Displaced Palestinians in Rafah huddle around a makeshift food market, facing yet another forced move as threat of an Israeli operation in the city looms.

WHO has said it is “deeply concerned” that a full-scale military operation “could lead to a bloodbath” as prospects of a major new Israeli incursion into Gaza’s southern enclave of Rafah appeared to grow over the weekend – while hopes of a cease-fire deal see-sawed wildly. 

“A new wave of displacement would exacerbate overcrowding, further limiting access to food, water, health and sanitation services, leading to increased disease outbreaks, worsening levels of hunger, and additional loss of lives,” said the global health agency.  

The WHO statement Friday was repeated Monday afternoon on X  by WHO Director General Dr Tedros Adhanom Ghebreyesus – as previously positive signs of a possible ceasefire and hostage deal between Israel and Hamas receded last week, crashed over the weekend, and then rebound slightly again Monday evening with Hamas announcing publicly that it would accept an Egyptian-Qatari mediated proposal – even as Israel launched a wave of air strikes on Rafah’s eastern neighbourhoods. 

“Only 33% of Gaza’s 36 hospitals and 30% of primary health care centres are functional in some capacity amid repeated attacks and shortages of vital medical supplies, fuel, and staff,” said the WHO statement on the health situation in the Palestinian enclave, only about 365 square kilometres in size. 

“As part of contingency efforts [for a possible operation], WHO and partners are urgently working to restore and resuscitate health services, including through expansion of services and pre-positioning of supplies, but the broken health system would not be able to cope with a surge in casualties and deaths that a Rafah incursion would cause.   

“The three hospitals (Al-Najjar, Al-Helal Al-Emarati and Kuwait hospitals) currently partially operational in Rafah will become unsafe to be reached by patients, staff, ambulance, and humanitarians when hostilities intensify in their vicinity and, as a result quickly become non-functional,” warned WHO.  

“The European Gaza Hospital in east Khan Younis, which is currently functioning as the third-level referral hospital for critical patients, is also vulnerable as it could become isolated and unreachable during the incursion. Given this, the south will be left with six field hospitals and Al-Aqsa Hospital in the Middle Area, serving as the only referral hospital.” 

Over 1 million displaced Palestinians are crowded in and around Rafah, a town hugging up against the Egyptian border, which is also heavily barricaded against crossings by Palestinians except for the seriously ill – and wealthy, well-connected families who can afford steep fixer fees to evacuate.  

Crisis began building last week 

Displaced Palestinian children in Gaza’s Rafah area play near a water pit filled by a rainstorm.

The current crisis began building up last week in the wake of a blunt series of statements by Israel’s Prime Minister Benjamin Netanyahu expressing his determination to invade Gaza’s Rafah area, whether or not a ceasefire and hostage deal is reached. 

Then on Sunday, a Hamas volley of rockets at an Israeli military base near the Kerem Shalom crossing into Gaza killed four Israeli soldiers – creating a political uproar inside Israel as it observed a national Holocaust remembrance day. Israel responded by shutting the Kerem Shalom crossing point to traffic Sunday morning  – one of the three vital humanitarian aid lifelines into the enclave.  Israeli-Hamas talks over a cease-fire and potential exchange of Israeli hostages and Palestinian prisoners held by Israel reportedly stalled – only to receive a new Monday evening with the Hamas announcement of a new offer, that Israel said it was “studying” – even as it launched a wave of “targeted” air strikes on what it claimed were Hamas strongholds east of Rafah.

Earlier on Monday Israel’s military issued orders to some 100,000 Palestinian civilians in parts Rafah close to the Israeli border to begin evacuating from the area, dropping leaflets in the targeted areas. The Israeli move, and its potential to expand to a larger attack, was decried by UN Human Rights Chief Volker Türk, who called Israel’s Rafah threat “inhumane” as well as by countries ranging from France to Saudi Arabia.  

“Gazans continue to be hit with bombs, disease, and even famine. And today, they have been told that they must relocate yet again as Israeli military operations into Rafah scale up,” the High Commissioner said. Israeli air strikes on homes in Rafah were reported to have killed over two dozen more people, including women and children over the past 24 hours, Turk’s office added. 

On Monday evening, air raid sirens were again sounding in Israeli communities around the Gaza perimeter – while Israel’s military spokesperson Daniel Hagari stepped up calls on Israeli television for Palestinians in “designated areas” of Rafah to move north and westward to the area of Al Mawasi, and northwards towards Khan Younis – in advance of planned Israeli operations got underway later Monday night. 

Some 400,000 displaced people are already located in Al-Mowasi, said Louise Wateridge, a spokesperson for the UN agency for Palestinian refugees, UNRWA, speaking from Rafah in a Geneva press briefing on Monday afternoon. 

Dashed hopes

Louise Wateridge, spokesperson for the UN agency for Palestinian refugees, UNRWA.

“There was really a lot of hope over the last days that there would be a ceasefire,”  Wateridge said. “So, we’re genuinely devastated to wake up today and have the reality that is the [Israeli] leaflet drop and you know, reports of evacuations beginning.”  

“Nobody has a clear path where to go, there is no advice on where to go, there is no safety to be led to,” she added. “So, in each circumstance, in each family, now it’s a lot of panic and a lot of chaos, because even though we’re hearing the evacuation orders are confined to a small area in Rafah, in the east of Rafah, you can imagine as people start to move, the panic is going to spread. 

“Already outside the window here, we’re in more central Rafah, people are beginning to take down shelters and leave.”

In the wake of the closure of Israel’s Kerem Shalom crossing into Gaza, Egypt’s Rafah checkpoint also remains the only reliable source of food aid – now threatened by a looming Israeli operations, she pointed out. Food supplies had only recently begun to rebound parts of Gaza, like Jabalya, where there has been more commercial food on the market, which is really promising to see,” Wateridge said. But in parts of northern Gaza, which UN humanitarian aid convoys have been unable to reach, “the situation remains just devastating.”

Inside Israel, families of hostages who had been hopeful last week of a possible deal to release the remaining women, elderly and ill who remain amongst the estimated 100 people still held captive by Hamas blocking a main highway in Tel Aviv, calling on Netanyahu to “stop playing with the lives of our children”.  

Israeli protestors block main highway in Tel Aviv, calling on government to put hostage release over military operation in Rafah.

UN Secretary General Antonio Guterres meanwhile called upon Israel and Hamas to ‘go the extra mile needed’ to finalise a deal in a statement Monday evening.

“The Secretary-General is deeply concerned by the indications that a large-scale military operation in Rafah may be imminent,” said UN spokesperson Stephane Dujarric in a statement. “The Secretary General reminds the parties that the protection of civilians is paramount in international humanitarian law.”

