A patient with age-related hearing loss (Presbycusis), receiving free treatment from the NGO, All Ears Cambodia.

Over 400 million people with hearing loss could benefit from hearing devices. However, less than 20% of those people actually get hearing aids. 

That’s one of the findings cited in new World Health Organisation guidelines on improving access to hearing care, published Friday, just ahead of World Hearing Day. 

“Unaddressed hearing loss is a global public health challenge and incurs an estimated cost of over US$ 1 trillion annually. Given the global shortage of ear and hearing care specialists, we have to rethink how we traditionally deliver services,” said Dr Bente Mikkelsen, director of the WHO’s Department for Noncommunicable Diseases.

By 2050, nearly 2.5 billion people are projected to experience a degree of hearing loss, as populations around the world age. More than 700 million will likely require hearing rehabilitation, estimates the WHO.

But nearly 80% of people with disabling hearing loss live in low-income countries – which historically have lacked capacity for providing assistive devices like hearing aids. 

Fighting misconceptions and lack of resources

But addressing hearing loss is not necessarily expensive. An investment of $1.4 per person annually would be sufficient to scale up ear and hearing care services worldwide, WHO said.

To overcome current limitations of capacity, the guidelines encourage more service delivery by non-specialists, based in primary health care settings. 

Debunking misconceptions and stigma around hearing loss is another key aim of the guidelines, created with the support of ATscale Global Partnership for Assistive Technology. 

“Common myths about hearing loss often prevent people from seeking the services they require, even where these services are available,” said Dr Shelly Chadha, technical lead for ear and hearing care at WHO. 

“Any effort to improve hearing care provision through health system strengthening must be accompanied by work to raise awareness within societies and address stigma related to ear and hearing care.”

Image Credits: WHO/Miguel Jeronimo.

WASHINGTON, DC – When US Senator Amy Klobuchar’s father, the late Jim Klobuchar, was diagnosed with Alzheimer’s disease, the noted Minnesota newspaper columnist gradually stopped recognizing her – although he retained “a kind of savoir faire” to the very end with words, jokes and storytelling based on the decades of “lines enmeshed in his memory,” she recalled.  

Senator Amy Klobuchar at an Alzheimer's disease event
Senator Amy Klobuchar (D-MN)

In the United States, one in every three seniors will be diagnosed with Alzheimer’s. The disease affects roughly 55 million people globally and is the seventh leading cause of death. 

“But it’s not just the numbers. It’s the fathers and mothers, it’s the brothers and sisters,” remarked Klobuchar, (D-MN), who recounted the story of her father’s illness at a high-level event here this week, organized by the Davos Alzheimer’s Collaborative (DAC) together with Scientific American. 

The meeting of the collaborative, a Swiss and US-based foundation launched at the World Economic Forum in 2021, brought together some 100 Alzheimer researchers and front-line clinicians as well as policymakers and industry and civil society advocates, to share progress on new innovations in diagnosing and treating the disease – as well as challenges faced in getting those same innovations into healthcare systems globally. 

But the event, co-hosted by Scientific American, also was marked by moments of personal reflections, both comic and tragic. Not only Klochubar, but other speakers in the room referred to their own experiences in dealing with family members with Alzheimer’s disease – what Senator Susan Collins (R-ME) termed “the defining disease” of her generation. 

Joining together across borders and cultures  

Older couple with Alzheimer's disease on a bench
Alzheimer’s is a growing issue worldwide as populations age

And while much of the attention around Alzheimer’s so far has been in the United States and other countries of the global north, the disease is a growing problem worldwide, as populations age and people live longer, but not always healthier lives. 

Researchers predict that lower and middle income countries will soon bear the brunt of Alzheimer’s disease – much as they already do with regards to other noncommunicable diseases. 

Worldwide projections of Alzheimer's prevalence
Alzheimer’s disease is projected to affect more than 100 million people globally 2050

And as in all disease research, a global approach can help identify new therapies more effectively and cost-efficiently.

“Rather than succumb to despair, what we’re doing is joining together across borders, cultures, and languages to chart a future for the world of prevention, effective treatment, and one day, a cure,” said Collins, who lost a brother to Alzheimer’s. Along with being vice-chair of the powerful Senate Appropriations Committee, Collins is also founder and co-chair of a Congressional Task Force on Alzheimer’s disease. 

