Young children in Harare scrounge for left-over food.

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

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

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

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

Regional crisis

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

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

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

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

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

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

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

Insufficient aid

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

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

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

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

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

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

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

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

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

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

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

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

Inflation fuels hunger

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

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

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

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

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

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

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

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

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

‘Nobody talks about it’

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

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

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

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

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

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

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

Image Credits: Jeffrey Moyo.

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

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

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

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

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

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

Additional risks

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

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

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

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

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

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

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

Image Credits: UN Women.

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

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

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

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

Primary prevention of zoonotic spillover

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

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

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

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

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

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

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

The second measure involves protecting where bats roost.

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

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

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

Integrating ecological and biomedical approaches

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

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

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

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

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

Pandemic agreement and One Health

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

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

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

Image Credits: Chris Black/WHO.

A convention of the Polish Left party, one of leading advocates for legalizing abortion.

Poland’s right-wing Law and Justice (PiS) party, which championed the country’s restrictive abortion laws, was voted out of power last October, but the path to improving access to abortion is not fast or straight forward.

“First of all, we need accessible abortions and we need, which is extremely important, the decriminalisation of abortion support,” activist Agata Adamczuk told Health Policy Watch. She is from Dziewuchy Dziewuchom (Gals Help Gals) Foundation, a Polish feminist NGO providing information on safe abortions. 

Yet, Parliamentary Speaker Szymon Hołownia says it’s not a good time to introduce abortion reform, the Polish Press Agency reports. According to Hołownia, parliamentarians may vote against any abortion reforms if they are placed on the agenda before the local government elections on 7 April, fearing reactions of more conservative voters.

“If we proceed after the [local] elections, the chances will be much greater. Talks and declarations about supporting the draft bills in the first reading will start,” said Hołownia, adding that discussion on a draft abortion reform Bill was set down for 11 April.

Coalition politics

Hołownia is leader of Polska 2050, a new Christian Democrat party,  and one of the three parties that make up the ruling coalition. The group is ambiguous in their stance towards reproductive rights, whereas the other two parties in ruling coalition, the New Left and Prime Minister Donald Tusk’s Civic Platform, have made abortion on demand up to the 12th week of pregnancy one of their priorities.

“It’s a good first step, in the right direction, but it’s not enough,” Adamczuk highlighted.

Even if there is a law granting abortion on demand until the 12th week of pregnancy, in practice it likely won’t be respected “because we’ve already faced such situations”, she adds.

Last year, demonstrations were held in 60 cities in protest against the unnecessary deaths of women because hospitals were reluctant to abort pregnancies that endangered their lives, even though performing them would have been legal, Newsweek Poland reported.

However, the Civic Platform and the New Left remain optimistic that abortion rights are a necessary and realistic goal for the current term of the parliament.

“We have the right to and we want the draft bill on abortion to be finally proceeded in the Sejm,” said Anna Maria Żukowska, a leader of the New Left, during the party’s summit.

Yet a new Bill to make abortion access less restrictive is likely to face opposition of some parties in the Catholic country, including the possibility that President Andrzej Duda, who is aligned to PiS, may veto it. He has been quoted as saying that advocating abortion access is “demanding the right to kill”.

Abortion mostly forbidden – but still happening

Poland’s abortion laws are the second most restrictive in Europe, with only Malta reaching a lower score on legality and accessibility, according to the Abortion Policies Atlas.

A comparison of abortion-related policies in Europe. Poland with considerably more restrictive laws than most countries.

Performing the procedure is now legal only in cases of rape and where there is serious risk to the mother’s health. Even then, doctors are permitted conscientious objection to performing abortions, which further limits access to abortion.

In 2020, the politicised Constitutional Tribunal ruled that it was against the Polish Constitution to allow abortion if there was a serious deformation of the foetus.

As a result of this ruling, the number of legal abortions decreased tenfold, amounting to only about a hundred cases per year since 2020, according to Statista.

Yet the total annual number of abortions is estimated to be between 80,000 and 93,000. Numerous NGOs help provide information and organisational support for ordering abortion pills online or assisting women to schedule a surgical abortion abroad.

Lack of education 

Women’s protests following the Constitutional Tribunal’s ruling are credited with helping to unseat the PiS party in the last parliamentary elections. The ruling coalition has made abortion on demand until the 12th week of pregnancy one of their top priorities.

Women’s Strike protests in Warsaw, 2020, against the constitutional tribunal sentence dramatically limiting access to abortions.

Even if the relaxation of abortion laws happens, it will do little to improve reproductive rights in Poland, according to Adamczuk. 

“Politicians should acknowledge the fact that simply changing the law will not automatically mean changing the situation for abortion accessibility. We need a more holistic revolution there,” she said.

“What we need is to do work at the ground level, to fight abortion stigma,” she stresses, pointing out that Polish medical circles are reluctant to provide abortion. 

The recent Polish Gynaecologists Association guidelines, for instance, say all other options should be tried before performing the procedure on a patient whose mental health is likely to suffer if they give birth.