Some 1,139 Israelis, mostly civilians, were killed and another 252 people taken captive by Hamas on 7 October, with 105 hostages released in late November as part of a week-long ceasefire, and seven more unilaterally by Hamas or by Israeli operations, while around 267 more Israeli soldiers have died in the ensuing six months of conflict. Meanwhile, over 34,000 Palestinians have been killed during Israel’s prolonged invasion of Gaza, according to Gaza’s Hamas-controlled Health Ministry. Most of the victims are reported to be women and children, but Hamas data does not distinguish between civilian and military casualties.  

Image Credits: OHCHR , UNRWA , Channel 11, Israel TV.

Mechanical milking machines may be facilitating the fast spread of H5N1 avian flu in dairy cows in the US.

Although cows have been infected with avian influenza subtype H5N1 for the first time and viral remnants have been found in milk, the World Health Organization (WHO) and the US Centers for Disease Control and Prevention (CDC) characterise its current risk to humans as “low”.

The risk for people exposed to infected birds and other animals is low to moderate, they add.

So far, there have been no cases of avian flu being transmitted from person to person in the current outbreak – only from infected birds and animals to humans.

The last human-to-human transmission of avian flu was detected in 2017 and involved infections between a small group of health workers.

Only one person has been infected in the current outbreak in US dairy herds, a man working on a Texas dairy farm who developed conjunctivitis. Swabs of the man’s throat and eye tested positive for H5N1, but he had mild symptoms and did not infect anyone in his household.

Meanwhile, some 220 workers who work at the 36 US dairies affected by the H5N1 outbreak have been screened, but none has been infected with the virus, according to the US CDC’s Dr Todd Davis, speaking at a WHO Information Network for Epidemics (EPI-WIN) briefing on Monday.

“After sequencing several hundred viruses from cattle, we don’t see any molecular changes that would indicate increased possibilities of infection or transmission from person to person,” said Davis. 

“So we still consider this public health risks to be quite low. I think some of the exceptions may be prolonged unprotected exposure to infected dairy cattle, so there are some likely risk associated with occupational exposure.”

US CDC’s Todd Davis

Milk and meat risks

About 20% of milk samples collected by the US Food and Drug Administration (FDA) tested positive for H5N1 viral RNA, said Dr Richard Webby, director of the WHO’s Collaborating Centre for studies on the ecology of influenza in animals and birds.

Meanwhile, a smaller sample set targeted at the states where outbreaks had occurred found  40% of the milk products contained viral remnants,  added Webby, who is based at St Jude Children’s Research Hospital in Memphis in the US.

“There has been a relatively large number of samples tested, but so far from a safety perspective, it does look like the pasteurisation process is removing viable virus from those samples,” added Webby.

Dr Moez Sanaa, head of the WHO’s Standard and Scientific Advice on Food Nutrition, confirmed that while viral RNA has been found in pasteurised milk, none of this was live virus “suggesting that the pasteurisation process effectively inactivates H5N1,” said 

“Preliminary results [of ongoing studies] indicate that virus is inactivated by heat treatment similar to pasteurisation,” said Sanaa, but added that more studies of milk with higher viral loads was still needed. He warned people to avoid raw milk.

Meanwhile, last week the USDA’s Food Safety and Inspection Service (FSIS) announced that all 30 samples of ground beef from retail outlets in the states with infected dairy cattle herds tested negative for H5N1. These results reaffirm that the meat supply is safe.

Webby’s group has also tested eggs and found them to be free of H5N1.

Richard Webby, Director of the WHO’s Collaborating Centre for studies on the ecology of influenza in animals and birds

Cow transmission: mechanical?

From the genomic analysis, it appears that the outbreak in the dairy farms stemmed from “a single introduction” but that “the moving of dairy cattle has spread that to multiple farms and different locations”, according to Dr David Swayne, a US influenza veterinarian.

Swayne added that as transmission seemed to occur “in the unique environment of a dairy parlour”, there were two leading hypotheses about how the rapid transmission was taking place.

One was that there was “mechanical transmission” with infections being spread via milking machines, for example.

The other was that transmission occurred during the “continual cleaning” in dairies that enabled viral spread through “large droplets produced from that washing down process”. 

Meanwhile, Dr Aspen Hammond from WHO’s Global Immunization Programme (GIP) said that H5N1 had been found in other animals near the affected dairy cattle herd, including cats, raccoons and wild and domestic birds nearby.

‘One Health in action’

Dr Maria van Kerkhove, the WHO’s acting head of Epidemic and Pandemic Prevention and Preparedness (EPP), described the outbreak as “one Health in action”.

“You cannot look at human health risk without looking at the risk in animals,” said Van Kerkhove, stressing that partnerships with bodies in the animal health field were essential.

“Right now, there’s a lot of focus on the US but we are seeing a global epizootic of avian influenza, and we’ve seen H5N1 infection in wild birds and poultry and marine mammals and land mammals,” she said.

“But what is concerning is that we are seeing new species that are being infected… We need much stronger surveillance in animals globally, not just in the US, looking at the species that we know can be infected with H5N1, but also in humans at the animal-human interface. “

She urged those doing surveillance to continue to sequence and share those sequences to enable regular assessments of the viruses as well as “what any changes in these viruses mean, in terms of transmissibility in terms of severity.”

Van Kerkhove also stressed that occupationally exposed people needed to be protected from infection, including by using personal protective equipment and washing hands frequently, “because prevention is key”. 

She also said that, while it was not yet necessary, the current H5N1 flu was covered by the candidate vaccines in the influenza prevention pipeline.

Image Credits: pxfuel, Charyse Reinfelder.

A Zimbabwean health worker administers an HIV test.

HARARE, Zimbabwe – Michelle and Michael Mutsvaki were infected with HIV at birth, but while their parents have  shunned antiretroviral (ARV) medicine to treat their HIV, the siblings opted for treatment in their teens.

The siblings, now aged 22 and 24, learnt about their HIV status from their mother, but she assured them that their faith would protect them from succumbing to the disease.

However, faith did not save their father. Instead, they watched him die of HIV complications a decade ago despite the intervention of faith healers. 

Meanwhile, their mother, a follower of the African indigenous Johane Masowe Church, still clings to her religious beliefs and concoctions instead of taking ARVs.

But after Michelle and Michael learnt about the importance of taking antiretroviral treatment from HIV/AIDS activists who visited their school in 2017, they made one of the most important decisions of their lives, opting to take ARV treatment despite their parents’ advice. Seven years on, they are doing well. 

The siblings were both born at home without the assistance of nurses because their parents avoided clinics and hospitals due to their religious beliefs. 

Labour and birth is a risky time for newborn babies born to mothers with HIV who are not on ARVs with suppressed viral loads as they can be exposed to the virus in bodily fluids.

But mother-to-child HIV transmission, also referred to as vertical transmission, is rare nowadays as pregnant women with HIV take ARVs to ensure that their viral load is undetectable before giving birth, meaning that the virus is untransmissible (referred to as U=U) . Newborns are also given ARVs at birth to prevent infection.

Unfortunately, being born at home without medical help, Michelle and Michael contracted HIV at birth.

