Empowering Global Health Reporting: Perspectives from Leading Journalists 13/04/2024 Maayan Hoffman Health stories are not just about medical facts; they are intricate tapestries woven with economic, political, and social threads, according to two international health journalists. Stephanie Nolen, a global health reporter for The New York Times, and Paul Adepoju, a Nigeria-based freelance health journalist and scientist who writes for Health Policy Watch, were guests on Dr. Garry Aslanyan‘s most recent Global Health Matters podcast. They discussed blending local insights with global perspectives when covering health narratives. “I want to hear these stories from the people who are living them, and I want to tell them from the perspective of the people living them,” Nolen said. Adepoju went on to say, “It’s not just about ensuring that journalists issue the true voices on the ground, a true reflection of what is being reported, but people like journalists who are around and closest to these places are actually empowered and adequately trained to be able to professionally report these stories at a global, international journalism quality level.” Uncovering Vital Health Narratives Aslanyan rolled out this latest episode against a rising wave of misinformation and disinformation, identifying journalists as crucial players in uncovering vital health stories nationally and internationally. Even before the COVID-19 pandemic, Nolen said she understood that health stories “are economic and political and social stories, and they’re about the most intimate moments of our lives and the things that matter the most to us, that shape how we interact with each other, but there are also always power stories, there are systems stories, and if people don’t have access to health care, then everything else going on in their lives is much less relevant.” However, COVID helped the rest of the world realise this, too. “COVID really changed things,” Nolen said. “Suddenly, everybody wants to read an epidemiology story. So that’s a significant difference from four years ago, I would say. Global health is just a microcosm of that larger phenomenon.” The journalists said the challenge now lies in maintaining the relevance of these stories, ultimately aiding in the achievement of global health goals by ensuring that crucial narratives are effectively shared and highlighted. “We need to sustain the momentum that COVID created for health stories and ensure that health stories, health issues, don’t find their way back to one tiny corner of the newspaper,” according to Adepoju. There is also the need to empower, amplify, and bring more attention to dedicated health reporting platforms because no matter what we do, there is still a limit to what a general news publication can commit to health reporting, and there are a lot of health issues.” Nolen agreed. She said, “I think it would be really useful to move past this idea of the health page or that once a week we cover these subjects. To go back to the idea … about health stories being also political, economic, social stories, we just need to take it out of that … silo.” Listen to previous episodes of Global Health Matters on Health Policy Watch. Image Credits: Global Health Matters. India’s Efforts to Address Hypertension Show Progress – Highlight Global Challenges 12/04/2024 Disha Shetty A health worker records a patient’s blood pressure at the Rural Hospital in Paud, India. PAUD, MAHARASHTRA STATE, INDIA – It is 11:15 on a Wednesday morning, and the March sun is hot but not yet punishing in this part of western India. Mathabai Jadhav, 65, waits patiently for her turn at the Paud Rural Hospital, some 30 kilometres from the city of Pune. At least two dozen patients like her, mostly elderly women and men from nearby rural areas, are waiting. Some sit on benches balancing a walking stick against their legs, others on the floor. They are here to attend a “screening camp” for non-communicable diseases (NCDs) that is held every Wednesday morning at the hospital. Four healthcare workers are in the midst of frenetic activity. One pricks patients’ fingers to draw blood and test sugar levels, another checks their blood pressure, the third dispenses government-subsidized medicines prescribed by hospital doctors and the fourth provides quick counselling on the dos and don’ts related to diet and exercise for better hypertension management. Jadhav has lived with hypertension for nearly 14 years. “I found out when I came to the doctor regarding a wrist injury,” she said. For over a decade, she went to private practitioners but for two-and-a-half years now she has been a regular at the Rural Hospital where the medication is free. Hypertension – a neglected condition Hypertension, simply put, is when the pressure in the blood vessels is too high. The World Health Organization (WHO) estimates that over a billion adults between the ages of 30-79 live with hypertension. Around half of them never find out or are not treated for the condition. This has grave consequences as hypertension is a leading single-preventable risk factor for cardiovascular disease (CVD) that killed an estimated 17.9 million people globally in 2019. In India, 28% of adults (18+) suffer from hypertension, with 70% of cases undiagnosed, a recent large-scale study found. Moreover, 90% of those living with hypertension don’t get treatment, or their treatment is ineffective to keep their hypertension within normal range. Scale at bottom indicates disability-adjusted life years (DALY’s) per 100,000 people lost to hypertension related to cardiovascular disease – with northeastern and southeastern India reflecting the highest burden. Strengthening programmes in LMICs In the past eight years, more than 40 low- and middle-income countries, including Bangladesh, Cuba, India and Sri Lanka, have strengthened their hypertension care, enroling more than 17 million people into treatment programmes based on a WHO-recommended package of primary health care interventions (HEARTS), according WHO’s first-ever global report on hypertension, released in September 2023 on the sidelines of the UN General Assembly. Meanwhile, high-income countries such as Canada and South Korea have achieved blood pressure control in over 50% of adults living with the condition through delivery of comprehensive hypertension programmes, WHO found. The report followed up on implementation of the global WHO HEARTS initiative first launched in 2016. Mathabai Jadhav, 65, sits on a bench at the Rural Hospital in Paud, India. India’s hypertension control initiative In 2017, India, now the world’s most populous country, started the India Hypertension Control Initiative (IHCI). The pilot was rolled out across five states and reaching over 15,000 public health facilities, including primary health care centers and rural hospitals, by March 2022. The programme relied on simple measures that can still be challenging to implement in low-resource settings: standardizing treatment protocols; ensuring the public healthcare system has the standard drugs to manage hypertension; equipping health centres with monitoring systems; and encouraging better digital or paper record-keeping to track patient progress. Prabhdeep Kaur, the lead investigator of the IHCI told Health Policy Watch that the idea was to decentralize care and prioritize evidence-based strategies that are known to work. “Then implement them by working along with the governments on the ground and see what kind of results we get, what challenges are there, can they be scaled up or not,” she said. This is the same approach recommended by the WHO, which has found that countries that strengthen primary healthcare (PHC) to improve hypertension management see a drop in CVD mortality as well. WHO was also a partner of the IHCI, along with India’s premier medical research agency – the Indian Council of Medical Research (ICMR). The project received additional funding support from both the central and some state governments in India. Reaching the global targets requires public and private collaboration WHO’s global target is to reduce hypertension by 33% between 2010 and 2030. WHO estimates that hypertension, as such, causes an estimated 10 million deaths annually. An estimated 10 million deaths are attributed to hypertension around the world by the WHO. India’s target is to reduce hypertension by a quarter by 2025, although the country has not specified a baseline year. Getting there requires not just a nudge from the government but also active involvement of civil society and the private sector, which provides around 70% of the country’s healthcare services. Two-pronged approach needed While a third of all adults globally, and nearly one-third in India, have hypertension, almost another third also have pre-hypertension that requires regular monitoring, said Dr Sailesh Mohan, Professor at the research non-profit Public Health Foundation of India and Director of the Centre for Chronic Conditions and Injuries (CCCI). “So there’s a large pool of people who are hypertensive and another pool waiting to convert to full-fledged hypertension from pre-hypertension,” he said. If pre-hypertension is not addressed, it quickly progresses to hypertension, and managing it effectively requires a synergistic approach, he explained. This approach involves promoting policies that reduce salt, tobacco and alcohol consumption, encourage and support an active lifestyle and healthier diet, as well as increase awareness about hypertension. The health system also needs to be bolstered to screen patients for hypertension and provide evidence-based care. The global incidence of hypertension has increased over the years, according to WHO data. Hypertension management in most cases requires regular monitoring, and a relatively cheap drug once a day, which can be done by trained nurses or healthcare workers. Aruna Kaware, NCD counsellor at the Paud Rural Hospital said on average three-quarters of the patients are above the age of 60. “We are able to handle most patients here. Around 10-20% of the patients might need to be referred to bigger hospitals,” she said. The state of Maharashtra where the hospital is located, has done a good job of scaling up NCD care, said Kaur. Detection is often the first challenge The detection of hypertension can be a challenge as patients might not always have symptoms, which is why it is called “the silent killer,” explained Mohan. Nathu Tonde, 83, now travels to the Rural Hospital every month alone to get this medication, using a cane for balance. But he came to the health centre for an unrelated ailment, and his hypertension was detected in a routine blood pressure measurement. Nathu Tonde, 83, sits waiting for his turn at the NCD camp held every Wednesday at the Rural Hospital in Paud, India. One of the striking results of the IHCI initiative was the increased accessibility of basic medications – due to a major reduction in drug stockouts, reduced to less than 5% in areas where the pilot was implemented. In addition, 47% of the 740,000 patients across 4,505 health facilities who took part in the project had their hypertension within the healthy limit during their visit in the first quarter of 2021. Technically, the five-year initiative concluded in 2022. But Kaur, the lead investigator, said the partners in the original initiative are currently working with the state governments across India to make it sustainable, as well as scaling it up further. Countering practical challenges – patient compliance and health system capacity While hypertension management is relatively easy in theory, there are other practical challenges. “People are not compliant with the medication,” said Dr Arvinder Pal Singh Narula, Assistant Professor of Community Medicine at Bharati Vidyapeeth Medical College. A key reason, especially in rural areas, is either the distance or when medicines run out. “My village is half an hour away and transport is hard to get,” Jadhav said of the monthly trips she makes to the health centre. It also costs money to make the trip. Kaware, the NCD counselor, said that many elderly patients come unaccompanied like Tonde had, and it is hard to explain even the basics like which medicines to take and when. Rural Hospital, Paud in western India. India has long focused on improving healthcare delivery by working with community health workers. More recently, states like Maharashta have countered the shortage of doctors and nurses in rural areas by engaging traditional medicine practitioners who are re-trained in “bridge programmes” to successfully deliver primary healthcare, especially in remote areas. These are doctors trained in Ayurvedic medicine or homeopathy who learn skills for delivering a package of modern health care measures, based on a government protocol. Even so, Kaur too said the lack of adequate healthcare workers remains a challenge in scaling up the initiative across India. Government services only one part of the picture However, initiatives such as the one in Paud have clear limitations – notably in who is targeted for services. While the Indian government provides primary healthcare in rural areas and limited secondary and tertiary care in some cities, most healthcare services are provided by the private sector. And here, chronic disease screening and prevention are typically paid for by the patient. Only around 41% of Indian households have a member covered by health insurance. Most Indian health insurance schemes only cover hospitalization, excluding primary health care visits and tests which are critical to the prevention, screening, and early treatment for NCDs, including hypertension. When people are finally diagnosed, it may often be at a later stage of the disease. In addition, treatment can involve hefty out-of-pocket costs for the average person. Leelabai Jaigude, 60, is one such case in point. A farmer, her hypertension medicine cost her Rs 80 ($1) every month at the private clinic that had diagnosed her, she said. But when she had to shell out Rs 550 ($6.60) for a blood test, she sought out a government center. She was fortunate enough to live near the Rural Hospital, and now receives both her hypertension and diabetes medication there. But not everyone is so fortunate to have a government facility near them. Overall, Indians bore more out-of-pocket expenditure than the government’s expenditure on health (48.2% compared to 40.6%), according to the Economic Survey 2022. Indian Government Health Expenditure (GHE) and Out of Pocket Expenditure (OOPE) as percent of Total Health Expenditure (THE) Alternative models proposed This has left experts such as Mohan looking for examples of how NCDs can be more effectively managed in private-sector healthcare and health insurance systems. He points to the Kaiser Permanente network in the United States as one such model that has delivered good results in hypertension management. Kaiser Permanente, which delivers healthcare to nearly 8.2 million Americans is a “Health Maintenance Organization” (HMO), which delivers holistic, cradle to grave care from primary to hospital level for those subscribed. The model operates nearly three dozen hospitals in the US. But since patients’ pay a subscription fee, HMOs have a vested interest in preventing disease from the outset – as it reduces their costs down the line. In India however, no comparable private-sector models exist, Mohan laments – or at least not one beyond the isolated initiatives of individual practitioners or hospitals. “The private sector is huge and very heterogeneous. And it’s very poorly regulated. So I am not aware of any concerted program or effort,” he said. In addition, while the government system has a hierarchy ranging from the primary to the tertiary level, in the private sector, the continuum is not as clear. Private providers at primary care level typically operate separately from hospitals and specialists. Finally, given that the private sector is largely unregulated, it also does not have to follow the government’s protocol for hypertension prevention detection and treatment. “The government has a protocol. They [public sector] will follow this protocol, which is not the protocol that the private practitioners will follow. They will give their own medicines,” Narula said. Kaur acknowledged this as a problem, saying that she and her team were very conscious of that fact in their work on the IHCI: “The strategies have to be different for the sectors. And since the public sector itself had not yet taken care of NCDs, trying to then replicate those strategies in private, we felt was a little premature,” she explained. In the coming years as the WHO works towards expanding universal health coverage (UHC) in different regions, the public and private divide, which differs enormously across countries and regions, will throw up a unique array of challenges depending on the setting. Universal healthcare requires healthcare to reach a large number of people, address the issue of equity, and ensure the care covers a hybrid of diseases, said Kaur. “So I feel our work tried to address all the three,” she said, of the IHCI collaboration. Additionally, this initiative taught the researchers what best practices work, like reducing the number of drugs to just a handful and procuring them in large quantities, and what the gaps are – the patient migration and ensuring continuity of care. “Now, many states are using the same best practices for diabetes. And going forward, we’d like to do pilots, and see which of these best practices can be used for other NCDs as well,” Kaur said. Image Credits: Disha Shetty, © 2021 Indian Council of Medical Research, Public Health Foundation of India, and Institute for Health Metrics and Evaluation, Global Hypertension Report, WHO, Economic Survey 2022. Clean Air Makes Economic Sense, Says Influential Group Ahead of World Bank Spring Meetings 11/04/2024 Chetan Bhattacharji Tackling air pollution makes economic sense, says Jane Burston, CEO of Clean Air Fund. What is the impact of air pollution on exam results or future earnings? Can governments agree to a 2050 net-zero-like goal for a key pollutant, PM 2.5? Such questions are part of an appeal by a new group of political, health, policy, and finance leaders for a policy approach to air pollution that is like that against greenhouse gas (GHG) – including an “intergovernmental” plan and nationally determined targets. Our Common Air (OCA) has put out a call to action that seeks to present a new and hopefully, more compelling way for global leaders and financiers to address air pollution, one of the world’s single biggest health crises. Frustrated by the lack of progress in addressing air pollution, the call presents new targets and suggests a new framework to improve air quality. The group’s co-chairs, former prime minister of New Zealand, Helen Clark, and former WHO chief scientist, Dr Soumya Swaminathan, say pollution has not received the attention or funding it deserves even though the devastating health costs have been documented. These include over seven million deaths estimated by WHO, links to heart attacks, strokes, dementia, high blood pressure, low birth weight, lung cancer, and chronic lung disease among many other ailments. About 99% of the world’s population suffers air pollution above the WHO’s guidelines. Commissioners and secretariat members at the Our Common Air convening in February at the Bellagio Center, Italy. Our Common Air is a new global commission of high-level government figures, renowned health experts, academics, and leading climate change specialists. Air pollution is a health and economic crisis OCA was set up last year as an independent commission. Apart from Clark and Swaminathan, its 16 commissioners include current WHO and World Bank officials participating in their personal capacities, as well as climate, pollution, finance, and policy experts. The group is backed by the UK-based Clean Air Fund and the report – Clean Air: A Call to Action – has been prepared by the Delhi-based Council on Energy, Environment and Water (CEEW). But OCA is re-phrasing the argument for clean air based on sound economics as well as a change in attitude. It is proposing four planks: value clean air as an asset, finance the transition, set clean air targets for all and collaboratively track progress, and work together to achieve solutions that benefit all. The report has been released ahead of the World Bank’s Spring Meetings, which take place next week, and serve as an important annual moment for reflectin and dialogue on global priorities by international finance and development actors. In a statement to Health Policy Watch, the commission says its focus on these meetings reflects the conviction that development finance institutions have a big role to play in transforming the landscape of clean air funding and action. Said Clark, “With every breath of toxic air endangering lives and having a knock-on effect on economies, we urgently need to take greater action on air pollution now. The upcoming World Bank and IMF Spring Meetings present a crucial opportunity for global leaders to come together and make clean air a priority.” There are numerous problems associated with air pollution, which often affect children and old people the most. From mitigation to protection The group is calling for a change in focus from mitigating air pollution as a harm to recognising and valuing clean air as an asset. It points out, for instance, that the United States found that every $1 spent on air pollution control yielded an estimated $30 in economic benefits. The World Bank estimates that the global cost of health damage due to air pollution amounts to $8.1 trillion a year, equivalent to 6.1% of global Gross Domestic Product (GDP). Contrast this with the $4.5 trillion needed a year by 2030 as investment in clean energy to limit global warming to 1.5°C, as estimated by the International Energy Agency (IEA). The report urges multilateral and regional development banks to incorporate economic impact analysis into their regular processes and demonstrate the economic benefits of reducing pollution. It calls on insurance firms to start incorporating air pollution-related health costs in risk assessments; many are already doing so for climate change in sectors like coal mining or housing in areas battered by rising cases of unpredictable, extreme weather. More funding needed The report calls for greater funding to combat air pollution. A study by Clean Air Fund, which supports OCA, showed that only 1% of international development funding ($2.5 billion per year) and 2% of international public climate finance ($1.66 billion per year) was committed to targeting air pollution over the last six years for which full data is available. The new report calls on all public development banks to develop metrics that ensure air quality impacts are publicised across investment portfolios. “Clean air does not have to be an ‘additional’ area to invest in,” says Clark. “Many of our existing public finance flows are already delivering clean air as a by-product. For example, action to reduce emissions to slow climate change also helps to cut air pollution. Our global public finance institutions should recognise and reinforce these ‘two birds, one stone’ solutions, by making clean air an explicit goal of existing programmes.” Image Credits: Our Common Air. European Court Ruling that Swiss Climate Policies Violate Human Rights Sets a Global Precedent 10/04/2024 Elaine Ruth Fletcher Supporters of the Swiss Climate Seniors Association “KlimaSenirorinnen” outside the European Court in Strasbourg, which ruled Tuesday that Switzerland’s climate policies were putting older women’s lives at risk. A European Court ruling Tuesday that Switzerland was violating human rights by not acting fast enough on climate change has been hailed by legal experts as a global precedent – and by WHO Director General Dr Tedros Adhanom Ghebreyesus as an important recognition of the links between climate change and health. The #ClimateCrisis is here and now. We salute this win and call on countries to step up their #ClimateAction to protect our health and planet! https://t.co/RbkbX4li3h — Tedros Adhanom Ghebreyesus (@DrTedros) April 9, 2024 In a case brought by the Swiss-based association of “Senior Women for Climate Protection” the Strasbourg-based European Court of Human Rights (ECHR) ruled that Swiss government inaction was putting their health at risk due to “critical gaps” in carbon reduction policies. The women, aged 64 and over, had argued that more extreme heat episodes, driven by climate change, undermined their health and quality of life, and put them at a greater risk of dying. A growing body of scientific evidence has documented the links between exposure to extreme heat and premature mortality -with heat relaed deaths of people over age 65 increasing by 85% since 1990, according to a Lancet Countdown study, published in November, 2023. The average person now experiences 86 days of “health-threatening high temperatures every year”, 60% of which are attributable to climate change, Lancet found in a global report by an international consortium of 114 scientists. Pardoxically, while the European Court ruling recognized the risks borne by older women in Alpine Switzerland, the overwhelming burden of those heat-related health risks is born by older people in low-income countries. Lancet Countdown: Average annual hours per person from 1991 to 2022 when light physical activity entailed at least a moderate, high, or extreme heat stress risk, arranged by HDI=Human Development Index groupings. A European and global precedent Today’s ruling against Switzerland sets a historic precedent that applies to all European countries,” said Gerry Listen, attorney at the Global Legal Action Network. The Network had represented a group of Portuguese children in a similar climate-related case before the European Court, which was ruled inadmissable for procedural and technical reasons. Listen said that the favorable ruling on the Swiss case, nonetheless, means that “all of the government lawyers who represented the 32 respondent states in our case are now going to have to advise their governments, the governments that they represented, that they are going to have to look at their targets again and update them. “Because none of the governments in Europe in cases that were before the court today have targets that are anywhere near 1.5 C. Most targets are aligned between 3-4 C within the lifetime of the young people before the court today,” he added in an interview on CNN Television. “So absolutely catastrophic levels of warming. So this precedent will require European wide revision of climate policies urgently. Otherwise, or anyways we are going to see a new wave of climate litigation at the European level sparked by this ruling from Strasbourg today. Today is a win for all generations! The Court has ruled that government failure to rapidly cut emissions is a violation of human rights. Although our #youth4climatejustice case was ruled inadmissible the court recognised the climate crisis is an existential threat to humanity. 1/ pic.twitter.com/EOhaTZQTqD — Global Legal Action Network (GLAN) (@GLAN_LAW) April 9, 2024 The court ruling is particularly significant because it is legally binding for Switzerland, and potentially for other European countries as well. However, litigation on climate issues has become increasingly common around the world. Both the International Court of Justice and the Inter American Court of Human Rights have cases pending which relate to the human rights impacts of climate change. As a result, the ruling will have impacts far beyond the European region, Joanne Setzer, Associate Professor at the UK-based Grantham Research Institute on Climate Change and the Environment, told the a English-language media channel, Swissinfo.ch. “The landmark ruling by the European Court of Human Rights not only sets a precedent in environmental and climate law but also signals a momentous shift in the global legal landscape concerning climate change,” she said. Only recently, India’s Supreme Court also recognized that the adverse effects of climate change violated people’s fundamental constitutional rights. There have also been a flurry of new reports and evidence suggesting that climate change disproportionately affects women and their health. My Oped in @the_hindu today on how the #ClimateCrisis is affecting women disproportionately. Adaptation plans need to be developed in a participatory manner with communities, panchayats & local urban bodies. @smritiirani @moesgoi @MinistryWCD @MoHFW_INDIA https://t.co/3Gs50mFpDU — Soumya Swaminathan (@doctorsoumya) April 10, 2024 In the ECHR ruling, Siofra O’Leary, president of the ECHR found numerous “critical gaps” in the Swiss regulatory frameworks that are supposed to reduce climate change. The court also criticized the lack of an effective Swiss monitoring system to determine levels of emissions that could indeed be permissible, while limiting warming to 1.5 °C in line with the 2015 Paris Climate Agreement. Fully implementing the #ParisAgreement is essential to respond to the threat of rising temperatures around the world pic.twitter.com/gIPHtOgwdK — UN Climate Change (@UNFCCC) August 9, 2017 Eight year battle Despite it’s “clean and green” reputation, Switzerland ranks among the “laggards” in economic incentives for zero emissions vehicles, according to a 2022 study. The Swiss senior’s association launched its legal case in 2016, charging the Swiss authorites for pursuing ineffective climate policies, which therefore threatened their health and right to life. The Swiss Federal Supreme Court rejected their request that the state adopt more ambitious targets for reducing climate emissions. Then in 2020, the Association appealed to the ECHR, anchoring its case in the violation of the European Convention on Human Rights, including clauses related to the right to life. The ECHR’s binding judgment means that Switzerland must take action to comply with the order – enacting new legislation to bring Swiss emissions reductions in line with the global goals of keeping temperature increase below 1.5 °C. Despite it’s global reputation as a clean and environmentally conscious nation, including solar panels on many rooftops and an efficient rail and cycle network, there has in fact been considerable pushback by Swiss center and center-right parties against more aggressive climate action – popularly perceived as adding to economic costs and undermining personal autonomy. Only one in 50 vehicles are fully electric, and Switzerland is one of the “laggards” in the tax incentivization of private, zero-emissions vehicles, according to a 2022 study by the NGO Transport & Environment. Even so, Switzerland now plans to end tax exemptions for EVs in 2024. Image Credits: @GLAN_LAW, Lancet Countdown on Health and Climate Change , Transport&Environment. New Dengue Vaccine Trials Show Promise in Brazil as Cases Continue to Rise 10/04/2024 Sophia Samantaroy Dengue cases have increased fourfold in some parts of the Americas As global cases of dengue are already close to last year’s record high of over four million, the Americas region is struggling to contain high transmission levels. Unplanned urbanization, heavier rainfall, warmer temperatures, and the El Nino effect create perfect conditions for the Aedes aegypti mosquito, the primary vector of dengue. The Southern Cone region of the Americas, which includes Argentina, Brazil, Chile, Paraguay, and Uruguay, has seen the highest burden of cases and deaths. Brazil alone accounts for close to 3.5 million cases. Challenges with vaccine distribution and availability This year, Brazil became the first country to deploy a newly approved vaccine, Qdenga. The vaccine, manufactured by the Japanese-based pharmaceutical company Takeda Pharmaceuticals, contains weakened versions of all four dengue serotypes. The European Medicines Agency and the UK have approved the vaccine for use in adults and children over four years of age. However, the manufacturers can only produce about six million doses – enough for three million individuals as each person needs two doses. Currently, Brazil is distributing the vaccine to children between the ages of 10 and 14 in areas of high transmission, and with previous exposure to dengue. This represents only a fraction of Brazil’s population. “[T]hey chose this age group because it was based on the analysis of the Minister of Health, the age group that was suffering the highest burden of hospitalization,” explained Dr. André Siqueira, a tropical medicine doctor and clinical researcher in Fundação Oswaldo Cruz, in a recent interview with the One Health Trust. “We can’t expect that to have a huge effect on the epidemics because it’s a restricted age group and it’s not the whole country. Full immunization is achieved within three months from the initial dose.” Given these limitations, the vaccination campaign is controversial in Brazil. “Some people said there’s no point. Even the Minister of Health said it won’t have any impact on this epidemic,” said Siqueira. However, Siqueira notes that vaccinating this initial cohort creates momentum “of people being involved with dengue to start promoting the vaccination, showing that it is safe and it can have an individual impact.” Public support is especially important after a prior vaccine, Dengvaxia, was linked to deaths in children in the Philippines. The Sanofi-produced vaccine was mired in controversy after the vaccine was shown to increase the risk of hospitalization for those without prior dengue exposure. When these individuals were infected with dengue, “instead of being protected, they were at higher risk of severe disease.” This is due to the dynamics between the four dengue serotypes. The antibodies for one serotype will only protect the individual against future infection from that same serotype. Individuals could then have up to four episodes of dengue over a lifespan. Furthermore, interactions between antibodies from the various serotypes can lead to more severe secondary dengue infection, a process called antibody-dependent enhancement. This dengue season in Brazil has seen the circulation of all four dengue serotypes. Many Brazilians are especially vulnerable to DENV-3 and DENV-4 as these subtypes have reappeared this season. Vaccine trials for domestically-produced doses In light of these challenges, researchers in Brazil are in the process of developing a new dengue vaccine to target all four serotypes. The vaccine, from the Butantan Institute in