Another crucial element is medical education: right now, no classes on abortion care are included in the gynaecologists’ curricula, Adamczuk says. 

Some sources highlight the causal link between the lack of education and the lack of accessibility. 

“If doctors receive the message that abortion is not a normal medical procedure during their studies, they will be more likely to carry on that opinion,” the activist added. “Performing abortions is almost exclusively our burden, of us activists, and most probably that won’t change in the nearest future.”

Decriminalising help

“We simply cannot be penalised for doing the job of the state,” Adamczuk highlighted, pointing out that decriminalising abortion help is one of the most urgent changes that need to happen. 

Last year, Polish abortion activist Justyna Wydrzyńska was found guilty of facilitating abortion and sentenced to eight months of community service. 

Although she declared that the court’s decision won’t stop her from continuing her work, such cases may have had a chilling effect on abortion access.

However, Wydrzyńska’s trial might have inspired another draft Bill currently waiting to be proceeded on decriminalising abortion support. 

The New Left has also proposed other Bills to advance women’s rights, including a change to the definition of rape and more favourable rules for maternity leave.

“We’re glad that abortion is the talk of the town right now, that there’s discussion about it,” says Adamczuk. “But just discussing is far too little.”

Image Credits: Lewica, Abortion Policies Atlas, Greenpeace Polska.

UN Security Council approves a first-ever resolution calling for a cease-fire in Gaza

WHO Director General Dr Tedros Adhanom Ghebreyesus on Monday welcomed a UN Security Council resolution calling for a ceasefire and the assurance of humanitarian aid in Gaza, and the immediate release of all hostages. 

The resolution, which passed with a vote of 14 in favor and the United States abstaining, was the first resolution to pass the body since the 7 October attack by Hamas-led gunmen on Israeli communities that left 1,200 Israelis dead, and triggered Israel’s massive invasion of Gaza in a war that so far has resulted in the deaths of over 32,000 Palestinians, according to Gaza’s Hamas-run health ministry.  

Fighting continues in Shifa and raging around two more Gaza hospitals

Gaza’s Al Shifa hospital during a WHO visit on Friday 1 March – was only just getting back into service after months of siege, officials say.

The director-general’s comments came as fierce fighting continued to rage in and around three strategically placed Gazan hospitals – Al Shifa in the north, and Nasser and Al Amal Hospitals in Khan Younis. 

Israel claims to have killed over 170 Hamas militants in battles at Shifa over the past week, including Hamas chief of internal security, Faiq Mabhouh, along with detaining around 800 people on the hospital grounds. 

Hamas and Islamic Jihad gunmen continued to barricade themselves inside parts of the facility Monday night, Israel said.  The claims were denied by Hamas, which said that over a dozen patients had died during the operation, the most prolonged in a health facility since the war began.   

Patients and health workers who managed to leave the compound described harrowing scenes, with a shortage of food and water, and bodies piling up on the hospital grounds. 

Dr. Tayseer al-Tanna, 54, a vascular surgeon, told the New York Times that Israeli forces had gathered doctors and patients together in parts of the hospital, while they swept the grounds outside.

“The Israeli military didn’t treat us violently,” Dr. Al-Tanna was quoted as saying. “But we had almost no food and water.”   

He declined to comment on whether Palestinian fighters had fortified themselves in parts of the medical complex.

On Monday evening, Israel’s military spokesman claimed that Hamas and Islamic Jihad forces were still positioned inside the hospital’s emergency room, the maternity ward and a burn ward, were firing at Israeli forces, and throwing mortar shells from their positions.  

Following its first incursion into the hospital in November, Israel exposed video footage of Israeli hostages being brought into Shifa on 7 October. It also displayed caches of arms, ammunition and a tunnel dug underneath the compound. But experts later disputed the army’s claims that the hospital had been a major Hamas command and control centre.  On Monday, 17 March, Israel said that it had moved back into the hospital during an overnight operation, after it discovered leading Hamas military operatives regrouping there.

The hospital was only just getting back into service after weeks of siege in northern Gaza, in which medical supply deliveries were largely blocked, said Rick Peeperkorn speaking at a WHO press conference last Thursday.

“Shifa hospital was bouncing back and providing minimal services,” he said. But then a planned WHO mission to the hospital last week was cancelled by Israel. 

“It was cancelled due to the ongoing insecurity in the region. And this is, again, I think we’ve raised so often, what is needed is an effective and a transparent, workable deconfliction mechanism,” Peeperkorn said. 

The northern Gaza area is desperately in need of emergency malnutrition measures to stave off looming famine, he assserted. Hospitals also need to play a key role in this, he said, acting as “nutrition stabilisation centres” while northern Gaza, the area most at risk, is flooded “with ready-to-use therapeutic foods,” followed by a return to local food production as soon as possible.