Citizens embrace ARVs

Zimbabwe’s adult population has come to embrace HIV treatment. The Zimbabwe Population-based HIV Impact Assessment Survey conducted in 2020 revealed 86.8% of adults living with HIV knew their status, and of those who were aware that they were living with HIV, 97% were receiving antiretroviral treatment.

About 1.4 million people in Zimbabwe are living with HIV, and the health ministry says that some 1.2 million Zimbabweans are on ARVs.

The huge uptake of ARVs has been the main reason for a 50% decline in the national HIV incidence over the past 10 years, according to a report from UN Development Programme (UNDP), which works with the health ministry and the Global Fund to prevent HIV.

HIV prevalence in adults (15-49 years) has fallen from its peak of 26.5% in 1997 to 11% in 2021. In 2022, the incidence rate of new infections was at 0.17%, and there was a decline in new HIV infections for all age groups. 

Meanwhile, AIDS deaths have also plummeted over the past 20 years. In 2002, an estimated 130,000 people died of HIV-related complications whereas by 2021, the death toll was around 20,200, according to a UNICEF report.

People living with HIV wait to collect their share of free life-prolonging ARVs at Sally Mugabe Hospital in Harare.

Treatment holdouts

Yet as the southern African nation registers success in combatting HIV/AIDS, other people living with the disease have remained adamant they will not take treatment.

Susan Mutsvaki, Michelle and Michael’s mother, has openly expressed contempt for ARV drugs, citing her faith as a barrier to taking modern medicines for any form of illness

Mutsvaki, aged 47, says she has lived with HIV for the past two decades without taking any treatment or ARVs. Instead, she firmly believes that a concoction of water and pebbles that she was instructed to drink by her bishop at her church a decade ago, has helped keep her safe while living with HIV.

Mutsvaki is a member of the Johane Masowe Church, which traditionally worships at open-air gatherings with all congregants donning white garments.

Mutsvaki operates a market stall at the Rezende Bus terminus in central Harare, where she  sells fruit, vegetables, popcorn and cigarettes. 

She keeps a white bag with her that contains a 750 ml bottle of water mixed with pebbles, which she sips from, as told by her religious leader whom she refers to as a “prophet”.

“I have not been sick at all from HIV. This bottle and the stones in it are my prayers from our prophet and I believe these are making wonders for me as you see how fit I look,” Mutsvaki said.

While Zimbabwe prides itself of achieving success in preventing HIV/AIDS, there are a few holdouts who have pulled in the opposite direction.

Hector Chinopa is one of these. When he contracted COVID-19 in 2020, he asked staff at the Wilkins Hospital in Harare for an HIV test, which came out positive.

But barely four years after surviving the coronavirus, 36-year-old Chinopa has been dodging antiretroviral drugs.

Like Mutsvaki, he reasons that he has not been ill since contracting COVID so he hasn’t felt a strong need to seek treatment.

“I’m not sick. Do I look sick when you look at me? No, I’m not sick,” Chinopa told Health Policy Watch.

Zimbawe’s death toll has plummeted since introducing ARVs

Teen sons may have died of HIV

Linet Gavi, 41, who tested HIV positive two years ago, also has not taken any treatment. But she is uncertain about whether her two teenage sons, who passed away in 2019, were living with HIV.

The boys, aged 15 and 18 at their deaths, suffered from severe headaches and coughing, and had bouts of diarrhoea, according to their mother. They vomited often and they both lost their hair and weight during the time of their illness.

At that stage, Gavi was in the dark about her HIV status. Since she was diagnosed, she wonders whether she might have passed the virus to them at birth.

But Gavi is resistant to taking ARVs because she claims she has witnessed friends and family becoming seriously ill after beginning ARV treatment.

“I don’t want to die by taking ARVs. I had relatives and friends who took ARVs after suffering from HIV, but they are no more today. I’m fine without treatment and I have not been sick. I just eat some crushed garlic to boost my immune system,” Gavi claimed.

Chinopa, Gavi and Mutsvaki all said they have not dared seeking treatment from government clinics after testing positive for HIV although the Zimbabwean government has been making urgent calls for all HIV patients to be placed on treatment.

Zimbabwe’s prevention of mother-to-child HIV transmission programme has been operational since 2002, transitioning from a pilot program in 1999 to a national initiative. Children born since then, such as Michelle and Michael, could have been spared HIV infection if their mothers consulted clinics and gave birth in health facilities.

International help

Between 2003 and 2022, the Global Fund has invested $1.8 billion in Zimbabwe’s HIV programme and recently approved a three-year HIV grant of  (2024-2026) $437 million.

Despite a few people refusing ARVs to this day, Zimbabwe has made significant strides in prevention and treatment.

An official from Zimbabwe’s Health Ministry, who declined to be named, told Health Policy Watch, that ARVs were available for everyone who tested postive for HIV and were willing to take the treatment.

“Those people you say are refusing treatment are making their own decisions not to have the ARVs, but I can tell you the treatment is available for all who test positive for HIV,” said the government official, who was not authorised to speak to the press.

Although some Zimbabweans are resisting HIV treatment, late last year authorities announced that 95% of its HIV-positive population reached undetectable levels of the virus. 

In November 2022, the Ministry of Health’s Dr Chiedza Mupanguri told a media briefing that 95% of Zimbabweans living with HIV had reached undetectable viral loads, meaning that the level of virus in their bodies is so small it cannot be transmitted to others.

This year, Zimbabwe became the first country in Africa, and the third in the world behind Australia and the US, to approve CAB-LA, a long-acting injectable medication that prevents HIV.

CAB-LA acts as a pre-exposure prophylaxis (PrEP) and is recommended by the World Health Organization (WHO) for those at high risk of contracting HIV.

While the country has pledged to target the entire population in its battle against HIV, individuals like Chinopa, Gavi, and Mutsvaki remain steadfast in their refusal to participate. 

HIV/AIDS activists attribute the current deaths to those living with the disease for rejecting treatment due to myths suggesting that the drugs intended to help them actually hasten their demise.

“Many getting killed by AIDS these days are either defaulting on treatment or not on treatment at all,” Moris Mukundu, an AIDS activist in Harare, told Heath Policy Watch.

 

Image Credits: UNICEF Zimbabwe.

Steve Solomon, WHO Principal Legal Officer, co-chairs Precious Matsoso and Roland Driece, and  Jaouad Mahjour, Head of WHO Secretariat to intergovernmental negotiating body.

“Get this done” – and if you disagree, don’t block consensus, was the heartfelt plea made by World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyessus to member states negotiating a pandemic agreement on Friday (3 May).

Tedros was addressing the ‘stocktake’ in the middle of the final 10-day meeting of the intergovernmental negotiating body (INB), and it was clear that member states were nowhere close to the finish.

“You are here for the same reason this organisation was created in the first place – because global threats demand a global response,” said Tedros.

“I appreciate that all of you are making compromises you did not want to make. I appreciate that, article-by-article, paragraph-by-paragraph, word-by-word, you are converging on a consensus, although you’re not there yet.

