotiations, a number of member states had complained that their proposals and agreements reached in sub-groups had not been reflected in the Bureau’s draft text.

The focus on consensus appeared to cheer delegates, including Switzerland which said there was “a clear way forward”. Switzerland had refused to accept the draft text at the start of the talks.

Meanwhile, WHO Director General Dr Tedros Adhanom Ghebreyesus implored delegates to draw on the “spirit of Geneva” to conclude the talks.

“Let the spirit of Geneva – the spirit of cooperation, mutual respect, and shared responsibility – guide your deliberations as you work towards finalising the agreement by the set deadline in May this year,” said a visibly tired Tedros.

“Together let us reaffirm our commitment to global health security, to solidarity in times of crisis and to a future where no one is left behind by operationalising equity with international law,” added Tedros.

WHO Director General Dr Tedros, flanked by WHO head of health emergencies, Dr Mike Ryan, at INB 9.

Putting on a brave face?

Finding consensus points may be hard in the coming days as many countries appear to have lost patience with one another, and with the INB Bureau and WHO Secretariat members who have been steering the process.

Countries across the political spectrum accused one another of refusing to make compromises, and criticised the Bureau for failing to provide direction.

However, the geopolitical reality is that some of the 194 member states are at war, while others are long-term trade enemies. This was never going to be easy, despite the recent trauma of COVID-19.

In the past two weeks, so much text has been added to the 31-page draft that the meeting started with that it had swollen to a completely unwieldy 100-page draft by Tuesday 26 March with multiple opposing clauses contained in brackets.

For example, by last Saturday (23 March), 50 countries had submitted at least one bracketed suggestion for Article 11, which deals with technology transfer, according to Knowledge Ecology International (KEI), which had two observers at the meeting.

However, the now notorious Article 12, which deals with pathogen access and benefit-sharing (PABS), remains the biggest obstacle.

The European Union believes that there is a place for intellectual property rights in PABS. However, this has been rejected by the Group on Equity – an alliance of 34 countries  – and the Africa region.

But the Group on Equity, which includes countries with large generic medicine producers such as India, Brazil and Indonesia, has also been accused of trying to secure advantages for these companies but taking a hard line on technology transfer.

Meanwhile, Colombia blamed the lack of progress in the past two weeks on “changing modalities, which were sometimes unclear, but also because we’re facing a highly complex document”.

“We support the Bureau in producing a streamline text and one which can achieve consensus but it will have to have substantive provisions which will take us beyond the status quo. The agreement that we will reach must be clearly based on the principles of equity and solidarity that tragic experiences that we live through during the COVID 19 pandemic.

Additional reporting by Elaine Ruth Fletcher

Farmworker Sonali Kadam has been finding it difficult to work in the fields during the summers because of unbearable pain caused by kidney stones.

Whenever farmworker Sonali Kadam experiences pain in her lower abdomen, she fears losing consciousness and pops a painkiller. 

Her fearful response goes back a decade when she was diagnosed with nephrolithiasis, commonly known as kidney stones, which are hard deposits of salt and minerals formed in the kidneys. 

When Kadam, a farmworker, first experienced this pain, she ignored it and kept working in the sugarcane fields. Within an hour, her pain aggravated, and she collapsed. 

Kadam, a resident of Arjunwad village in India’s Maharashtra state, has multiple stones in the kidney, each around 8mm in size. Usually, stones smaller than 5mm pass on their own through urine, while bigger stones might need medical intervention and sometimes even surgery.

In her quest to get rid of these stones, Kadam has consulted over 10 different doctors and took hundreds of painkillers but nothing worked. 

“This has traumatized me so much that whenever it starts paining, I fear I will either faint or die,” she told Health Policy Watch.

Kadam, 34, says her condition worsens in summers when the temperature tops 40° Celsius. As a farmworker, her day in the fields begins at 9am. There she sows seeds, clears weeds and harvests crops until about 5.30pm each day. 

“During this time, I am exposed to a lot of heat, which has been worsening my kidney stones,” she shares

Kidney disease rises with temperature

What Kadam has experienced isn’t a one-off case. Higher temperatures cause dehydration, leading to a rising concentration of minerals like calcium in the urine, which is responsible for the growth of kidney stones. 

A study published in the Lancet in March 2024 analyzed 135,4675 Acute Kidney Injury (AKI) cases in England between 2017 and 2021 and found a 62.3% increased odds of AKI when temperatures reached 32°C compared with that at 17°C. The researchers also found that in July 2021, a week-long heatwave led to a 28.6% increase in AKI counts. 