Al Amal and Nasser Hospitals also now under siege 

Meanwhile, two other hospitals in the southern Gaza city of Khan Younis, Al Amal and Al Nasser, also came under siege by Israeli troops over the weekend, as fierce fighting raged in surrounding neighbourhoods.   

In separate statements, both Hamas officials in Gaza and the Palestinian Authority in the West Bank claimed that Israel had launched assaults on the hospitals, resulting in a number of casualties. Israel denied its forces had entered the hospitals, but said they had been cordoned off during fighting in the area.  

“@WHO and @ochaopt are extremely worried about the safety of the patients, companions, and the few health workers remaining at the hospital. We urgently need safe access to ensure patients can be provided with life-saving care,” stated an X post by WHO’s Office for the Occupied Palestinian Territories. 

“Our team was not given clearance to proceed to the hospital for assessment and facilitating patient transfer this evening but was able to assist nine health workers who walked from Al-Amal to south #Gaza with water and first aid.

“International law is clear: patients, health workers, and civilians must be protected. We urge parties to the conflict to respect their obligations.”

Image Credits: UN News , WHO.

Deep breath: A woman is screened for TB in Valenzuela.

A woman walks to an open tent and stands before a “camera” on a tripod, with a green curtain serving as her backdrop. 

“One, two, three…hold still…deep breath,” instructs the man in a black vest, speaking in Filipino, then presses the shutter.

Within five minutes, the photo is ready. But this is no ordinary snapshot from a photo booth. It is an image of the woman’s lungs taken by a portable X-ray machine.

A radiologist examines the image, and it is clear. The woman doesn’t have tuberculosis and is able to leave the tent feeling relieved. 

With the help of artificial intelligence, this portable X-ray can screen for possible cases of tuberculosis (TB) – even without a radiologist being present.

But while an X-ray is a valuable screening tool, it does not provide confirmatory results. This is where the rapid molecular test machine, Truenat, steps in.

Diagnosis of TB takes just an hour with the Truenat machine, which can run 10 to 12 specimens in eight hours, testing two specimens simultaneously. Compact and portable, it eliminates the need for patients to travel to hospitals or diagnostic centers – and it too can run on batteries.

The instant TB screening was a hit in Valenzuela.

The portable X-ray machine offering free TB screening was a blockbuster hit, particularly amongst the elderly residents of Valenzuela, a city north of Manila, the capital of Philippines. 

The Philippines has the fourth highest TB burden in the world and contributes 7% of global cases, behind India (27%), Indonesia (10%), and China (7.1%), according to the World Health Organization’s (WHO) Global Tuberculosis Report 2021.  

But for the archipelagic country with 7,640 islands, citizens’ access to healthcare and diagnostic  tools has been one of the greatest barriers to addressing tuberculosis. 

The portage X-ray machine are able to determine who should be tested for TB.

The portable X-ray machine, which is compact enough to fit in a regular-sized backpack and runs of batteries that each have the capacity to capture at least 100 images, has the potential to change that – along with the portable rapid tests. 

“In metro Manila, our streets can be very narrow. Where a regular car cannot [enter], But these (X-ray and Truenat machines) can be brought in a suit[case] so we can reach the unreachable,” said Dr Lalaine Mortera, of the United States Agency for International Development (USAID)  Tuberculosis Innovations and Health Systems Strengthening programme.

USAID and Stop TB Partnership have donated eight portable X-ray machines to the country. The other seven machines have been strategically distributed to geographically isolated regions and areas with high TB prevalence, including Bataan, Cebu, Laguna, Tarlac, Pampanga and South Cotabato.

An elderly woman gets screened for TB for the first time in her life.

Mortera told Health Policy Watch that during their visit to Minglanilla, an area near the city of Cebu, a 93-year-old woman had her chest X-rayed for the first time in her life. 

The X-ray machine can screen out those whose lungs are healthy, identifying those who should be tested for TB. Because of these new technologies, Valenzuela was able to achieve a 135% increase in case notification rate for tuberculosis.

Once diagnosed with TB, the city government provides free medication to the patients.

Aside from portable X-rays and Truenat machines, the health department also has mobile clinics. Like an ice cream truck, these mobile clinics go around the country providing basic health diagnosis. 

The Truenat TB test can get results in an hour, and the testing machine is portable and runs on batteries.

Tackling TB in the workplace

Valenzuela, with a population of around 675,000 residents, is home to numerous factories employing thousands of workers. As an industrial city, it became the first in the Philippines to adopt the Workplaces #WorkTBFree initiative run by the labor and health departments.

The initiative offers online resources to assist human resources and occupational safety officers to implement tuberculosis programs in workplaces.

“We hope that these learning tools will help the business sector in Valenzuela City find and treat workers with TB, toward our goal of maintaining healthy workplaces,” USAID Director of Health Michelle Lang-Alli said.

Dr Marthony Basco, Valenzuela’s health officer, said that company nurses also serve as their partners.  

“We just provide them with meds. The patient can take the medicine within their workplaces. We ask for the assistance of their nurses so this doesn’t compromise the continuity of the work,” Basco said.