“I also appreciate that consensus does not mean unanimity. I recognise that there may be delegations who, despite their good faith efforts, may not be in a position to join a consensus, but they have a choice. They can choose not to block consensus.”

Evoking “the people of the world”, including future generations, those struggling to survive and those mourning family members who died during COVID-19, Tedros said: “Please, get this done, for them.”

Pandemic Agreement negotiations status (3 May).

At the stocktake, INB co-chairs told stakeholders that revised text has been circulated for Articles 4, 6, 10 and 19, and there is broad agreement on parts of Articles 4, 6 and 10.

New text for Articles 13, 13bis, 14, 17 and 20 still need to be circulated. Meanwhile,  Chapter 1 (definitions) and Chapter 3 have not yet been discussed.

However, at a media briefing later on Friday INB co-chairs said that agreement had been reached on Article 18, an innocuous article on communication. However, they were cagey about giving any specifics on the negotiations, stressing that countries “are trying to find each other”

“Nothing is agreed yet, but also nothing has been taken out yet,” said co-chair Roland Driece, adding that negotiations became complex when trade issues became involved.

“It’s not uncommon, actually is quite normal, that everything should come together almost in the last couple of days,” he added. “It’s standard negotiation practice that countries will only give up on what’s important for them when they see the whole picture.”

Driece added: “In the situation that we would not find consensus by the end of the week, we will report that to the World Health Assembly and it’s up to the World Health Assembly then to decide what should be happening next.” 

Matsoso concluded the briefing by warning: “The window of opportunity is closing, and once it closes, it will be a missed opportunity intergenerationally because there are new priorities and we cannot afford to miss this.  We can only but encourage countries to work towards finalising the agreement.”

Member states will be meeting in working groups on contentious articles over most of the weekend, then the 12-hour daily schedule resumes officially on Monday.

The programme for next week involves finalising all text. Working groups will meet in mornings to discuss and “yellow” text, indicating which areas are ready to be put up for discussion. Plenary sessions will be held in the afternoons to read and “green” this text. There is also time for breakouts and working groups in evenings.

Image Credits: WHO, Nina Schwalbe.

The WHO assisted Zimbabwe to respond to a cholera outbreak in the country. As part of the response, mobile community centres were set up to detect and treat cases.

Deaths during the cholera outbreaks over the past two years have been “unacceptably high”, according to the World Health Organization (WHO).

“We are looking at outbreaks with unacceptably high case fatality ratios (CFR),” said Philippe Barboza, WHO’s cholera lead and head of the Global Task Force on Cholera Control (GTFCC) secretariat.

“Without any type of treatment or case management, the CFR of cholera can be up to 50%. However, with adequate treatment, the CFR should be below 1%. The 1% is not the target, the 1% is the maximum acceptable CFR,” Barbosa told a WHO meeting on cholera this week.

But in recent outbreaks in Malawi, Zambia, Uganda and Sudan, around 3% of those infected have died, according to WHO statistics.

“This is totally unacceptable. And when I say that, I’m not blaming the country. The size of the outbreaks are so big, that they overwhelmed the national capacity,” said Barbosa.

Cholera is a bacterial disease spread largely in contaminated food and water, and can cause severe acute watery diarrhoea.

However, Barboza added that it was also “totally unacceptable” that, in the 21st century people are still dying “because they are drinking water contaminated with faeces”.

Between 2017 and 2020, significant progress was made to reduce cholera but the pandemic reversed these gains. Climate change and conflict are also driving the recent outbreaks.`

Since the start of 2023, there have been almost 850,000 reported cases, with this year alone already recording 140,000 cases.

The WHO declared cholera a Stage Three health emergency, the most serious level, in early 2023 and this remains the case currently, with 23 countries experiencing outbreaks.

“Around 80% of the patients WHO have symptoms of cholera can be treated have either no or very mild signs or mild to moderate dehydration and can be treated with oral rehydration solution alone,” said Kathryn Alberti, WHO technical offer on cholera.

Although the global surveillance of cholera is poor, a GTFCC review shows that many deaths occur in communities rather than in health facilities.

Barboza and other speakers emphasised the importance of involving the community in outbreak response. During a large cholera outbreak in Malawi following a cyclone that caused widespread flooding, the country’s health ministry set up community outreach centres to provide people with oral rehydration. Community engagement was also seen as essential in encouraging people to seek care.

Representatives from civil society organisations wait around in the WHO canteen in Geneva for news from the pandemic agreement negotiations.

A crucial stocktake of the state-of-play of the World Health Organization (WHO) pandemic agreement talks on Friday afternoon (3 May) will determine the way forward for the final five days’ negotiations.

But progress has been slow in the past four days, according to reports – with differing opinions about whether a skeleton agreement can or even should be nailed down in time for the World Health Assembly (WHA) at the end of the month – or whether it should be deferred for another year.

An array of civil society organisations wrote to WHO Director-General Dr Tedros Adhanom Ghebreyessus last week expressing concern that the Bureau co-chairs of the intergovernmental negotiating body (INB) are pushing hard for countries to adopt an agreement that “perpetuates the status quo, entrenching discretionary, voluntary measures and maintaining inequitable access as the norm for addressing PPPR” [pandemic preparedness, prevention and response]. 

Meanwhile, 20 medicines access advocacy groups also issued an open letter over the weekend describing a pandemic instrument that does not deliver equity as a “failure”.

This group – which includes organisations from Brazil, South Africa, Kenya, Mexico and Peru – made various suggestions to make the PABS system more equitable, including that “all users that financially benefit from using the PABS system must be required to make monetary contributions to WHO especially to build resilient health systems in developing countries”.

However, over the past weekend,  AU deputy chairperson Dr Monique Nsanzabaganwa, told a meeting of African health ministers that postponing an agreement may not be in the continent’s interests “because we may postpone forever”. 

In a communique issued after the meeting, Africa called for “an international financing mechanism that is accountable to the Conference of Parties [envisaged to govern the agreement] and enshrining explicit commitments to new, sustainable, and increased funding support from developed countries for country-level PPPR in developing countries, debt relief and debt restructuring mechanisms including debt for PPPR swaps”.

PABS: Equity and bitter experience

The proposed WHO pathogen access and benefit-sharing (PABS) system (Article 12) remains the biggest sticking point, absorbing almost two days of the five-day talks so far, according to an INB report-back to stakeholders. By the end of Thursday, little progress had been made. However,  member states are to come up with a consensus on the text and bring it back to plenary, according to a stakeholder briefing.

While it sounds dry and technical, PABS encapsulates all the inequity and heartache of past pandemics. It is also one place where developing countries have some leverage, given that many outbreaks originate in these countries from zoonotic transfer from animals to people – so they might well have first access to information about responsible pathogens.

In short, the PABS system wants to facilitate the rapid sharing of genetic and biological data of pathogens that could become global threats so that researchers and manufacturers can develop medicines and vaccines to prevent their spread.