collaboration with the US National Institutes of Health (NIH), shows early promise in clinical trials. The live, attenuated, tetravalent vaccine requires only one dose, unlike Qdenga, which uses a two-dose system with three months between shots. In phase 3 trials, the vaccine has shown an efficacy of 79.6% among those without prior dengue exposure, and 89.2% for those with prior exposure. The results, published in The New England Journal of Medicine, are a culmination of years of research and trials, and bolster Brazil’s hopes for disrupting dengue’s hyperendemicity. “It should be stressed that Butantan Institute’s vaccine has also proved extremely safe for people who have never had dengue, which is an advantage over the vaccines now available on the market. Furthermore, it can be administered to a broader age group and a single dose is sufficient,”said virologist Maurício Lacerda Nogueira in a press release. Image Credits: PAHO/WHO. Amid Global Cholera Surge, Gavi Launches New Testing Programme 10/04/2024 Zuzanna Stawiska Lilongwe, Mali. A woman collects unsafe water from a local well. Contaminated water is a major source of cholera outbreaks. A new programme aiming at providing 1.2 million rapid cholera diagnostic tests has been launched in 14 African and Asian countries. “Routine use of diagnostics will bolster cholera surveillance in impacted countries, and must be leveraged to better target vaccination efforts, which play a critical role in multisectoral cholera prevention and control programmes,” said Aurélia Nguyen, Chief Programme Officer at Gavi, the vaccine alliance. Cholera is an acute diarrhoeal disease with a potentially severe and rapid trajectory when left uncured, WHO warns. The intestinal infection spreads through food and water contaminated with faeces with the bacterium Vibrio cholerae. It has surged globally since 2021, with high case fatality rates despite the availability of simple, effective and affordable treatment. According to the WHO, there are 1,3 to four million cases of cholera annually, with a death toll of between 21,000 and 143,000 worldwide. Existing triggers for cholera outbreaks – lack of access to clean water and sanitation – are exacerbated by climate change, WHO highlights. It occurs in situations of poor sanitation and little access to clean water, for instance in humanitarian crises or in migration camps. Once an outbreak has occurred, the infection can spreads quickly if authorities fail to detect it and limit its spread. A 25% increase in countries reporting cholera cases was noted in 2022, reaching 44 countries, and recent outbreaks recorded the highest fatality rate in over a decade. Rapid testing Even though the vaccine supply has increased 18-fold between 2013 and 2023, it still fails to meet the demand, especially as emergency doses need to be stocked in case of a sudden rise in cases. In effect, preventive vaccination campaigns have generally been too slow to stop the disease spread. Last year, WHO’s Global Task Force on Cholera Control (GTFCC) updated its recommendations to favour strategic, routine and systematic testing of suspected cholera cases to strengthen cholera surveillance. They also launched a strategy for cholera control, aiming to reduce cholera deaths by 90% by 2030. Responding to the challenge, Gavi has directed funds to cholera rapid testing and vaccination. “We are experiencing an unprecedented multi-year upsurge in cholera cases worldwide,” said said Nguyen. “The rise in infections is being driven by continued gaps in access to safe water and sanitation, and our inability to reach vulnerable communities that are being put further at risk by climate change, conflict and displacement.” Gavi is working with UNICEF, WHO and FIND, the diagnostics organisation, to develop and deliver the rapid tests. Leila Pakkala, of UNICEF’s Supply Division highlighted that “surveillance diagnostics help pinpoint hotspots with great precision. This allows partners to target cholera vaccines to exactly the time and place where the limited supply will save the most lives.” The long-term sustainability of the programme depends on successful fundraising for Gavi’s next strategic period, from 2026 to 2030. Image Credits: UNICEF. Stigma Prevents Europeans Living with Hepatitis B and C From Telling Families and Getting Care 10/04/2024 Zuzanna Stawiska Presenting research on hepatitis stigma during the 2024 World Hepatitis Summit. From the left: Freddy Green of UK Health Security Age, Caroline Thomas, founder of Peduli Hati Bangsa foundation and Cary James, Director of the World Hepatitis Alliance UK. Half the people living with hepatitis B or C struggle to tell others about their condition and a quarter had not told their families of their diagnosis, concluded a first-ever European study on the stigma related to the disease. Findings from the multi-country study, conducted by the World Hepatitis Alliance (WHA) and the European Centre for Disease Prevention and Control (ECDC), were presented during the World Hepatitis Summit taking place this week in Lisbon. The actual report will be released in the coming weeks. “Living with hepatitis is challenging enough, and the added burden of discrimination whether in social or healthcare settings can have a hugely negative impact on peoples’ quality of life,” said Cary James, Chief Executive of the World Hepatitis Alliance. “More needs to be done to reduce the stigma that surrounds hepatitis. Our ambition for this new study is to help policy makers formulate informed policies and strategies to reduce stigma and discrimination among people living with hepatitis and improve their quality of life.” Hepatitis is a liver disease affecting 350 million people worldwide. Every year, over a million people lose their lives because of related conditions. Hepatitis B and C are transmitted mostly through blood or sexual contact, which is the basis of the existing stigma. Negative attitudes “When I told my friends and family I am living with hepatitis it was hard at first. My mother’s response was toxic and she accused me of being sexually promiscuous outside of my studies,” said Joy Ko, a Peer Support Worker at the Bloomsbury Clinic living with hepatitis recalls. “I was once disengaged from the care for five years because of fear and stigma and received no support at all,” continues Ko. According to the study, nearly half of people living with hepatitis C (46%) and over a quarter (26%) of people living with hepatitis B reported not being treated well in healthcare settings. In effect, four out of ten of those with hepatitis C and one in six people with hepatitis B (17%) avoided receiving health care services when they needed them because of the expected discrimination and stigma. The worry was often not exaggerated: 38% of people with hepatitis C reported hearing healthcare workers talking inappropriately about them. Feeling judged and concealing this diagnosis had a negative effect on patients’ mental health burden. Over a third of people living with hepatitis B and C, even when cured, report experiencing some emotional distress such as anxiety or depression. Ending stigma, ending hepatitis Andrea Ammon, director of the ECDC says “Stigma surrounding hepatitis perpetuates discrimination and undermines efforts to prevent and control the disease. Education, awareness but also key policies are crucial for promoting understanding and support for those affected.” The WHO also stresses that ending the stigma surrounding hepatitis is a key element of hepatitis elimination. As many WHO countries are delayed in reaching the target of eliminating viral hepatitis by 2030, ending the related stigma could be an important factor to curb the disease, CDA Foundation’s Polaris Observatory noted. A new WHO report released on Tuesday shows only 13% of people living with chronic hepatitis B infection had been diagnosed. Moreover, only about three percent had received antiviral therapy at the end of 2022. Hepatitis C paints only a slightly better picture, with 36% of patients who had been diagnosed and 20% had received curative treatment. “I believe it is the start of our recovery journey when we can talk about it,” Joy Ko noted on her work with patients. “People living with hepatitis must know they are not alone in their diagnosis and there is lots of support available to them.” Mike Ryan Announced as New WHO Deputy Director General 09/04/2024 Kerry Cullinan Dr Mike Ryan helps attend to a health worker wounded in an attack in January 2019 against the Ebola vaccination team in the Democratic Republic of the Congo. The group, including Dr Tedros, were being evacuated by helicopter at the time. The new Deputy Director General of the World Health Organization (WHO) is Dr Mike Ryan, who will assume the position alongside his current post as the executive director of Health Emergencies, Preparedness and Response. Ryan, who succeeds Zsuzsanna Jakab, who retired in February, assumed the position on 1 April according to an internal staff communique send out last Thursday. WHO Director General Dr Tedros Adhanom Ghebreyusus announced the appointment publicly on Monday at an event at the WHO headquarters, describing Ryan as “the general” and a “soldier”, and thanking him “for all his sacrifices”. In 1990, Ryan, an Irish epidemiologist who trained as a trauma surgeon, went to work in a hospital Iraq that was being supported by the College of Surgeons in Ireland, supposedly for three months while he waited for his surgical residency to begin in Australia. However, during that time, “Kuwait was invaded by Iraq, and we all became hostages in Baghdad”, said Ryan an interview with ‘Awake at Night’, a UN podcast series. Tragically, during this time he was injured in an accident involving a military convoy and stuck in Iraq with minimal treatment. This ended his career as a surgeon, resulting in him switching to infectious diseases. “It was very clear to me that you were either a surgeon or a good infectious disease doctor because these seemed to be the two things [where] a doctor could make a difference in many developing country environments. So I went into infectious diseases and then ended up coming to WHO In 1996, to join David Heymann, who was setting up a new emerging disease programme in WHO,” Ryan explains. During this time, he worked on responses to a number of outbreaks including measles, Ebola (while based in Uganda), and other infectious diseases. Between 2011 and 2017, he worked on the Global Polio Eradication Initiative (GPEI) in Pakistan, Afghanistan, and the Middle East. From 2017 to 2019, Ryan served as Assistant Director-General for Emergency Preparedness and Response in WHO’s Health Emergencies Programme. In 2019, Ryan became Executive Director of Health Emergencies Programme, and one of the WHO’s public faces during the COVID-19 pandemic. Image Credits: Lindsay Mackenzie/ WHO. Deaths from Viral Hepatitis Increase Globally With Limited Access to Diagnostics and Treatment 09/04/2024 Kerry Cullinan Baltazar Lucas, living with hepatitis B and a survivor of liver cancer who went through a liver transplant, goes for regular check-ups in Ortigas, Philippines. There has been an increase in deaths from hepatitis B and C, the infectious viral liver diseases that kill as many people each year as tuberculosis – yet few people know that they are infected and get the treatment they need. This is according to the World Health Organization (WHO) 2024 Global Hepatitis Report – the first to document epidemiology, service and product access – which was released on Tuesday at the start of the World Hepatitis Summit in Portugal. New data from 187 countries show that the estimated number of deaths rose from 1.1 million in 2019 to 1.3 million in 2022. Hepatitis B and C cause around 3,500 deaths every day. Around 83% the deaths were caused by hepatitis B, most commonly spread by mother-to-child transmission, and 17% by hepatitis C, usually spread through contact with infected blood. While sexual transmission is also a route for hepatitis B transmission, this typically results in acute infections, which are, in fact, less life-threatening than the chronic infections that may be acquired in infancy and may lead to early mortality. “Sexual transmission of hepatitis B usually results in an acute infection which is not life threatening. This report is about chronic infections which often lead to early mortality from liver disease and cancer,” explained Cary James, CEO of the World Hepatitis Alliance. “This is an important point as the misconception that chronic HBV is associated with sexual activity can be a major contributor to stigma within families, societies and health systems.” WHO’s Dr Meg Doherty and report author Dr Francoise Renaud “Hepatitis infection is a silent killer,” said Dr Meg Doherty, WHO’s Director of HIV, Hepatitis. “Awareness is very low worldwide. Most symptoms appear only once the disease has advanced, resulting in a huge volume of undiagnosed people living with hepatitis. Even when hepatitis is diagnosed, the number of people who go on to receive treatment remains low.” According to the report, by the end of 2022 only around 13% of people living with chronic hepatitis B infection had been diagnosed and approximately 3% (seven million) had received antiviral therapy, while about 36% of those with hepatitis C, 36% had been diagnosed and 20% (12.5 million) had received curative treatment. Almost two-thirds of global cases are concentrated in 10 countries – Bangladesh, China, Ethiopia, India, Indonesia, Nigeria, Pakistan, the Philippines, the Russian Federation and Viet Nam. Meanwhile, the WHO African region accounts for 63% of new hepatitis B infections, and yet only 18% of newborns receive the hepatitis B birth-dose vaccination. “Achieving universal access to prevention, diagnosis and treatment in these 10 countries by 2025, alongside intensified efforts in the African region, will be essential to get our response back on track,” stressed Doherty. On the other end of the spectrum, Egypt has made huge strides to eliminate hepatitis C in particular. “There are five main strains of hepatitis virus referred to as types A, B, C, D, and E. And in particular types B and C lead to chronic disease and together are the most common causes of liver cirrhosis, liver cancer and viral hepatitis related deaths,” she explained. Updated WHO estimates indicate that 254 million people live with hepatitis B and 50 million with hepatitis C in 2022. Half the burden of chronic hepatitis B and C infections is among people 30–54 years old, with 12% among children under 18 years of age. Men account for 58% of all cases. Treatment costs Pricing disparities persist both across and within WHO regions, with many countries paying above global benchmarks, even for off-patent drugs or when included in voluntary licensing agreements. “Despite the availability of affordable generic hepatitis medicines, many countries fail to procure them at these low prices,” said report author Dr Francoise Renaud. “Pricing disparities persist both across and within the WHO regions with many countries paying above global benchmarks, even for off patent medicines or when there are voluntary licencing agreements, which allow countries to produce or import generic formulations.” For example, although tenofovir for treatment of hepatitis B is off patent and available at a global benchmark price of $2.4 per month, only seven of the 26 reporting countries paid prices at or below the benchmark. The lowest reported monthly treatment prices reported by countries ranged from $1.22 for 30 tablets in China and India to $34.20 in Russia. Similarly, a 12-week course of pangenotypic sofosbuvir/daclatasvir to treat hepatitis C is available at a global benchmark price of $60, yet only four of 24 reporting countries paid prices at or below the benchmark. The lowest reported price for a 12-week course of this treatment was from Pakistan at about $33 for a generic course of treatment, while the highest reported price was from China, at about $ 10,000. About 75% of the reporting WHO focus countries rely primarily on government funding or out-of-pocket expenditure for viral hepatitis diagnostics Only 60% of reporting countries offer viral hepatitis testing and treatment services free of charge, either entirely or partially, in the public sector. Financial protection is low in the African region, where only about one third of reporting countries provide these services free of charge. –Correction (15 April, 2024). The original version of the story stated that hepatitis B infections are most commonly spread by sexual contact, when in fact the most common transmission route is mother to child transmission, according to WHO. Image Credits: Yoshi Shimizu/ WHO. Ensuring Ethical AI Implementation: HealthAI Launches Global Community of Practice 09/04/2024 Maayan Hoffman An artist’s depiction of artificial intelligence. Artificial Intelligence (AI) can save lives – but “we need to get the regulations right,” according to Dr Ricardo Baptista Leite, CEO of HealthAI, the agency responsible for artificial intelligence in health. To address the urgent need for the robust regulation of AI in the healthcare sector, HealthAI has initiated a worldwide community of practice (CoP), the organisation said last week. This initiative aims to strengthen each nation’s capacity to create well-informed regulations that promote AI’s ethical and fair utilisation in healthcare. “Our global community of practice is a critical platform for addressing the urgent need for regulation, bringing together global leaders from all sectors to ensure AI’s impact on health is positive, responsible and inclusive,” Leite said. The CoP will be a platform for discussing AI in healthcare and sharing experiences with responsible AI use in this field. It will bring together organisations, policymakers, technology experts, and leaders in health AI, fostering potential collaborations. “Since equity is core to our mission, we wanted to ensure a bottom-up approach be made to ensure the voices of all stakeholders from around the world would be heard as part of the development of these AI regulatory standards and in the implementation of these standards,” Leite told Health Policy Watch. He said the CoP would be open to all institutions – public, private, academic, patient and community-based organisations, civil society movements and technologists – by application. “We want to give a voice to those not heard as part of international processes and for us to be an important sounding board as we move forward and contribute to building this global ecosystem,” Leite added. HealthAI has a three-year strategy implementation plan that focusses on identifying at least 10 pioneer countries that it can help support and provide technical assistance. Leite said one of the challenges in many countries is the “absolute absence” of any form of expertise at the regulatory level. “To be able to address this matter seriously in the future, countries will need to invest in developing that capacity.” Leite noted that although organisations such as the World Health Organization (WHO), UNESCO, and the OECD are tasked with setting global standards, the countries must implement and apply these standards in practical situations. The future of AI in healthcare (illustrative) Regulatory confidence in technology There is a debate about whether regulations could hinder technology adoption in healthcare. However, Leite said HealthAI’s analysis is that many companies are hesitant to use technology due to concerns about legal liability in case of issues. His team believes establishing a regulatory framework will give companies the confidence to implement technology solutions. HealthAI, including through its CoP, aims to create an online global repository of validated AI solutions. This platform will be open source and showcase approved technologies, their functions, and their compliance with ethical AI standards. “This is especially important for startups in low- and middle-income countries,” Leite said. “Let’s say their national regulator just approved their technology. Now, suddenly, you can see their technology shown on this platform so that their innovations can be used in the Global North, meaning the tools developed in lower-resource settings could be a source of inspiration in high-income countries and not always the other way around.” At the same time, Leite said, another global network goal would be establishing an early warning system. This system would detect unintended negative impacts of AI technologies worldwide, triggering a red flag for all agencies to take immediate action. “This is important to ensure that governments can act in a timely manner and avoid harming citizens,” Leite said. WHO Announces S.A.R.A.H. HealthAI’s announcement about the CoP followed WHO’s announcement of S.A.R.A.H., a digital health promoter prototype with enhanced empathetic response powered by generative AI. S.A.R.A.H stands for “Smart AI Resource Assistant for Health.” “For too long health has often been viewed as a passive beneficiary of innovation rather than a driver of it,” wrote Hans Henri P. Kluge, WHO Regional Director for Europe in an article for Health Policy Watch. “It’s time to change this mentality and harness the power of innovation.” S.A.R.A.H is an advanced AI resource assistant designed for healthcare. WHO said the tool incorporates the latest language models and cutting-edge technology to engage users round the clock in eight languages, covering a wide range of health topics across various devices. It will provide information on a number of health topics, including healthy habits and mental health, cancer, heart and lung disease, and diabetes. “S.A.R.A.H gives us a glimpse of how artificial intelligence could be used in future to improve access to health information in a more interactive way,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. Image Credits: Quick Creator, Pexels. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. 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India’s Efforts to Address Hypertension Show Progress – Highlight Global Challenges 12/04/2024 Disha Shetty A health worker records a patient’s blood pressure at the Rural Hospital in Paud, India. PAUD, MAHARASHTRA STATE, INDIA – It is 11:15 on a Wednesday morning, and the March sun is hot but not yet punishing in this part of western India. Mathabai Jadhav, 65, waits patiently for her turn at the Paud Rural Hospital, some 30 kilometres from the city of Pune. At least two dozen patients like her, mostly elderly women and men from nearby rural areas, are waiting. Some sit on benches balancing a walking stick against their legs, others on the floor. They are here to attend a “screening camp” for non-communicable diseases (NCDs) that is held every Wednesday morning at the hospital. Four healthcare workers are in the midst of frenetic activity. One pricks patients’ fingers to draw blood and test sugar levels, another checks their blood pressure, the third dispenses government-subsidized medicines prescribed by hospital doctors and the fourth provides quick counselling on the dos and don’ts related to diet and exercise for better hypertension management. Jadhav has lived with hypertension for nearly 14 years. “I found out when I came to the doctor regarding a wrist injury,” she said. For over a decade, she went to private practitioners but for two-and-a-half years now she has been a regular at the Rural Hospital where the medication is free. Hypertension – a neglected condition Hypertension, simply put, is when the pressure in the blood vessels is too high. The World Health Organization (WHO) estimates that over a billion adults between the ages of 30-79 live with hypertension. Around half of them never find out or are not treated for the condition. This has grave consequences as hypertension is a leading single-preventable risk factor for cardiovascular disease (CVD) that killed an estimated 17.9 million people globally in 2019. In India, 28% of adults (18+) suffer from hypertension, with 70% of cases undiagnosed, a recent large-scale study found. Moreover, 90% of those living with hypertension don’t get treatment, or their treatment is ineffective to keep their hypertension within normal range. Scale at bottom indicates disability-adjusted life years (DALY’s) per 100,000 people lost to hypertension related to cardiovascular disease – with northeastern and southeastern India reflecting the highest burden. Strengthening programmes in LMICs In the past eight years, more than 40 low- and middle-income countries, including Bangladesh, Cuba, India and Sri Lanka, have strengthened their hypertension care, enroling more than 17 million people into treatment programmes based on a WHO-recommended package of primary health care interventions (HEARTS), according WHO’s first-ever global report on hypertension, released in September 2023 on the sidelines of the UN General Assembly. Meanwhile, high-income countries such as Canada and South Korea have achieved blood pressure control in over 50% of adults living with the condition through delivery of comprehensive hypertension programmes, WHO found. The report followed up on implementation of the global WHO HEARTS initiative first launched in 2016. Mathabai Jadhav, 65, sits on a bench at the Rural Hospital in Paud, India. India’s hypertension control initiative In 2017, India, now the world’s most populous country, started the India Hypertension Control Initiative (IHCI). The pilot was rolled out across five states and reaching over 15,000 public health facilities, including primary health care centers and rural hospitals, by March 2022. The programme relied on simple measures that can still be challenging to implement in low-resource settings: standardizing treatment protocols; ensuring the public healthcare system has the standard drugs to manage hypertension; equipping health centres with monitoring systems; and encouraging better digital or paper record-keeping to track patient progress. Prabhdeep Kaur, the lead investigator of the IHCI told Health Policy Watch that the idea was to decentralize care and prioritize evidence-based strategies that are known to work. “Then implement them by working along with the governments on the ground and see what kind of results we get, what challenges are there, can they be scaled up or not,” she said. This is the same approach recommended by the WHO, which has found that countries that strengthen primary healthcare (PHC) to improve hypertension management see a drop in CVD mortality as well. WHO was also a partner of the IHCI, along with India’s premier medical research agency – the Indian Council of Medical Research (ICMR). The project received additional funding support from both the central and some state governments in India. Reaching the global targets requires public and private collaboration WHO’s global target is to reduce hypertension by 33% between 2010 and 2030. WHO estimates that hypertension, as such, causes an estimated 10 million deaths annually. An estimated 10 million deaths are attributed to hypertension around the world by the WHO. India’s target is to reduce hypertension by a quarter by 2025, although the country has not specified a baseline year. Getting there requires not just a nudge from the government but also active involvement of civil society and the private sector, which provides around 70% of the country’s healthcare services. Two-pronged approach needed While a third of all adults globally, and nearly one-third in India, have hypertension, almost another third also have pre-hypertension that requires regular monitoring, said Dr Sailesh Mohan, Professor at the research non-profit Public Health Foundation of India and Director of the Centre for Chronic Conditions and Injuries (CCCI). “So there’s a large pool of people who are hypertensive and another pool waiting to convert to full-fledged hypertension from pre-hypertension,” he said. If pre-hypertension is not addressed, it quickly progresses to hypertension, and managing it effectively requires a synergistic approach, he explained. This approach involves promoting policies that reduce salt, tobacco and alcohol consumption, encourage and support an active lifestyle and healthier diet, as well as increase awareness about hypertension. The health system also needs to be bolstered to screen patients for hypertension and provide evidence-based care. The global incidence of hypertension has increased over the years, according to WHO data. Hypertension management in most cases requires regular monitoring, and a relatively cheap drug once a day, which can be done by trained nurses or healthcare workers. Aruna Kaware, NCD counsellor at the Paud Rural Hospital said on average three-quarters of the patients are above the age of 60. “We are able to handle most patients here. Around 10-20% of the patients might need to be referred to bigger hospitals,” she said. The state of Maharashtra where the hospital is located, has done a good job of scaling up NCD care, said Kaur. Detection is often the first challenge The detection of hypertension can be a challenge as patients might not always have symptoms, which is why it is called “the silent killer,” explained Mohan. Nathu Tonde, 83, now travels to the Rural Hospital every month alone to get this medication, using a cane for balance. But he came to the health centre for an unrelated ailment, and his hypertension was detected in a routine blood pressure measurement. Nathu Tonde, 83, sits waiting for his turn at the NCD camp held every Wednesday at the Rural Hospital in Paud, India. One of the striking results of the IHCI initiative was the increased accessibility of basic medications – due to a major reduction in drug stockouts, reduced to less than 5% in areas where the pilot was implemented. In addition, 47% of the 740,000 patients across 4,505 health facilities who took part in the project had their hypertension within the healthy limit during their visit in the first quarter of 2021. Technically, the five-year initiative concluded in 2022. But Kaur, the lead investigator, said the partners in the original initiative are currently working with the state governments across India to make it sustainable, as well as scaling it up further. Countering practical challenges – patient compliance and health system capacity While hypertension management is relatively easy in theory, there are other practical challenges. “People are not compliant with the medication,” said Dr Arvinder Pal Singh Narula, Assistant Professor of Community Medicine at Bharati Vidyapeeth Medical College. A key reason, especially in rural areas, is either the distance or when medicines run out. “My village is half an hour away and transport is hard to get,” Jadhav said of the monthly trips she makes to the health centre. It also costs money to make the trip. Kaware, the NCD counselor, said that many elderly patients come unaccompanied like Tonde had, and it is hard to explain even the basics like which medicines to take and when. Rural Hospital, Paud in western India. India has long focused on improving healthcare delivery by working with community health workers. More recently, states like Maharashta have countered the shortage of doctors and nurses in rural areas by engaging traditional medicine practitioners who are re-trained in “bridge programmes” to successfully deliver primary healthcare, especially in remote areas. These are doctors trained in Ayurvedic medicine or homeopathy who learn skills for delivering a package of modern health care measures, based on a government protocol. Even so, Kaur too said the lack of adequate healthcare workers remains a challenge in scaling up the initiative across India. Government services only one part of the picture However, initiatives such as the one in Paud have clear limitations – notably in who is targeted for services. While the Indian government provides primary healthcare in rural areas and limited secondary and tertiary care in some cities, most healthcare services are provided by the private sector. And here, chronic disease screening and prevention are typically paid for by the patient. Only around 41% of Indian households have a member covered by health insurance. Most Indian health insurance schemes only cover hospitalization, excluding primary health care visits and tests which are critical to the prevention, screening, and early treatment for NCDs, including hypertension. When people are finally diagnosed, it may often be at a later stage of the disease. In addition, treatment can involve hefty out-of-pocket costs for the average person. Leelabai Jaigude, 60, is one such case in point. A farmer, her hypertension medicine cost her Rs 80 ($1) every month at the private clinic that had diagnosed her, she said. But when she had to shell out Rs 550 ($6.60) for a blood test, she sought out a government center. She was fortunate enough to live near the Rural Hospital, and now receives both her hypertension and diabetes medication there. But not everyone is so fortunate to have a government facility near them. Overall, Indians bore more out-of-pocket expenditure than the government’s expenditure on health (48.2% compared to 40.6%), according to the Economic Survey 2022. Indian Government Health Expenditure (GHE) and Out of Pocket Expenditure (OOPE) as percent of Total Health Expenditure (THE) Alternative models proposed This has left experts such as Mohan looking for examples of how NCDs can be more effectively managed in private-sector healthcare and health insurance systems. He points to the Kaiser Permanente network in the United States as one such model that has delivered good results in hypertension management. Kaiser Permanente, which delivers healthcare to nearly 8.2 million Americans is a “Health Maintenance Organization” (HMO), which delivers holistic, cradle to grave care from primary to hospital level for those subscribed. The model operates nearly three dozen hospitals in the US. But since patients’ pay a subscription fee, HMOs have a vested interest in preventing disease from the outset – as it reduces their costs down the line. In India however, no comparable private-sector models exist, Mohan laments – or at least not one beyond the isolated initiatives of individual practitioners or hospitals. “The private sector is huge and very heterogeneous. And it’s very poorly regulated. So I am not aware of any concerted program or effort,” he said. In addition, while the government system has a hierarchy ranging from the primary to the tertiary level, in the private sector, the continuum is not as