George Vrandenburg davos alzheimer's collaborative
George Vradenburg, founding chairman of the Davos Alzheimer’s Collaborative

“I want to speak on behalf of families…50 million families worldwide are struggling with this disease.” said DAC chairman George Vradenburg, who first launched the initiative in response to a challenge by WEF founder and executive director Klaus Schwab.  He said that DAC was committed to “including researchers, clinicians and families in this fight globally, ensuring that no corner of the world is left untouched by our efforts.” 

Added Collins, “We need a global approach modeled on what we’ve done with AIDS, tuberculosis, and malaria. And we know that that kind of global collaborative approach to bring the research directly to a broader spectrum of countries and communities will remove long standing barriers to care and help us eliminate disparities.” 

“A transformative moment”: Novel diagnostic tests, gene sequencing, and precision medicine

Panelists discuss Alzheimer's disease research
Moderator Jeremy Abbate, VP and publisher of Scientific American with former NIH Director Dr. Elias Zerhouni, University of Washington’s Dr. Suzanne Schindler and Dr. Jeffrey Burns, University of Kansas Medical Center

Early Alzheimer’s disease research was rather akin to “staring up a cliff,” said former US National Institutes of Health (NIH) director Elias Zerhouni, one of the other speakers at the event. Now, however, the world has reached a turning point where, “we can truly have a global approach.”  

Improved genetic sequencing, the advent of digital and biological markers, novel drugs, and a more open mindset to alternative hypotheses have seen Alzheimer’s disease research leap into a new era. 

“We have an explosion of ways to test for Alzheimer’s disease,” remarked Suzanne Schindler, Associate Professor of Neurology at Washington University School of Medicine. Among them are blood tests that can measure up to 5,000 various proteins- a method faster and less invasive than dreaded spinal taps. 

Other panelists shared this optimism, citing the use of amyloid pet-scans and other diagnostics to more accurately assess Alzheimer’s progression in patients.  Genetic sequencing too is cheaper, a marked change since the early days when researchers remained in the dark about the potential genetic drivers of the disease.  

‘More than buildup of amyloid plaques’ 

Alzheimer's disease and tau proteins
One of the causes of Alzheimer’s appears to be the abnormal accumulation of tau proteins in the brain, eventually forming tangles inside neurons, seen here

With these tools comes an understanding that “the disease is more than just about build up [of amyloid plaques],” commented Jeffrey Burns, Professor of Neurology at University of Kansas Medical Center. 

New research into disease risk factors is moving beyond conventional descriptions of amyloid plaques and tau protein pathways to include research into inflammation and lifestyle factors. 

The future of prevention, he speculated, will increasingly lie in more holistic lifestyle approaches undertaken in tandem with medications. “We don’t just give patients with heart disease medication, we tell them to modify their diet, their lifestyle.

“I believe we will prevent the disease,” Burns added. 

Early Alzheimer’s detection remains a missing link

Panelists discuss aging and Alzheimer's disease at an event in DC
Phyllis Ferrell (center left,) Arindam Nandi, and Terry Fulmer discuss the implications of an aging society with Jeremy Abbate.

One major challenge is the need to move new knowledge into hospitals and health clinics; currently it can take as long 17-20 years for innovations to get into clinical practice due to outdated models of care. 

“We are building bullet trains, but running them on the same wooden tracks,” said Dr Phyllis Ferrell, DAC advisor on healthcare systems preparedness. 

Too often, practitioners still take a “wait and see” approach, while symptoms of cognitive impairment go unrecognized or undiagnosed until much later in the disease course. She urged a shift to a more preventative approach with screenings and help manage cognitive symptoms early.

“Why did it take four separate visits to get my dad an inconclusive diagnosis?” Ferrell asked.

“Early detection gives people the time to focus on what matters most to them,” she added. “It provides an opportunity to implement positive lifestyle changes and address risk factors, pursue treatment options and/or enroll in a clinical trial.”

Getting new innovations into practice 

Ferrell also bemoaned the frustration families feel over the lack of access to new diagnostics and therapeutics – in the wake of progress made in research. 