Countries that share this information will be compensated with “access to pandemic-related health products, and other benefits, both monetary and non-monetary, arising from such sharing”  according to the proposal from text from INB’s 16 April draft.

Most tangible offer: 20% of the goods

Article 12.3 contains the agreement’s most tangible offering: that 20% of pandemic-related health products are allocated to the WHO for distribution – 10% as a donation and 10% at cost. 

This would ensure that the WHO, not wealthy governments playing to their electorates, could then distribute these products to those in greatest need. So, for example, if this had been the case during the COVID-19 pandemic, the WHO could have ensured that health workers and the world’s most vulnerable got early access to vaccines.

But as Nina Schwalbe of Spark Street Advisers and a key commentator on the process says: “Will 20% be the ceiling or the floor?” That still needs to be decided.

The INB co-chairs have proposed that the mechanics of the PABS system, as well as One Health implementation measures, should be finalised by May 2026 but the basic principles still need to be agreed on.

The INB also discussed surveillance (Article 4), diversified production of pandemic products (Article 10), and are reaching consensus on Cooperation (Article 19) and Financing (Article 20). Working groups have been established on Articles 4, 5, 10, and 11 to fast-track agreements, INB co-chairs told stakeholders this week.

However, as the Pandemic Action Network (PAN) has noted, civil society organisations  “are still relying on snippets from the corridor” and there is “no confirmation yet on whether the Friday stocktake will be opened to relevant stakeholders”.

Image Credits: Nina Schwalbe.

Surgeons in Burkina Faso operate on a patient after undergoing surgical training at the Geneva University Hospitals (HUG) as part of an international collaboration.

In the universe of Geneva’s global health hub, which includes dozens of international NGOs and WHO as the brightest star in the solar system, a parallel universe of locally-grown health and humanitarian collaborations have also developed around the University of Geneva and Geneva University Hospitals.

GENEVA – Ten years ago, two medical professionals from Madagascar met up with Dr Alexandra Calmy, a leading infectious disease expert at the Geneva University Hospitals (HUG in French) at the Geneva Health Forum to tell her about the bane of TB-meningitis that they were confronting in their country among people with HIV or weakened immunity – a disease that has a 40% mortality rate. 

“They told me ‘we are really in trouble in Madagascar with TB-Meningitis – we don’t know what to do and we have no way to diagnose and treat them efficiently,” recalled Calmy.  

That chance meeting proved to be the beginning of a major collaboration between the HUG and a hospital in Madagascar that introduced, firstly, more accurate GeneXpert diagnostics for earlier intervention, and later, two alternative treatment options for TB-meningitis. 

That eventually led to a grant from the European Union’s EDCTP, and a randomized, multi-country trial of the new treatments  in Madagascar as well as three other African countries – Ivory Coast, South Africa and Uganda (INTENSE-TBM), now underway. 

International Geneva’s ‘global health hub’ 

A training session in Mali for health professionals about therapeutic patient education and diabetes co-organized by the Malian Ministry of Health, HUG and the NGO, Santé Diabète

The story is one of dozens of examples of research innovations and health and international development success stories that have emerged out of a unique ecosystem of the University of Geneva and its university hospital affiliate, working in partnership with the city’s many NGOs and international aid organizations, all part of the constellation known as “International Geneva”.  

Others call it the Geneva ‘Global Health Hub’- with the World Health Organization as the center of the solar system –  around which dozens of other planets and satellites revolve.  

The projects stimulated by the University-HUG collaborations, per se, range from new medicine regimes like the one being tested for TB, to new, easy-to-use diagnostic tools for conditions such as cervical cancer, long-neglected in developing regions. 

They also span an enormous range of initiatives to actually introduce innovations into health systems and build the capacity of medical professionals. Examples of the latter include educating nurses to provide diabetes control information and training community health workers in refugee settings.   

In fact, the labyrinth of collaborations, particularly in the health and humanitarian arena, is so extensive and complex that it is difficult to map and describe. At the core are the HUG, the University of Geneva Faculty of Medicine and the University’s Geneva Centre of Humanitarian Studies.  

Around these, are a satellite array of collaborations and partnerships with WHO, ICRC, Médecins Sans Frontières and other, smaller, but influential Swiss-based NGOs, such as Terre des Hommes. The Geneva Health Forum, convening this year on 27-29 May, historically has played a key role as a platform to showcase many of the initiatives and bring stakeholders together.  

And finally, the ‘State’ of Geneva, and its “Service of International Solidarity” stand as the backbone behind all of these efforts – funding directly and indirectly over CHF 40 million in international health and development projects in the name of the “State of Geneva” – a title reflecting the influence it wields. And that is in addition to financial support from the Swiss national government’s department of Development and Cooperation (DDC)

HUG equalization fund ‘kickstarts’ innovative projects

The HUG has funded or partially funded nearly 100 health and humanitarian collaborations across the globe over the past six years.

A report on the HUG’s collaborations cites a total of 97 international health projects, entirely or partly funded by the Hospital, in the most vulnerable countries of sub-Saharan Africa and the world, over the past six years for a total of more than 3 million CHF, says Calmy. Some 43 projects are currently ongoing, with 20 new projects approved in 2023, she adds.  

The HUG finances start-up projects based on a “Fond de Péréquation” capitalized by doctors’ income from private patient visits to the hospital, Calmy notes. (The English translation is “Equalization Fund” – with all that implies). 

The fund enables HUG-affiliated staff to propose and launch innovative projects from the grassroots in their areas of expertise, notes Calmy, providing a unique laboratory for creative collaborations. Proposals can be submitted by any health professional – from doctors and  nurses to psychologists and dieticians.

“We are here to provide the kickstart,” added Calmy who is co-chair of the HUG Commission of Humanitarian Affairs and International Cooperation, that administers the medical facility’s programme – in collaboration with a parallel Commission at the University of Geneva. 

“You want to do cervical cancer detection in Cameroon.  You have to map what is going on there, what is the expertise, who are your contacts.  So we’ll give you the money to kickstart – after that you can go to the Canton, the ICRC, the Confederation for help in obtaining larger grants for research and implementation.”  

A nurse-led project launched in education about chronic diseases is one such example that she cites. A noteworthy feature of the HUG approach is its eclectic sponsorship of a very diverse portfolio, she adds.  

“We are well aware that we are funding diverse projects, there is no line in terms of themes, countries, or types of projects. Anyone in this hospital that has expertise, identified partners, and wants to do a project, can make a proposal,” she said. 

Seeking coherence amidst diversity

Alexandra Calmy, HUG Vice-Dean for Clinical Research and co-chair of the Medical Faculty’s Commisson for Humanitarian Affairs at the HUG-University  Humanitarian Conference “Assises de l’Humanitaire”, 9 October 2023

At the same time, there is growing recognition that more coherence and coordination amongst a wide array of initiatives would be useful – to share lessons learned and ensure maximum impact. 