clear. Private providers at primary care level typically operate separately from hospitals and specialists. Finally, given that the private sector is largely unregulated, it also does not have to follow the government’s protocol for hypertension prevention detection and treatment. “The government has a protocol. They [public sector] will follow this protocol, which is not the protocol that the private practitioners will follow. They will give their own medicines,” Narula said. Kaur acknowledged this as a problem, saying that she and her team were very conscious of that fact in their work on the IHCI: “The strategies have to be different for the sectors. And since the public sector itself had not yet taken care of NCDs, trying to then replicate those strategies in private, we felt was a little premature,” she explained. In the coming years as the WHO works towards expanding universal health coverage (UHC) in different regions, the public and private divide, which differs enormously across countries and regions, will throw up a unique array of challenges depending on the setting. Universal healthcare requires healthcare to reach a large number of people, address the issue of equity, and ensure the care covers a hybrid of diseases, said Kaur. “So I feel our work tried to address all the three,” she said, of the IHCI collaboration. Additionally, this initiative taught the researchers what best practices work, like reducing the number of drugs to just a handful and procuring them in large quantities, and what the gaps are – the patient migration and ensuring continuity of care. “Now, many states are using the same best practices for diabetes. And going forward, we’d like to do pilots, and see which of these best practices can be used for other NCDs as well,” Kaur said. Image Credits: Disha Shetty, © 2021 Indian Council of Medical Research, Public Health Foundation of India, and Institute for Health Metrics and Evaluation, Global Hypertension Report, WHO, Economic Survey 2022. Clean Air Makes Economic Sense, Says Influential Group Ahead of World Bank Spring Meetings 11/04/2024 Chetan Bhattacharji Tackling air pollution makes economic sense, says Jane Burston, CEO of Clean Air Fund. What is the impact of air pollution on exam results or future earnings? Can governments agree to a 2050 net-zero-like goal for a key pollutant, PM 2.5? Such questions are part of an appeal by a new group of political, health, policy, and finance leaders for a policy approach to air pollution that is like that against greenhouse gas (GHG) – including an “intergovernmental” plan and nationally determined targets. Our Common Air (OCA) has put out a call to action that seeks to present a new and hopefully, more compelling way for global leaders and financiers to address air pollution, one of the world’s single biggest health crises. Frustrated by the lack of progress in addressing air pollution, the call presents new targets and suggests a new framework to improve air quality. The group’s co-chairs, former prime minister of New Zealand, Helen Clark, and former WHO chief scientist, Dr Soumya Swaminathan, say pollution has not received the attention or funding it deserves even though the devastating health costs have been documented. These include over seven million deaths estimated by WHO, links to heart attacks, strokes, dementia, high blood pressure, low birth weight, lung cancer, and chronic lung disease among many other ailments. About 99% of the world’s population suffers air pollution above the WHO’s guidelines. Commissioners and secretariat members at the Our Common Air convening in February at the Bellagio Center, Italy. Our Common Air is a new global commission of high-level government figures, renowned health experts, academics, and leading climate change specialists. Air pollution is a health and economic crisis OCA was set up last year as an independent commission. Apart from Clark and Swaminathan, its 16 commissioners include current WHO and World Bank officials participating in their personal capacities, as well as climate, pollution, finance, and policy experts. The group is backed by the UK-based Clean Air Fund and the report – Clean Air: A Call to Action – has been prepared by the Delhi-based Council on Energy, Environment and Water (CEEW). But OCA is re-phrasing the argument for clean air based on sound economics as well as a change in attitude. It is proposing four planks: value clean air as an asset, finance the transition, set clean air targets for all and collaboratively track progress, and work together to achieve solutions that benefit all. The report has been released ahead of the World Bank’s Spring Meetings, which take place next week, and serve as an important annual moment for reflectin and dialogue on global priorities by international finance and development actors. In a statement to Health Policy Watch, the commission says its focus on these meetings reflects the conviction that development finance institutions have a big role to play in transforming the landscape of clean air funding and action. Said Clark, “With every breath of toxic air endangering lives and having a knock-on effect on economies, we urgently need to take greater action on air pollution now. The upcoming World Bank and IMF Spring Meetings present a crucial opportunity for global leaders to come together and make clean air a priority.” There are numerous problems associated with air pollution, which often affect children and old people the most. From mitigation to protection The group is calling for a change in focus from mitigating air pollution as a harm to recognising and valuing clean air as an asset. It points out, for instance, that the United States found that every $1 spent on air pollution control yielded an estimated $30 in economic benefits. The World Bank estimates that the global cost of health damage due to air pollution amounts to $8.1 trillion a year, equivalent to 6.1% of global Gross Domestic Product (GDP). Contrast this with the $4.5 trillion needed a year by 2030 as investment in clean energy to limit global warming to 1.5°C, as estimated by the International Energy Agency (IEA). The report urges multilateral and regional development banks to incorporate economic impact analysis into their regular processes and demonstrate the economic benefits of reducing pollution. It calls on insurance firms to start incorporating air pollution-related health costs in risk assessments; many are already doing so for climate change in sectors like coal mining or housing in areas battered by rising cases of unpredictable, extreme weather. More funding needed The report calls for greater funding to combat air pollution. A study by Clean Air Fund, which supports OCA, showed that only 1% of international development funding ($2.5 billion per year) and 2% of international public climate finance ($1.66 billion per year) was committed to targeting air pollution over the last six years for which full data is available. The new report calls on all public development banks to develop metrics that ensure air quality impacts are publicised across investment portfolios. “Clean air does not have to be an ‘additional’ area to invest in,” says Clark. “Many of our existing public finance flows are already delivering clean air as a by-product. For example, action to reduce emissions to slow climate change also helps to cut air pollution. Our global public finance institutions should recognise and reinforce these ‘two birds, one stone’ solutions, by making clean air an explicit goal of existing programmes.” Image Credits: Our Common Air. European Court Ruling that Swiss Climate Policies Violate Human Rights Sets a Global Precedent 10/04/2024 Elaine Ruth Fletcher Supporters of the Swiss Climate Seniors Association “KlimaSenirorinnen” outside the European Court in Strasbourg, which ruled Tuesday that Switzerland’s climate policies were putting older women’s lives at risk. A European Court ruling Tuesday that Switzerland was violating human rights by not acting fast enough on climate change has been hailed by legal experts as a global precedent – and by WHO Director General Dr Tedros Adhanom Ghebreyesus as an important recognition of the links between climate change and health. The #ClimateCrisis is here and now. We salute this win and call on countries to step up their #ClimateAction to protect our health and planet! https://t.co/RbkbX4li3h — Tedros Adhanom Ghebreyesus (@DrTedros) April 9, 2024 In a case brought by the Swiss-based association of “Senior Women for Climate Protection” the Strasbourg-based European Court of Human Rights (ECHR) ruled that Swiss government inaction was putting their health at risk due to “critical gaps” in carbon reduction policies. The women, aged 64 and over, had argued that more extreme heat episodes, driven by climate change, undermined their health and quality of life, and put them at a greater risk of dying. A growing body of scientific evidence has documented the links between exposure to extreme heat and premature mortality -with heat relaed deaths of people over age 65 increasing by 85% since 1990, according to a Lancet Countdown study, published in November, 2023. The average person now experiences 86 days of “health-threatening high temperatures every year”, 60% of which are attributable to climate change, Lancet found in a global report by an international consortium of 114 scientists. Pardoxically, while the European Court ruling recognized the risks borne by older women in Alpine Switzerland, the overwhelming burden of those heat-related health risks is born by older people in low-income countries. Lancet Countdown: Average annual hours per person from 1991 to 2022 when light physical activity entailed at least a moderate, high, or extreme heat stress risk, arranged by HDI=Human Development Index groupings. A European and global precedent Today’s ruling against Switzerland sets a historic precedent that applies to all European countries,” said Gerry Listen, attorney at the Global Legal Action Network. The Network had represented a group of Portuguese children in a similar climate-related case before the European Court, which was ruled inadmissable for procedural and technical reasons. Listen said that the favorable ruling on the Swiss case, nonetheless, means that “all of the government lawyers who represented the 32 respondent states in our case are now going to have to advise their governments, the governments that they represented, that they are going to have to look at their targets again and update them. “Because none of the governments in Europe in cases that were before the court today have targets that are anywhere near 1.5 C. Most targets are aligned between 3-4 C within the lifetime of the young people before the court today,” he added in an interview on CNN Television. “So absolutely catastrophic levels of warming. So this precedent will require European wide revision of climate policies urgently. Otherwise, or anyways we are going to see a new wave of climate litigation at the European level sparked by this ruling from Strasbourg today. Today is a win for all generations! The Court has ruled that government failure to rapidly cut emissions is a violation of human rights. Although our #youth4climatejustice case was ruled inadmissible the court recognised the climate crisis is an existential threat to humanity. 1/ pic.twitter.com/EOhaTZQTqD — Global Legal Action Network (GLAN) (@GLAN_LAW) April 9, 2024 The court ruling is particularly significant because it is legally binding for Switzerland, and potentially for other European countries as well. However, litigation on climate issues has become increasingly common around the world. Both the International Court of Justice and the Inter American Court of Human Rights have cases pending which relate to the human rights impacts of climate change. As a result, the ruling will have impacts far beyond the European region, Joanne Setzer, Associate Professor at the UK-based Grantham Research Institute on Climate Change and the Environment, told the a English-language media channel, Swissinfo.ch. “The landmark ruling by the European Court of Human Rights not only sets a precedent in environmental and climate law but also signals a momentous shift in the global legal landscape concerning climate change,” she said. Only recently, India’s Supreme Court also recognized that the adverse effects of climate change violated people’s fundamental constitutional rights. There have also been a flurry of new reports and evidence suggesting that climate change disproportionately affects women and their health. My Oped in @the_hindu today on how the #ClimateCrisis is affecting women disproportionately. Adaptation plans need to be developed in a participatory manner with communities, panchayats & local urban bodies. @smritiirani @moesgoi @MinistryWCD @MoHFW_INDIA https://t.co/3Gs50mFpDU — Soumya Swaminathan (@doctorsoumya) April 10, 2024 In the ECHR ruling, Siofra O’Leary, president of the ECHR found numerous “critical gaps” in the Swiss regulatory frameworks that are supposed to reduce climate change. The court also criticized the lack of an effective Swiss monitoring system to determine levels of emissions that could indeed be permissible, while limiting warming to 1.5 °C in line with the 2015 Paris Climate Agreement. Fully implementing the #ParisAgreement is essential to respond to the threat of rising temperatures around the world pic.twitter.com/gIPHtOgwdK — UN Climate Change (@UNFCCC) August 9, 2017 Eight year battle Despite it’s “clean and green” reputation, Switzerland ranks among the “laggards” in economic incentives for zero emissions vehicles, according to a 2022 study. The Swiss senior’s association launched its legal case in 2016, charging the Swiss authorites for pursuing ineffective climate policies, which therefore threatened their health and right to life. The Swiss Federal Supreme Court rejected their request that the state adopt more ambitious targets for reducing climate emissions. Then in 2020, the Association appealed to the ECHR, anchoring its case in the violation of the European Convention on Human Rights, including clauses related to the right to life. The ECHR’s binding judgment means that Switzerland must take action to comply with the order – enacting new legislation to bring Swiss emissions reductions in line with the global goals of keeping temperature increase below 1.5 °C. Despite it’s global reputation as a clean and environmentally conscious nation, including solar panels on many rooftops and an efficient rail and cycle network, there has in fact been considerable pushback by Swiss center and center-right parties against more aggressive climate action – popularly perceived as adding to economic costs and undermining personal autonomy. Only one in 50 vehicles are fully electric, and Switzerland is one of the “laggards” in the tax incentivization of private, zero-emissions vehicles, according to a 2022 study by the NGO Transport & Environment. Even so, Switzerland now plans to end tax exemptions for EVs in 2024. Image Credits: @GLAN_LAW, Lancet Countdown on Health and Climate Change , Transport&Environment. New Dengue Vaccine Trials Show Promise in Brazil as Cases Continue to Rise 10/04/2024 Sophia Samantaroy Dengue cases have increased fourfold in some parts of the Americas As global cases of dengue are already close to last year’s record high of over four million, the Americas region is struggling to contain high transmission levels. Unplanned urbanization, heavier rainfall, warmer temperatures, and the El Nino effect create perfect conditions for the Aedes aegypti mosquito, the primary vector of dengue. The Southern Cone region of the Americas, which includes Argentina, Brazil, Chile, Paraguay, and Uruguay, has seen the highest burden of cases and deaths. Brazil alone accounts for close to 3.5 million cases. Challenges with vaccine distribution and availability This year, Brazil became the first country to deploy a newly approved vaccine, Qdenga. The vaccine, manufactured by the Japanese-based pharmaceutical company Takeda Pharmaceuticals, contains weakened versions of all four dengue serotypes. The European Medicines Agency and the UK have approved the vaccine for use in adults and children over four years of age. However, the manufacturers can only produce about six million doses – enough for three million individuals as each person needs two doses. Currently, Brazil is distributing the vaccine to children between the ages of 10 and 14 in areas of high transmission, and with previous exposure to dengue. This represents only a fraction of Brazil’s population. “[T]hey chose this age group because it was based on the analysis of the Minister of Health, the age group that was suffering the highest burden of hospitalization,” explained Dr. André Siqueira, a tropical medicine doctor and clinical researcher in Fundação Oswaldo Cruz, in a recent interview with the One Health Trust. “We can’t expect that to have a huge effect on the epidemics because it’s a restricted age group and it’s not the whole country. Full immunization is achieved within three months from the initial dose.” Given these limitations, the vaccination campaign is controversial in Brazil. “Some people said there’s no point. Even the Minister of Health said it won’t have any impact on this epidemic,” said Siqueira. However, Siqueira notes that vaccinating this initial cohort creates momentum “of people being involved with dengue to start promoting the vaccination, showing that it is safe and it can have an individual impact.” Public support is especially important after a prior vaccine, Dengvaxia, was linked to deaths in children in the Philippines. The Sanofi-produced vaccine was mired in controversy after the vaccine was shown to increase the risk of hospitalization for those without prior dengue exposure. When these individuals were infected with dengue, “instead of being protected, they were at higher risk of severe disease.” This is due to the dynamics between the four dengue serotypes. The antibodies for one serotype will only protect the individual against future infection from that same serotype. Individuals could then have up to four episodes of dengue over a lifespan. Furthermore, interactions between antibodies from the various serotypes can lead to more severe secondary dengue infection, a process called antibody-dependent enhancement. This dengue season in Brazil has seen the circulation of all four dengue serotypes. Many Brazilians are especially vulnerable to DENV-3 and DENV-4 as these subtypes have reappeared this season. Vaccine trials for domestically-produced doses In light of these challenges, researchers in Brazil are in the process of developing a new dengue vaccine to target all four serotypes. The vaccine, from the Butantan Institute in collaboration with the US National Institutes of Health (NIH), shows early promise in clinical trials. The live, attenuated, tetravalent vaccine requires only one dose, unlike Qdenga, which uses a two-dose system with three months between shots. In phase 3 trials, the vaccine has shown an efficacy of 79.6% among those without prior dengue exposure, and 89.2% for those with prior exposure. The results, published in The New England Journal of Medicine, are a culmination of years of research and trials, and bolster Brazil’s hopes for disrupting dengue’s hyperendemicity. “It should be stressed that Butantan Institute’s vaccine has also proved extremely safe for people who have never had dengue, which is an advantage over the vaccines now available on the market. Furthermore, it can be administered to a broader age group and a single dose is sufficient,”said virologist Maurício Lacerda Nogueira in a press release. Image Credits: PAHO/WHO. Amid Global Cholera Surge, Gavi Launches New Testing Programme 10/04/2024 Zuzanna Stawiska Lilongwe, Mali. A woman collects unsafe water from a local well. Contaminated water is a major source of cholera outbreaks. A new programme aiming at providing 1.2 million rapid cholera diagnostic tests has been launched in 14 African and Asian countries. “Routine use of diagnostics will bolster cholera surveillance in impacted countries, and must be leveraged to better target vaccination efforts, which play a critical role in multisectoral cholera prevention and control programmes,” said Aurélia Nguyen, Chief Programme Officer at Gavi, the vaccine alliance. Cholera is an acute diarrhoeal disease with a potentially severe and rapid trajectory when left uncured, WHO warns. The intestinal infection spreads through food and water contaminated with faeces with the bacterium Vibrio cholerae. It has surged globally since 2021, with high case fatality rates despite the availability of simple, effective and affordable treatment. According to the WHO, there are 1,3 to four million cases of cholera annually, with a death toll of between 21,000 and 143,000 worldwide. Existing triggers for cholera outbreaks – lack of access to clean water and sanitation – are exacerbated by climate change, WHO highlights. It occurs in situations of poor sanitation and little access to clean water, for instance in humanitarian crises or in migration camps. Once an outbreak has occurred, the infection can spreads quickly if authorities fail to detect it and limit its spread. A 25% increase in countries reporting cholera cases was noted in 2022, reaching 44 countries, and recent outbreaks recorded the highest fatality rate in over a decade. Rapid testing Even though the vaccine supply has increased 18-fold between 2013 and 2023, it still fails to meet the demand, especially as emergency doses need to be stocked in case of a sudden rise in cases. In effect, preventive vaccination campaigns have generally been too slow to stop the disease spread. Last year, WHO’s Global Task Force on Cholera Control (GTFCC) updated its recommendations to favour strategic, routine and systematic testing of suspected cholera cases to strengthen cholera surveillance. They also launched a strategy for cholera control, aiming to reduce cholera deaths by 90% by 2030. Responding to the challenge, Gavi has directed funds to cholera rapid testing and vaccination. “We are experiencing an unprecedented multi-year upsurge in cholera cases worldwide,” said said Nguyen. “The rise in infections is being driven by continued gaps in access to safe water and sanitation, and our inability to reach vulnerable communities that are being put further at risk by climate change, conflict and displacement.” Gavi is working with UNICEF, WHO and FIND, the diagnostics organisation, to develop and deliver the rapid tests. Leila Pakkala, of UNICEF’s Supply Division highlighted that “surveillance diagnostics help pinpoint hotspots with great precision. This allows partners to target cholera vaccines to exactly the time and place where the limited supply will save the most lives.” The long-term sustainability of the programme depends on successful fundraising for Gavi’s next strategic period, from 2026 to 2030. Image Credits: UNICEF. Stigma Prevents Europeans Living with Hepatitis B and C From Telling Families and Getting Care 10/04/2024 Zuzanna Stawiska Presenting research on hepatitis stigma during the 2024 World Hepatitis Summit. From the left: Freddy Green of UK Health Security Age, Caroline Thomas, founder of Peduli Hati Bangsa foundation and Cary James, Director of the World Hepatitis Alliance UK. Half the people living with hepatitis B or C struggle to tell others about their condition and a quarter had not told their families of their diagnosis, concluded a first-ever European study on the stigma related to the disease. Findings from the multi-country study, conducted by the World Hepatitis Alliance (WHA) and the European Centre for Disease Prevention and Control (ECDC), were presented during the World Hepatitis Summit taking place this week in Lisbon. The actual report will be released in the coming weeks. “Living with hepatitis is challenging enough, and the added burden of discrimination whether in social or healthcare settings can have a hugely negative impact on peoples’ quality of life,” said Cary James, Chief Executive of the World Hepatitis Alliance. “More needs to be done to reduce the stigma that surrounds hepatitis. Our ambition for this new study is to help policy makers formulate informed policies and strategies to reduce stigma and discrimination among people living with hepatitis and improve their quality of life.” Hepatitis is a liver disease affecting 350 million people worldwide. Every year, over a million people lose their lives because of related conditions. Hepatitis B and C are transmitted mostly through blood or sexual contact, which is the basis of the existing stigma. Negative attitudes “When I told my friends and family I am living with hepatitis it was hard at first. My mother’s response was toxic and she accused me of being sexually promiscuous outside of my studies,” said Joy Ko, a Peer Support Worker at the Bloomsbury Clinic living with hepatitis recalls. “I was once disengaged from the care for five years because of fear and stigma and received no support at all,” continues Ko. According to the study, nearly half of people living with hepatitis C (46%) and over a quarter (26%) of people living with hepatitis B reported not being treated well in healthcare settings. In effect, four out of ten of those with hepatitis C and one in six people with hepatitis B (17%) avoided receiving health care services when they needed them because of the expected discrimination and stigma. The worry was often not exaggerated: 38% of people with hepatitis C reported hearing healthcare workers talking inappropriately about them. Feeling judged and concealing this diagnosis had a negative effect on patients’ mental health burden. Over a third of people living with hepatitis B and C, even when cured, report experiencing some emotional distress such as anxiety or depression. Ending stigma, ending hepatitis Andrea Ammon, director of the ECDC says “Stigma surrounding hepatitis perpetuates discrimination and undermines efforts to prevent and control the disease. Education, awareness but also key policies are crucial for promoting understanding and support for those affected.” The WHO also stresses that ending the stigma surrounding hepatitis is a key element of hepatitis elimination. As many WHO countries are delayed in reaching the target of eliminating viral hepatitis by 2030, ending the related stigma could be an important factor to curb the disease, CDA Foundation’s Polaris Observatory noted. A new WHO report released on Tuesday shows only 13% of people living with chronic hepatitis B infection had been diagnosed. Moreover, only about three percent had received antiviral therapy at the end of 2022. Hepatitis C paints only a slightly better picture, with 36% of patients who had been diagnosed and 20% had received curative treatment. “I believe it is the start of our recovery journey when we can talk about it,” Joy Ko noted on her work with patients. “People living with hepatitis must know they are not alone in their diagnosis and there is lots of support available to them.” Mike Ryan Announced as New WHO Deputy Director General 09/04/2024 Kerry Cullinan Dr Mike Ryan helps attend to a health worker wounded in an attack in January 2019 against the Ebola vaccination team in the Democratic Republic of the Congo. The group, including Dr Tedros, were being evacuated by helicopter at the time. The new Deputy Director General of the World Health Organization (WHO) is Dr Mike Ryan, who will assume the position alongside his current post as the executive director of Health Emergencies, Preparedness and Response. Ryan, who succeeds Zsuzsanna Jakab, who retired in February, assumed the position on 1 April according to an internal staff communique send out last Thursday. WHO Director General Dr Tedros Adhanom Ghebreyusus announced the appointment publicly on Monday at an event at the WHO headquarters, describing Ryan as “the general” and a “soldier”, and thanking him “for all his sacrifices”. In 1990, Ryan, an Irish epidemiologist who trained as a trauma surgeon, went to work in a hospital Iraq that was being supported by the College of Surgeons in Ireland, supposedly for three months while he waited for his surgical residency to begin in Australia. However, during that time, “Kuwait was invaded by Iraq, and we all became hostages in Baghdad”, said Ryan an interview with ‘Awake at Night’, a UN podcast series. Tragically, during this time he was injured in an accident involving a military convoy and stuck in Iraq with minimal treatment. This ended his career as a surgeon, resulting in him switching to infectious diseases. “It was very clear to me that you were either a surgeon or a good infectious disease doctor because these seemed to be the two things [where] a doctor could make a difference in many developing country environments. So I went into infectious diseases and then ended up coming to WHO In 1996, to join David Heymann, who was setting up a new emerging disease programme in WHO,” Ryan explains. During this time, he worked on responses to a number of outbreaks including measles, Ebola (while based in Uganda), and other infectious diseases. Between 2011 and 2017, he worked on the Global Polio Eradication Initiative (GPEI) in Pakistan, Afghanistan, and the Middle East. From 2017 to 2019, Ryan served as Assistant Director-General for Emergency Preparedness and Response in WHO’s Health Emergencies Programme. In 2019, Ryan became Executive Director of Health Emergencies Programme, and one of the WHO’s public faces during the COVID-19 pandemic. Image Credits: Lindsay Mackenzie/ WHO. Deaths from Viral Hepatitis Increase Globally With Limited Access to Diagnostics and Treatment 09/04/2024 Kerry Cullinan Baltazar Lucas, living with hepatitis B and a survivor of liver cancer who went through a liver transplant, goes for regular check-ups in Ortigas, Philippines. There has been an increase in deaths from hepatitis B and C, the infectious viral liver diseases that kill as many people each year as tuberculosis – yet few people know that they are infected and get the treatment they need. This is according to the World Health Organization (WHO) 2024 Global Hepatitis Report – the first to document epidemiology, service and product access – which was released on Tuesday at the start of the World Hepatitis Summit in Portugal. New data from 187 countries show that the estimated number of deaths rose from 1.1 million in 2019 to 1.3 million in 2022. Hepatitis B and C cause around 3,500 deaths every day. Around 83% the deaths were caused by hepatitis B, most commonly spread by mother-to-child transmission, and 17% by hepatitis C, usually spread through contact with infected blood. While sexual transmission is also a route for hepatitis B transmission, this typically results in acute infections, which are, in fact, less life-threatening than the chronic infections that may be acquired in infancy and may lead to early mortality. “Sexual transmission of hepatitis B usually results in an acute infection which is not life threatening. This report is about chronic infections which often lead to early mortality from liver disease and cancer,” explained Cary James, CEO of the World Hepatitis Alliance. “This is an important point as the misconception that chronic HBV is associated with sexual activity can be a major contributor to stigma within families, societies and health systems.” WHO’s Dr Meg Doherty and report author Dr Francoise Renaud “Hepatitis infection is a silent killer,” said Dr Meg Doherty, WHO’s Director of HIV, Hepatitis. “Awareness is very low worldwide. Most symptoms appear only once the disease has advanced, resulting in a huge volume of undiagnosed people living with hepatitis. Even when hepatitis is diagnosed, the number of people who go on to receive treatment remains low.” According to the report, by the end of 2022 only around 13% of people living with chronic hepatitis B infection had been diagnosed and approximately 3% (seven million) had received antiviral therapy, while about 36% of those with hepatitis C, 36% had been diagnosed and 20% (12.5 million) had received curative treatment. Almost two-thirds of global cases are concentrated in 10 countries – Bangladesh, China, Ethiopia, India, Indonesia, Nigeria, Pakistan, the Philippines, the Russian Federation and Viet Nam. Meanwhile, the WHO African region accounts for 63% of new hepatitis B infections, and yet only 18% of newborns receive the hepatitis B birth-dose vaccination. “Achieving universal access to prevention, diagnosis and treatment in these 10 countries by 2025, alongside intensified efforts in the African region, will be essential to get our response back on track,” stressed Doherty. On the other end of the spectrum, Egypt has made huge strides to eliminate hepatitis C in particular. “There are five main strains of hepatitis virus referred to as types A, B, C, D, and E. And in particular types B and C lead to chronic disease and together are the most common causes of liver cirrhosis, liver cancer and viral hepatitis related deaths,” she explained. Updated WHO estimates indicate that 254 million people live with hepatitis B and 50 million with hepatitis C in 2022. Half the burden of chronic hepatitis B and C infections is among people 30–54 years old, with 12% among children under 18 years of age. Men account for 58% of all cases. Treatment costs Pricing disparities persist both across and within WHO regions, with many countries paying above global benchmarks, even for off-patent drugs or when included in voluntary licensing agreements. “Despite the availability of affordable generic hepatitis medicines, many countries fail to procure them at these low prices,” said report author Dr Francoise Renaud. “Pricing disparities persist both across and within the WHO regions with many countries paying above global benchmarks, even for off patent medicines or when there are voluntary licencing agreements, which allow countries to produce or import generic formulations.” For example, although tenofovir for treatment of hepatitis B is off patent and available at a global benchmark price of $2.4 per month, only seven of the 26 reporting countries paid prices at or below the benchmark. The lowest reported monthly treatment prices reported by countries ranged from $1.22 for 30 tablets in China and India to $34.20 in Russia. Similarly, a 12-week course of pangenotypic sofosbuvir/daclatasvir to treat hepatitis C is available at a global benchmark price of $60, yet only four of 24 reporting countries paid prices at or below