In 2010 the NIH funded Alzheimer’s disease research to the tune of $400 million annually. Fourteen years later, the annual investment is now close to $4 billion, she noted. 

Yet, despite this influx of funding for research, there’s a huge gap emerging in affordable and available drugs. 

“We have innovations that are ready, but are not being used,” she said, adding “Yes, to research, but we need to do things today. Let’s go after clinically ready innovations.”

Staying the course on research 

Senator Susan Collins (R-ME)- a leading champion in Congress for Alzheimer’s disease research.

At the same time, more research into the disease remains critical to find even more effective preventive strategies as well as possible cures.  This means building specimen repositories across the country, performing skin tests for early detection of Alzheimer-related protein abnormalities traditionally only detectable from brain biopsies, and other research. 

Zerhouni called it breaking the “taboo of the brain” – an area of human physiology where research was historically inadequate. “This is a frontier that has to be broken.”

For many years, such research was impeded by social taboos around Alzheimer’s disease. “People used to just call it senility,” said Collins, who has been the leading champion of Alzheimer’s research and action on Capitol Hill for over a decade. 

Collins last year initiated bipartisan legislation in the US Congress to help maintain the funding for Alzheimer’s research, as well as supporting initiatives to bring down the cost of new drugs in the US for Alzheimer patients. At $345 million billion a year, the disease is currently the most costly disease in the nation to treat, she says. 

A global economic burden 

Globally, Alzheimer’s disease also presents an enormous economic burden – costing the world’s economies some $1.3 trillion, in terms of medications as well as care – much of it unpaid, noted Population Council economist Arindam Nandi.  

In the past, economic data came mostly from high income countries, Now, data is available from lower and middle-income countries like India and China. 

“These data depict a worrying trend; the percentage of unpaid care is higher in these countries, meaning that caregivers are not able to get other jobs, decreasing economic output,’ he said. 

 

Nandi also mentioned that predictive models forecast the shifting burden of disease from high income countries to middle and low income countries. “We don’t know how these populations will fare.” Investments in these countries are needed to strengthen their overall public health measures. 

Meanwhile, the US and high income countries can learn from the experiences of low and middle income countries, which often are first to devise lower-costs methods for detecting and treating diseases.

DAC, for instance, funded an Early Detection Flagship program involving six countries, including the US, Scotland, Jamaica, Japan, Mexico and Brazil. They participated in a pilot designed to increase access to early detection and diagnosis of the disease through the use of innovative new screening tools. 

“One of the things I loved [about the Early Detection program]  was watching the US and high resource countries learn from LMICs,” Ferrell observed. “As the founder of the Brain and Mind Institute of Aga Khan University once said, ‘when it comes to Alzheimer’s disease we are all developing nations.’ “

Image Credits: Getty Images, Pixelmestudio/DAC, National Institutes on Aging , UCLA , S. Samantaroy/HPW.

Member states have been slow to implement WHO policies to address obesity, including taxes on sugary drinks and restrictions on marketing junk food to kids

The private sector “must be held accountable for the health impacts of their products”, warned the head of the World Health Organization (WHO) amid news that obesity has quadrupled in children and more than doubled in adults since 1990.

Dr Tedros Adhanom Ghebreyesus was speaking ahead of the release of a huge global obesity study involving over 220 million people from more than 190 countries published in The Lancet on Friday. 

“Getting back on track to meet the global targets for curbing obesity will take the work of governments and communities, supported by evidence-based policies from WHO and national public health agencies,” added Tedros.

Countries with highest obesity rates 2022

Tonga, American Samoa and Nauru have the world’s highest obesity rates, affecting some 60% of their adult populations. 

“The largest increases are in some countries in the Pacific, the Caribbean, the Middle East and North Africa, and some of the newly high income countries like Chile,” said senior author Professor Majid Ezzati, of Imperial College in London, at a media briefing on Thursday.

The US is the only high-income country that features in the ten worst affected countries – with the 10th highest obesity rate in men. Some 43.8% of US women and 41.6% of men were living with obesity in 2022.

Meanwhile, obesity is slowing in a handful of west European countries – notably Spain and France. However, countries with the lowest obesity rates are generally low-income countries with high rates of under-nutrition, with a few exceptions such as Japan and Viet Nam.