A study by the Children’s Hospital of Philadelphia in 2014 analyzed over 60,000 US patients and found a rising probability of people being diagnosed with kidney stones as daily temperatures rose. Researchers found that, at 30° C, the relative risk of kidney stone presentation was 36-39% higher than at 10° C.

Research from Australia points out that even a 1°C rise in daily minimum temperature increased emergency department admissions for kidney stones. 

Meanwhile, a paper in Nature’s Scientific Reports in January 2022 projecting the impact of rising heat on kidney stones in South Carolina, predicts that by 2089, even in the case of aggressive reduction in greenhouse gas emissions, the prevalence of kidney stones will increase by between 2.2% and 3.9%, costing an additional $57 million to $99 million respectively..  

According to the Global Burden of Disease study, 116 million cases of acute urolithiasis, a condition in which kidney stones move into the ureters, urethra, and bladder from the renal pelvis, occurred in 2019. 

This led to 13,300 deaths and 604,000 global disability-adjusted life years. For every 100,000 people, 1,394 were diagnosed with acute kidney stones. While there are no global projections yet, a rising chorus of experts are warning that kidney stones will rise sharply with the soaring temperatures.

“Global warming from climate change predisposes to kidney stones and acute kidney injury,” says Dr Matthew Borg, one of the authors and a biostatistician and research epidemiologist at t the University of Adelaide in Australia

Climate change can disrupt water treatment processes due to increased pollutant loads in heavy rainfall, which can decrease the availability of clean drinking water. 

“This can increase the risk of diarrhoeal diseases such as leptospirosis and schistosomiasis that, if not adequately managed, can cause dehydration and AKI,” Borg explains. 

There is already a 12% average prevalence of kidney stones worldwide, with 15% being the norm in Northern India. 

Unable to afford surgery 

Last year was the warmest year on the planet, during which India witnessed some of its deadliest heat waves. 

A report by international climate scientists found that human-induced climate change made the April 2023 heatwaves 30 times more likely in India and Bangladesh.  

Moreover, a paper published in PLOS Climate in 2023 found that heat waves can impact over 90% of India. 

Doctors have advised Vandana Badame to have surgery to remove her kidney stones, but she can’t afford it.

Three years ago, farmworker Vandana Badame felt a cramping pain in her side and back while working in the chilli fields in Maharashtra’s Ganeshwadi village. 

“The pain was unbearable. I kept puking and thought I was going to die,” 40-year-old Badame remembers. 

The culprit was a 9mm kidney stone. The doctors suggested surgery but she simply can’t afford it.

 Since then, she has relied solely on drinking water, hoping that the stone will pass through urine. But the kidney stone has caused her tremendous pain, which increases when she works in scorching heat. 

During such times, her only solution is to immediately go to a nearby clinic, take pain management injections, and continue working in the field. 

“Even if it pains, I have to keep working. What else can I do?” asks Badame, who is her family’s sole earner. 

Every month, she relies on intravenous drips to continue working in the fields. She gets 220 Indian Rupees ($2.65) for eight hours in the field, while an intravenous drip costs her at least Rs600 ($7). 

Whenever she steps out in the field, she carries five litres of water and painkillers. As the temperature increases, so does her vulnerability to the pain caused by kidney stones. 

A 2013 paper published in the International Journal of Environmental Health Research found that “the number of hot days in a year is positively correlated with the number of urolith patients”.

 Researchers also found that drought and semi-arid conditions in India made groundwater more saline, which is associated with the formation of kidney stones. 

Moreover, a 2020 study that analyzed 1500 industrial workers from South India exposed to extreme heat had a 2.3 times higher chance of severe health outcomes, with one third of steelworkers reporting kidney stones.

Lack of health facilities 

When farmworker Basappa Kamble, 51, collapsed from kidney stone pain at 1am in 2022, it took over an hour for him to reach the hospital. 

“There are no sonography facilities in the nearby areas,” says community healthcare worker Shubhangi Kamble, who rushed him to a private hospital where a 17 mm kidney stone was detected.  

“He was hospitalized for a week,” says Kamble. Despite the surgery, he complains of recurring pain. 

In his village, Arjunwad, with less than 6000 people, a majority are farmers, farm workers, and outdoor workers exposed to tremendous heat. 

Kamble started surveying her community and found that the problem of kidney stones peaked during summers. 

Workplace guidelines

“Workplace guidelines, such as enforced work to rest ratios, reducing physically strenuous work during the hottest hours of the day, and adequate access to good ventilation and shade, should be reviewed to improve workers’ safety in hot temperatures,” suggests Borge.

Besides this, he suggests general precautions like preparing for increased presentations of kidney stones and AKI, including staffing, equipment, training, and dialysis facilities during hot seasons.