the benchmark. The lowest reported price for a 12-week course of this treatment was from Pakistan at about $33 for a generic course of treatment, while the highest reported price was from China, at about $ 10,000. About 75% of the reporting WHO focus countries rely primarily on government funding or out-of-pocket expenditure for viral hepatitis diagnostics Only 60% of reporting countries offer viral hepatitis testing and treatment services free of charge, either entirely or partially, in the public sector. Financial protection is low in the African region, where only about one third of reporting countries provide these services free of charge. –Correction (15 April, 2024). The original version of the story stated that hepatitis B infections are most commonly spread by sexual contact, when in fact the most common transmission route is mother to child transmission, according to WHO. Image Credits: Yoshi Shimizu/ WHO. Ensuring Ethical AI Implementation: HealthAI Launches Global Community of Practice 09/04/2024 Maayan Hoffman An artist’s depiction of artificial intelligence. Artificial Intelligence (AI) can save lives – but “we need to get the regulations right,” according to Dr Ricardo Baptista Leite, CEO of HealthAI, the agency responsible for artificial intelligence in health. To address the urgent need for the robust regulation of AI in the healthcare sector, HealthAI has initiated a worldwide community of practice (CoP), the organisation said last week. This initiative aims to strengthen each nation’s capacity to create well-informed regulations that promote AI’s ethical and fair utilisation in healthcare. “Our global community of practice is a critical platform for addressing the urgent need for regulation, bringing together global leaders from all sectors to ensure AI’s impact on health is positive, responsible and inclusive,” Leite said. The CoP will be a platform for discussing AI in healthcare and sharing experiences with responsible AI use in this field. It will bring together organisations, policymakers, technology experts, and leaders in health AI, fostering potential collaborations. “Since equity is core to our mission, we wanted to ensure a bottom-up approach be made to ensure the voices of all stakeholders from around the world would be heard as part of the development of these AI regulatory standards and in the implementation of these standards,” Leite told Health Policy Watch. He said the CoP would be open to all institutions – public, private, academic, patient and community-based organisations, civil society movements and technologists – by application. “We want to give a voice to those not heard as part of international processes and for us to be an important sounding board as we move forward and contribute to building this global ecosystem,” Leite added. HealthAI has a three-year strategy implementation plan that focusses on identifying at least 10 pioneer countries that it can help support and provide technical assistance. Leite said one of the challenges in many countries is the “absolute absence” of any form of expertise at the regulatory level. “To be able to address this matter seriously in the future, countries will need to invest in developing that capacity.” Leite noted that although organisations such as the World Health Organization (WHO), UNESCO, and the OECD are tasked with setting global standards, the countries must implement and apply these standards in practical situations. The future of AI in healthcare (illustrative) Regulatory confidence in technology There is a debate about whether regulations could hinder technology adoption in healthcare. However, Leite said HealthAI’s analysis is that many companies are hesitant to use technology due to concerns about legal liability in case of issues. His team believes establishing a regulatory framework will give companies the confidence to implement technology solutions. HealthAI, including through its CoP, aims to create an online global repository of validated AI solutions. This platform will be open source and showcase approved technologies, their functions, and their compliance with ethical AI standards. “This is especially important for startups in low- and middle-income countries,” Leite said. “Let’s say their national regulator just approved their technology. Now, suddenly, you can see their technology shown on this platform so that their innovations can be used in the Global North, meaning the tools developed in lower-resource settings could be a source of inspiration in high-income countries and not always the other way around.” At the same time, Leite said, another global network goal would be establishing an early warning system. This system would detect unintended negative impacts of AI technologies worldwide, triggering a red flag for all agencies to take immediate action. “This is important to ensure that governments can act in a timely manner and avoid harming citizens,” Leite said. WHO Announces S.A.R.A.H. HealthAI’s announcement about the CoP followed WHO’s announcement of S.A.R.A.H., a digital health promoter prototype with enhanced empathetic response powered by generative AI. S.A.R.A.H stands for “Smart AI Resource Assistant for Health.” “For too long health has often been viewed as a passive beneficiary of innovation rather than a driver of it,” wrote Hans Henri P. Kluge, WHO Regional Director for Europe in an article for Health Policy Watch. “It’s time to change this mentality and harness the power of innovation.” S.A.R.A.H is an advanced AI resource assistant designed for healthcare. WHO said the tool incorporates the latest language models and cutting-edge technology to engage users round the clock in eight languages, covering a wide range of health topics across various devices. It will provide information on a number of health topics, including healthy habits and mental health, cancer, heart and lung disease, and diabetes. “S.A.R.A.H gives us a glimpse of how artificial intelligence could be used in future to improve access to health information in a more interactive way,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. Image Credits: Quick Creator, Pexels. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. 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Clean Air Makes Economic Sense, Says Influential Group Ahead of World Bank Spring Meetings 11/04/2024 Chetan Bhattacharji Tackling air pollution makes economic sense, says Jane Burston, CEO of Clean Air Fund. What is the impact of air pollution on exam results or future earnings? Can governments agree to a 2050 net-zero-like goal for a key pollutant, PM 2.5? Such questions are part of an appeal by a new group of political, health, policy, and finance leaders for a policy approach to air pollution that is like that against greenhouse gas (GHG) – including an “intergovernmental” plan and nationally determined targets. Our Common Air (OCA) has put out a call to action that seeks to present a new and hopefully, more compelling way for global leaders and financiers to address air pollution, one of the world’s single biggest health crises. Frustrated by the lack of progress in addressing air pollution, the call presents new targets and suggests a new framework to improve air quality. The group’s co-chairs, former prime minister of New Zealand, Helen Clark, and former WHO chief scientist, Dr Soumya Swaminathan, say pollution has not received the attention or funding it deserves even though the devastating health costs have been documented. These include over seven million deaths estimated by WHO, links to heart attacks, strokes, dementia, high blood pressure, low birth weight, lung cancer, and chronic lung disease among many other ailments. About 99% of the world’s population suffers air pollution above the WHO’s guidelines. Commissioners and secretariat members at the Our Common Air convening in February at the Bellagio Center, Italy. Our Common Air is a new global commission of high-level government figures, renowned health experts, academics, and leading climate change specialists. Air pollution is a health and economic crisis OCA was set up last year as an independent commission. Apart from Clark and Swaminathan, its 16 commissioners include current WHO and World Bank officials participating in their personal capacities, as well as climate, pollution, finance, and policy experts. The group is backed by the UK-based Clean Air Fund and the report – Clean Air: A Call to Action – has been prepared by the Delhi-based Council on Energy, Environment and Water (CEEW). But OCA is re-phrasing the argument for clean air based on sound economics as well as a change in attitude. It is proposing four planks: value clean air as an asset, finance the transition, set clean air targets for all and collaboratively track progress, and work together to achieve solutions that benefit all. The report has been released ahead of the World Bank’s Spring Meetings, which take place next week, and serve as an important annual moment for reflectin and dialogue on global priorities by international finance and development actors. In a statement to Health Policy Watch, the commission says its focus on these meetings reflects the conviction that development finance institutions have a big role to play in transforming the landscape of clean air funding and action. Said Clark, “With every breath of toxic air endangering lives and having a knock-on effect on economies, we urgently need to take greater action on air pollution now. The upcoming World Bank and IMF Spring Meetings present a crucial opportunity for global leaders to come together and make clean air a priority.” There are numerous problems associated with air pollution, which often affect children and old people the most. From mitigation to protection The group is calling for a change in focus from mitigating air pollution as a harm to recognising and valuing clean air as an asset. It points out, for instance, that the United States found that every $1 spent on air pollution control yielded an estimated $30 in economic benefits. The World Bank estimates that the global cost of health damage due to air pollution amounts to $8.1 trillion a year, equivalent to 6.1% of global Gross Domestic Product (GDP). Contrast this with the $4.5 trillion needed a year by 2030 as investment in clean energy to limit global warming to 1.5°C, as estimated by the International Energy Agency (IEA). The report urges multilateral and regional development banks to incorporate economic impact analysis into their regular processes and demonstrate the economic benefits of reducing pollution. It calls on insurance firms to start incorporating air pollution-related health costs in risk assessments; many are already doing so for climate change in sectors like coal mining or housing in areas battered by rising cases of unpredictable, extreme weather. More funding needed The report calls for greater funding to combat air pollution. A study by Clean Air Fund, which supports OCA, showed that only 1% of international development funding ($2.5 billion per year) and 2% of international public climate finance ($1.66 billion per year) was committed to targeting air pollution over the last six years for which full data is available. The new report calls on all public development banks to develop metrics that ensure air quality impacts are publicised across investment portfolios. “Clean air does not have to be an ‘additional’ area to invest in,” says Clark. “Many of our existing public finance flows are already delivering clean air as a by-product. For example, action to reduce emissions to slow climate change also helps to cut air pollution. Our global public finance institutions should recognise and reinforce these ‘two birds, one stone’ solutions, by making clean air an explicit goal of existing programmes.” Image Credits: Our Common Air. European Court Ruling that Swiss Climate Policies Violate Human Rights Sets a Global Precedent 10/04/2024 Elaine Ruth Fletcher Supporters of the Swiss Climate Seniors Association “KlimaSenirorinnen” outside the European Court in Strasbourg, which ruled Tuesday that Switzerland’s climate policies were putting older women’s lives at risk. A European Court ruling Tuesday that Switzerland was violating human rights by not acting fast enough on climate change has been hailed by legal experts as a global precedent – and by WHO Director General Dr Tedros Adhanom Ghebreyesus as an important recognition of the links between climate change and health. The #ClimateCrisis is here and now. We salute this win and call on countries to step up their #ClimateAction to protect our health and planet! https://t.co/RbkbX4li3h — Tedros Adhanom Ghebreyesus (@DrTedros) April 9, 2024 In a case brought by the Swiss-based association of “Senior Women for Climate Protection” the Strasbourg-based European Court of Human Rights (ECHR) ruled that Swiss government inaction was putting their health at risk due to “critical gaps” in carbon reduction policies. The women, aged 64 and over, had argued that more extreme heat episodes, driven by climate change, undermined their health and quality of life, and put them at a greater risk of dying. A growing body of scientific evidence has documented the links between exposure to extreme heat and premature mortality -with heat relaed deaths of people over age 65 increasing by 85% since 1990, according to a Lancet Countdown study, published in November, 2023. The average person now experiences 86 days of “health-threatening high temperatures every year”, 60% of which are attributable to climate change, Lancet found in a global report by an international consortium of 114 scientists. Pardoxically, while the European Court ruling recognized the risks borne by older women in Alpine Switzerland, the overwhelming burden of those heat-related health risks is born by older people in low-income countries. Lancet Countdown: Average annual hours per person from 1991 to 2022 when light physical activity entailed at least a moderate, high, or extreme heat stress risk, arranged by HDI=Human Development Index groupings. A European and global precedent Today’s ruling against Switzerland sets a historic precedent that applies to all European countries,” said Gerry Listen, attorney at the Global Legal Action Network. The Network had represented a group of Portuguese children in a similar climate-related case before the European Court, which was ruled inadmissable for procedural and technical reasons. Listen said that the favorable ruling on the Swiss case, nonetheless, means that “all of the government lawyers who represented the 32 respondent states in our case are now going to have to advise their governments, the governments that they represented, that they are going to have to look at their targets again and update them. “Because none of the governments in Europe in cases that were before the court today have targets that are anywhere near 1.5 C. Most targets are aligned between 3-4 C within the lifetime of the young people before the court today,” he added in an interview on CNN Television. “So absolutely catastrophic levels of warming. So this precedent will require European wide revision of climate policies urgently. Otherwise, or anyways we are going to see a new wave of climate litigation at the European level sparked by this ruling from Strasbourg today. Today is a win for all generations! The Court has ruled that government failure to rapidly cut emissions is a violation of human rights. Although our #youth4climatejustice case was ruled inadmissible the court recognised the climate crisis is an existential threat to humanity. 1/ pic.twitter.com/EOhaTZQTqD — Global Legal Action Network (GLAN) (@GLAN_LAW) April 9, 2024 The court ruling is particularly significant because it is legally binding for Switzerland, and potentially for other European countries as well. However, litigation on climate issues has become increasingly common around the world. Both the International Court of Justice and the Inter American Court of Human Rights have cases pending which relate to the human rights impacts of climate change. As a result, the ruling will have impacts far beyond the European region, Joanne Setzer, Associate Professor at the UK-based Grantham Research Institute on Climate Change and the Environment, told the a English-language media channel, Swissinfo.ch. “The landmark ruling by the European Court of Human Rights not only sets a precedent in environmental and climate law but also signals a momentous shift in the global legal landscape concerning climate change,” she said. Only recently, India’s Supreme Court also recognized that the adverse effects of climate change violated people’s fundamental constitutional rights. There have also been a flurry of new reports and evidence suggesting that climate change disproportionately affects women and their health. My Oped in @the_hindu today on how the #ClimateCrisis is affecting women disproportionately. Adaptation plans need to be developed in a participatory manner with communities, panchayats & local urban bodies. @smritiirani @moesgoi @MinistryWCD @MoHFW_INDIA https://t.co/3Gs50mFpDU — Soumya Swaminathan (@doctorsoumya) April 10, 2024 In the ECHR ruling, Siofra O’Leary, president of the ECHR found numerous “critical gaps” in the Swiss regulatory frameworks that are supposed to reduce climate change. The court also criticized the lack of an effective Swiss monitoring system to determine levels of emissions that could indeed be permissible, while limiting warming to 1.5 °C in line with the 2015 Paris Climate Agreement. Fully implementing the #ParisAgreement is essential to respond to the threat of rising temperatures around the world pic.twitter.com/gIPHtOgwdK — UN Climate Change (@UNFCCC) August 9, 2017 Eight year battle Despite it’s “clean and green” reputation, Switzerland ranks among the “laggards” in economic incentives for zero emissions vehicles, according to a 2022 study. The Swiss senior’s association launched its legal case in 2016, charging the Swiss authorites for pursuing ineffective climate policies, which therefore threatened their health and right to life. The Swiss Federal Supreme Court rejected their request that the state adopt more ambitious targets for reducing climate emissions. Then in 2020, the Association appealed to the ECHR, anchoring its case in the violation of the European Convention on Human Rights, including clauses related to the right to life. The ECHR’s binding judgment means that Switzerland must take action to comply with the order – enacting new legislation to bring Swiss emissions reductions in line with the global goals of keeping temperature increase below 1.5 °C. Despite it’s global reputation as a clean and environmentally conscious nation, including solar panels on many rooftops and an efficient rail and cycle network, there has in fact been considerable pushback by Swiss center and center-right parties against more aggressive climate action – popularly perceived as adding to economic costs and undermining personal autonomy. Only one in 50 vehicles are fully electric, and Switzerland is one of the “laggards” in the tax incentivization of private, zero-emissions vehicles, according to a 2022 study by the NGO Transport & Environment. Even so, Switzerland now plans to end tax exemptions for EVs in 2024. Image Credits: @GLAN_LAW, Lancet Countdown on Health and Climate Change , Transport&Environment. New Dengue Vaccine Trials Show Promise in Brazil as Cases Continue to Rise 10/04/2024 Sophia Samantaroy Dengue cases have increased fourfold in some parts of the Americas As global cases of dengue are already close to last year’s record high of over four million, the Americas region is struggling to contain high transmission levels. Unplanned urbanization, heavier rainfall, warmer temperatures, and the El Nino effect create perfect conditions for the Aedes aegypti mosquito, the primary vector of dengue. The Southern Cone region of the Americas, which includes Argentina, Brazil, Chile, Paraguay, and Uruguay, has seen the highest burden of cases and deaths. Brazil alone accounts for close to 3.5 million cases. Challenges with vaccine distribution and availability This year, Brazil became the first country to deploy a newly approved vaccine, Qdenga. The vaccine, manufactured by the Japanese-based pharmaceutical company Takeda Pharmaceuticals, contains weakened versions of all four dengue serotypes. The European Medicines Agency and the UK have approved the vaccine for use in adults and children over four years of age. However, the manufacturers can only produce about six million doses – enough for three million individuals as each person needs two doses. Currently, Brazil is distributing the vaccine to children between the ages of 10 and 14 in areas of high transmission, and with previous exposure to dengue. This represents only a fraction of Brazil’s population. “[T]hey chose this age group because it was based on the analysis of the Minister of Health, the age group that was suffering the highest burden of hospitalization,” explained Dr. André Siqueira, a tropical medicine doctor and clinical researcher in Fundação Oswaldo Cruz, in a recent interview with the One Health Trust. “We can’t expect that to have a huge effect on the epidemics because it’s a restricted age group and it’s not the whole country. Full immunization is achieved within three months from the initial dose.” Given these limitations, the vaccination campaign is controversial in Brazil. “Some people said there’s no point. Even the Minister of Health said it won’t have any impact on this epidemic,” said Siqueira. However, Siqueira notes that vaccinating this initial cohort creates momentum “of people being involved with dengue to start promoting the vaccination, showing that it is safe and it can have an individual impact.” Public support is especially important after a prior vaccine, Dengvaxia, was linked to deaths in children in the Philippines. The Sanofi-produced vaccine was mired in controversy after the vaccine was shown to increase the risk of hospitalization for those without prior dengue exposure. When these individuals were infected with dengue, “instead of being protected, they were at higher risk of severe disease.” This is due to the dynamics between the four dengue serotypes. The antibodies for one serotype will only protect the individual against future infection from that same serotype. Individuals could then have up to four episodes of dengue over a lifespan. Furthermore, interactions between antibodies from the various serotypes can lead to more severe secondary dengue infection, a process called antibody-dependent enhancement. This dengue season in Brazil has seen the circulation of all four dengue serotypes. Many Brazilians are especially vulnerable to DENV-3 and DENV-4 as these subtypes have reappeared this season. Vaccine trials for domestically-produced doses In light of these challenges, researchers in Brazil are in the process of developing a new dengue vaccine to target all four serotypes. The vaccine, from the Butantan Institute in collaboration with the US National Institutes of Health (NIH), shows early promise in clinical trials. The live, attenuated, tetravalent vaccine requires only one dose, unlike Qdenga, which uses a two-dose system with three months between shots. In phase 3 trials, the vaccine has shown an efficacy of 79.6% among those without prior dengue exposure, and 89.2% for those with prior exposure. The results, published in The New England Journal of Medicine, are a culmination of years of research and trials, and bolster Brazil’s hopes for disrupting dengue’s hyperendemicity. “It should be stressed that Butantan Institute’s vaccine has also proved extremely safe for people who have never had dengue, which is an advantage over the vaccines now available on the market. Furthermore, it can be administered to a broader age group and a single dose is sufficient,”said virologist Maurício Lacerda Nogueira in a press release. Image Credits: PAHO/WHO. Amid Global Cholera Surge, Gavi Launches New Testing Programme 10/04/2024 Zuzanna Stawiska Lilongwe, Mali. A woman collects unsafe water from a local well. Contaminated water is a major source of cholera outbreaks. A new programme aiming at providing 1.2 million rapid cholera diagnostic tests has been launched in 14 African and Asian countries. “Routine use of diagnostics will bolster cholera surveillance in impacted countries, and must be leveraged to better target vaccination efforts, which play a critical role in multisectoral cholera prevention and control programmes,” said Aurélia Nguyen, Chief Programme Officer at Gavi, the vaccine alliance. Cholera is an acute diarrhoeal disease with a potentially severe and rapid trajectory when left uncured, WHO warns. The intestinal infection spreads through food and water contaminated with faeces with the bacterium Vibrio cholerae. It has surged globally since 2021, with high case fatality rates despite the availability of simple, effective and affordable treatment. According to the WHO, there are 1,3 to four million cases of cholera annually, with a death toll of between 21,000 and 143,000 worldwide. Existing triggers for cholera outbreaks – lack of access to clean water and sanitation – are exacerbated by climate change, WHO highlights. It occurs in situations of poor sanitation and little access to clean water, for instance in humanitarian crises or in migration camps. Once an outbreak has occurred, the infection can spreads quickly if authorities fail to detect it and limit its spread. A 25% increase in countries reporting cholera cases was noted in 2022, reaching 44 countries, and recent outbreaks recorded the highest fatality rate in over a decade. Rapid testing Even though the vaccine supply has increased 18-fold between 2013 and 2023, it still fails to meet the demand, especially as emergency doses need to be stocked in case of a sudden rise in cases. In effect, preventive vaccination campaigns have generally been too slow to stop the disease spread. Last year, WHO’s Global Task Force on Cholera Control (GTFCC) updated its recommendations to favour strategic, routine and systematic testing of suspected cholera cases to strengthen cholera surveillance. They also launched a strategy for cholera control, aiming to reduce cholera deaths by 90% by 2030. Responding to the challenge, Gavi has directed funds to cholera rapid testing and vaccination. “We are experiencing an unprecedented multi-year upsurge in cholera cases worldwide,” said said Nguyen. “The rise in infections is being driven by continued gaps in access to safe water and sanitation, and our inability to reach vulnerable communities that are being put further at risk by climate change, conflict and displacement.” Gavi is working with UNICEF, WHO and FIND, the diagnostics organisation, to develop and deliver the rapid tests. Leila Pakkala, of UNICEF’s Supply Division highlighted that “surveillance diagnostics help pinpoint hotspots with great precision. This allows partners to target cholera vaccines to exactly the time and place where the limited supply will save the most lives.” The long-term sustainability of the programme depends on successful fundraising for Gavi’s next strategic period, from 2026 to 2030. Image Credits: UNICEF. Stigma Prevents Europeans Living with Hepatitis B and C From Telling Families and Getting Care 10/04/2024 Zuzanna Stawiska Presenting research on hepatitis stigma during the 2024 World Hepatitis Summit. From the left: Freddy Green of UK Health Security Age, Caroline Thomas, founder of Peduli Hati Bangsa foundation and Cary James, Director of the World Hepatitis Alliance UK. Half the people living with hepatitis B or C struggle to tell others about their condition and a quarter had not told their families of their diagnosis, concluded a first-ever European study on the stigma related to the disease. Findings from the multi-country study, conducted by the World Hepatitis Alliance (WHA) and the European Centre for Disease Prevention and Control (ECDC), were presented during the World Hepatitis Summit taking place this week in Lisbon. The actual report will be released in the coming weeks. “Living with hepatitis is challenging enough, and the added burden of discrimination whether in social or healthcare settings can have a hugely negative impact on peoples’ quality of life,” said Cary James, Chief Executive of the World Hepatitis Alliance. “More needs to be done to reduce the stigma that surrounds hepatitis. Our ambition for this new study is to help policy makers formulate informed policies and strategies to reduce stigma and discrimination among people living with hepatitis and improve their quality of life.” Hepatitis is a liver disease affecting 350 million people worldwide. Every year, over a million people lose their lives because of related conditions. Hepatitis B and C are transmitted mostly through blood or sexual contact, which is the basis of the existing stigma. Negative attitudes “When I told my friends and family I am living with hepatitis it was hard at first. My mother’s response was toxic and she accused me of being sexually promiscuous outside of my studies,” said Joy Ko, a Peer Support Worker at the Bloomsbury Clinic living with hepatitis recalls. “I was once disengaged from the care for five years because of fear and stigma and received no support at all,” continues Ko. According to the study, nearly half of people living with hepatitis C (46%) and over a quarter (26%) of people living with hepatitis B reported not being treated well in healthcare settings. In effect, four out of ten of those with hepatitis C and one in six people with hepatitis B (17%) avoided receiving health care services when they needed them because of the expected discrimination and stigma. The worry was often not exaggerated: 38% of people with hepatitis C reported hearing healthcare workers talking inappropriately about them. Feeling judged and concealing this diagnosis had a negative effect on patients’ mental health burden. Over a third of people living with hepatitis B and C, even when cured, report experiencing some emotional distress such as anxiety or depression. Ending stigma, ending hepatitis Andrea Ammon, director of the ECDC says “Stigma surrounding hepatitis perpetuates discrimination and undermines efforts to prevent and control the disease. Education, awareness but also key policies are crucial for promoting understanding and support for those affected.” The WHO also stresses that ending the stigma surrounding hepatitis is a key element of hepatitis elimination. As many WHO countries are delayed in reaching the target of eliminating viral hepatitis by 2030, ending the related stigma could be an important factor to curb the disease, CDA Foundation’s Polaris Observatory noted. A new WHO report released on Tuesday shows only 13% of people living with chronic hepatitis B infection had been diagnosed. Moreover, only about three percent had received antiviral therapy at the end of 2022. Hepatitis C paints only a slightly better picture, with 36% of patients who had been diagnosed and 20% had received curative treatment. “I believe it is the start of our recovery journey when we can talk about it,” Joy Ko noted on her work with patients. “People living with hepatitis must know they are not alone in their diagnosis and there is lots of support available to them.” Mike Ryan Announced as New WHO Deputy Director General 09/04/2024 Kerry Cullinan Dr Mike Ryan helps attend to a health worker wounded in an attack in January 2019 against the Ebola vaccination team in the Democratic Republic of the Congo. The group, including Dr Tedros, were being evacuated by helicopter at the time. The new Deputy Director General of the World Health Organization (WHO) is Dr Mike Ryan, who will assume the position alongside his current post as the executive director of Health Emergencies, Preparedness and Response. Ryan, who succeeds Zsuzsanna Jakab, who retired in February, assumed the position on 1 April according to an internal staff communique send out last Thursday. WHO Director General Dr Tedros Adhanom Ghebreyusus announced the appointment publicly on Monday at an event at the WHO headquarters, describing Ryan as “the general” and a “soldier”, and thanking him “for all his sacrifices”. In 1990, Ryan, an Irish epidemiologist who trained as a trauma surgeon, went to work in a hospital Iraq that was being supported by the College of Surgeons in Ireland, supposedly for three months while he waited for his surgical residency to begin in Australia. However, during that time, “Kuwait was invaded by Iraq, and we all became hostages in Baghdad”, said Ryan an interview with ‘Awake at Night’, a UN podcast series. Tragically, during this time he was injured in an accident involving a military convoy and stuck in Iraq with minimal treatment. This ended his career as a surgeon, resulting in him switching to infectious diseases. “It was very clear to me that you were either a surgeon or a good infectious disease doctor because these seemed to be the two things [where] a doctor could make a difference in many developing country environments. So I went into infectious diseases and then ended up coming to WHO In 1996, to join David Heymann, who was setting up a new emerging disease programme in WHO,” Ryan explains. During this time, he worked on responses to a number of outbreaks including measles, Ebola (while based in Uganda), and other infectious diseases. Between 2011 and 2017, he worked on the Global Polio Eradication Initiative (GPEI) in Pakistan, Afghanistan, and the Middle East. From 2017 to 2019, Ryan served as Assistant Director-General for Emergency Preparedness and Response in WHO’s Health Emergencies Programme. In 2019, Ryan became Executive Director of Health Emergencies Programme, and one of the WHO’s public faces during the COVID-19 pandemic. Image Credits: Lindsay Mackenzie/ WHO. Deaths from Viral Hepatitis Increase Globally With Limited Access to Diagnostics and Treatment 09/04/2024 Kerry Cullinan Baltazar Lucas, living with hepatitis B and a survivor of liver cancer who went through a liver transplant, goes for regular check-ups in Ortigas, Philippines. There has been an increase in deaths from hepatitis B and C, the infectious viral liver diseases that kill as many people each year as tuberculosis – yet few people know that they are infected and get the treatment they need. This is according to the World Health Organization (WHO) 2024 Global Hepatitis Report – the first to document epidemiology, service and product access – which was released on Tuesday at