That plethora of programmes and projects led all of the partners to hold a first-ever stocktaking event in October 2023, to seek a common direction and way forward. 

Called simply the Assises de L’Humanitaire (Humanitarian Conference)” the one-day encounter brought together stakeholders from the HUG and University system, along with the Swiss Confederation, Geneva State, WHO, ICRC and a wide array of other international organizations working with the Geneva-based institutions.

Now, six months later, a report on the findings and recommendations for a way forward is soon to be published. 

“I think the conclusion was that ours is still a good approach. But we wanted to explore new ways of doing things better,” said Blanchet.  

Key themes that emerged as recommendations include an increased focus on facilitating south-south along with north-south collaborations, and in-country partnerships that emphasize the education and training of local actors to ensure sustainability and scale up of projects. 

“But we want to remain a laboratory of ideas,” Calmly said.

‘Assises de l’Humanitaire was the triangle’  

The day was particularly important in terms of helping the University and the HUG share experiences between themselves and better align, said Karl Blanchet, who is the director of the university’s Geneva Centre for Humanitarian Studies. 

“The Assises de l’humanitaire was this triangle of the Geneva Centre, the Faculty of Medicine and the HUG. There were two objectives to all meet and all be aware to make sure that we are aware of what we do in different parts of the world,” he said.

“The next step is to formalize relationships and contribution to these programmes,” he added, noting the wide range of UN and NGO actors, like MSF and ICRC involved in individual projects.

The same network of collaborations underpins many of the events featured in the Geneva Health Forum, co-founded by the HUG, the University of Geneva and its Faculty of Medicine in 2006. 

This year’s GHF takes place 27-29 May, and coincides with the kickoff of the 77th World Health Assembly.  Health and Environment, Migration Health and Equity and Malaria Elimination are the key themes.  But a day-long session on  “International Hospital Collaborations” is also taking place on 29 May. Held in French, it will look even more deeply at some of the topics discussed at the conference last October.   

“The aim of the seminar is to collectively question the way partnerships between hospitals in the global north and global south are designed, and how to promote ethics and sustainable solutions within the frame of these partnerships,” said Bruno Lab, head of Humanitarian and International Cooperation Affairs at the HUG. 

“It’s a dive into the specific domain of long-term technical assistance projects. Through multi-year collaborations, the objectives are set around capacity building, teaching and research.”

Karl Blanchet, head of the University of Geneva’s Centre for Humanitarian Affairs

Many HUG staff also have joint appointments in the University of Geneva’s Medical Faculty, which also hosts an array of international health research initiatives, under the research portfolios of various departments. 

The Centre for Humanitarian Studies, therefore, collaborates with both institutions, and others, in a range of health and humanitarian research and education projects, says Blanchet. 

Examples of the former include a research study on reducing the impact of attacks on healthcare, as well as a five-university initiative on re-imagining the future of global health, he adds

But there are also collaborations in field settings on priorities like teaching doctors how to perform war surgery or a new programme in community health for refugees. 

The latter, targeting long-time refugees in Jordan and Kenya, provides students with a basic education that allows them to gain employment as health workers, as well as to qualify for further university training in their host countries, Blanchet says. 

The end result is better integration into local communities and health systems after decades as refugees.  

“During the COVID pandemic, the first settings that were closed in lockdown were in refugee camps,” Blanchet recalls. “”So we created a course not only to help refugees deal with health issues in their community, but to be able to get jobs.

“It’s the first advanced course on community health accredited by a University Faculty of Medicine, for students and refugees who cannot demonstrate their level of studies.  If they finish the certificate, they can go onto national university,” he said. 

University ‘open to the world’

Blanchet himself has a strong public health background. He came to the centre as an academic from the London School of Tropical Hygiene and Medicine.

He found the pace much faster and topical than the usual university ivory tower.    

“I can’t tell you how amazing this environment is,” he said. “When I arrived at this new post, where we are grappling with some of the most challenging environments, people would tell me, over and over, ‘just tell me what you need.’

That led to initiatives such as a website publishing briefs on the latest scientific knowledge about  COVID in Ukrainian after  the 2022 Russian invasion; as well as the hosting of leading Afghan health experts in the Centre, including the former minister of health, following the Taliban’s takeover of Kabul. 

The centre is likewise involved in an initiative to help medical students in conflict-ridden regions such as Gaza, Iran, Pakistan and Afghanistan to complete their studies in host countries abroad.  And there are now plans now in the works to host an international symposium soon on the rebuilding of Gaza’s health system, he confides.  

“These are all examples of the agility of the teams and the faculty,” he said. “The University of Geneva is so anchored in the news and what is going on – and they want to make sure that they can contribute, not only to research but as a university open to the world.” 

Paula Dupraz-Dubois contributed reporting to this story

Image Credits: Hopitaux Universitaires de Genève, Hopitaux Universitaires de Genève, Geneva University Hospitals , Paula Dupraz-Dubois.

Milking a cow in Texas. H5N1 Avian influenza is spreading among US cattle herds, most probably during the time of milking.

Most H5N1 infections spreading through US dairy cattle and other animal populations are likely going undetected despite stepped up surveillance by the US Department of Agriculture, Michael Osterholm, director of the Centre for Infectious Disease Research and Policy (CIDRAP), told Health Policy Watch on Wednesday.

Osterholm spoke as a growing number of infectious experts were sounding alarm bells about the expanding spread of the deadly virus to mammalian populations – and especially dairy cattle in the United States, where some 36 herds have so far been infected, according to the latest US Centers for Disease Control and Prevention (CDC) update April 30. Sanitation gaps and lax surveillance in industrial dairy operations are facilitating H5N1 transmission, experts now suggest. 

Total number of H5N1 cases in different animals in the US. Infection spread in dairy cattle, the newest ‘terrain’ for the virus, is causing the most concern.

And “most” infections are likely going undetected due to farmer reluctance to have cattle and employees tested for avian flu, warned Osterholm, an internationally-known expert. 

“We need much more extensive follow up, serology studies and close monitoring of mixing vessel animal species, e.g. pigs,” Osterholm stressed in emailed remarks. 

He noted that pig infections, for example, constitute a “mixing vessel animal species” because they can become co-infected with both animal and human forms of avian influenza, increasing the risks of spread to humans of a virus that has a greater than 50% fatality rate.

On the positive side, Osterholm added that it was “very unlikely” pasteurized milk could transmit the infection if pasteurization “is done properly.”

Policymakers have taken their ‘eye off the ball’ of ‘One Health’ principles

“Policymakers have again taken their eyes off the ball in efforts to protect humanity from new pandemics,” stated Dr Nigel Sizer, an Executive Director of the non-profit Preventing Pandemics at the Source (PPATS), as part of a stiff warning  issued Tuesday by half a dozen international experts on the wave of H5N1 infections.

“In this case, it is hard not to point the finger at lax monitoring and regulation of animal agriculture in the United States and elsewhere,” Sizer said.