However, for its 833 million strong rural population, India just has 764 district and 1224 sub-district hospitals catering to kidney ailments. 

“Since these hospitals are overcrowded and far away from villages, the only solution for many is to take a painkiller. Its overdose has led to several side effects,” shares Kamble. 

Farmworkers are forced to rely on costly private hospitals during such pressing times and a single doctor’s visit costs at least $6. Kadam and Badame earn this money after toiling in the fields for 16 hours. 

“Many times, I avoid going to the doctor and buy medicines from the pharmacy directly,” shares Kadam. 

Frustrated with the unbearable pain, sometimes she even ties a rope around her waist, attaches it to a firm object or a hook in the wall, and pushes herself against it. 

“This comforts me for a while. Every day, I feel like there is no end to this pain, and it will only go after I die.”

Image Credits: Sanket Jain.

Young children in Harare scrounge for left-over food.

HARARE, Zimbabwe – The maize meal porridge that their mother had previously blended with peanut butter and sugar for them is now a thing of the past for scrawny 13-year-old Nesbit Chigariro and his three siblings.

The family barely has enough food for a single meal a day, as the El Nino-induced drought sweeping southern Africa has pushed them to the wobbly edge of survival.

Miranda Chigariro, Nesbit’s 33-year-old mother, told Health Policy Watch that her children had fallen sick all at once earlier this year and nurses at a local clinic told her that they all suffered from kwashiorkor, a severe form of malnutrition.

The Chigariro family lives in Caledonia, an informal settlement 17 km east of the Zimbabwean capital, Harare. Harare is  home to nearly two million people, many battling starvation as a result of the latest drought.

Regional crisis

Many parts of southern Africa are contending with intense food shortages following the drought that has devastated crops during the region’s peak agricultural season from October 2023 to March 2024. 

The UN’s Food and Agriculture Organization (FAO) predicts that 33 African countries, including Zimbabwe and Zambia, will require outside help to address food insecurity.

“Many parts of Southern Africa are abnormally dry, with drought in eastern Angola, western and central Zambia, northeastern Namibia, northern Botswana, much of Zimbabwe, central Mozambique, central and eastern South Africa, and Lesotho,” according to the latest report (22-28 March) from the Famine Early Warning System (FEWS)

The El Nino phenomenon is triggered by the warming of the Pacific Ocean off the coast of South America, resulting in much less rainfall across many African countries and excessive rainfall in other parts of the world.

The governments of neighbouring Malawi and Zambia have already declared states of emergency because of drought and the Zimbabwean government is also believed to be contemplating this.

The drought has also reduced people’s access to clean water, causing cholera outbreaks. By mid-March 2024, a total of 28,556 cholera cases had been reported and 589 deaths from 62 districts across the 10 provinces, according to the United Nation’s children’s agency, UNICEF.

Some measured portions of maize meal on a vendor’s makeshift table in Harare, Zimbabwe. Times are desperate and many people are forced to buy tiny food portions.

Insufficient aid

In January, the United States Agency for International Development (USAID) announced a contribution of $11.27 million to the World Food Program (WFP) in Zimbabwe aimed at food aid for approximately 230,000 of the most vulnerable people across the hardest-hit districts, including Mwenezi, Mangwe, Chivi and Buhera.

This was supplemented by a $1.36 million contribution to the WFP by the Japanese government in February.

But this is a drop in the ocean as around a quarter of the population – 4.1 million Zimbabweans – teeter on the brink of food insecurity.

Amongst these millions are Nesbit and his three siblings, aged 10, six, and one, each facing the gnawing ache of hunger every day.

Nesbit’s parents sell sweets and popcorn on the streets in central Harare. If the siblings are lucky, they may get plain and unsweetened maize meal porridge once in a while.

The children are emaciated with jutting-out bellies that show their malnourished state.

Worst off is Nesbit’s one- year-old sister, who was weaned early because her mother, Miranda, could no longer produce adequate breast milk to feed her owing to hunger.

Miranda blames the drought for the family’s predicament, explaining that she and her husband rarely had enough to feed their children, let alone themselves.

“Our field, from which we have often harvested some maize each year, has produced nothing for us this time around, while very few people are buying from us these days as we sell our wares in the city,” Miranda told Health Policy Watch.

Looking thin and frail, Miranda said the family had been bashed by hunger that had worsened in the past three months.

Her malnourished husband, 37-year-old Dickson Chigariro, said that they only eat once at dinner time when they return home to their children.

A result of perpetual starvation and stress, Dickson and Miranda both suffer from stomach ulcers.