the start of the World Hepatitis Summit in Portugal. New data from 187 countries show that the estimated number of deaths rose from 1.1 million in 2019 to 1.3 million in 2022. Hepatitis B and C cause around 3,500 deaths every day. Around 83% the deaths were caused by hepatitis B, most commonly spread by mother-to-child transmission, and 17% by hepatitis C, usually spread through contact with infected blood. While sexual transmission is also a route for hepatitis B transmission, this typically results in acute infections, which are, in fact, less life-threatening than the chronic infections that may be acquired in infancy and may lead to early mortality. “Sexual transmission of hepatitis B usually results in an acute infection which is not life threatening. This report is about chronic infections which often lead to early mortality from liver disease and cancer,” explained Cary James, CEO of the World Hepatitis Alliance. “This is an important point as the misconception that chronic HBV is associated with sexual activity can be a major contributor to stigma within families, societies and health systems.” WHO’s Dr Meg Doherty and report author Dr Francoise Renaud “Hepatitis infection is a silent killer,” said Dr Meg Doherty, WHO’s Director of HIV, Hepatitis. “Awareness is very low worldwide. Most symptoms appear only once the disease has advanced, resulting in a huge volume of undiagnosed people living with hepatitis. Even when hepatitis is diagnosed, the number of people who go on to receive treatment remains low.” According to the report, by the end of 2022 only around 13% of people living with chronic hepatitis B infection had been diagnosed and approximately 3% (seven million) had received antiviral therapy, while about 36% of those with hepatitis C, 36% had been diagnosed and 20% (12.5 million) had received curative treatment. Almost two-thirds of global cases are concentrated in 10 countries – Bangladesh, China, Ethiopia, India, Indonesia, Nigeria, Pakistan, the Philippines, the Russian Federation and Viet Nam. Meanwhile, the WHO African region accounts for 63% of new hepatitis B infections, and yet only 18% of newborns receive the hepatitis B birth-dose vaccination. “Achieving universal access to prevention, diagnosis and treatment in these 10 countries by 2025, alongside intensified efforts in the African region, will be essential to get our response back on track,” stressed Doherty. On the other end of the spectrum, Egypt has made huge strides to eliminate hepatitis C in particular. “There are five main strains of hepatitis virus referred to as types A, B, C, D, and E. And in particular types B and C lead to chronic disease and together are the most common causes of liver cirrhosis, liver cancer and viral hepatitis related deaths,” she explained. Updated WHO estimates indicate that 254 million people live with hepatitis B and 50 million with hepatitis C in 2022. Half the burden of chronic hepatitis B and C infections is among people 30–54 years old, with 12% among children under 18 years of age. Men account for 58% of all cases. Treatment costs Pricing disparities persist both across and within WHO regions, with many countries paying above global benchmarks, even for off-patent drugs or when included in voluntary licensing agreements. “Despite the availability of affordable generic hepatitis medicines, many countries fail to procure them at these low prices,” said report author Dr Francoise Renaud. “Pricing disparities persist both across and within the WHO regions with many countries paying above global benchmarks, even for off patent medicines or when there are voluntary licencing agreements, which allow countries to produce or import generic formulations.” For example, although tenofovir for treatment of hepatitis B is off patent and available at a global benchmark price of $2.4 per month, only seven of the 26 reporting countries paid prices at or below the benchmark. The lowest reported monthly treatment prices reported by countries ranged from $1.22 for 30 tablets in China and India to $34.20 in Russia. Similarly, a 12-week course of pangenotypic sofosbuvir/daclatasvir to treat hepatitis C is available at a global benchmark price of $60, yet only four of 24 reporting countries paid prices at or below the benchmark. The lowest reported price for a 12-week course of this treatment was from Pakistan at about $33 for a generic course of treatment, while the highest reported price was from China, at about $ 10,000. About 75% of the reporting WHO focus countries rely primarily on government funding or out-of-pocket expenditure for viral hepatitis diagnostics Only 60% of reporting countries offer viral hepatitis testing and treatment services free of charge, either entirely or partially, in the public sector. Financial protection is low in the African region, where only about one third of reporting countries provide these services free of charge. –Correction (15 April, 2024). The original version of the story stated that hepatitis B infections are most commonly spread by sexual contact, when in fact the most common transmission route is mother to child transmission, according to WHO. Image Credits: Yoshi Shimizu/ WHO. Ensuring Ethical AI Implementation: HealthAI Launches Global Community of Practice 09/04/2024 Maayan Hoffman An artist’s depiction of artificial intelligence. Artificial Intelligence (AI) can save lives – but “we need to get the regulations right,” according to Dr Ricardo Baptista Leite, CEO of HealthAI, the agency responsible for artificial intelligence in health. To address the urgent need for the robust regulation of AI in the healthcare sector, HealthAI has initiated a worldwide community of practice (CoP), the organisation said last week. This initiative aims to strengthen each nation’s capacity to create well-informed regulations that promote AI’s ethical and fair utilisation in healthcare. “Our global community of practice is a critical platform for addressing the urgent need for regulation, bringing together global leaders from all sectors to ensure AI’s impact on health is positive, responsible and inclusive,” Leite said. The CoP will be a platform for discussing AI in healthcare and sharing experiences with responsible AI use in this field. It will bring together organisations, policymakers, technology experts, and leaders in health AI, fostering potential collaborations. “Since equity is core to our mission, we wanted to ensure a bottom-up approach be made to ensure the voices of all stakeholders from around the world would be heard as part of the development of these AI regulatory standards and in the implementation of these standards,” Leite told Health Policy Watch. He said the CoP would be open to all institutions – public, private, academic, patient and community-based organisations, civil society movements and technologists – by application. “We want to give a voice to those not heard as part of international processes and for us to be an important sounding board as we move forward and contribute to building this global ecosystem,” Leite added. HealthAI has a three-year strategy implementation plan that focusses on identifying at least 10 pioneer countries that it can help support and provide technical assistance. Leite said one of the challenges in many countries is the “absolute absence” of any form of expertise at the regulatory level. “To be able to address this matter seriously in the future, countries will need to invest in developing that capacity.” Leite noted that although organisations such as the World Health Organization (WHO), UNESCO, and the OECD are tasked with setting global standards, the countries must implement and apply these standards in practical situations. The future of AI in healthcare (illustrative) Regulatory confidence in technology There is a debate about whether regulations could hinder technology adoption in healthcare. However, Leite said HealthAI’s analysis is that many companies are hesitant to use technology due to concerns about legal liability in case of issues. His team believes establishing a regulatory framework will give companies the confidence to implement technology solutions. HealthAI, including through its CoP, aims to create an online global repository of validated AI solutions. This platform will be open source and showcase approved technologies, their functions, and their compliance with ethical AI standards. “This is especially important for startups in low- and middle-income countries,” Leite said. “Let’s say their national regulator just approved their technology. Now, suddenly, you can see their technology shown on this platform so that their innovations can be used in the Global North, meaning the tools developed in lower-resource settings could be a source of inspiration in high-income countries and not always the other way around.” At the same time, Leite said, another global network goal would be establishing an early warning system. This system would detect unintended negative impacts of AI technologies worldwide, triggering a red flag for all agencies to take immediate action. “This is important to ensure that governments can act in a timely manner and avoid harming citizens,” Leite said. WHO Announces S.A.R.A.H. HealthAI’s announcement about the CoP followed WHO’s announcement of S.A.R.A.H., a digital health promoter prototype with enhanced empathetic response powered by generative AI. S.A.R.A.H stands for “Smart AI Resource Assistant for Health.” “For too long health has often been viewed as a passive beneficiary of innovation rather than a driver of it,” wrote Hans Henri P. Kluge, WHO Regional Director for Europe in an article for Health Policy Watch. “It’s time to change this mentality and harness the power of innovation.” S.A.R.A.H is an advanced AI resource assistant designed for healthcare. WHO said the tool incorporates the latest language models and cutting-edge technology to engage users round the clock in eight languages, covering a wide range of health topics across various devices. It will provide information on a number of health topics, including healthy habits and mental health, cancer, heart and lung disease, and diabetes. “S.A.R.A.H gives us a glimpse of how artificial intelligence could be used in future to improve access to health information in a more interactive way,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. Image Credits: Quick Creator, Pexels. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. 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European Court Ruling that Swiss Climate Policies Violate Human Rights Sets a Global Precedent 10/04/2024 Elaine Ruth Fletcher Supporters of the Swiss Climate Seniors Association “KlimaSenirorinnen” outside the European Court in Strasbourg, which ruled Tuesday that Switzerland’s climate policies were putting older women’s lives at risk. A European Court ruling Tuesday that Switzerland was violating human rights by not acting fast enough on climate change has been hailed by legal experts as a global precedent – and by WHO Director General Dr Tedros Adhanom Ghebreyesus as an important recognition of the links between climate change and health. The #ClimateCrisis is here and now. We salute this win and call on countries to step up their #ClimateAction to protect our health and planet! https://t.co/RbkbX4li3h — Tedros Adhanom Ghebreyesus (@DrTedros) April 9, 2024 In a case brought by the Swiss-based association of “Senior Women for Climate Protection” the Strasbourg-based European Court of Human Rights (ECHR) ruled that Swiss government inaction was putting their health at risk due to “critical gaps” in carbon reduction policies. The women, aged 64 and over, had argued that more extreme heat episodes, driven by climate change, undermined their health and quality of life, and put them at a greater risk of dying. A growing body of scientific evidence has documented the links between exposure to extreme heat and premature mortality -with heat relaed deaths of people over age 65 increasing by 85% since 1990, according to a Lancet Countdown study, published in November, 2023. The average person now experiences 86 days of “health-threatening high temperatures every year”, 60% of which are attributable to climate change, Lancet found in a global report by an international consortium of 114 scientists. Pardoxically, while the European Court ruling recognized the risks borne by older women in Alpine Switzerland, the overwhelming burden of those heat-related health risks is born by older people in low-income countries. Lancet Countdown: Average annual hours per person from 1991 to 2022 when light physical activity entailed at least a moderate, high, or extreme heat stress risk, arranged by HDI=Human Development Index groupings. A European and global precedent Today’s ruling against Switzerland sets a historic precedent that applies to all European countries,” said Gerry Listen, attorney at the Global Legal Action Network. The Network had represented a group of Portuguese children in a similar climate-related case before the European Court, which was ruled inadmissable for procedural and technical reasons. Listen said that the favorable ruling on the Swiss case, nonetheless, means that “all of the government lawyers who represented the 32 respondent states in our case are now going to have to advise their governments, the governments that they represented, that they are going to have to look at their targets again and update them. “Because none of the governments in Europe in cases that were before the court today have targets that are anywhere near 1.5 C. Most targets are aligned between 3-4 C within the lifetime of the young people before the court today,” he added in an interview on CNN Television. “So absolutely catastrophic levels of warming. So this precedent will require European wide revision of climate policies urgently. Otherwise, or anyways we are going to see a new wave of climate litigation at the European level sparked by this ruling from Strasbourg today. Today is a win for all generations! The Court has ruled that government failure to rapidly cut emissions is a violation of human rights. Although our #youth4climatejustice case was ruled inadmissible the court recognised the climate crisis is an existential threat to humanity. 1/ pic.twitter.com/EOhaTZQTqD — Global Legal Action Network (GLAN) (@GLAN_LAW) April 9, 2024 The court ruling is particularly significant because it is legally binding for Switzerland, and potentially for other European countries as well. However, litigation on climate issues has become increasingly common around the world. Both the International Court of Justice and the Inter American Court of Human Rights have cases pending which relate to the human rights impacts of climate change. As a result, the ruling will have impacts far beyond the European region, Joanne Setzer, Associate Professor at the UK-based Grantham Research Institute on Climate Change and the Environment, told the a English-language media channel, Swissinfo.ch. “The landmark ruling by the European Court of Human Rights not only sets a precedent in environmental and climate law but also signals a momentous shift in the global legal landscape concerning climate change,” she said. Only recently, India’s Supreme Court also recognized that the adverse effects of climate change violated people’s fundamental constitutional rights. There have also been a flurry of new reports and evidence suggesting that climate change disproportionately affects women and their health. My Oped in @the_hindu today on how the #ClimateCrisis is affecting women disproportionately. Adaptation plans need to be developed in a participatory manner with communities, panchayats & local urban bodies. @smritiirani @moesgoi @MinistryWCD @MoHFW_INDIA https://t.co/3Gs50mFpDU — Soumya Swaminathan (@doctorsoumya) April 10, 2024 In the ECHR ruling, Siofra O’Leary, president of the ECHR found numerous “critical gaps” in the Swiss regulatory frameworks that are supposed to reduce climate change. The court also criticized the lack of an effective Swiss monitoring system to determine levels of emissions that could indeed be permissible, while limiting warming to 1.5 °C in line with the 2015 Paris Climate Agreement. Fully implementing the #ParisAgreement is essential to respond to the threat of rising temperatures around the world pic.twitter.com/gIPHtOgwdK — UN Climate Change (@UNFCCC) August 9, 2017 Eight year battle Despite it’s “clean and green” reputation, Switzerland ranks among the “laggards” in economic incentives for zero emissions vehicles, according to a 2022 study. The Swiss senior’s association launched its legal case in 2016, charging the Swiss authorites for pursuing ineffective climate policies, which therefore threatened their health and right to life. The Swiss Federal Supreme Court rejected their request that the state adopt more ambitious targets for reducing climate emissions. Then in 2020, the Association appealed to the ECHR, anchoring its case in the violation of the European Convention on Human Rights, including clauses related to the right to life. The ECHR’s binding judgment means that Switzerland must take action to comply with the order – enacting new legislation to bring Swiss emissions reductions in line with the global goals of keeping temperature increase below 1.5 °C. Despite it’s global reputation as a clean and environmentally conscious nation, including solar panels on many rooftops and an efficient rail and cycle network, there has in fact been considerable pushback by Swiss center and center-right parties against more aggressive climate action – popularly perceived as adding to economic costs and undermining personal autonomy. Only one in 50 vehicles are fully electric, and Switzerland is one of the “laggards” in the tax incentivization of private, zero-emissions vehicles, according to a 2022 study by the NGO Transport & Environment. Even so, Switzerland now plans to end tax exemptions for EVs in 2024. Image Credits: @GLAN_LAW, Lancet Countdown on Health and Climate Change , Transport&Environment. New Dengue Vaccine Trials Show Promise in Brazil as Cases Continue to Rise 10/04/2024 Sophia Samantaroy Dengue cases have increased fourfold in some parts of the Americas As global cases of dengue are already close to last year’s record high of over four million, the Americas region is struggling to contain high transmission levels. Unplanned urbanization, heavier rainfall, warmer temperatures, and the El Nino effect create perfect conditions for the Aedes aegypti mosquito, the primary vector of dengue. The Southern Cone region of the Americas, which includes Argentina, Brazil, Chile, Paraguay, and Uruguay, has seen the highest burden of cases and deaths. Brazil alone accounts for close to 3.5 million cases. Challenges with vaccine distribution and availability This year, Brazil became the first country to deploy a newly approved vaccine, Qdenga. The vaccine, manufactured by the Japanese-based pharmaceutical company Takeda Pharmaceuticals, contains weakened versions of all four dengue serotypes. The European Medicines Agency and the UK have approved the vaccine for use in adults and children over four years of age. However, the manufacturers can only produce about six million doses – enough for three million individuals as each person needs two doses. Currently, Brazil is distributing the vaccine to children between the ages of 10 and 14 in areas of high transmission, and with previous exposure to dengue. This represents only a fraction of Brazil’s population. “[T]hey chose this age group because it was based on the analysis of the Minister of Health, the age group that was suffering the highest burden of hospitalization,” explained Dr. André Siqueira, a tropical medicine doctor and clinical researcher in Fundação Oswaldo Cruz, in a recent interview with the One Health Trust. “We can’t expect that to have a huge effect on the epidemics because it’s a restricted age group and it’s not the whole country. Full immunization is achieved within three months from the initial dose.” Given these limitations, the vaccination campaign is controversial in Brazil. “Some people said there’s no point. Even the Minister of Health said it won’t have any impact on this epidemic,” said Siqueira. However, Siqueira notes that vaccinating this initial cohort creates momentum “of people being involved with dengue to start promoting the vaccination, showing that it is safe and it can have an individual impact.” Public support is especially important after a prior vaccine, Dengvaxia, was linked to deaths in children in the Philippines. The Sanofi-produced vaccine was mired in controversy after the vaccine was shown to increase the risk of hospitalization for those without prior dengue exposure. When these individuals were infected with dengue, “instead of being protected, they were at higher risk of severe disease.” This is due to the dynamics between the four dengue serotypes. The antibodies for one serotype will only protect the individual against future infection from that same serotype. Individuals could then have up to four episodes of dengue over a lifespan. Furthermore, interactions between antibodies from the various serotypes can lead to more severe secondary dengue infection, a process called antibody-dependent enhancement. This dengue season in Brazil has seen the circulation of all four dengue serotypes. Many Brazilians are especially vulnerable to DENV-3 and DENV-4 as these subtypes have reappeared this season. Vaccine trials for domestically-produced doses In light of these challenges, researchers in Brazil are in the process of developing a new dengue vaccine to target all four serotypes. The vaccine, from the Butantan Institute in collaboration with the US National Institutes of Health (NIH), shows early promise in clinical trials. The live, attenuated, tetravalent vaccine requires only one dose, unlike Qdenga, which uses a two-dose system with three months between shots. In phase 3 trials, the vaccine has shown an efficacy of 79.6% among those without prior dengue exposure, and 89.2% for those with prior exposure. The results, published in The New England Journal of Medicine, are a culmination of years of research and trials, and bolster Brazil’s hopes for disrupting dengue’s hyperendemicity. “It should be stressed that Butantan Institute’s vaccine has also proved extremely safe for people who have never had dengue, which is an advantage over the vaccines now available on the market. Furthermore, it can be administered to a broader age group and a single dose is sufficient,”said virologist Maurício Lacerda Nogueira in a press release. Image Credits: PAHO/WHO. Amid Global Cholera Surge, Gavi Launches New Testing Programme 10/04/2024 Zuzanna Stawiska Lilongwe, Mali. A woman collects unsafe water from a local well. Contaminated water is a major source of cholera outbreaks. A new programme aiming at providing 1.2 million rapid cholera diagnostic tests has been launched in 14 African and Asian countries. “Routine use of diagnostics will bolster cholera surveillance in impacted countries, and must be leveraged to better target vaccination efforts, which play a critical role in multisectoral cholera prevention and control programmes,” said Aurélia Nguyen, Chief Programme Officer at Gavi, the vaccine alliance. Cholera is an acute diarrhoeal disease with a potentially severe and rapid trajectory when left uncured, WHO warns. The intestinal infection spreads through food and water contaminated with faeces with the bacterium Vibrio cholerae. It has surged globally since 2021, with high case fatality rates despite the availability of simple, effective and affordable treatment. According to the WHO, there are 1,3 to four million cases of cholera annually, with a death toll of between 21,000 and 143,000 worldwide. Existing triggers for cholera outbreaks – lack of access to clean water and sanitation – are exacerbated by climate change, WHO highlights. It occurs in situations of poor sanitation and little access to clean water, for instance in humanitarian crises or in migration camps. Once an outbreak has occurred, the infection can spreads quickly if authorities fail to detect it and limit its spread. A 25% increase in countries reporting cholera cases was noted in 2022, reaching 44 countries, and recent outbreaks recorded the highest fatality rate in over a decade. Rapid testing Even though the vaccine supply has increased 18-fold between 2013 and 2023, it still fails to meet the demand, especially as emergency doses need to be stocked in case of a sudden rise in cases. In effect, preventive vaccination campaigns have generally been too slow to stop the disease spread. Last year, WHO’s Global Task Force on Cholera Control (GTFCC) updated its recommendations to favour strategic, routine and systematic testing of suspected cholera cases to strengthen cholera surveillance. They also launched a strategy for cholera control, aiming to reduce cholera deaths by 90% by 2030. Responding to the challenge, Gavi has directed funds to cholera rapid testing and vaccination. “We are experiencing an unprecedented multi-year upsurge in cholera cases worldwide,” said said Nguyen. “The rise in infections is being driven by continued gaps in access to safe water and sanitation, and our inability to reach vulnerable communities that are being put further at risk by climate change, conflict and displacement.” Gavi is working with UNICEF, WHO and FIND, the diagnostics organisation, to develop and deliver the rapid tests. Leila Pakkala, of UNICEF’s Supply Division highlighted that “surveillance diagnostics help pinpoint hotspots with great precision. This allows partners to target cholera vaccines to exactly the time and place where the limited supply will save the most lives.” The long-term sustainability of the programme depends on successful fundraising for Gavi’s next strategic period, from 2026 to 2030. Image Credits: UNICEF. Stigma Prevents Europeans Living with Hepatitis B and C From Telling Families and Getting Care 10/04/2024 Zuzanna Stawiska Presenting research on hepatitis stigma during the 2024 World Hepatitis Summit. From the left: Freddy Green of UK Health Security Age, Caroline Thomas, founder of Peduli Hati Bangsa foundation and Cary James, Director of the World Hepatitis Alliance UK. Half the people living with hepatitis B or C struggle to tell others about their condition and a quarter had not told their families of their diagnosis, concluded a first-ever European study on the stigma related to the disease. Findings from the multi-country study, conducted by the World Hepatitis Alliance (WHA) and the European Centre for Disease Prevention and Control (ECDC), were presented during the World Hepatitis Summit taking place this week in Lisbon. The actual report will be released in the coming weeks. “Living with hepatitis is challenging enough, and the added burden of discrimination whether in social or healthcare settings can have a hugely negative impact on peoples’ quality of life,” said Cary James, Chief Executive of the World Hepatitis Alliance. “More needs to be done to reduce the stigma that surrounds hepatitis. Our ambition for this new study is to help policy makers formulate informed policies and strategies to reduce stigma and discrimination among people living with hepatitis and improve their quality of life.” Hepatitis is a liver disease affecting 350 million people worldwide. Every year, over a million people lose their lives because of related conditions. Hepatitis B and C are transmitted mostly through blood or sexual contact, which is the basis of the existing stigma. Negative attitudes “When I told my friends and family I am living with hepatitis it was hard at first. My mother’s response was toxic and she accused me of being sexually promiscuous outside of my studies,” said Joy Ko, a Peer Support Worker at the Bloomsbury Clinic living with hepatitis recalls. “I was once disengaged from the care for five years because of fear and stigma and received no support at all,” continues Ko. According to the study, nearly half of people living with hepatitis C (46%) and over a quarter (26%) of people living with hepatitis B reported not being treated well in healthcare settings. In effect, four out of ten of those with hepatitis C and one in six people with hepatitis B (17%) avoided receiving health care services when they needed them because of the expected discrimination and stigma. The worry was often not exaggerated: 38% of people with hepatitis C reported hearing healthcare workers talking inappropriately about them. Feeling judged and concealing this diagnosis had a negative effect on patients’ mental health burden. Over a third of people living with hepatitis B and C, even when cured, report experiencing some emotional distress such as anxiety or depression. Ending stigma, ending hepatitis Andrea Ammon, director of the ECDC says “Stigma surrounding hepatitis perpetuates discrimination and undermines efforts to prevent and control the disease. Education, awareness but also key policies are crucial for promoting understanding and support for those affected.” The WHO also stresses that ending the stigma surrounding hepatitis is a key element of hepatitis elimination. As many WHO countries are delayed in reaching the target of eliminating viral hepatitis by 2030, ending the related stigma could be an important factor to curb the disease, CDA Foundation’s Polaris Observatory noted. A new WHO report released on Tuesday shows only 13% of people living with chronic hepatitis B infection had been diagnosed. Moreover, only about three percent had received antiviral therapy at the end of 2022. Hepatitis C paints only a slightly better picture, with 36% of patients who had been diagnosed and 20% had received curative treatment. “I believe it is the start of our recovery journey when we can talk about it,” Joy Ko noted on her work with patients. “People living with hepatitis must know they are not alone in their diagnosis and there is lots of support available to them.” Mike Ryan Announced as New WHO Deputy Director General 09/04/2024 Kerry Cullinan Dr Mike Ryan helps attend to a health worker wounded in an attack in January 2019 against the Ebola vaccination team in the Democratic Republic of the Congo. The group, including Dr Tedros, were being evacuated by helicopter at the time. The new Deputy Director General of the World Health Organization (WHO) is Dr Mike Ryan, who will assume the position alongside his current post as the executive director of Health Emergencies, Preparedness and Response. Ryan, who succeeds Zsuzsanna Jakab, who retired in February, assumed the position on 1 April according to an internal staff communique send out last Thursday. WHO Director General Dr Tedros Adhanom Ghebreyusus announced the appointment publicly on Monday at an event at the WHO headquarters, describing Ryan as “the general” and a “soldier”, and thanking him “for all his sacrifices”. In 1990, Ryan, an Irish epidemiologist who trained as a trauma surgeon, went to work in a hospital Iraq that was being supported by the College of Surgeons in Ireland, supposedly for three months while he waited for his surgical residency to begin in Australia. However, during that time, “Kuwait was invaded by Iraq, and we all became hostages in Baghdad”, said Ryan an interview with ‘Awake at Night’, a UN podcast series. Tragically, during this time he was injured in an accident involving a military convoy and stuck in Iraq with minimal treatment. This ended his career as a surgeon, resulting in him switching to infectious diseases. “It was very clear to me that you were either a surgeon or a good infectious disease doctor because these seemed to be the two things [where] a doctor could make a difference in many developing country environments. So I went into infectious diseases and then ended up coming to WHO In 1996, to join David Heymann, who was setting up a new emerging disease programme in WHO,” Ryan explains. During this time, he worked on responses to a number of outbreaks including measles, Ebola (while based in Uganda), and other infectious diseases. Between 2011 and 2017, he worked on the Global Polio Eradication Initiative (GPEI) in Pakistan, Afghanistan, and the Middle East. From 2017 to 2019, Ryan served as Assistant Director-General for Emergency Preparedness and Response in WHO’s Health Emergencies Programme. In 2019, Ryan became Executive Director of Health Emergencies Programme, and one of the WHO’s public faces during the COVID-19 pandemic. Image Credits: Lindsay Mackenzie/ WHO. Deaths from Viral Hepatitis Increase Globally With Limited Access to Diagnostics and Treatment 09/04/2024 Kerry Cullinan Baltazar Lucas, living with hepatitis B and a survivor of liver cancer who went through a liver transplant, goes for regular check-ups in Ortigas, Philippines. There has been an increase in deaths from hepatitis B and C, the infectious viral liver diseases that kill as many people each year as tuberculosis – yet few people know that they are infected and get the treatment they need. This is according to the World Health Organization (WHO) 2024 Global Hepatitis Report – the first to document epidemiology, service and product access – which was released on Tuesday at the start of the World Hepatitis Summit in Portugal. New data from 187 countries show that the estimated number of deaths rose from 1.1 million in 2019 to 1.3 million in 2022. Hepatitis B and C cause around 3,500 deaths every day. Around 83% the deaths were caused by hepatitis B, most commonly spread by mother-to-child transmission, and 17% by hepatitis C, usually spread through contact with infected blood. While sexual transmission is also a route for hepatitis B transmission, this typically results in acute infections, which are, in fact, less life-threatening than the chronic infections that may be acquired in infancy and may lead to early mortality. “Sexual transmission of hepatitis B usually results in an acute infection which is not life threatening. This report is about chronic infections which often lead to early mortality from liver disease and cancer,” explained Cary James, CEO of the World Hepatitis Alliance. “This is an important point as the misconception that chronic HBV is associated with sexual activity can be a major contributor to stigma within families, societies and health systems.” WHO’s Dr Meg Doherty and report author Dr Francoise Renaud “Hepatitis infection is a silent killer,” said Dr Meg Doherty, WHO’s Director of HIV, Hepatitis. “Awareness is very low worldwide. Most symptoms appear only