To sustain TB treatment, the city government also allocates around $17,700 annually, augmenting aid from the national government and external agencies.

“It is not enough that we rely on what the region[al office] or Department of Health give us but also to augment because we do not want any diagnosed patients that are not treated timely,” said Dr Ma Cecilia  Aquino, National TB Medical Coordinator for Valenzuela City.

Recognizing the financial burden on individuals reliant on daily income, the city government also provides financial assistance to workers diagnosed with tuberculosis to ensure treatment continuity.

Moreover, the city has implemented an ordinance aimed at eradicating workplace discrimination which protects workers diagnosed with TB from unjust termination.

Fighting stigma

The stigma and discrimination surrounding tuberculosis present significant challenges in both diagnosis and treatment. The Philippines addresses this issue creatively, presenting TB screening as a routine check-up.

With the slogan “Para healthy lungs, pa-check ka lungs” (For healthy lungs, just check your lungs), the initiative aims to encourage individuals to prioritize their lung health without stigma.

“If you talk about TB screening, people will not come even if it’s free,” Mortera said. “You have to package it like a general check-up. Because the stigma is very high.”

The health department also launched a catchy informative jingle on how to take care of your lungs. 

TB prevalence in the Western Pacific

Despite concerted efforts, the fight against tuberculosis (TB) in the Philippines, as well as in countries around the world, remains an uphill battle. 

According to Health Secretary Teodoro Herbosa, the country recorded 612,534 new TB cases in 2023. This alarming figure represents a significant increase, with 549 cases per 100,000 population compared to 2022’s 439 cases per 100,000 people.

In 2022, the Western Pacific region had an estimated 1.9 million TB cases and 104,000 fatalities. This morbidity figure surpasses the pre-COVID-19 toll recorded in 2019, which stood at 92,000 deaths.

The WHO estimates that around 280 people lose their lives to TB and close to 5,000 people fall ill with this preventable and curable disease every day. 

In response, the 2023 UN General Assembly High-Level Meeting on TB outlined ambitious targets, aiming to accelerate the end of TB by 2027. These goals emphasize comprehensive care, rapid diagnosis, and closing funding gaps.

Image Credits: James Cruz.

mpox virus
Both Clade I and II strains of mpox are circulating in outbreak stricken DRC

WHO officials said that they are trying to expedite delivery of mpox vaccines to outbreak-stricken DR Congo through talks with the world’s only two mpox vaccine manufacturers, as well as appeals for vaccine donations and negotiations with DRC officials.

But speaking at a press briefing on Thursday, WHO’s Dr Mike Ryan, Executive Director of Health Emergencies, and technical lead Maria Van Kerkhove were unable to provide concrete details as to when significant quantities of vaccines could be rolled out – and how many, in light of the global shortage of supplies.  

Despite two years of millions of doses of global mpox vaccine rollout, there has been no mass administration of the vaccines so far in DRC or other west African countries. This is despite the fact that the region, and DRC in particular, is now the epicenter of the largest and deadliest mpox outbreak to date. 

The problems are multiple – ranging from global supply lines to local regulatory hurdles, stigma around mpox and vaccine hesitancy. 

Mpox lesions

At the global level, the production line of Bavarian Nordic, the Belgium-based manufacturer of one the world’s two available mpox vaccines, MVA-BN, halted its production for months in 2022 due to building renovations.  

Then in August, 2023, it received a $120 million contract from the US Biomedical Advanced Research and Development Authority (BARDA) to manufacture new mpox vaccine product in bulk.  But that has only partly restored the depleted US stockpile – believed to be the world’s largest.  

At the same time, stigma around the disease, which can be sexually transmitted, as well as around vaccines more generally has also held back progress in the DRC – one of the most vaccine-hesitant countries in Africa. 

An attempt to donate doses of mpox vaccine was stalled for more than a year, Bavarian Nordic Chief Executive Paul Chaplin said in a statement to Reuters, in December 2023. National regulatory approval of vaccines and medicines has thus inched forward at snail’s pace. 

Taking gloves off to join in partnership

Dr Mike Ryan mpox press conference
Dr Mike Ryan, WHO Executive Director of Health Emergencies at a recent press conference

“We know that production capacity of the manufacturers is closely held proprietary information sometimes, but we have an idea of production,” Ryan said, adding. “I think Bavarian Nordic has been very open to discussing how they could scale up production. 

“And I do know that GAVI and others are willing to engage around how the existing vaccines beyond donations could also be procured.  

“So we are taking the gloves off to join hands in partnership – not to beat anyone around on the head,” Ryan said. 

The MVA-BN vaccine as well as a second vaccine, LC16 KMB, produced by the Japanese firm KM Biologics, both present technical challenges in terms of their administration as well, Ryan pointed out. The MVA-BN requires two jabs – a challenge in settings like DRC wracked by conflict and insecurity.  