Inflation fuels hunger

A destitute blind beggar and her child on a street of Harare waits for Good Samaritans to donate anything to her.

With the cost of food ever rising, Zimbabwe’s inflation rate stands out at over 1,000%, the highest in the world, according to Professor Steve Hanke, a US economist at Johns Hopkins University.

In 1992, another drought killed over a million cattle in this country and many malnourished people turned to donors to help them survive.

But even as many Zimbabweans both in urban and rural areas are suffering, the government has remained adamant that nobody will succumb to hunger.

“Cabinet wishes to assure the nation that there will be enough grain before the commencement of the next maize or traditional grains intake in April 2024,” Zimbabwe’s Information Minister, Jenfan Muswere, told reporters last month after a Cabinet meeting. 

Not long after Muswere made the claims about food self-sufficiency, Zimbabwe received a donation of 25,000 tonnes of wheat and 23,000 tonnes of fertiliser from Russia.

Zimbabwe’s Agriculture Minister, Anxious Masuka, has also been on record in the media claiming that the southern African nation holds 190,000 metric tonnes of maize in its grain silos.

Yet with many Zimbabweans like the Chigariro family enduring hunger, government officials have played hide-and-seek games with the media, evading questions about the mounting hunger-related ailments.

“Thanks for your questions. However, the Ministry of Public Service and Social Welfare is most appropriate,”Donald Mujiri, a spokesman in the Ministry of Health, said in an emailed response to Health Policy Watch.

‘Nobody talks about it’

Malory Chagwiza, a trained nurse who volunteers as a community health worker because he cannot find work, said that the drought had also meant people were short of drinking water, which was causing dehydration.”

“Food insecurity is leading to malnutrition, which has negatively impacted the majority of people’s immune systems, rendering them susceptible to diseases. Some are already dying from the underlying effects of hunger, with nobody talking about it,” claimed Chagwiza.

Heatwaves and lack of water are also causing food-borne diseases as a result of food vendors operating under unhygienic conditions, he added.

Zimbabwe has also seen a surge in cholera cases, usually caused by people’s lack of access to clean water.

While the Zimbabwean authorities are indecisive about whether to declare the drought a state of disaster, there is grim evidence of this disaster in the country’s starving population.

“We can only endure, resting in the comfort that there are many like us here, some of whom are even worse,” said Miranda, from her disintegrating shack.

As Health Policy Watch, left she held a small bottle filled only with water to her one-year-old’s mouth. 

Image Credits: Jeffrey Moyo.

Women over the age of 60 and women with disabilities, face a higher risk of abuse yet their experiences are largely hidden in most data, according to two new publications released today by the World Health Organization (WHO).

Where there is data, these groups face high prevalence, with one systematic review finding greater risks of intimate partner violence for women with disabilities and another finding higher rates of sexual violence. 

“Older women and women with disabilities are under-represented in much of the available research on violence against women, which undermines the ability of programmes to meet their particular needs,” said Dr Lynnmarie Sardinha, Technical Officer at WHO and the UN Special Programme on Human Reproduction (HRP) for Violence against Women Data and Measurement.

Sardinha is one of the authors of two new WHO briefs on measuring violence against older women and against women with disabilities. These briefs are the first in a series on neglected forms of violence by the UN Women-WHO Joint Programme on Violence against Women Data. 

“Understanding how diverse women and girls are differently affected, and if and how they are accessing services, is critical to ending violence in all its forms,” said Sardinha.

According to the WHO, one in three women worldwide experience physical and/or sexual violence in their lifetime, whether from their intimate partners or from others. The prevalence of violence ranges from 20% in the WHO’s Western Pacific region, to 22% in Europe, and as high as 31- 33% in the Africa, Eastern Mediterranean and South-East Asia regions.

Additional risks

But older women and women with disabilities also face specific risks and additional forms of abuse, sometimes at the hands of caregivers or health care professionals. These include coercive and controlling behaviours such as withholding of medicines, assistive devices or other aspects of care, and financial abuse.

In older age, intimate partner violence tends to change from physical to psychological abuse, including threats of abandonment, although more research is needed to understand how power dynamics shift in older age.

Older women and women with disabilities can be extremely isolated when violence occurs, making it more difficult for them to escape and report the abuse. Stigma and discrimination can further reduce access to services or information, or result in their accounts of violence being dismissed by responders.

“Gender-based violence is rooted in unequal power and control over women,” said Dr Avni Amin, Head of the Rights and Equality across the Life Course Unit at WHO and HRP. 