once the disease has advanced, resulting in a huge volume of undiagnosed people living with hepatitis. Even when hepatitis is diagnosed, the number of people who go on to receive treatment remains low.” According to the report, by the end of 2022 only around 13% of people living with chronic hepatitis B infection had been diagnosed and approximately 3% (seven million) had received antiviral therapy, while about 36% of those with hepatitis C, 36% had been diagnosed and 20% (12.5 million) had received curative treatment. Almost two-thirds of global cases are concentrated in 10 countries – Bangladesh, China, Ethiopia, India, Indonesia, Nigeria, Pakistan, the Philippines, the Russian Federation and Viet Nam. Meanwhile, the WHO African region accounts for 63% of new hepatitis B infections, and yet only 18% of newborns receive the hepatitis B birth-dose vaccination. “Achieving universal access to prevention, diagnosis and treatment in these 10 countries by 2025, alongside intensified efforts in the African region, will be essential to get our response back on track,” stressed Doherty. On the other end of the spectrum, Egypt has made huge strides to eliminate hepatitis C in particular. “There are five main strains of hepatitis virus referred to as types A, B, C, D, and E. And in particular types B and C lead to chronic disease and together are the most common causes of liver cirrhosis, liver cancer and viral hepatitis related deaths,” she explained. Updated WHO estimates indicate that 254 million people live with hepatitis B and 50 million with hepatitis C in 2022. Half the burden of chronic hepatitis B and C infections is among people 30–54 years old, with 12% among children under 18 years of age. Men account for 58% of all cases. Treatment costs Pricing disparities persist both across and within WHO regions, with many countries paying above global benchmarks, even for off-patent drugs or when included in voluntary licensing agreements. “Despite the availability of affordable generic hepatitis medicines, many countries fail to procure them at these low prices,” said report author Dr Francoise Renaud. “Pricing disparities persist both across and within the WHO regions with many countries paying above global benchmarks, even for off patent medicines or when there are voluntary licencing agreements, which allow countries to produce or import generic formulations.” For example, although tenofovir for treatment of hepatitis B is off patent and available at a global benchmark price of $2.4 per month, only seven of the 26 reporting countries paid prices at or below the benchmark. The lowest reported monthly treatment prices reported by countries ranged from $1.22 for 30 tablets in China and India to $34.20 in Russia. Similarly, a 12-week course of pangenotypic sofosbuvir/daclatasvir to treat hepatitis C is available at a global benchmark price of $60, yet only four of 24 reporting countries paid prices at or below the benchmark. The lowest reported price for a 12-week course of this treatment was from Pakistan at about $33 for a generic course of treatment, while the highest reported price was from China, at about $ 10,000. About 75% of the reporting WHO focus countries rely primarily on government funding or out-of-pocket expenditure for viral hepatitis diagnostics Only 60% of reporting countries offer viral hepatitis testing and treatment services free of charge, either entirely or partially, in the public sector. Financial protection is low in the African region, where only about one third of reporting countries provide these services free of charge. –Correction (15 April, 2024). The original version of the story stated that hepatitis B infections are most commonly spread by sexual contact, when in fact the most common transmission route is mother to child transmission, according to WHO. Image Credits: Yoshi Shimizu/ WHO. Ensuring Ethical AI Implementation: HealthAI Launches Global Community of Practice 09/04/2024 Maayan Hoffman An artist’s depiction of artificial intelligence. Artificial Intelligence (AI) can save lives – but “we need to get the regulations right,” according to Dr Ricardo Baptista Leite, CEO of HealthAI, the agency responsible for artificial intelligence in health. To address the urgent need for the robust regulation of AI in the healthcare sector, HealthAI has initiated a worldwide community of practice (CoP), the organisation said last week. This initiative aims to strengthen each nation’s capacity to create well-informed regulations that promote AI’s ethical and fair utilisation in healthcare. “Our global community of practice is a critical platform for addressing the urgent need for regulation, bringing together global leaders from all sectors to ensure AI’s impact on health is positive, responsible and inclusive,” Leite said. The CoP will be a platform for discussing AI in healthcare and sharing experiences with responsible AI use in this field. It will bring together organisations, policymakers, technology experts, and leaders in health AI, fostering potential collaborations. “Since equity is core to our mission, we wanted to ensure a bottom-up approach be made to ensure the voices of all stakeholders from around the world would be heard as part of the development of these AI regulatory standards and in the implementation of these standards,” Leite told Health Policy Watch. He said the CoP would be open to all institutions – public, private, academic, patient and community-based organisations, civil society movements and technologists – by application. “We want to give a voice to those not heard as part of international processes and for us to be an important sounding board as we move forward and contribute to building this global ecosystem,” Leite added. HealthAI has a three-year strategy implementation plan that focusses on identifying at least 10 pioneer countries that it can help support and provide technical assistance. Leite said one of the challenges in many countries is the “absolute absence” of any form of expertise at the regulatory level. “To be able to address this matter seriously in the future, countries will need to invest in developing that capacity.” Leite noted that although organisations such as the World Health Organization (WHO), UNESCO, and the OECD are tasked with setting global standards, the countries must implement and apply these standards in practical situations. The future of AI in healthcare (illustrative) Regulatory confidence in technology There is a debate about whether regulations could hinder technology adoption in healthcare. However, Leite said HealthAI’s analysis is that many companies are hesitant to use technology due to concerns about legal liability in case of issues. His team believes establishing a regulatory framework will give companies the confidence to implement technology solutions. HealthAI, including through its CoP, aims to create an online global repository of validated AI solutions. This platform will be open source and showcase approved technologies, their functions, and their compliance with ethical AI standards. “This is especially important for startups in low- and middle-income countries,” Leite said. “Let’s say their national regulator just approved their technology. Now, suddenly, you can see their technology shown on this platform so that their innovations can be used in the Global North, meaning the tools developed in lower-resource settings could be a source of inspiration in high-income countries and not always the other way around.” At the same time, Leite said, another global network goal would be establishing an early warning system. This system would detect unintended negative impacts of AI technologies worldwide, triggering a red flag for all agencies to take immediate action. “This is important to ensure that governments can act in a timely manner and avoid harming citizens,” Leite said. WHO Announces S.A.R.A.H. HealthAI’s announcement about the CoP followed WHO’s announcement of S.A.R.A.H., a digital health promoter prototype with enhanced empathetic response powered by generative AI. S.A.R.A.H stands for “Smart AI Resource Assistant for Health.” “For too long health has often been viewed as a passive beneficiary of innovation rather than a driver of it,” wrote Hans Henri P. Kluge, WHO Regional Director for Europe in an article for Health Policy Watch. “It’s time to change this mentality and harness the power of innovation.” S.A.R.A.H is an advanced AI resource assistant designed for healthcare. WHO said the tool incorporates the latest language models and cutting-edge technology to engage users round the clock in eight languages, covering a wide range of health topics across various devices. It will provide information on a number of health topics, including healthy habits and mental health, cancer, heart and lung disease, and diabetes. “S.A.R.A.H gives us a glimpse of how artificial intelligence could be used in future to improve access to health information in a more interactive way,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. Image Credits: Quick Creator, Pexels. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. 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New Dengue Vaccine Trials Show Promise in Brazil as Cases Continue to Rise 10/04/2024 Sophia Samantaroy Dengue cases have increased fourfold in some parts of the Americas As global cases of dengue are already close to last year’s record high of over four million, the Americas region is struggling to contain high transmission levels. Unplanned urbanization, heavier rainfall, warmer temperatures, and the El Nino effect create perfect conditions for the Aedes aegypti mosquito, the primary vector of dengue. The Southern Cone region of the Americas, which includes Argentina, Brazil, Chile, Paraguay, and Uruguay, has seen the highest burden of cases and deaths. Brazil alone accounts for close to 3.5 million cases. Challenges with vaccine distribution and availability This year, Brazil became the first country to deploy a newly approved vaccine, Qdenga. The vaccine, manufactured by the Japanese-based pharmaceutical company Takeda Pharmaceuticals, contains weakened versions of all four dengue serotypes. The European Medicines Agency and the UK have approved the vaccine for use in adults and children over four years of age. However, the manufacturers can only produce about six million doses – enough for three million individuals as each person needs two doses. Currently, Brazil is distributing the vaccine to children between the ages of 10 and 14 in areas of high transmission, and with previous exposure to dengue. This represents only a fraction of Brazil’s population. “[T]hey chose this age group because it was based on the analysis of the Minister of Health, the age group that was suffering the highest burden of hospitalization,” explained Dr. André Siqueira, a tropical medicine doctor and clinical researcher in Fundação Oswaldo Cruz, in a recent interview with the One Health Trust. “We can’t expect that to have a huge effect on the epidemics because it’s a restricted age group and it’s not the whole country. Full immunization is achieved within three months from the initial dose.” Given these limitations, the vaccination campaign is controversial in Brazil. “Some people said there’s no point. Even the Minister of Health said it won’t have any impact on this epidemic,” said Siqueira. However, Siqueira notes that vaccinating this initial cohort creates momentum “of people being involved with dengue to start promoting the vaccination, showing that it is safe and it can have an individual impact.” Public support is especially important after a prior vaccine, Dengvaxia, was linked to deaths in children in the Philippines. The Sanofi-produced vaccine was mired in controversy after the vaccine was shown to increase the risk of hospitalization for those without prior dengue exposure. When these individuals were infected with dengue, “instead of being protected, they were at higher risk of severe disease.” This is due to the dynamics between the four dengue serotypes. The antibodies for one serotype will only protect the individual against future infection from that same serotype. Individuals could then have up to four episodes of dengue over a lifespan. Furthermore, interactions between antibodies from the various serotypes can lead to more severe secondary dengue infection, a process called antibody-dependent enhancement. This dengue season in Brazil has seen the circulation of all four dengue serotypes. Many Brazilians are especially vulnerable to DENV-3 and DENV-4 as these subtypes have reappeared this season. Vaccine trials for domestically-produced doses In light of these challenges, researchers in Brazil are in the process of developing a new dengue vaccine to target all four serotypes. The vaccine, from the Butantan Institute in collaboration with the US National Institutes of Health (NIH), shows early promise in clinical trials. The live, attenuated, tetravalent vaccine requires only one dose, unlike Qdenga, which uses a two-dose system with three months between shots. In phase 3 trials, the vaccine has shown an efficacy of 79.6% among those without prior dengue exposure, and 89.2% for those with prior exposure. The results, published in The New England Journal of Medicine, are a culmination of years of research and trials, and bolster Brazil’s hopes for disrupting dengue’s hyperendemicity. “It should be stressed that Butantan Institute’s vaccine has also proved extremely safe for people who have never had dengue, which is an advantage over the vaccines now available on the market. Furthermore, it can be administered to a broader age group and a single dose is sufficient,”said virologist Maurício Lacerda Nogueira in a press release. Image Credits: PAHO/WHO. Amid Global Cholera Surge, Gavi Launches New Testing Programme 10/04/2024 Zuzanna Stawiska Lilongwe, Mali. A woman collects unsafe water from a local well. Contaminated water is a major source of cholera outbreaks. A new programme aiming at providing 1.2 million rapid cholera diagnostic tests has been launched in 14 African and Asian countries. “Routine use of diagnostics will bolster cholera surveillance in impacted countries, and must be leveraged to better target vaccination efforts, which play a critical role in multisectoral cholera prevention and control programmes,” said Aurélia Nguyen, Chief Programme Officer at Gavi, the vaccine alliance. Cholera is an acute diarrhoeal disease with a potentially severe and rapid trajectory when left uncured, WHO warns. The intestinal infection spreads through food and water contaminated with faeces with the bacterium Vibrio cholerae. It has surged globally since 2021, with high case fatality rates despite the availability of simple, effective and affordable treatment. According to the WHO, there are 1,3 to four million cases of cholera annually, with a death toll of between 21,000 and 143,000 worldwide. Existing triggers for cholera outbreaks – lack of access to clean water and sanitation – are exacerbated by climate change, WHO highlights. It occurs in situations of poor sanitation and little access to clean water, for instance in humanitarian crises or in migration camps. Once an outbreak has occurred, the infection can spreads quickly if authorities fail to detect it and limit its spread. A 25% increase in countries reporting cholera cases was noted in 2022, reaching 44 countries, and recent outbreaks recorded the highest fatality rate in over a decade. Rapid testing Even though the vaccine supply has increased 18-fold between 2013 and 2023, it still fails to meet the demand, especially as emergency doses need to be stocked in case of a sudden rise in cases. In effect, preventive vaccination campaigns have generally been too slow to stop the disease spread. Last year, WHO’s Global Task Force on Cholera Control (GTFCC) updated its recommendations to favour strategic, routine and systematic testing of suspected cholera cases to strengthen cholera surveillance. They also launched a strategy for cholera control, aiming to reduce cholera deaths by 90% by 2030. Responding to the challenge, Gavi has directed funds to cholera rapid testing and vaccination. “We are experiencing an unprecedented multi-year upsurge in cholera cases worldwide,” said said Nguyen. “The rise in infections is being driven by continued gaps in access to safe water and sanitation, and our inability to reach vulnerable communities that are being put further at risk by climate change, conflict and displacement.” Gavi is working with UNICEF, WHO and FIND, the diagnostics organisation, to develop and deliver the rapid tests. Leila Pakkala, of UNICEF’s Supply Division highlighted that “surveillance diagnostics help pinpoint hotspots with great precision. This allows partners to target cholera vaccines to exactly the time and place where the limited supply will save the most lives.” The long-term sustainability of the programme depends on successful fundraising for Gavi’s next strategic period, from 2026 to 2030. Image Credits: UNICEF. Stigma Prevents Europeans Living with Hepatitis B and C From Telling Families and Getting Care 10/04/2024 Zuzanna Stawiska Presenting research on hepatitis stigma during the 2024 World Hepatitis Summit. From the left: Freddy Green of UK Health Security Age, Caroline Thomas, founder of Peduli Hati Bangsa foundation and Cary James, Director of the World Hepatitis Alliance UK. Half the people living with hepatitis B or C struggle to tell others about their condition and a quarter had not told their families of their diagnosis, concluded a first-ever European study on the stigma related to the disease. Findings from the multi-country study, conducted by the World Hepatitis Alliance (WHA) and the European Centre for Disease Prevention and Control (ECDC), were presented during the World Hepatitis Summit taking place this week in Lisbon. The actual report will be released in the coming weeks. “Living with hepatitis is challenging enough, and the added burden of discrimination whether in social or healthcare settings can have a hugely negative impact on peoples’ quality of life,” said Cary James, Chief Executive of the World Hepatitis Alliance. “More needs to be done to reduce the stigma that surrounds hepatitis. Our ambition for this new study is to help policy makers formulate informed policies and strategies to reduce stigma and discrimination among people living with hepatitis and improve their quality of life.” Hepatitis is a liver disease affecting 350 million people worldwide. Every year, over a million people lose their lives because of related conditions. Hepatitis B and C are transmitted mostly through blood or sexual contact, which is the basis of the existing stigma. Negative attitudes “When I told my friends and family I am living with hepatitis it was hard at first. My mother’s response was toxic and she accused me of being sexually promiscuous outside of my studies,” said Joy Ko, a Peer Support Worker at the Bloomsbury Clinic living with hepatitis recalls. “I was once disengaged from the care for five years because of fear and stigma and received no support at all,” continues Ko. According to the study, nearly half of people living with hepatitis C (46%) and over a quarter (26%) of people living with hepatitis B reported not being treated well in healthcare settings. In effect, four out of ten of those with hepatitis C and one in six people with hepatitis B (17%) avoided receiving health care services when they needed them because of the expected discrimination and stigma. The worry was often not exaggerated: 38% of people with hepatitis C reported hearing healthcare workers talking inappropriately about them. Feeling judged and concealing this diagnosis had a negative effect on patients’ mental health burden. Over a third of people living with hepatitis B and C, even when cured, report experiencing some emotional distress such as anxiety or depression. Ending stigma, ending hepatitis Andrea Ammon, director of the ECDC says “Stigma surrounding hepatitis perpetuates discrimination and undermines efforts to prevent and control the disease. Education, awareness but also key policies are crucial for promoting understanding and support for those affected.” The WHO also stresses that ending the stigma surrounding hepatitis is a key element of hepatitis elimination. As many WHO countries are delayed in reaching the target of eliminating viral hepatitis by 2030, ending the related stigma could be an important factor to curb the disease, CDA Foundation’s Polaris Observatory noted. A new WHO report released on Tuesday shows only 13% of people living with chronic hepatitis B infection had been diagnosed. Moreover, only about three percent had received antiviral therapy at the end of 2022. Hepatitis C paints only a slightly better picture, with 36% of patients who had been diagnosed and 20% had received curative treatment. “I believe it is the start of our recovery journey when we can talk about it,” Joy Ko noted on her work with patients. “People living with hepatitis must know they are not alone in their diagnosis and there is lots of support available to them.” Mike Ryan Announced as New WHO Deputy Director General 09/04/2024 Kerry Cullinan Dr Mike Ryan helps attend to a health worker wounded in an attack in January 2019 against the Ebola vaccination team in the Democratic Republic of the Congo. The group, including Dr Tedros, were being evacuated by helicopter at the time. The new Deputy Director General of the World Health Organization (WHO) is Dr Mike Ryan, who will assume the position alongside his current post as the executive director of Health Emergencies, Preparedness and Response. Ryan, who succeeds Zsuzsanna Jakab, who retired in February, assumed the position on 1 April according to an internal staff communique send out last Thursday. WHO Director General Dr Tedros Adhanom Ghebreyusus announced the appointment publicly on Monday at an event at the WHO headquarters, describing Ryan as “the general” and a “soldier”, and thanking him “for all his sacrifices”. In 1990, Ryan, an Irish epidemiologist who trained as a trauma surgeon, went to work in a hospital Iraq that was being supported by the College of Surgeons in Ireland, supposedly for three months while he waited for his surgical residency to begin in Australia. However, during that time, “Kuwait was invaded by Iraq, and we all became hostages in Baghdad”, said Ryan an interview with ‘Awake at Night’, a UN podcast series. Tragically, during this time he was injured in an accident involving a military convoy and stuck in Iraq with minimal treatment. This ended his career as a surgeon, resulting in him switching to infectious diseases. “It was very clear to me that you were either a surgeon or a good infectious disease doctor because these seemed to be the two things [where] a doctor could make a difference in many developing country environments. So I went into infectious diseases and then ended up coming to WHO In 1996, to join David Heymann, who was setting up a new emerging disease programme in WHO,” Ryan explains. During this time, he worked on responses to a number of outbreaks including measles, Ebola (while based in Uganda), and other infectious diseases. Between 2011 and 2017, he worked on the Global Polio Eradication Initiative (GPEI) in Pakistan, Afghanistan, and the Middle East. From 2017 to 2019, Ryan served as Assistant Director-General for Emergency Preparedness and Response in WHO’s Health Emergencies Programme. In 2019, Ryan became Executive Director of Health Emergencies Programme, and one of the WHO’s public faces during the COVID-19 pandemic. Image Credits: Lindsay Mackenzie/ WHO. Deaths from Viral Hepatitis Increase Globally With Limited Access to Diagnostics and Treatment 09/04/2024 Kerry Cullinan Baltazar Lucas, living with hepatitis B and a survivor of liver cancer who went through a liver transplant, goes for regular check-ups in Ortigas, Philippines. There has been an increase in deaths from hepatitis B and C, the infectious viral liver diseases that kill as many people each year as tuberculosis – yet few people know that they are infected and get the treatment they need. This is according to the World Health Organization (WHO) 2024 Global Hepatitis Report – the first to document epidemiology, service and product access – which was released on Tuesday at the start of the World Hepatitis Summit in Portugal. New data from 187 countries show that the estimated number of deaths rose from 1.1 million in 2019 to 1.3 million in 2022. Hepatitis B and C cause around 3,500 deaths every day. Around 83% the deaths were caused by hepatitis B, most commonly spread by mother-to-child transmission, and 17% by hepatitis C, usually spread through contact with infected blood. While sexual transmission is also a route for hepatitis B transmission, this typically results in acute infections, which are, in fact, less life-threatening than the chronic infections that may be acquired in infancy and may lead to early mortality. “Sexual transmission of hepatitis B usually results in an acute infection which is not life threatening. This report is about chronic infections which often lead to early mortality from liver disease and cancer,” explained Cary James, CEO of the World Hepatitis Alliance. “This is an important point as the misconception that chronic HBV is associated with sexual activity can be a major contributor to stigma within families, societies and health systems.” WHO’s Dr Meg Doherty and report author Dr Francoise Renaud “Hepatitis infection is a silent killer,” said Dr Meg Doherty, WHO’s Director of HIV, Hepatitis. “Awareness is very low worldwide. Most symptoms appear only once the disease has advanced, resulting in a huge volume of undiagnosed people living with hepatitis. Even when hepatitis is diagnosed, the number of people who go on to receive treatment remains low.” According to the report, by the end of 2022 only around 13% of people living with chronic hepatitis B infection had been diagnosed and approximately 3% (seven million) had received antiviral therapy, while about 36% of those with hepatitis C, 36% had been diagnosed and 20% (12.5 million) had received curative treatment. Almost two-thirds of global cases are concentrated in 10 countries – Bangladesh, China, Ethiopia, India, Indonesia, Nigeria, Pakistan, the Philippines, the Russian Federation and Viet Nam. Meanwhile, the WHO African region accounts for 63% of new hepatitis B infections, and yet only 18% of newborns receive the hepatitis B birth-dose vaccination. “Achieving universal access to prevention, diagnosis and treatment in these 10 countries by 2025, alongside intensified efforts in the African region, will be essential to get our response back on track,” stressed Doherty. On the other end of the spectrum, Egypt has made huge strides to eliminate hepatitis C in particular. “There are five main strains of hepatitis virus referred to as types A, B, C, D, and E. And in particular types B and C lead to chronic disease and together are the most common causes of liver cirrhosis, liver cancer and viral hepatitis related deaths,” she explained. Updated WHO estimates indicate that 254 million people live with hepatitis B and 50 million with hepatitis C in 2022. Half the burden of chronic hepatitis B and C infections is among people 30–54 years old, with 12% among children under 18 years of age. Men account for 58% of all cases. Treatment costs Pricing disparities persist both across and within WHO regions, with many countries paying above global benchmarks, even for off-patent drugs or when included in voluntary licensing agreements. “Despite the availability of affordable generic hepatitis medicines, many countries fail to procure them at these low prices,” said report author Dr Francoise Renaud. “Pricing disparities persist both across and within the WHO regions with many countries paying above global benchmarks, even for off patent medicines or when there are voluntary licencing agreements, which allow countries to produce or import generic formulations.” For example, although tenofovir for treatment of hepatitis B is off patent and available at a global benchmark price of $2.4 per month, only seven of the 26 reporting countries paid prices at or below the benchmark. The lowest reported monthly treatment prices reported by countries ranged from $1.22 for 30 tablets in China and India to $34.20 in Russia. Similarly, a 12-week course of pangenotypic sofosbuvir/daclatasvir to treat hepatitis C is available at a global benchmark price of $60, yet only four of 24 reporting countries paid prices at or below the benchmark. The lowest reported price for a 12-week course of this treatment was from Pakistan at about $33 for a generic course of treatment, while the highest reported price was from China, at about $ 10,000. About 75% of the reporting WHO focus countries rely primarily on government funding or out-of-pocket expenditure for viral hepatitis diagnostics Only 60% of reporting countries offer viral hepatitis testing and treatment services free of charge, either entirely or partially, in the public sector. Financial protection is low in the African region, where only about one third of reporting countries provide these services free of charge. –Correction (15 April, 2024). The original version of the story stated that hepatitis B infections are most commonly spread by sexual contact, when in fact the most common transmission route is mother to child transmission, according to WHO. Image Credits: Yoshi Shimizu/ WHO. Ensuring Ethical AI Implementation: HealthAI Launches Global Community of Practice 09/04/2024 Maayan Hoffman An artist’s depiction of artificial intelligence. Artificial Intelligence (AI) can save lives – but “we need to get the regulations right,” according to Dr Ricardo Baptista Leite, CEO of HealthAI, the agency responsible for artificial intelligence in health. To address the urgent need for the robust regulation of AI in the healthcare sector, HealthAI has initiated a worldwide community of practice (CoP), the organisation said last week. This initiative aims to strengthen each nation’s capacity to create well-informed regulations that promote AI’s ethical and fair utilisation in healthcare. “Our global community of practice is a critical platform for addressing the urgent need for regulation, bringing together global leaders from all sectors to ensure AI’s impact on health is positive, responsible and inclusive,” Leite said. The CoP will be a platform for discussing AI in healthcare and sharing experiences with responsible AI use in this field. It will bring together organisations, policymakers, technology experts, and leaders in health AI, fostering potential collaborations. “Since equity is core to our mission, we wanted to ensure a bottom-up approach be made to ensure the voices of all stakeholders from around the world would be heard as part of the development of these AI regulatory standards and in the implementation of these standards,” Leite told Health Policy Watch. He said the CoP would be open to all institutions – public, private, academic, patient and community-based organisations, civil society movements and technologists – by application. “We want to give a voice to those not heard as part of international processes and for us to be an important sounding board as we move forward and contribute to building this global ecosystem,” Leite added. HealthAI has a three-year strategy implementation plan that focusses on identifying at least 10 pioneer countries that it can help support and provide technical assistance. Leite said one of the challenges in many countries is the “absolute absence” of any form of expertise at the regulatory level. “To be able to address this matter seriously in the future, countries will need to invest in developing that capacity.” Leite noted that although organisations such as the World Health Organization (WHO), UNESCO, and the OECD are tasked with setting global standards, the countries must implement and apply these standards in practical situations. The future of AI in healthcare (illustrative) Regulatory confidence in technology There is a debate about whether regulations could hinder technology adoption in healthcare. However, Leite said HealthAI’s analysis is that many companies are hesitant to use technology due to concerns about legal liability in case of issues. His team believes establishing a regulatory framework will give companies the confidence to implement technology solutions. HealthAI, including through its CoP, aims to create an online global repository of validated AI solutions. This platform will be open source and showcase approved technologies, their functions, and their compliance with ethical AI standards. “This is especially important for startups in low- and middle-income countries,” Leite said. “Let’s say their national regulator just approved their technology. Now, suddenly, you can see their technology shown on this platform so that their innovations can be used in the Global North, meaning the tools developed in lower-resource settings could be a source of inspiration in high-income countries and not always the other way around.” At the same time, Leite said, another global network goal would be establishing an early warning system. This system would detect unintended negative impacts of AI technologies worldwide, triggering a red flag for all agencies to take immediate action. “This is important to ensure that governments can act in a timely manner and avoid harming citizens,” Leite said. WHO Announces S.A.R.A.H. HealthAI’s announcement about the CoP followed WHO’s announcement of S.A.R.A.H., a digital health promoter prototype with enhanced empathetic response powered by generative AI. S.A.R.A.H stands for “Smart AI Resource Assistant for Health.” “For too long health has often been viewed as a passive beneficiary of innovation rather than a driver of it,” wrote Hans Henri P. Kluge, WHO Regional Director for Europe in an article for Health Policy Watch. “It’s time to change this mentality and harness the power of innovation.” S.A.R.A.H is an advanced AI resource assistant designed for healthcare. WHO said the tool incorporates the latest language models and cutting-edge technology to engage users round the clock in eight languages, covering a wide range of health topics across various devices. It will provide information on a number of health topics, including healthy habits and mental health, cancer, heart and lung disease, and diabetes. “S.A.R.A.H gives us a glimpse of how artificial intelligence could be used in future to improve access to health information in a more interactive way,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. Image Credits: Quick Creator, Pexels. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. 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Amid Global Cholera Surge, Gavi Launches New Testing Programme 10/04/2024 Zuzanna Stawiska Lilongwe, Mali. A woman collects unsafe water from a local well. Contaminated water is a major source of cholera outbreaks. A new programme aiming at providing 1.2 million rapid cholera diagnostic tests has been launched in 14 African and Asian countries. “Routine use of diagnostics will bolster cholera surveillance in impacted countries, and must be leveraged to better target vaccination efforts, which play a critical role in multisectoral cholera prevention and control programmes,” said Aurélia Nguyen, Chief Programme Officer at Gavi, the vaccine alliance. Cholera is an acute diarrhoeal disease with a potentially severe and rapid trajectory when left uncured, WHO warns. The intestinal infection spreads through food and water contaminated with faeces with the bacterium Vibrio cholerae. It has surged globally since 2021, with high case fatality rates despite the availability of simple, effective and affordable treatment. According to the WHO, there are 1,3 to four million cases of cholera annually, with a death toll of between 21,000 and 143,000 worldwide. Existing triggers for cholera outbreaks – lack of access to clean water and sanitation – are exacerbated by climate change, WHO highlights. It occurs in situations of poor sanitation and little access to clean water, for instance in humanitarian crises or in migration camps. Once an outbreak has occurred, the infection can spreads quickly if authorities fail to detect it and limit its spread. A 25% increase in countries reporting cholera cases was noted in 2022, reaching 44 countries, and recent outbreaks recorded the highest fatality rate in over a decade. Rapid testing Even though the vaccine supply has increased 18-fold between 2013 and 2023, it still fails to meet the demand, especially as emergency doses need to be stocked in case of a sudden rise in cases. In effect, preventive vaccination campaigns have generally been too slow to stop the disease spread. Last year, WHO’s Global Task Force on Cholera Control (GTFCC) updated its recommendations to favour strategic, routine and systematic testing of suspected cholera cases to strengthen cholera surveillance. They also launched a strategy for cholera control, aiming to reduce cholera deaths by 90% by 2030. Responding to the challenge, Gavi has directed funds to cholera rapid testing and vaccination. “We are experiencing an unprecedented multi-year upsurge in cholera cases worldwide,” said said Nguyen. “The rise in infections is being driven by continued gaps in access to safe water and sanitation, and our inability to reach vulnerable communities that are being put further at risk by climate change, conflict and displacement.” Gavi is working with UNICEF, WHO and FIND, the diagnostics organisation, to develop and deliver the rapid tests. Leila Pakkala, of UNICEF’s Supply Division highlighted that “surveillance diagnostics help pinpoint hotspots with great precision. This allows partners to target cholera vaccines to exactly the time and place where the limited supply will save the most lives.” The long-term sustainability of the programme depends on successful fundraising for Gavi’s next strategic period, from 2026 to 2030. Image Credits: UNICEF. Stigma Prevents Europeans Living with Hepatitis B and C From Telling Families and Getting Care 10/04/2024 Zuzanna Stawiska Presenting research on hepatitis stigma during the 2024 World Hepatitis Summit. From the left: Freddy Green of UK Health Security Age, Caroline Thomas, founder of Peduli Hati Bangsa foundation and Cary James, Director of the World Hepatitis Alliance UK. Half the people living with hepatitis B or C struggle to tell others about their condition and a quarter had not told their families of their diagnosis, concluded a first-ever European study on the stigma related to the disease. Findings from the multi-country study, conducted by the World Hepatitis Alliance (WHA) and the European Centre for Disease Prevention and Control (ECDC), were presented during the World Hepatitis Summit taking place this week in Lisbon. The actual report will be released in the coming weeks. “Living with hepatitis is challenging enough, and the added burden of discrimination whether in social or healthcare settings can have a hugely negative impact on peoples’ quality of life,” said Cary James, Chief Executive of the World Hepatitis Alliance. “More needs to be done to reduce the stigma that surrounds hepatitis. Our ambition for this new study is to help policy makers formulate informed policies and strategies to reduce stigma and discrimination among people living with hepatitis and improve their quality of life.” Hepatitis is a liver disease affecting 350 million people worldwide. Every year, over a million people lose their lives because of related conditions. Hepatitis B and C are transmitted mostly through blood or sexual contact, which is the basis of the existing stigma. Negative attitudes “When I told my friends and family I am living with hepatitis it was hard at first. My mother’s response was toxic and she accused me of being sexually promiscuous outside of my studies,” said Joy Ko, a Peer Support Worker at the Bloomsbury Clinic living with hepatitis recalls. “I was once disengaged from the care for five years because of fear and stigma and received no support at all,” continues Ko. According to the study, nearly half of people living with hepatitis C (46%) and over a quarter (26%) of people living with hepatitis B reported not being treated well in healthcare settings. In effect, four out of ten of those with hepatitis C and one in six people with hepatitis B (17%) avoided receiving health care services when they needed them because of the expected discrimination and stigma. The worry was often not exaggerated: 38% of people with hepatitis C reported hearing healthcare workers talking inappropriately about them. Feeling judged and concealing this diagnosis had a negative effect on patients’ mental health burden. Over a third of people living with hepatitis B and C, even when cured, report experiencing some emotional distress such as anxiety or depression. Ending stigma, ending hepatitis Andrea Ammon, director of the ECDC says “Stigma surrounding hepatitis perpetuates discrimination and undermines efforts to prevent and control the disease. Education, awareness but also key policies are crucial for promoting understanding and support for those affected.” The WHO also stresses that ending the stigma surrounding hepatitis is a key element of hepatitis elimination. As many WHO countries are delayed in reaching the target of eliminating viral hepatitis by 2030, ending the related stigma could be an important factor to curb the disease, CDA Foundation’s Polaris Observatory noted. A new WHO report released on Tuesday shows only 13% of people living with chronic hepatitis B infection had been diagnosed. Moreover, only about three percent had received antiviral therapy at the end of 2022. Hepatitis C paints only a slightly better picture, with 36% of patients who had been diagnosed and 20% had received curative treatment. “I believe it is the start of our recovery journey when we can talk about it,” Joy Ko noted on her work with patients. “People living with hepatitis must know they are not alone in their diagnosis and there is lots of support available to them.” Mike Ryan Announced as New WHO Deputy Director General 09/04/2024 Kerry Cullinan Dr Mike Ryan helps attend to a health worker wounded in an attack in January 2019 against the Ebola vaccination team in the Democratic Republic of the Congo. The group, including Dr Tedros, were being evacuated by helicopter at the time. The new Deputy Director General of the World Health Organization (WHO) is Dr Mike Ryan, who will assume the position alongside his current post as the executive director of Health Emergencies, Preparedness and Response. Ryan, who succeeds Zsuzsanna Jakab, who retired in February, assumed the position on 1 April according to an internal staff communique send out last Thursday. WHO Director General Dr Tedros Adhanom Ghebreyusus announced the appointment publicly on Monday at an event at the WHO headquarters, describing Ryan as “the general” and a “soldier”, and thanking him “for all his sacrifices”. In 1990, Ryan, an Irish epidemiologist who trained as a trauma surgeon, went to work in a hospital Iraq that was being supported by the College of Surgeons in Ireland, supposedly for three months while he waited for his surgical residency to begin in Australia. However, during that time, “Kuwait was invaded by Iraq, and we all became hostages in Baghdad”, said Ryan an interview with ‘Awake at Night’, a UN podcast series. Tragically, during this time he was injured in an accident involving a military convoy and stuck in Iraq with minimal treatment. This ended his career as a surgeon, resulting in him switching to infectious diseases. “It was very clear to me that you were either a surgeon or a good infectious disease doctor because these seemed to be the two things [where] a doctor could make a difference in many developing country environments. So I went into infectious diseases and then ended up coming to WHO In 1996, to join David Heymann, who was setting up a new emerging disease programme in WHO,” Ryan explains. During this time, he worked on responses to a number of outbreaks including measles, Ebola (while based in Uganda), and other infectious diseases. Between 2011 and 2017, he worked on the Global Polio Eradication Initiative (GPEI) in Pakistan, Afghanistan, and the Middle East. From 2017 to 2019, Ryan served as Assistant Director-General for Emergency Preparedness and Response in WHO’s Health Emergencies Programme. In 2019, Ryan became Executive Director of Health Emergencies Programme, and one of the WHO’s public faces during the COVID-19 pandemic. Image Credits: Lindsay Mackenzie/ WHO. Deaths from Viral Hepatitis Increase Globally With Limited Access to Diagnostics and Treatment 09/04/2024 Kerry Cullinan Baltazar Lucas, living with hepatitis B and a survivor of liver cancer who went through a liver transplant, goes for regular check-ups in Ortigas, Philippines. There has been an increase in deaths from hepatitis B and C, the infectious viral liver diseases that kill as many people each year as tuberculosis – yet few people know that they are infected and get the treatment they need. This is according to the World Health Organization (WHO) 2024 Global Hepatitis Report – the first to document epidemiology, service and product access – which was released on Tuesday at the start of the World Hepatitis Summit in Portugal. New data from 187 countries show that the estimated number of deaths rose from 1.1 million in 2019 to 1.3 million in 2022. Hepatitis B and C cause around 3,500 deaths every day. Around 83% the deaths were caused by hepatitis B, most commonly spread by mother-to-child transmission, and 17% by hepatitis C, usually spread through contact with infected blood. While sexual transmission is also a route for hepatitis B transmission, this typically results in acute infections, which are, in fact, less life-threatening than the chronic infections that may be acquired in infancy and may lead to early mortality. “Sexual transmission of hepatitis B usually results in an acute infection which is not life threatening. This report is about chronic infections which often lead to early mortality from liver disease and cancer,” explained Cary James, CEO of the World Hepatitis Alliance. “This is an important point as the misconception that chronic HBV is associated with sexual activity can be a major contributor to stigma within families, societies and health systems.” WHO’s Dr Meg Doherty and report author Dr Francoise Renaud “Hepatitis infection is a silent killer,” said Dr Meg Doherty, WHO’s Director of HIV, Hepatitis. “Awareness is very low worldwide. Most symptoms appear only once the disease has advanced, resulting in a huge volume of undiagnosed people living with hepatitis. Even when hepatitis is diagnosed, the number of people who go on to receive treatment remains low.” According to the report, by the end of 2022 only around 13% of people living with chronic hepatitis B infection had been diagnosed and approximately 3% (seven million) had received antiviral therapy, while about 36% of those with hepatitis C, 36% had been diagnosed and 20% (12.5 million) had received curative treatment. Almost two-thirds of global cases are concentrated in 10 countries – Bangladesh, China, Ethiopia, India, Indonesia, Nigeria, Pakistan, the Philippines, the Russian Federation and Viet Nam. Meanwhile, the WHO African region accounts for 63% of new hepatitis B infections, and yet only 18% of newborns receive the hepatitis B birth-dose vaccination. “Achieving universal access to prevention, diagnosis and treatment in these 10 countries by 2025, alongside intensified efforts in the African region, will be essential to get our response back on track,” stressed Doherty. On the other end of the spectrum, Egypt has made huge strides to eliminate hepatitis C in particular. “There are five main strains of hepatitis virus referred to as types A, B, C, D, and E. And in particular types B and C lead to chronic disease and together are the most common causes of liver cirrhosis, liver cancer and viral hepatitis related deaths,” she explained. Updated WHO estimates indicate that 254 million people live with hepatitis B and 50 million with hepatitis C in 2022. Half the burden of chronic hepatitis B and C infections is among people 30–54 years old, with 12% among children under 18 years of age. Men account for 58% of all cases. Treatment costs Pricing disparities persist both across and within WHO regions, with many countries paying above global benchmarks, even for off-patent drugs or when included in voluntary licensing agreements. “Despite the availability of affordable generic hepatitis medicines, many countries fail to procure them at these low prices,” said report author Dr Francoise Renaud. “Pricing disparities persist both across and within the WHO regions with many countries paying above global benchmarks, even for off patent medicines or when there are voluntary licencing agreements, which allow countries to produce or import generic formulations.” For example, although tenofovir for treatment of hepatitis B is off patent and available at a global benchmark price of $2.4 per month, only seven of the 26 reporting countries paid prices at or below the benchmark. The lowest reported monthly treatment prices reported by countries ranged from $1.22 for 30 tablets in China and India to $34.20 in Russia. Similarly, a 12-week course of pangenotypic sofosbuvir/daclatasvir to treat hepatitis C is available at a global benchmark price of $60, yet only four of 24 reporting countries paid prices at or below the benchmark. The lowest reported price for a 12-week course of this treatment was from Pakistan at about $33 for a generic course of treatment, while the highest reported price was from China, at about $ 10,000. About 75% of the reporting WHO focus countries rely primarily on government funding or out-of-pocket expenditure for viral hepatitis diagnostics Only 60% of reporting countries offer viral hepatitis testing and treatment services free of charge, either entirely or partially, in the public sector. Financial protection is low in the African region, where only about one third of reporting countries provide these services free of charge. –Correction (15 April, 2024). The original version of the story stated that hepatitis B infections are most commonly spread by sexual contact, when in fact the most common transmission route is mother to child transmission, according to WHO. Image Credits: Yoshi Shimizu/ WHO. Ensuring Ethical AI Implementation: HealthAI Launches Global Community of Practice 09/04/2024 Maayan Hoffman An artist’s depiction of artificial intelligence. Artificial Intelligence (AI) can save lives – but “we need to get the regulations right,” according to Dr Ricardo Baptista Leite, CEO of HealthAI, the agency responsible for artificial intelligence in health. To address the urgent need for the robust regulation of AI in the healthcare sector, HealthAI has initiated a worldwide community of practice (CoP), the organisation said last week. This initiative aims to strengthen each nation’s capacity to create well-informed regulations that promote AI’s ethical and fair utilisation in healthcare. “Our global community of practice is a critical platform for addressing the urgent need for regulation, bringing together global leaders from all sectors to ensure AI’s impact on health is positive, responsible and inclusive,” Leite said. The CoP will be a platform for discussing AI in healthcare and sharing experiences with responsible AI use in this field. It will bring together organisations, policymakers, technology experts, and leaders in health AI, fostering potential collaborations. “Since equity is core to our mission, we wanted to ensure a bottom-up approach be made to ensure the voices of all stakeholders from around the world would be heard as part of the development of these AI regulatory standards and in the implementation of these standards,” Leite told Health Policy Watch. He said the CoP would be open to all institutions – public, private, academic, patient and community-based organisations, civil society movements and technologists – by application. “We want to give a voice to those not heard as part of international processes and for us to be an important sounding board as we move forward and contribute to building this global ecosystem,” Leite added. HealthAI has a three-year strategy implementation plan that focusses on identifying at least 10 pioneer countries that it can help support and provide technical assistance. Leite said one of the challenges in many countries is the “absolute absence” of any form of expertise at the regulatory level. “To be able to address this matter seriously in the future, countries will need to invest in developing that capacity.” Leite noted that although organisations such as the World Health Organization (WHO), UNESCO, and the OECD are tasked with setting global standards, the countries must implement and apply these standards in practical situations. The future of AI in healthcare (illustrative) Regulatory confidence in technology There is a debate about whether regulations could hinder technology adoption in healthcare. However, Leite said HealthAI’s analysis is that many companies are hesitant to use technology due to concerns about legal liability in case of issues. His team believes establishing a regulatory framework will give companies the confidence to implement technology solutions. HealthAI, including through its CoP, aims to create an online global repository of validated AI solutions. This platform will be open source and showcase approved technologies, their functions, and their compliance with ethical AI standards. “This is especially important for startups in low- and middle-income countries,” Leite said. “Let’s say their national regulator just approved their technology. Now, suddenly, you can see their technology shown on this platform so that their innovations can be used in the Global North, meaning the tools developed in lower-resource settings could be a source of inspiration in high-income countries and not always the other way around.” At the same time, Leite said, another global network goal would be establishing an early warning system. This system would detect unintended negative impacts of AI technologies worldwide, triggering a red flag for all agencies to take immediate action. “This is important to ensure that governments can act in a timely manner and avoid harming citizens,” Leite said. WHO Announces S.A.R.A.H. HealthAI’s announcement about the CoP followed WHO’s announcement of S.A.R.A.H., a digital health promoter prototype with enhanced empathetic response powered by generative AI. S.A.R.A.H stands for “Smart AI Resource Assistant for Health.” “For too long health has often been viewed as a passive beneficiary of innovation rather than a driver of it,” wrote Hans Henri P. Kluge, WHO Regional Director for Europe in an article for Health Policy Watch. “It’s time to change this mentality and harness the power of innovation.” S.A.R.A.H is an advanced AI resource assistant designed for healthcare. WHO said the tool incorporates the latest language models and cutting-edge technology to engage users round the clock in eight languages, covering a wide range of health topics across various devices. It will provide information on a number of health topics, including healthy habits and mental health, cancer, heart and lung disease, and diabetes. “S.A.R.A.H gives us a glimpse of how artificial intelligence could be used in future to improve access to health information in a more interactive way,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. Image Credits: Quick Creator, Pexels. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
Stigma Prevents Europeans Living with Hepatitis B and C From Telling Families and Getting Care 10/04/2024 Zuzanna Stawiska Presenting research on hepatitis stigma during the 2024 World Hepatitis Summit. From the left: Freddy Green of UK Health Security Age, Caroline Thomas, founder of Peduli Hati Bangsa foundation and Cary James, Director of the World Hepatitis Alliance UK. Half the people living with hepatitis B or C struggle to tell others about their condition and a quarter had not told their families of their diagnosis, concluded a first-ever European study on the stigma related to the disease. Findings from the multi-country study, conducted by the World Hepatitis Alliance (WHA) and the European Centre for Disease Prevention and Control (ECDC), were presented during the World Hepatitis Summit taking place this week in Lisbon. The actual report will be released in the coming weeks. “Living with hepatitis is challenging enough, and the added burden of discrimination whether in social or healthcare settings can have a hugely negative impact on peoples’ quality of life,” said Cary James, Chief Executive of the World Hepatitis Alliance. “More needs to be done to reduce the stigma that surrounds hepatitis. Our ambition for this new study is to help policy makers formulate informed policies and strategies to reduce stigma and discrimination among people living with hepatitis and improve their quality of life.” Hepatitis is a liver disease affecting 350 million people worldwide. Every year, over a million people lose their lives because of related conditions. Hepatitis B and C are transmitted mostly through blood or sexual contact, which is the basis of the existing stigma. Negative attitudes “When I told my friends and family I am living with hepatitis it was hard at first. My mother’s response was toxic and she accused me of being sexually promiscuous outside of my studies,” said Joy Ko, a Peer Support Worker at the Bloomsbury Clinic living with hepatitis recalls. “I was once disengaged from the care for five years because of fear and stigma and received no support at all,” continues Ko. According to the study, nearly half of people living with hepatitis C (46%) and over a quarter (26%) of people living with hepatitis B reported not being treated well in healthcare settings. In effect, four out of ten of those with hepatitis C and one in six people with hepatitis B (17%) avoided receiving health care services when they needed them because of the expected discrimination and stigma. The worry was often not exaggerated: 38% of people with hepatitis C reported hearing healthcare workers talking inappropriately about them. Feeling judged and concealing this diagnosis had a negative effect on patients’ mental health burden. Over a third of people living with hepatitis B and C, even when cured, report experiencing some emotional distress such as anxiety or depression. Ending stigma, ending hepatitis Andrea Ammon, director of the ECDC says “Stigma surrounding hepatitis perpetuates discrimination and undermines efforts to prevent and control the disease. Education, awareness but also key policies are crucial for promoting understanding and support for those affected.” The WHO also stresses that ending the stigma surrounding hepatitis is a key element of hepatitis elimination. As many WHO countries are delayed in reaching the target of eliminating viral hepatitis by 2030, ending the related stigma could be an important factor to curb the disease, CDA Foundation’s Polaris Observatory noted. A new WHO report released on Tuesday shows only 13% of people living with chronic hepatitis B infection had been diagnosed. Moreover, only about three percent had received antiviral therapy at the end of 2022. Hepatitis C paints only a slightly better picture, with 36% of patients who had been diagnosed and 20% had received curative treatment. “I believe it is the start of our recovery journey when we can talk about it,” Joy Ko noted on her work with patients. “People living with hepatitis must know they are not alone in their diagnosis and there is lots of support available to them.” Mike Ryan Announced as New WHO Deputy Director General 09/04/2024 Kerry Cullinan Dr Mike Ryan helps attend to a health worker wounded in an attack in January 2019 against the Ebola vaccination team in the Democratic Republic of the Congo. The group, including Dr Tedros, were being evacuated by helicopter at the time. The new Deputy Director General of the World Health Organization (WHO) is Dr Mike Ryan, who will assume the position alongside his current post as the executive director of Health Emergencies, Preparedness and Response. Ryan, who succeeds Zsuzsanna Jakab, who retired in February, assumed the position on 1 April according to an internal staff communique send out last Thursday. WHO Director General Dr Tedros Adhanom Ghebreyusus announced the appointment publicly on Monday at an event at the WHO headquarters, describing Ryan as “the general” and a “soldier”, and thanking him “for all his sacrifices”. In 1990, Ryan, an Irish epidemiologist who trained as a trauma surgeon, went to work in a hospital Iraq that was being supported by the College of Surgeons in Ireland, supposedly for three months while he waited for his surgical residency to begin in Australia. However, during that time, “Kuwait was invaded by Iraq, and we all became hostages in Baghdad”, said Ryan an interview with ‘Awake at Night’, a UN podcast series. Tragically, during this time he was injured in an accident involving a military convoy and stuck in Iraq with minimal treatment. This ended his career as a surgeon, resulting in him switching to infectious diseases. “It was very clear to me that you were either a surgeon or a good infectious disease doctor because these seemed to be the two things [where] a doctor could make a difference in many developing country environments. So I went into infectious diseases and then ended up coming to WHO In 1996, to join David Heymann, who was setting up a new emerging disease programme in WHO,” Ryan explains. During this time, he worked on responses to a number of outbreaks including measles, Ebola (while based in Uganda), and other infectious diseases. Between 2011 and 2017, he worked on the Global Polio Eradication Initiative (GPEI) in Pakistan, Afghanistan, and the Middle East. From 2017 to 2019, Ryan served as Assistant Director-General for Emergency Preparedness and Response in WHO’s Health Emergencies Programme. In 2019, Ryan became Executive Director of Health Emergencies Programme, and one of the WHO’s public faces during the COVID-19 pandemic. Image Credits: Lindsay Mackenzie/ WHO. Deaths from Viral Hepatitis Increase Globally With Limited Access to Diagnostics and Treatment 09/04/2024 Kerry Cullinan Baltazar Lucas, living with hepatitis B and a survivor of liver cancer who went through a liver transplant, goes for regular check-ups in Ortigas, Philippines. There has been an increase in deaths from hepatitis B and C, the infectious viral liver diseases that kill as many people each year as tuberculosis – yet few people know that they are infected and get the treatment they need. This is according to the World Health Organization (WHO) 2024 Global Hepatitis Report – the first to document epidemiology, service and product access – which was released on Tuesday at the start of the World Hepatitis Summit in Portugal. New data from 187 countries show that the estimated number of deaths rose from 1.1 million in 2019 to 1.3 million in 2022. Hepatitis B and C cause around 3,500 deaths every day. Around 83% the deaths were caused by hepatitis B, most commonly spread by mother-to-child transmission, and 17% by hepatitis C, usually spread through contact with infected blood. While sexual transmission is also a route for hepatitis B transmission, this typically results in acute infections, which are, in fact, less life-threatening than the chronic infections that may be acquired in infancy and may lead to early mortality. “Sexual transmission of hepatitis B usually results in an acute infection which is not life threatening. This report is about chronic infections which often lead to early mortality from liver disease and cancer,” explained Cary James, CEO of the World Hepatitis Alliance. “This is an important point as the misconception that chronic HBV is associated with sexual activity can be a major contributor to stigma within families, societies and health systems.” WHO’s Dr Meg Doherty and report author Dr Francoise Renaud “Hepatitis infection is a silent killer,” said Dr Meg Doherty, WHO’s Director of HIV, Hepatitis. “Awareness is very low worldwide. Most symptoms appear only once the disease has advanced, resulting in a huge volume of undiagnosed people living with hepatitis. Even when hepatitis is diagnosed, the number of people who go on to receive treatment remains low.” According to the report, by the end of 2022 only around 13% of people living with chronic hepatitis B infection had been diagnosed and approximately 3% (seven million) had received antiviral therapy, while about 36% of those with hepatitis C, 36% had been diagnosed and 20% (12.5 million) had received curative treatment. Almost two-thirds of global cases are concentrated in 10 countries – Bangladesh, China, Ethiopia, India, Indonesia, Nigeria, Pakistan, the Philippines, the Russian Federation and Viet Nam. Meanwhile, the WHO African region accounts for 63% of new hepatitis B infections, and yet only 18% of newborns receive the hepatitis B birth-dose vaccination. “Achieving universal access to prevention, diagnosis and treatment in these 10 countries by 2025, alongside intensified efforts in the African region, will be essential to get our response back on track,” stressed Doherty. On the other end of the spectrum, Egypt has made huge strides to eliminate hepatitis C in particular. “There are five main strains of hepatitis virus referred to as types A, B, C, D, and E. And in particular types B and C lead to chronic disease and together are the most common causes of liver cirrhosis, liver cancer and viral hepatitis related deaths,” she explained. Updated WHO estimates indicate that 254 million people live with hepatitis B and 50 million with hepatitis C in 2022. Half the burden of chronic hepatitis B and C infections is among people 30–54 years old, with 12% among children under 18 years of age. Men account for 58% of all cases. Treatment costs Pricing disparities persist both across and within WHO regions, with many countries paying above global benchmarks, even for off-patent drugs or when included in voluntary licensing agreements. “Despite the availability of affordable generic hepatitis medicines, many countries fail to procure them at these low prices,” said report author Dr Francoise Renaud. “Pricing disparities persist both across and within the WHO regions with many countries paying above global benchmarks, even for off patent medicines or when there are voluntary licencing agreements, which allow countries to produce or import generic formulations.” For example, although tenofovir for treatment of hepatitis B is off patent and available at a global benchmark price of $2.4 per month, only seven of the 26 reporting countries paid prices at or below the benchmark. The lowest reported monthly treatment prices reported by countries ranged from $1.22 for 30 tablets in China and India to $34.20 in Russia. Similarly, a 12-week course of pangenotypic sofosbuvir/daclatasvir to treat hepatitis C is available at a global benchmark price of $60, yet only four of 24 reporting countries paid prices at or below the benchmark. The lowest reported price for a 12-week course of this treatment was from Pakistan at about $33 for a generic course of treatment, while the highest reported price was from China, at about $ 10,000. About 75% of the reporting WHO focus countries rely primarily on government funding or out-of-pocket expenditure for viral hepatitis diagnostics Only 60% of reporting countries offer viral hepatitis testing and treatment services free of charge, either entirely or partially, in the public sector. Financial protection is low in the African region, where only about one third of reporting countries provide these services free of charge. –Correction (15 April, 2024). The original version of the story stated that hepatitis B infections are most commonly spread by sexual contact, when in fact the most common transmission route is mother to child transmission, according to WHO. Image Credits: Yoshi Shimizu/ WHO. Ensuring Ethical AI Implementation: HealthAI Launches Global Community of Practice 09/04/2024 Maayan Hoffman An artist’s depiction of artificial intelligence. Artificial Intelligence (AI) can save lives – but “we need to get the regulations right,” according to Dr Ricardo Baptista Leite, CEO of HealthAI, the agency responsible for artificial intelligence in health. To address the urgent need for the robust regulation of AI in the healthcare sector, HealthAI has initiated a worldwide community of practice (CoP), the organisation said last week. This initiative aims to strengthen each nation’s capacity to create well-informed regulations that promote AI’s ethical and fair utilisation in healthcare. “Our global community of practice is a critical platform for addressing the urgent need for regulation, bringing together global leaders from all sectors to ensure AI’s impact on health is positive, responsible and inclusive,” Leite said. The CoP will be a platform for discussing AI in healthcare and sharing experiences with responsible AI use in this field. It will bring together organisations, policymakers, technology experts, and leaders in health AI, fostering potential collaborations. “Since equity is core to our mission, we wanted to ensure a bottom-up approach be made to ensure the voices of all stakeholders from around the world would be heard as part of the development of these AI regulatory standards and in the implementation of these standards,” Leite told Health Policy Watch. He said the CoP would be open to all institutions – public, private, academic, patient and community-based organisations, civil society movements and technologists – by application. “We want to give a voice to those not heard as part of international processes and for us to be an important sounding board as we move forward and contribute to building this global ecosystem,” Leite added. HealthAI has a three-year strategy implementation plan that focusses on identifying at least 10 pioneer countries that it can help support and provide technical assistance. Leite said one of the challenges in many countries is the “absolute absence” of any form of expertise at the regulatory level. “To be able to address this matter seriously in the future, countries will need to invest in developing that capacity.” Leite noted that although organisations such as the World Health Organization (WHO), UNESCO, and the OECD are tasked with setting global standards, the countries must implement and apply these standards in practical situations. The future of AI in healthcare (illustrative) Regulatory confidence in technology There is a debate about whether regulations could hinder technology adoption in healthcare. However, Leite said HealthAI’s analysis is that many companies are hesitant to use technology due to concerns about legal liability in case of issues. His team believes establishing a regulatory framework will give companies the confidence to implement technology solutions. HealthAI, including through its CoP, aims to create an online global repository of validated AI solutions. This platform will be open source and showcase approved technologies, their functions, and their compliance with ethical AI standards. “This is especially important for startups in low- and middle-income countries,” Leite said. “Let’s say their national regulator just approved their technology. Now, suddenly, you can see their technology shown on this platform so that their innovations can be used in the Global North, meaning the tools developed in lower-resource settings could be a source of inspiration in high-income countries and not always the other way around.” At the same time, Leite said, another global network goal would be establishing an early warning system. This system would detect unintended negative impacts of AI technologies worldwide, triggering a red flag for all agencies to take immediate action. “This is important to ensure that governments can act in a timely manner and avoid harming citizens,” Leite said. WHO Announces S.A.R.A.H. HealthAI’s announcement about the CoP followed WHO’s announcement of S.A.R.A.H., a digital health promoter prototype with enhanced empathetic response powered by generative AI. S.A.R.A.H stands for “Smart AI Resource Assistant for Health.” “For too long health has often been viewed as a passive beneficiary of innovation rather than a driver of it,” wrote Hans Henri P. Kluge, WHO Regional Director for Europe in an article for Health Policy Watch. “It’s time to change this mentality and harness the power of innovation.” S.A.R.A.H is an advanced AI resource assistant designed for healthcare. WHO said the tool incorporates the latest language models and cutting-edge technology to engage users round the clock in eight languages, covering a wide range of health topics across various devices. It will provide information on a number of health topics, including healthy habits and mental health, cancer, heart and lung disease, and diabetes. “S.A.R.A.H gives us a glimpse of how artificial intelligence could be used in future to improve access to health information in a more interactive way,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. Image Credits: Quick Creator, Pexels. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