The LC16 vaccine, on the other hand, requires intradermal administration – a relatively simple skin jab, but still a procedure requiring training for the health workers unfamiliar with the technique.  

In addition, Ryan added, neither vaccine has yet been formally approved for use in children – and amongst the 250 deaths seen so far in DRC this year, most victims have been children under the age of 15. 

Targeting vaccines due to limited supplies 

“Given limited supply, limited availability of vaccines need to really be able to use those vaccines in a targeted way to reach those who are most at risk,” Van Kerkhove said. 

“We’re currently looking at a number of different ways the vaccines could enter into the country, led by our country office, the Ministry of Health and their partners. We’re looking at bilateral donations, at the use of vaccines as part of a response strategy – at a number of different options apply, but we’re also looking at supply,” she stressed, adding:  “We’re looking at how many doses could be available. And then of course the strategies in which those vaccines can be used in outbreak situations.”

Still trying to understand the epidemiology ’

While the barriers remain, virus transmission continues to expand within communities and geographies. 

“In 2024 alone there have been more than 3000 suspected cases and about 250 deaths with a crude case fatality ratio around 7.8%,” said Van Kerkhove, of the outbreak, the largest ever seen by the DRC to date.  

The high fatality rate is due to the fact that most cases seen so far in the DRC have been of the Clade I mpox virus, which very deadly. 

In contrast, it was the much milder Clade II virus that triggered WHO’s declaration of a global health emergency in 2022 – which it began circulating widely outside of Africa, primarily among men who have sex with men. The emergency  was declared to be over in 2023, after the successful rollout of millions of vaccines among at-risk groups in high and middle income countries.  

As well as being more deadly, the patterns of transmission of the Clade I virus in DRC and West Africa, also appear to be much more varied – although sexual transmission is a factor, it is not the only one.

DRC and global health officials are thus struggling to “better understand the epidemiology,” of the outbreak, which is happening amongs a wide variety of communities and populations – from children to sex workers.  

“There are clearly different outbreaks that are happening, some are happening among sex workers, some are zoonotic transmission and some family clusters,” Van Kerkhove said. 

“We’re working with our country office in DRC, our regional office and many different partners to look at the types of interventions that can prevent infections, but also stop transmission,” Van Kerkhove said. “And one of those interventions is vaccines.”  

“We had a big partnership meeting yesterday. A lot of people are now actively engaged. But let’s be real here.  We do have to look at the different types of scenarios and be realistic about how much vaccine is available, how quickly the vaccines can be used, and how they can optimally be used in different parts of DRC and beyond. To have the biggest impact in stopping human-to-human transmission.”

Image Credits: National Foundation for Infectious Diseases , Tessa Davis/Twitter , WHO.

What actions and strategies are required for countries and communities to have more agency in their health?

This is the topic of the latest episode of the Global Health Matters “Dialogues” podcast series, in which host Dr. Garry Aslanyan tries to “blow up some of the echo chambers that exist in global health.”

In this episode, he talks with Olusoji Adeyi, a seasoned Nigerian global health practitioner who has held many prominent leadership positions, about overhauling the existing power dynamics in global health.

Dr. Garry Aslanyan (left) and Olusoji (Soji) Adeyi
Dr. Garry Aslanyan (left) and Olusoji (Soji) Adeyi

“Aid is still used as a lever to exert power over nations at times,” Aslanyan said.

Adeyi proposed six essential changes to turn the situation around.

No. 1—Have clarity of purpose.

No. 2—Consider the needs, realities, and interests of recipient countries as the starting point for any deliberation.

No. 3—Emphasise learning.

“All too often, it’s almost as if principal actors in global health resist learning because such learning might threaten the status quo,” said Adeyi. “When it threatens the status quo, it threatens the current imbalance. And so it’s shut down or suffocated.”

No. 4—Overhaul the legacy foreign aid paradigm, including ending aid for basic health services and commodities and goods.

“This is not a call for an abrupt cessation today,” Adeyi stressed, “but it ought to be done, say by the year 2030, that’s a six to seven-year period so that there’s a finite date in sight and there is a transition out of it, with exceptions only for say countries at war, because then we’re talking about humanitarian purposes or countries that have suffered sudden and devastating natural disasters. Those would be sensible exceptions there.”

No. 5—End the current practice of technical assistance so that the aid given via technical assistance is no longer tied to the source of financing for that technical assistance.

No. 6—Developing/improving/supporting mission-critical institutions in low- and lower-middle-income countries.

Systemic Flaws in Vaccine Distribution

Adeyi highlighted the vaccine distribution process during the COVID-19 pandemic as a prime illustration of systemic flaws. He told Aslanyan that during the pandemic’s peak, “a few individuals convened at Davos and hastily drafted what would essentially become global policy for distributing COVID-19 vaccines and related technologies to low- and middle-income nations.”

Those initial sketches materialized into ACT-A for accelerated access to COVID technologies and COVAX, managed by Gavi. Consequently, during the pandemic’s peak, high-income nations stockpiled vaccines, leaving African countries in a predicament where even those countries that wanted to buy vaccines had to rely on donations rather than purchase vaccines themselves.