“For older women and women with disabilities, their dependency and isolation are further exploited by perpetrators, increasing their risk of abuse. Services must be responsive to their needs and identify appropriate contacts through the health and care systems, so that all women experiencing violence can access empathetic, survivor-centered care.”

Noting that older women are currently represented in only about 10% of data on violence against women, the WHO recommends extending the age limit for survey participation and incorporating questions relating to different types of violence, encompassing a broad spectrum of disabilities.

They also advocate for user-friendly formats such as Braille or EasyRead to enhance the accessibility and participation of some disabled women.

Image Credits: UN Women.

Bats captured from the Kitaka mine in Uganda were discovered to be the source of a Marburg virus outbreak in July 2007.

As World Health Organization (WHO) member states bang heads in Geneva over a pandemic agreement to keep the world safe, a group of scientists has challenged global decision-makers to pay far more attention to humans’ relationship with animals.

“Although preparedness and response have received significant focus, prevention, especially the prevention of zoonotic spillover, remains largely absent from global conversations,” write the 24 scientists from a range of different global institutions in an article in Nature Communications published on Tuesday (26 March).

Using bats as their case study, they show how environmental changes exacerbate zoonotic spillover – and identify the “ecological interventions that can disrupt these spillover mechanisms”.

Primary prevention of zoonotic spillover

Their ecological countermeasures focus on bats because a number of major epidemics and pandemics” – SARS-CoV-2, Ebola, SARS-CoV-1, MERS-CoV, and Nipah virus –  have an evolutionary origin in bats.

Certain bat species also host four of the nine diseases identified by the WHO as having the potential to generate epidemics that pose a great risk to public health.

So what does an ecological approach look like when applied to bats? The authors propose three measures to prevent zoonotic spillover from bats to humans.

The first involves protecting where bats eat, which involves numerous interventions including preserving and restoring vegetation diversity and structural complexity in bat foraging habitats.

In subtropical Australia, for example, Pteropus species bats (which carry the deadly Hendra virus) feed on nectar in winter-flowering forests. But in some areas, over 90% of these forests have been destroyed.

“Replanting winter habitats would be a sustainable, scalable, and effective strategy to reduce the risk of spillover of not just Hendra virus, but other viruses carried by Pteropus species bats,” they argue.

Preventing zoonotic spillover involves protecting bats where they eat and roost and protecting people wo interact with them.

The second measure involves protecting where bats roost.

“Roosts are locations where bats sleep, shelter, mate, socialise, and raise their young. With few exceptions, bats cannot construct shelters and must roost in pre-existing natural (eg, caves, rock crevices, tree cavities, and tree foliage) or human-made (eg, buildings, bridges, mines) structures,” the authors state.

The third measure involves protecting people and their livestock who come into contact with bats. This can be done by reducing livestock’s interactions with bats and bat excreta and providing personal protective equipment for peoplein contact with bats or their excreta.

In Malaysia, for example, “a regulation requiring fruit trees to be planted at a distance from pig sties may explain the lack of subsequent Nipah virus spillovers”, the authors note.

Integrating ecological and biomedical approaches

“Recognising that pandemics originate in ecological systems, we advocate for integrating ecological approaches alongside biomedical approaches in a comprehensive and balanced pandemic prevention strategy,” they argue.

Pandemics almost always start with a microbe infecting a wild animal in a natural environment, but when a wild animal then infects a human, this is often triggered by “human-caused land-use change”. The more land use changes, the greater the risk of zoonotic spillover.

“Designing land management and conservation strategies to explicitly limit spillover is central to meeting the challenge of pandemic prevention at a global scale,” they argue.

“In our view, the most effective strategy to reduce the probability of another pandemic is to preserve intact ecosystems and bolster their resilience through restoration and the creation of buffer zones.

“Our primary emphasis should be on maintaining and enhancing the integrity and resilience of still-intact landscapes to prevent new interfaces that could enable the emergence of Disease X.”

Pandemic agreement and One Health

Article 5 of the draft pandemic agreement is devoted to One Health, which it defines as “an integrated, unifying approach that aims to sustainably balance and optimise the health of people, animals and ecosystems. It recognizes that the health of humans, domestic and wild animals, plants and the wider environment (including ecosystems) is closely linked and interdependent”.

According to the draft agreement, parties will commit to a One Health approach for pandemic prevention, preparedness and response that is “coherent, comprehensive, integrated, coordinated and collaborative among relevant actors and sectors”.

Proposed measures include engaging communities to prevent, detect and respond to zoonotic outbreaks; workforce training; updating international standards and guidelines, and developing multilateral mechanisms to help developing countries to adopt a One Health approach.

Image Credits: Chris Black/WHO.