Colorized transmission electron micrograph of Avian influenza A H5N1 viruses (seen in gold) grown in MDCK cells (seen in green).

The expanding outbreak takes place as WHO member states are in the throes of finalizing a draft Pandemic Accord agreement, where a commitment to stronger “One Health” measures for preventing spillovers of animal pathogens to humans remains a sticking point for some countries in the Global South. 

But in the case of the USA, a dearth of surveillance is also a hallmark of the rapidly expanding avian flu outbreak in the Global North, other experts also pointed out.  

“The situation with avian influenza across the United States exemplifies the inherent hypocrisy and vested economic interests around Pandemic Prevention, Preparedness, and Response,” said Dr. Christian Walzer, Executive Director of Health at the Wildlife Conservation Society, and a professor at the University of Veterinary Medicine in Vienna, Austria, in the PPATS statement of experts.

“As one hundred ninety-four member states of the World Health Organization (WHO) are negotiating perceived responsibilities and equity around a new Pathogen Access and Benefits-Sharing [PABS] Mechanism – while the Global North is demanding transparent and rapid access to pathogen data from the Global South to develop diagnostics, vaccines, and therapeutics, it seems unwilling to share such information with the world,” Walzer said.

Spread through milking machines

Among dairy cows, H5N1 appears to be transmitting rapidly through their mammary glands via virus contaminated milking machines, Stat News reported on Tuesday. The milking equipment is typically not sanitized between sessions with individual animals, becoming an obvious transmission path to infection by more and more cows from the herd.

Experts such as Jared Taylor, a professor of veterinary pathobiology at Oklahoma State University, noted that the H5N1 infections in cattle herds reported so far have been  limited to lactating dairy cows. And the ones who produce most milk – and therefore spend more time on the milking machines – have the highest disease incidence.

Even more worrisome is the potential presence of the virus in raw milk – which some consumers in the USA as well as in Europe prefer as a more ‘natural’ alternative.

US states where H1N5 has been detected in cattle

There also have been virus remnants found in pasteurised milk. “The role of pasteurization in inactivation of the virus […] is currently being investigated,” states a 23 April assessment by the WHO, issued jointly with the UN Food and Agriculture Organization (FAO) and the World Organisation for Animal Health (WOAH).

Infection with H5N1 from pasteurised milk is, however, “very unlikely, if [the pasteurisation is] done properly,” Osterholm said.

As compared with consumers, farm workers who have everyday contact with cattle are, however, at a far higher risk of infection. And the one case of human infection reported in March, does not reflect the scale of the disease spread to people, experts say because farmers have been reluctant to allow testing of cattle or employees, and such testing remains voluntary. 

That’s why “most” cases likely go undetected, Osterholm told Health Policy Watch.

Avian influenza as symptom of world’s failure to apply ‘One Health’ measures

Virus spillovers to more and more species are a direct effect of the poor animal management practices in the  intensive livestock production conditions that are common throughout the developed world today, said Sizer in the statement on April 30.

“Improved animal husbandry conditions, more rigorous inspection standards, as well as better reporting and sharing of animal health information could reduce the risk of these outbreaks as well as improve the welfare of the animals we consume,” he asserted. “We must question for how much longer consumers will have to worry that the price of a cheap sausage or steak is the risk of another global pandemic.”

One Health principles recognize the interlinkages between ecosystems, animal and human health, and call for enhanced collaboration between sectors to prevent zoonotic spillover into human populations. 

“This outbreak highlights the need for One Health approaches for preventing spillovers and interventions to reduce risk of such threats ‘at source’,” argued Dr. Malik Peiris, Professor of Virology at the School of Public Health at The University of Hong Kong, and a leading H5N1 expert.

Pigs are an important possible intermediary host for avian influenza.

“There is still a widespread philosophy of aiming for maximum profit in meat production, when it should be about optimizing food security, food safety, animal welfare and ecological sustainability,” added Dr. Dirk Pfeiffer, Professor of One Health at City University of Hong Kong, in the same statement, adding: 

 “Global investors who see opportunities in making money out of meat production should be aware that ‘growing cattle, pigs or chickens’ is not the same as making parts for mobile telephones.”

WHO still ranks human health risks as low or low-to moderate

In its 23 April assessment, WHO ranked avian influenza risks to humans as low generally insofar as human-to-human transmission has never been documented, and low-to-moderate for those “with exposure to infected birds or animals or contaminated environments.”

Only one human case connected with the US outbreak has been reported, a cattle worker from Texas.

Since 2003, WHO reported only rare instances of human infections all from close contact with animals. Even so, the mortality was “extraordinarily high,” according to WHO Chief Scientist Jeremy Farrar. He was referring to the 52% mortality rate registered amongst the 889 human cases of H5N1 reported to WHO between 2003 and 1 April 2024.

Jeremy Farrar, WHO Chief Scientist, during a press briefing April 18

“Being one of the few people around the world who have actually treated patients with H5N1 […] this remains I think an enormous concern,” Farrar stressed at an April 18 media briefing in Geneva. From 1996 until 2013, Farrar was Director of the Oxford University Clinical Research Unit in Ho Chi Minh City, where he and a Vietnamese colleague identified the re-emergence of the deadly bird flu, or H5N1, in humans in 2004. 

What worries experts the most is the virus’s expanding host range. Naturally found in wild birds, avian influenza has developed a limited ability to infect other species, including mammals. The recent joint assessment by WHO, FAO and WOAH reports mentions the virus as the probable source of infection in sea mammals, multiple fur animal farms and ferret-to-ferret infections, according to some studies.

The list of infected animals is getting longer: cats, dogs, goat kids or polar bears, already known to suffer from the disease were recently joined by a walrus, as The Guardian reported.

“The great concern, of course, is […] that that virus now evolves and develops the ability to infect humans. And then critically, the ability to go from human-to-human transmission,” Farrar told the media briefing.

Reassurance, but… 

Other WHO officials have still sought to issue a more reassuring note.

Speaking at another WHO press briefing on April 24, Dr. Maria Van Kerkhove, a WHO epidemiologist, asserted that appropriate surveillance systems are working well.

“We are concerned about this particular virus because we know influenza has the potential to cause epidemics that have the potential to cause pandemics,” she said. “And that’s why we have a global system in place to monitor, detect, and to rapidly do risk assessments to look at viruses that could potentially be used in vaccines as we go forward. There’s a lot of work in place right now,” she said.

Since the beginning of 2021, 28 detections of H5N1 in humans have been reported to WHO, with all nine cases reported in Europe or North America being assymptomatic or mild cases, notes the WHO/FAO/WOAH joint assessment. Still the three agencies also recommended tougher monitoring – calling on national authorities to  use “active case finding and serologic methods, as well as work with national agencies to understand the exposure and risk from milk and milk products.”

Osterholm, like other experts doubts that US authorities have the situation under control. What’s needed is, among others, a “much more extensive follow up,” said Osterholm. 