“If you go to buy a car, a computer, or a pair of shoes, you are empowered as the buyer,” Adeyi explained. “But if you are waiting for somebody to donate a car, a pair of shoes, or a computer to you, you are disempowered, and you are at the mercy of the donor. And, of course, COVID did not live up to the hype.

“If you had accountable leadership, they would acknowledge that failure and find ways to do better,” he continued. “But the leadership of Gavi did the exact opposite by claiming they had established a blueprint for how to get vaccines to poor people in an emergency, which was just the exact opposite of what had happened.”

Adeyi said that this illustrates how significant power imbalances result in policies, decisions, and practices that counter the interests of those intended to benefit.

Previous “Dialogues” episode: A Conversation with Daisy Hernández.

Listen to previous episodes of Global Health Matters on Health Policy Watch.

Image Credits: Screenshot, Global Health Matters Podcast.

Tired INB co-chairs Roland Driece and Precious Matsoso brief stakeholders.

Negotiations for a pandemic agreement currently underway in Geneva have made  little progress over the past four days, with member states still reading the current revised draft in plenary, and there is now talk of a further meeting in late April.

Co-chairs of the process believe that the best way forward is for member states with opposing views on particular clauses to negotiate directly with one another in smaller groups.

This emerged at a 90-minute briefing given to civil society organisations on Thursday night.

Roland Driece, co-chair of the World Health Organization’s (WHO) intergovernmental negotiating body (INB), told the briefing that the current revised draft had “not been matured” enough for a new draft to be issued, and could not predict when a new version would be available.

“We still have the stage of many countries adding textual suggestions to the text,” said Driece.

His co-chair counterpart, Precious Matsoso, said that the INB has dealt with the section on “objectives and principles”, and completed “a first reading” of articles 4, 5, 6, 7, 8, 9 and 10. 

Despite Ramadan, delegates had been meeting for additional evening sessions from 8pm-10pm and would be meeting for the whole of Saturday, she noted. The talks are scheduled to end next Thursday (28th March) but the process is very unlikely to have yielded an agreement by then.

Very few delegates were in the negotiating room at the WHO headquarters for the briefing, as two regions – most likely Africa and the European Union – were holding an informal discussion, while others were attending a briefing, said Matsoso. 

Both she and Driece expressed support for such meetings to find consensus.

Driece said there were a number of challenges, the biggest being the “time-consuming” nature of talks.

“Basically, I think these texts are progressing. But a lot of these ideas we already had on the table for a long time,” he said.

“Procedurally, the biggest challenge is, of course, the fact that you are here with a lot of countries. So if 50 of them speak out for three minutes, you can imagine that it takes a long time just to go around for one article”.

Devil in the detail

Content-wise, “the deeper you go into the details, the more difficult it is to agree”, said Driece. For example, while there was broad agreement on the need for technology transfer, discussing how this could be achieved touched on intellectual property – a point of disagreement. 

Increasing countries’ capacity to prevent pandemics had come up against poorer countries’ lack of resources to do so.

The contentious pathogen access and benefit-sharing (PABS) system is currently being discussed. The International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) proposing a way forward this week that involves manufacturers getting access to information about pathogens with pandemic potential in exchange for their support for certain equity-related measures.

IFPMA Director General Thomas Cueni at the CSO briefing

IFPMA Director-General Thomas Cueni, who attended the briefing, articulated the pharma industries’ proposal: “We do want a pandemic accord and companies are willing to accept mandatory commitments to delivering equitable access to essential countermeasures provided the system is workable.

“These commitments do include allocation of a percentage of real-time production of relevant therapeutics or vaccines after the pandemic is declared on the basis of a public health risk needs and demand,” said Cueni, who addressed the INB directly for the first time.

“It can include part portion expected as a donation, don’t exclude that, and part on the basis of equity based tiered pricing,” said Cueni, adding that manufacturers from the Global North and South were “fully aligned” on their position.

“We urge you to develop a flexible and agile approach to equitable access [to pathogen information], which will induce a critical mass of companies to sign up,” said Cueni.

“Coercion sadly will not work. You need to induce them, and I’m confident that it can be done,” he added, appealing for the industry to be included in a partnership to govern the proposed PABS system.

“Time is running short. So we really call for realism and pragmatism to find an agreement. We believe that the recently submitted proposal by the European Union, we don’t like it, but we do believe it does includes quite a number of elements which could make a workable system,” he concluded.

Civil society organisations raised more questions that answers during the session – most of which went unanswered by the co-chairs, who sounded tired and out of ideas.

Oxfam’s Mogha Kamal-Yanni at the INB briefing.

Pressure mounts on negotiators 

Country delegates negotiating the pandemic agreement are facing increasing pressure from a number of quarters.

Representatives from civil society organisations are camped on the doorstep of the INB  meeting room, along with journalists.