Mike Ryan Announced as New WHO Deputy Director General 09/04/2024 Kerry Cullinan Dr Mike Ryan helps attend to a health worker wounded in an attack in January 2019 against the Ebola vaccination team in the Democratic Republic of the Congo. The group, including Dr Tedros, were being evacuated by helicopter at the time. The new Deputy Director General of the World Health Organization (WHO) is Dr Mike Ryan, who will assume the position alongside his current post as the executive director of Health Emergencies, Preparedness and Response. Ryan, who succeeds Zsuzsanna Jakab, who retired in February, assumed the position on 1 April according to an internal staff communique send out last Thursday. WHO Director General Dr Tedros Adhanom Ghebreyusus announced the appointment publicly on Monday at an event at the WHO headquarters, describing Ryan as “the general” and a “soldier”, and thanking him “for all his sacrifices”. In 1990, Ryan, an Irish epidemiologist who trained as a trauma surgeon, went to work in a hospital Iraq that was being supported by the College of Surgeons in Ireland, supposedly for three months while he waited for his surgical residency to begin in Australia. However, during that time, “Kuwait was invaded by Iraq, and we all became hostages in Baghdad”, said Ryan an interview with ‘Awake at Night’, a UN podcast series. Tragically, during this time he was injured in an accident involving a military convoy and stuck in Iraq with minimal treatment. This ended his career as a surgeon, resulting in him switching to infectious diseases. “It was very clear to me that you were either a surgeon or a good infectious disease doctor because these seemed to be the two things [where] a doctor could make a difference in many developing country environments. So I went into infectious diseases and then ended up coming to WHO In 1996, to join David Heymann, who was setting up a new emerging disease programme in WHO,” Ryan explains. During this time, he worked on responses to a number of outbreaks including measles, Ebola (while based in Uganda), and other infectious diseases. Between 2011 and 2017, he worked on the Global Polio Eradication Initiative (GPEI) in Pakistan, Afghanistan, and the Middle East. From 2017 to 2019, Ryan served as Assistant Director-General for Emergency Preparedness and Response in WHO’s Health Emergencies Programme. In 2019, Ryan became Executive Director of Health Emergencies Programme, and one of the WHO’s public faces during the COVID-19 pandemic. Image Credits: Lindsay Mackenzie/ WHO. Deaths from Viral Hepatitis Increase Globally With Limited Access to Diagnostics and Treatment 09/04/2024 Kerry Cullinan Baltazar Lucas, living with hepatitis B and a survivor of liver cancer who went through a liver transplant, goes for regular check-ups in Ortigas, Philippines. There has been an increase in deaths from hepatitis B and C, the infectious viral liver diseases that kill as many people each year as tuberculosis – yet few people know that they are infected and get the treatment they need. This is according to the World Health Organization (WHO) 2024 Global Hepatitis Report – the first to document epidemiology, service and product access – which was released on Tuesday at the start of the World Hepatitis Summit in Portugal. New data from 187 countries show that the estimated number of deaths rose from 1.1 million in 2019 to 1.3 million in 2022. Hepatitis B and C cause around 3,500 deaths every day. Around 83% the deaths were caused by hepatitis B, most commonly spread by mother-to-child transmission, and 17% by hepatitis C, usually spread through contact with infected blood. While sexual transmission is also a route for hepatitis B transmission, this typically results in acute infections, which are, in fact, less life-threatening than the chronic infections that may be acquired in infancy and may lead to early mortality. “Sexual transmission of hepatitis B usually results in an acute infection which is not life threatening. This report is about chronic infections which often lead to early mortality from liver disease and cancer,” explained Cary James, CEO of the World Hepatitis Alliance. “This is an important point as the misconception that chronic HBV is associated with sexual activity can be a major contributor to stigma within families, societies and health systems.” WHO’s Dr Meg Doherty and report author Dr Francoise Renaud “Hepatitis infection is a silent killer,” said Dr Meg Doherty, WHO’s Director of HIV, Hepatitis. “Awareness is very low worldwide. Most symptoms appear only once the disease has advanced, resulting in a huge volume of undiagnosed people living with hepatitis. Even when hepatitis is diagnosed, the number of people who go on to receive treatment remains low.” According to the report, by the end of 2022 only around 13% of people living with chronic hepatitis B infection had been diagnosed and approximately 3% (seven million) had received antiviral therapy, while about 36% of those with hepatitis C, 36% had been diagnosed and 20% (12.5 million) had received curative treatment. Almost two-thirds of global cases are concentrated in 10 countries – Bangladesh, China, Ethiopia, India, Indonesia, Nigeria, Pakistan, the Philippines, the Russian Federation and Viet Nam. Meanwhile, the WHO African region accounts for 63% of new hepatitis B infections, and yet only 18% of newborns receive the hepatitis B birth-dose vaccination. “Achieving universal access to prevention, diagnosis and treatment in these 10 countries by 2025, alongside intensified efforts in the African region, will be essential to get our response back on track,” stressed Doherty. On the other end of the spectrum, Egypt has made huge strides to eliminate hepatitis C in particular. “There are five main strains of hepatitis virus referred to as types A, B, C, D, and E. And in particular types B and C lead to chronic disease and together are the most common causes of liver cirrhosis, liver cancer and viral hepatitis related deaths,” she explained. Updated WHO estimates indicate that 254 million people live with hepatitis B and 50 million with hepatitis C in 2022. Half the burden of chronic hepatitis B and C infections is among people 30–54 years old, with 12% among children under 18 years of age. Men account for 58% of all cases. Treatment costs Pricing disparities persist both across and within WHO regions, with many countries paying above global benchmarks, even for off-patent drugs or when included in voluntary licensing agreements. “Despite the availability of affordable generic hepatitis medicines, many countries fail to procure them at these low prices,” said report author Dr Francoise Renaud. “Pricing disparities persist both across and within the WHO regions with many countries paying above global benchmarks, even for off patent medicines or when there are voluntary licencing agreements, which allow countries to produce or import generic formulations.” For example, although tenofovir for treatment of hepatitis B is off patent and available at a global benchmark price of $2.4 per month, only seven of the 26 reporting countries paid prices at or below the benchmark. The lowest reported monthly treatment prices reported by countries ranged from $1.22 for 30 tablets in China and India to $34.20 in Russia. Similarly, a 12-week course of pangenotypic sofosbuvir/daclatasvir to treat hepatitis C is available at a global benchmark price of $60, yet only four of 24 reporting countries paid prices at or below the benchmark. The lowest reported price for a 12-week course of this treatment was from Pakistan at about $33 for a generic course of treatment, while the highest reported price was from China, at about $ 10,000. About 75% of the reporting WHO focus countries rely primarily on government funding or out-of-pocket expenditure for viral hepatitis diagnostics Only 60% of reporting countries offer viral hepatitis testing and treatment services free of charge, either entirely or partially, in the public sector. Financial protection is low in the African region, where only about one third of reporting countries provide these services free of charge. –Correction (15 April, 2024). The original version of the story stated that hepatitis B infections are most commonly spread by sexual contact, when in fact the most common transmission route is mother to child transmission, according to WHO. Image Credits: Yoshi Shimizu/ WHO. Ensuring Ethical AI Implementation: HealthAI Launches Global Community of Practice 09/04/2024 Maayan Hoffman An artist’s depiction of artificial intelligence. Artificial Intelligence (AI) can save lives – but “we need to get the regulations right,” according to Dr Ricardo Baptista Leite, CEO of HealthAI, the agency responsible for artificial intelligence in health. To address the urgent need for the robust regulation of AI in the healthcare sector, HealthAI has initiated a worldwide community of practice (CoP), the organisation said last week. This initiative aims to strengthen each nation’s capacity to create well-informed regulations that promote AI’s ethical and fair utilisation in healthcare. “Our global community of practice is a critical platform for addressing the urgent need for regulation, bringing together global leaders from all sectors to ensure AI’s impact on health is positive, responsible and inclusive,” Leite said. The CoP will be a platform for discussing AI in healthcare and sharing experiences with responsible AI use in this field. It will bring together organisations, policymakers, technology experts, and leaders in health AI, fostering potential collaborations. “Since equity is core to our mission, we wanted to ensure a bottom-up approach be made to ensure the voices of all stakeholders from around the world would be heard as part of the development of these AI regulatory standards and in the implementation of these standards,” Leite told Health Policy Watch. He said the CoP would be open to all institutions – public, private, academic, patient and community-based organisations, civil society movements and technologists – by application. “We want to give a voice to those not heard as part of international processes and for us to be an important sounding board as we move forward and contribute to building this global ecosystem,” Leite added. HealthAI has a three-year strategy implementation plan that focusses on identifying at least 10 pioneer countries that it can help support and provide technical assistance. Leite said one of the challenges in many countries is the “absolute absence” of any form of expertise at the regulatory level. “To be able to address this matter seriously in the future, countries will need to invest in developing that capacity.” Leite noted that although organisations such as the World Health Organization (WHO), UNESCO, and the OECD are tasked with setting global standards, the countries must implement and apply these standards in practical situations. The future of AI in healthcare (illustrative) Regulatory confidence in technology There is a debate about whether regulations could hinder technology adoption in healthcare. However, Leite said HealthAI’s analysis is that many companies are hesitant to use technology due to concerns about legal liability in case of issues. His team believes establishing a regulatory framework will give companies the confidence to implement technology solutions. HealthAI, including through its CoP, aims to create an online global repository of validated AI solutions. This platform will be open source and showcase approved technologies, their functions, and their compliance with ethical AI standards. “This is especially important for startups in low- and middle-income countries,” Leite said. “Let’s say their national regulator just approved their technology. Now, suddenly, you can see their technology shown on this platform so that their innovations can be used in the Global North, meaning the tools developed in lower-resource settings could be a source of inspiration in high-income countries and not always the other way around.” At the same time, Leite said, another global network goal would be establishing an early warning system. This system would detect unintended negative impacts of AI technologies worldwide, triggering a red flag for all agencies to take immediate action. “This is important to ensure that governments can act in a timely manner and avoid harming citizens,” Leite said. WHO Announces S.A.R.A.H. HealthAI’s announcement about the CoP followed WHO’s announcement of S.A.R.A.H., a digital health promoter prototype with enhanced empathetic response powered by generative AI. S.A.R.A.H stands for “Smart AI Resource Assistant for Health.” “For too long health has often been viewed as a passive beneficiary of innovation rather than a driver of it,” wrote Hans Henri P. Kluge, WHO Regional Director for Europe in an article for Health Policy Watch. “It’s time to change this mentality and harness the power of innovation.” S.A.R.A.H is an advanced AI resource assistant designed for healthcare. WHO said the tool incorporates the latest language models and cutting-edge technology to engage users round the clock in eight languages, covering a wide range of health topics across various devices. It will provide information on a number of health topics, including healthy habits and mental health, cancer, heart and lung disease, and diabetes. “S.A.R.A.H gives us a glimpse of how artificial intelligence could be used in future to improve access to health information in a more interactive way,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. Image Credits: Quick Creator, Pexels. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
Deaths from Viral Hepatitis Increase Globally With Limited Access to Diagnostics and Treatment 09/04/2024 Kerry Cullinan Baltazar Lucas, living with hepatitis B and a survivor of liver cancer who went through a liver transplant, goes for regular check-ups in Ortigas, Philippines. There has been an increase in deaths from hepatitis B and C, the infectious viral liver diseases that kill as many people each year as tuberculosis – yet few people know that they are infected and get the treatment they need. This is according to the World Health Organization (WHO) 2024 Global Hepatitis Report – the first to document epidemiology, service and product access – which was released on Tuesday at the start of the World Hepatitis Summit in Portugal. New data from 187 countries show that the estimated number of deaths rose from 1.1 million in 2019 to 1.3 million in 2022. Hepatitis B and C cause around 3,500 deaths every day. Around 83% the deaths were caused by hepatitis B, most commonly spread by mother-to-child transmission, and 17% by hepatitis C, usually spread through contact with infected blood. While sexual transmission is also a route for hepatitis B transmission, this typically results in acute infections, which are, in fact, less life-threatening than the chronic infections that may be acquired in infancy and may lead to early mortality. “Sexual transmission of hepatitis B usually results in an acute infection which is not life threatening. This report is about chronic infections which often lead to early mortality from liver disease and cancer,” explained Cary James, CEO of the World Hepatitis Alliance. “This is an important point as the misconception that chronic HBV is associated with sexual activity can be a major contributor to stigma within families, societies and health systems.” WHO’s Dr Meg Doherty and report author Dr Francoise Renaud “Hepatitis infection is a silent killer,” said Dr Meg Doherty, WHO’s Director of HIV, Hepatitis. “Awareness is very low worldwide. Most symptoms appear only once the disease has advanced, resulting in a huge volume of undiagnosed people living with hepatitis. Even when hepatitis is diagnosed, the number of people who go on to receive treatment remains low.” According to the report, by the end of 2022 only around 13% of people living with chronic hepatitis B infection had been diagnosed and approximately 3% (seven million) had received antiviral therapy, while about 36% of those with hepatitis C, 36% had been diagnosed and 20% (12.5 million) had received curative treatment. Almost two-thirds of global cases are concentrated in 10 countries – Bangladesh, China, Ethiopia, India, Indonesia, Nigeria, Pakistan, the Philippines, the Russian Federation and Viet Nam. Meanwhile, the WHO African region accounts for 63% of new hepatitis B infections, and yet only 18% of newborns receive the hepatitis B birth-dose vaccination. “Achieving universal access to prevention, diagnosis and treatment in these 10 countries by 2025, alongside intensified efforts in the African region, will be essential to get our response back on track,” stressed Doherty. On the other end of the spectrum, Egypt has made huge strides to eliminate hepatitis C in particular. “There are five main strains of hepatitis virus referred to as types A, B, C, D, and E. And in particular types B and C lead to chronic disease and together are the most common causes of liver cirrhosis, liver cancer and viral hepatitis related deaths,” she explained. Updated WHO estimates indicate that 254 million people live with hepatitis B and 50 million with hepatitis C in 2022. Half the burden of chronic hepatitis B and C infections is among people 30–54 years old, with 12% among children under 18 years of age. Men account for 58% of all cases. Treatment costs Pricing disparities persist both across and within WHO regions, with many countries paying above global benchmarks, even for off-patent drugs or when included in voluntary licensing agreements. “Despite the availability of affordable generic hepatitis medicines, many countries fail to procure them at these low prices,” said report author Dr Francoise Renaud. “Pricing disparities persist both across and within the WHO regions with many countries paying above global benchmarks, even for off patent medicines or when there are voluntary licencing agreements, which allow countries to produce or import generic formulations.” For example, although tenofovir for treatment of hepatitis B is off patent and available at a global benchmark price of $2.4 per month, only seven of the 26 reporting countries paid prices at or below the benchmark. The lowest reported monthly treatment prices reported by countries ranged from $1.22 for 30 tablets in China and India to $34.20 in Russia. Similarly, a 12-week course of pangenotypic sofosbuvir/daclatasvir to treat hepatitis C is available at a global benchmark price of $60, yet only four of 24 reporting countries paid prices at or below the benchmark. The lowest reported price for a 12-week course of this treatment was from Pakistan at about $33 for a generic course of treatment, while the highest reported price was from China, at about $ 10,000. About 75% of the reporting WHO focus countries rely primarily on government funding or out-of-pocket expenditure for viral hepatitis diagnostics Only 60% of reporting countries offer viral hepatitis testing and treatment services free of charge, either entirely or partially, in the public sector. Financial protection is low in the African region, where only about one third of reporting countries provide these services free of charge. –Correction (15 April, 2024). The original version of the story stated that hepatitis B infections are most commonly spread by sexual contact, when in fact the most common transmission route is mother to child transmission, according to WHO. Image Credits: Yoshi Shimizu/ WHO. Ensuring Ethical AI Implementation: HealthAI Launches Global Community of Practice 09/04/2024 Maayan Hoffman An artist’s depiction of artificial intelligence. Artificial Intelligence (AI) can save lives – but “we need to get the regulations right,” according to Dr Ricardo Baptista Leite, CEO of HealthAI, the agency responsible for artificial intelligence in health. To address the urgent need for the robust regulation of AI in the healthcare sector, HealthAI has initiated a worldwide community of practice (CoP), the organisation said last week. This initiative aims to strengthen each nation’s capacity to create well-informed regulations that promote AI’s ethical and fair utilisation in healthcare. “Our global community of practice is a critical platform for addressing the urgent need for regulation, bringing together global leaders from all sectors to ensure AI’s impact on health is positive, responsible and inclusive,” Leite said. The CoP will be a platform for discussing AI in healthcare and sharing experiences with responsible AI use in this field. It will bring together organisations, policymakers, technology experts, and leaders in health AI, fostering potential collaborations. “Since equity is core to our mission, we wanted to ensure a bottom-up approach be made to ensure the voices of all stakeholders from around the world would be heard as part of the development of these AI regulatory standards and in the implementation of these standards,” Leite told Health Policy Watch. He said the CoP would be open to all institutions – public, private, academic, patient and community-based organisations, civil society movements and technologists – by application. “We want to give a voice to those not heard as part of international processes and for us to be an important sounding board as we move forward and contribute to building this global ecosystem,” Leite added. HealthAI has a three-year strategy implementation plan that focusses on identifying at least 10 pioneer countries that it can help support and provide technical assistance. Leite said one of the challenges in many countries is the “absolute absence” of any form of expertise at the regulatory level. “To be able to address this matter seriously in the future, countries will need to invest in developing that capacity.” Leite noted that although organisations such as the World Health Organization (WHO), UNESCO, and the OECD are tasked with setting global standards, the countries must implement and apply these standards in practical situations. The future of AI in healthcare (illustrative) Regulatory confidence in technology There is a debate about whether regulations could hinder technology adoption in healthcare. However, Leite said HealthAI’s analysis is that many companies are hesitant to use technology due to concerns about legal liability in case of issues. His team believes establishing a regulatory framework will give companies the confidence to implement technology solutions. HealthAI, including through its CoP, aims to create an online global repository of validated AI solutions. This platform will be open source and showcase approved technologies, their functions, and their compliance with ethical AI standards. “This is especially important for startups in low- and middle-income countries,” Leite said. “Let’s say their national regulator just approved their technology. Now, suddenly, you can see their technology shown on this platform so that their innovations can be used in the Global North, meaning the tools developed in lower-resource settings could be a source of inspiration in high-income countries and not always the other way around.” At the same time, Leite said, another global network goal would be establishing an early warning system. This system would detect unintended negative impacts of AI technologies worldwide, triggering a red flag for all agencies to take immediate action. “This is important to ensure that governments can act in a timely manner and avoid harming citizens,” Leite said. WHO Announces S.A.R.A.H. HealthAI’s announcement about the CoP followed WHO’s announcement of S.A.R.A.H., a digital health promoter prototype with enhanced empathetic response powered by generative AI. S.A.R.A.H stands for “Smart AI Resource Assistant for Health.” “For too long health has often been viewed as a passive beneficiary of innovation rather than a driver of it,” wrote Hans Henri P. Kluge, WHO Regional Director for Europe in an article for Health Policy Watch. “It’s time to change this mentality and harness the power of innovation.” S.A.R.A.H is an advanced AI resource assistant designed for healthcare. WHO said the tool incorporates the latest language models and cutting-edge technology to engage users round the clock in eight languages, covering a wide range of health topics across various devices. It will provide information on a number of health topics, including healthy habits and mental health, cancer, heart and lung disease, and diabetes. “S.A.R.A.H gives us a glimpse of how artificial intelligence could be used in future to improve access to health information in a more interactive way,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. Image Credits: Quick Creator, Pexels. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. 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Ensuring Ethical AI Implementation: HealthAI Launches Global Community of Practice 09/04/2024 Maayan Hoffman An artist’s depiction of artificial intelligence. Artificial Intelligence (AI) can save lives – but “we need to get the regulations right,” according to Dr Ricardo Baptista Leite, CEO of HealthAI, the agency responsible for artificial intelligence in health. To address the urgent need for the robust regulation of AI in the healthcare sector, HealthAI has initiated a worldwide community of practice (CoP), the organisation said last week. This initiative aims to strengthen each nation’s capacity to create well-informed regulations that promote AI’s ethical and fair utilisation in healthcare. “Our global community of practice is a critical platform for addressing the urgent need for regulation, bringing together global leaders from all sectors to ensure AI’s impact on health is positive, responsible and inclusive,” Leite said. The CoP will be a platform for discussing AI in healthcare and sharing experiences with responsible AI use in this field. It will bring together organisations, policymakers, technology experts, and leaders in health AI, fostering potential collaborations. “Since equity is core to our mission, we wanted to ensure a bottom-up approach be made to ensure the voices of all stakeholders from around the world would be heard as part of the development of these AI regulatory standards and in the implementation of these standards,” Leite told Health Policy Watch. He said the CoP would be open to all institutions – public, private, academic, patient and community-based organisations, civil society movements and technologists – by application. “We want to give a voice to those not heard as part of international processes and for us to be an important sounding board as we move forward and contribute to building this global ecosystem,” Leite added. HealthAI has a three-year strategy implementation plan that focusses on identifying at least 10 pioneer countries that it can help support and provide technical assistance. Leite said one of the challenges in many countries is the “absolute absence” of any form of expertise at the regulatory level. “To be able to address this matter seriously in the future, countries will need to invest in developing that capacity.” Leite noted that although organisations such as the World Health Organization (WHO), UNESCO, and the OECD are tasked with setting global standards, the countries must implement and apply these standards in practical situations. The future of AI in healthcare (illustrative) Regulatory confidence in technology There is a debate about whether regulations could hinder technology adoption in healthcare. However, Leite said HealthAI’s analysis is that many companies are hesitant to use technology due to concerns about legal liability in case of issues. His team believes establishing a regulatory framework will give companies the confidence to implement technology solutions. HealthAI, including through its CoP, aims to create an online global repository of validated AI solutions. This platform will be open source and showcase approved technologies, their functions, and their compliance with ethical AI standards. “This is especially important for startups in low- and middle-income countries,” Leite said. “Let’s say their national regulator just approved their technology. Now, suddenly, you can see their technology shown on this platform so that their innovations can be used in the Global North, meaning the tools developed in lower-resource settings could be a source of inspiration in high-income countries and not always the other way around.” At the same time, Leite said, another global network goal would be establishing an early warning system. This system would detect unintended negative impacts of AI technologies worldwide, triggering a red flag for all agencies to take immediate action. “This is important to ensure that governments can act in a timely manner and avoid harming citizens,” Leite said. WHO Announces S.A.R.A.H. HealthAI’s announcement about the CoP followed WHO’s announcement of S.A.R.A.H., a digital health promoter prototype with enhanced empathetic response powered by generative AI. S.A.R.A.H stands for “Smart AI Resource Assistant for Health.” “For too long health has often been viewed as a passive beneficiary of innovation rather than a driver of it,” wrote Hans Henri P. Kluge, WHO Regional Director for Europe in an article for Health Policy Watch. “It’s time to change this mentality and harness the power of innovation.” S.A.R.A.H is an advanced AI resource assistant designed for healthcare. WHO said the tool incorporates the latest language models and cutting-edge technology to engage users round the clock in eight languages, covering a wide range of health topics across various devices. It will provide information on a number of health topics, including healthy habits and mental health, cancer, heart and lung disease, and diabetes. “S.A.R.A.H gives us a glimpse of how artificial intelligence could be used in future to improve access to health information in a more interactive way,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. Image Credits: Quick Creator, Pexels. Posts navigation Older postsNewer posts