He also advises a close monitoring of pigs, which have “influenza virus receptors for both avian and human influenza viruses.

“If they get coinfected with both viruses simultaneously then viral reassortment can occur and a new human virus emerge, like what happened in 2009 with the new H1N1 [strain] that emerged in swine in Mexico.” 

With editing and reporting contributions by Elaine Ruth Fletcher 

Image Credits: Josh Kelahan, US CDC, CDC/ Courtesy of Cynthia Goldsmith, Flickr: Dutchairplaneshooter.

On the final day of INC-4, delegates held talks until the early hours of the morning trying to find a way forward

The fourth session of the UN intergovernmental negotiating committee (INC) to develop an international legally binding instrument on plastic pollution ended in Ottawa on Tuesday with “an advanced draft text of the instrument and agreement on inter-sessional work ahead”, according to the UN Environment Programme (UNEP).

Delegates engaged in text-based discussion on the revised draft for the first time, but there were major sticking points – especially on limiting plastic production. The European Union (EU) proposed extending the meeting but delegates failed to agree on the proposal, according to the Earth Negotiation Bulletin.

Other issues on the table related to emissions and releases; product design; waste management; problematic and avoidable plastics; financing, and a just transition.

The INC members agreement to hold inter-sessional work – expert meetings between the official INC sessions –  to work on “convergence on key issues” ahead of the next negotiating session, INC5, will take place in Busan, Korea, in November.

The inter-sessional groups will look at financing to achieve the objectives of the instrument and approaches to address  plastic pollution and chemicals of concern in plastic products and product design, focusing on products that can be recycled and reused. 

Long road to agreement

INC5 is supposed to adopt an agreement, but there is still a long road ahead as “meetings to discuss the technical elements of the text diverged on almost all points of discussion, from problematic and avoidable plastics to product design, composition and performance,” according to the Earth Negotiation Bulletin..

“We came to Ottawa to advance the text and with the hope that members would agree on the intersessional work required to make even greater progress ahead of INC-5. We leave Ottawa having achieved both goals and a clear path to landing an ambitious deal in Busan ahead of us,” said Inger Andersen, UNEP executive director.

 “The work, however, is far from over. The plastic pollution crisis continues to engulf the world and we have just a few months left before the end of year deadline agreed upon in 2022. I urge members to show continued commitment and flexibility to achieve maximum ambition.”

However, several NGOs that attending as observers were unhappy with the influence of member states with significant fossil fuel industries. Most plastics are made from oil and gas derivatives.

“Despite hearing people from polluted communities around the world give sensible proposals to curb the lifecycle harms of plastics, fossil fuel and petrochemical interests are still shamelessly blocking progress and focusing on utterly inadequate plastic waste management,” said Julie Teel Simmonds, a senior attorney at the Center for Biological Diversity (CBD).

While Rwanda and Peru, part of the high-ambition coalition, proposed production reductions,  a coalition of fossil fuel–aligned countries, including Russia, China, and Saudi Arabia, objected to treaty measures to address plastic production, according to the CBD. 

Not ‘if ‘but ‘how’

“Canada is committed to reaching a final agreement at INC-5 in the Republic of Korea before year end. We are no longer talking about ‘if’ we can get there, but ‘how.’ Together we can land one of the most significant environmental decisions since the Paris Agreement and the Kunming Montreal Global Biodiversity Framework,” said Steven Guilbeault, Canada’s Minister of Environment and Climate Change, who hosted INC4. 

“We are doing everything we can to raise the international profile of the plastic pollution crisis so that the agreement gets the global attention it deserves to cross the finish line.”

INC chairperson Ambassador Luis Vayas said that “some common ground” had been found and “I firmly believe that we can carry this same spirit forth to Busan to deliver on our mandate.” Delegates accepted Vayas’ proposal for a legal drafting group to ensure legal clarity in the text of the future agreement.

Jyoti Mathur-Filipp, executive secretary of the INC secretariat,  said that “compromise and commitment remains strong at this advanced stage of the negotiations”.

“Members should arrive in Busan ready to deliver on their mandate and agree a final text of the instrument. This is more than a process – it is the fulfilment of your commitment to saving future generations from the global scourge of plastic pollution.”

Image Credits: Kiara Worth/IISD.

A rollout of malaria vaccine in Western African countries with a special focus on immunising children is an important step towards eliminating the disease

Rollout of malaria vaccines are starting in Benin, Sierra Leone and Liberia, and the West African countries plan to deliver more than 800 000 doses of the RTS,S or R21 vaccines, according to WHO.

The new vaccine will be added to their immunisation programmes for children, and are expected to protect over 200,000 children from the life-threatening disease. The RTS.S vaccine can be administered to children as young as five months old.

In another promising development against malaria, a new formulation of a malaria treatment, Coartem, has proven to be safe and efficacious for babies under five kilograms, a previously overlooked group of patients.

Pharmaceutical company Novartis and Medicines for Malaria Venture (MMV), a leading product development partnership, announced that their product has good efficacy and safety and is appropriate for babies in the wake of the successful CALINA study.

The trial data have been submitted for regulatory review, they informed during the Multilateral Initiative on Malaria conference.

“Infants below five kilograms make up a critical neglected group, and developing antimalarials specifically suited to their needs is essential to malaria control efforts,” said Wiweka Kaszubska, MMV vice president.

The new formulation, known as Coartem <5 kg Baby, uses a new ratio and dose of artemether-lumefantrine to account for metabolic differences in babies under 5kg to minimise the risk of overdose and toxicity.

“Infants under five kg can be affected by placental malaria, leading to poor birth outcomes, or contract malaria from the bite of an infected mosquito. The prevalence of the disease in this age and weight group is poorly understood, and it is therefore often misdiagnosed,” according to a company media release.

Current antimalarials have not been developed small babies, who are usually treated with tablets meant for children above 5 kg adjusted by weight – yet, these tiny patients handle drugs differently due to the immaturity of their metabolising organs.

Decreasing the burden

Malaria is a life-threatening infectious disease with an estimated 249 million cases and 608 000 deaths in 2022, according to the World Malaria Report 2023. It is present in 85 countries, with 95% of cases in the African region. Most of the fatalities in the region – four out of five – are children under the age of five.

“With the new, safe and efficacious malaria vaccine, we now have an additional tool to fight this disease. In combination with insecticide-treated nets, effective diagnosis and treatment, and indoor spraying, no child should die from malaria infection,” said Dr Austin Demby, the Minister of Health of Sierra Leone.

The emerging interventions will likely decrease the burden of malaria substantially. In the recent years, (2019-2023), a pilot malaria vaccine programme in Ghana, Kenya and Malawi reached over two million children, showing a significant reduction in malaria illness. It also reached a 13% drop in overall child mortality and a reduction in hospitalisations.

Benin, Liberia and Sierra Leone joined five other African countries that have already implemented the rollout of the newly developed malaria vaccines.

Image Credits: WHO.