At each INB open session, a consistent set of civil society stakeholders speak and while they all represent different constituencies, they convey a similar complaint: when a pandemic strikes, they will be needed – so why aren’t they allowed in the room?

Meanwhile, a series of global campaigning efforts have converged this week. A powerful group of over 100 global leaders, including former presidents and prime ministers, sent the negotiators an open letter on Wednesday reminding them of their  “opportunity to safeguard the world” and urging progress.

The former world leaders reminded INB members of the seven million dead (officially) and the $2 trillion wiped from the world economy.

“Only a strong global pact on pandemics can protect future generations from a repeat of the COVID-19 crisis, which led to millions of deaths and caused widespread social and economic devastation, owing not least to insufficient international collaboration,” the leaders write in their joint letter. 

Signatories include former UN General Secretary Ban-ki Moon, former New Zealand Prime Minister Helen Clark, former UK Prime Ministers Gordon Brown and Tony Blair, former Malawi President Joyce Banda, and former Peru President Franciso Sagasti.

Earlier in the week, religious leaders also sent a letter to negotiators, urging that they prioritise equity.

“A bitterly inequitable vaccine distribution protected people in the Global North but left the world’s poorest to face COVID-19 unprotected for too long. Countless lives were lost unnecessarily as a result. As world leaders/negotiators, you have a moral duty to ensure that this never happens again,” they noted.

Young leaders has campaigned online in support of an equitable agreement, while Global Citizen has a petition urging world leaders to  “find a common ground” to achieve a strong agreement.

On Tuesday, 12 prominent U.S. political leaders led by Senator Bernie Sanders published a letter pressuring the US to “support strong, binding equitable access standards.”

Then there are those outside the tent, spewing out misinformation that the agreement will enable the WHO to impose global lockdowns who hope that the talks will fail – amongst them, anti-vaxxers, staunch nationalists and extreme libertarians.

Thomas Cueni, director general, IFPMA at a briefing with UN press on Wednesday in Geneva.

Pharmaceutical giants could support a formula whereby companies are guaranteed free and immediate access to pathogens with pandemic potential in exchange for binding equity agreements as part of a proposed World Health Organization (WHO) pandemic agreement, says a leading industry figure.   

The statement by Thomas Cueni, director-general of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), aims to turn the classic formula for industry pathogen access in exchange for benefit-sharing (PABS) on its head. 

Cueni honed out key details of the offer to Health Policy Watch in an exclusive interview Thursday, following a press briefing for UN accredited journalists in Geneva on Wednesday where he outlined the main features of the offer. He spoke against the backdrop of intensifying debate among WHO member states meeting this week in the Intergovernmental Negotiating Body (INB) over the final shape of a pandemic accord, which is supposed to be ready for approval by May’s World Health Assembly. 

Instead of a PABS system that requires industry to pay a cash benefit outright to get pathogen samples or genetic material critical to new drug and vaccine R&D, as some civil society groups and low-income countries have proposed, he suggests focusing on “in-kind benefits” in the form of clear industry commitments for the allocation of drugs, diagnostics and vaccines. 

Depending on the final outlines of the agreement negotiated by member states, this could include mandatory set-asides of free or discounted drugs, vaccines and other countermeasures by companies that sign up to the WHO PABS system that is currently proposed as part of the draft agreement. 

“Commitment is what is voluntary. But industry offers to sign up to binding obligations if the system is workable. And for the system to be workable, it really needs to have this free access to pathogens,” Cueni said. 

He added that, effectively, the position acknowledges a linkage between access and benefits sharing – one that industry long sought to avoid – but in a different kind of paradigm. 

“The two go together,” he admitted, “because countries want industry to sign up in terms of mandatory obligations in terms of sharing medical countermeasures, and industry is ready to do that – but states very firmly that, in able to develop the medical countermeasures, we need this access to happen.”

In-kind benefits not cash 

SARS-CoV-2: Pharma argues pathogens should be treated differently from other biological resources, enabling swift and unhindered sharing of genetic sequences.

But Cueni also flatly rejected proposals for what he described as a  “sales tax” on industry participation in the PABS system,  saying commitments to donated drugs and vaccines or their tiered pricing would be more effective. 

“We are not willing to be a cash card,” he stated. 

As an example of the precedent that industry doesn’t want to imitate, Cueni pointed to the fees assessed to pharma now for accessing flu pathogens, under the WHO Pandemic Influenza Preparedness framework.  

“There’s a lack of transparency, there’s a lack of accountability, and you are relying on 2024 contributions based on industry sales in 2009 – which somehow doesn’t make you trust that this would work in the future,” Cueni said.

Moreover, the system is so bureaucratically awkward that only 14 sample sharing agreements have actually been signed over the past decade, he asserts. 

In contrast, for the PABS to ever be workable, a much wider range of pathogen sample sources and data types (e.g. genetic data and not only biological samples) need to be in play – with the system allowing for very rapid and transparent sharing in the R&D community.  

And governance as well as operational costs should be shared by all of the system’s stakeholders – and with industry also having a seat at the table in the governance mechanism that is developed..

“We think that the only way to do this is as a partnership,” Cueni declared.  We’ll have WHO as a central player.. You will clearly have a majority of member states. But it shouldn’t be a closed process,” he said, noting that along with industry representations, research institutions, particularly pathogen data banks, might also play an important role.   

Precedent for this exists, he said, noting that The Global Fund, and Gavi, the Vaccine Alliance, also have industry on their boards as well as civil society advocates.  

Backing by leading pharma manufacturers 

Cueni pointed to a little-noticed IFPMA statement on 11 March, backed by a number of leading pharma manufacturers, as laying out key elements of the industry plan. Those firms included BMS (Bristol Myers Squibb), Gilead, Sanofi, Roche, Pfizer and MSD (Merck, Sharp & Dohme).

Key to the statement is a commitment to:  “reserve a percentage of real time production volume of a relevant therapeutic or vaccine for equitable distribution on the basis of public health risks, needs, and demand. 

“This could include a portion expected as a donation to LICs [lower-income countries] and/or a portion negotiated under equity-based tiered pricing with the lowest tiers dedicated to LICs and LMICs.”

Elaborating further on the offer to Health Policy Watch, Cueni said that industry’s binding obligations in the PABS should include the “flexibility to respond to the dynamics of any pandemic based on medical need. 

“Looking at COVID, I really emphasize the medical need point,” he said, noting that the initial hotspots for the pandemic were in Europe, notably Italy, but later followed by India, “quite a few Latin American countries, and then parts of Africa.” 

Pandemic Accord provisions on pathogens should supersede Nagoya Protocol 

The Convention on Biodiversity (CBD) aims to protect the world’s biodiversity, mostly found in developing countries. But the CBD’s Nagoya Protocol provision allowing countries to demand compensation in exchange for accessing pathogens can harm vital R&D into medicines and vaccines, pharma leaders argue.

Finally, Cueni argues that one key incentive for industry to sign up to the proposed PABS in any  pandemic agreement arrangement would be its potential to “override” pre-existing provisions around access to pathogens and benefit sharing  in Article 4 of the Nagoya Protocol of the Convention on Biodiversity (CBD). 

This could be established by designating the PABS a “Special International Instrument” (SII) that would thus automatically override the CBD’s protocols and, by inference, related national legislation. 

National rules established following the Nagoya Protocol’s ABS provisions have, at times, greatly slowed down the development of vital drugs at critical moments such as the 2016 Zika virus outbreak in Latin America, Cueni contends.

“The benefit of signing up is that you would have legal certainty of not violating Article 4 of the Nagoya Protocol,” he says. 

“And if this system would bring open and free access to pathogens, there would be multiple countries from the global north and south, sign up to it and have access to the network of certified labs in the world which shares data and allows you to work on prototype vaccines.”     

Political fallout likely

Designating the PABS as a Special International Instrument that supersedes the Nagoya Protocol is likely to be controversial among those LMICs  that have already set up national ABS systems for pathogens, Cueni admits. 

At the same time, he maintains that sharing the benefits outright of drugs developed from dangerous pathogens to those countries most in need, makes more sense than creating a new international financial model that, effectively, makes the trade in pathogens profitable. 

“The attempts to monetize pathogens scares me, because at the end, monetizing, which means ‘I share if you give me money’ … means pathogens could become a business model. You do not really want that,” he said, speaking at Wednesday’s press briefing. . 

“I’ve been involved in Switzerland in the ratification of CBD and the Nagoya Protocol. Everybody wants to protect the beauty and richness, diversity of biodiversity –  whether it’s the Amazon rainforest, or melting glaciers in Switzerland, or forests. 

“I’ve never met anybody who is arguing to protect the diversity of pathogens. Pathogens, you know, can be dangerous, they can cause pandemics, they can kill people, therefore, the notion of treating pathogens in the ABS… [in the model of] I gave you the information if you give me money doesn’t really make sense.”

Cueni’s comments on the perverse nature of the ABS business model were met with resistance from some civil society voices who see the trade-off as one way to correct the imbalance between wealthy pharma firms and poor countries.  It is in developing countries where pathogens like HIV, Ebola and mpox that originally circulated among wild animals first began their journey into human bodies and communities. 

“Open pathogens and closed IP isn’t fair,” said Oscar Lizarazo-Cortés, a professor at the Universidad Nacional Colombia. But not everyone sees it that way either. As Jamie Love, head of Knowledge Ecology International (KEI), one of the leading civil society advocating for more pharma IP sharing and transparency, said in another X post:

“I agree with Cueni.  

“If you protect pathogens (not exactly what is going  on in the text, but in general), you are protecting pathogens, at least in the sense that knowledge about the pathogens is not open.  You may want to justify that, but it is what it is,” Love added.

 

Image Credits: Fletcher/HPW, NIAID-RML , Lubasi.