Countries with lowest obesity rates 2022

Huge rise in child obesity

In 1990, around 31 million children (2,1% of boys and 1.7% of girls) were obese. But 32 years later, there had been a fourfold increase in both boys (to 9,3%) and girls (6.9%) affecting almost 160 million children.

“It is very concerning that the epidemic of obesity that was evident amongst adults in much of the world in 1990 is now mirrored in school-aged children and adolescents,” said Ezzati.

Professor Majid Ezzati, of Imperial College in London

While boys are more likely to be obese than girls globally, this trend is reversed in adulthood with many more women than men living with obesity. 

But men seem to be catching up. Obesity in men has nearly tripled over the past 32 years, while it has doubled in women. 

“Different forms of malnutrition still coexist in many countries,” said Dr Francesco Branca, WHO Director of Nutrition and Food Safety and one of the co-authors of the study. 

“The child who was undernourished in the first years of life can later become overweight or obese as an adolescent or an adult. Undernutrition and obesity are two faces of the same problem, which is the lack of access to healthy diets.”

Greater risk of NCDs

Undernourished people are more susceptible to infectious diseases, while obesity can lead to Type 2 diabetes, heart disease, certain cancers and affect bone health and reproduction, added Branca, who was also addressing the briefing.

“The increase in the double burden of malnutrition is a result of a transition in food system and lifestyle that has not been governed by public health policies,” he added.

However, despite WHO guidelines on what countries can do to address the massive rise in consumption of energy-dense ultra-processed food, adoption by member states has been slow.

At the World Health Assembly in 2022, member states adopted the WHO Acceleration plan to stop obesity. Core interventions include promoting breastfeeding,  regulating marketing of ultra-processed food and drinks to kids, taxation and warning labels on foods high in fats, salt and sugar.

Dr Francesco Branca, WHO Director of Nutrition and Food Safety

“The reason why the epidemic has progressed so quickly is because the policy action has not been incisive enough,” said Branca, adding that countries had focused on behaviour change rather than “structural elements, which is the policies around food environment”. 

However, he added that more countries were taxing sugary drinks, although “not many countries have done it for sufficiently long time and in ways that are demonstrated to be most effective”. 

“Very few countries put a restriction on marketing food to children. We know that some South American countries are taking that action much more effectively, and we look forward seeing the impact of those policies,[as well as] having warning signs on the processed food which would really discourage people from f buying products which are high in salt, sugar and fat”.

If these policies were implemented, this would likely lead to food and beverage companies reformulating their products to reduce harmful ingredients, he added.

Role of new weight-loss pills?

Branca said that the WHO was currently looking at the efficacy of the new drugs called glucagon-like peptide 1 (GLP-1) agonists – such as Wegovy, Ozempic – which have been approved as weight-loss medication in some countries.

“The solution is still is a transformation of the food system and in the environment such obesity can be prevented,” Branca stressed.

However, the GLP-1 drugs could provide a tool to help those that already live with obesity, as long as they were integrated into a primary healthcare package to manage obesity that included guidance on exercise and diet.

The new study was conducted by the NCD Risk Factor Collaboration (NCD-RisC), in collaboration with the World Health Organization (WHO), and involved over 1,500 researchers. They based their analysis on body mass index (BMI). Adults with BMI 30kg/m2 and over were classified as obese and underweight if their BMI was below 18.5kg/m2. For children, BMI was adjusted according to age. .

Image Credits: World Obesity Federation.

Covid-19 pandemic
Thousands of small white flags representing Americans who have died from COVID-19, outside the DC Armory in Washington DC.

The overall benefits of COVID-19 vaccines far outweigh potential risks, according to a recent study of 99 million vaccinated people – despite a number of misleading and sensational reports about the study. 

The study, published in the journal Vaccine in mid-February, aimed to get more precise estimates of the risk of adverse events following vaccination.

Researchers used data collected from over 99 million vaccinated individuals, who took a total of 183 million Pfizer doses, 36 million Moderna doses and 23 million AstraZeneca doses. 

The study specifically noted a slightly elevated risk of myocarditis (inflammation of the heart muscle) and pericarditis (inflammation of the lining around the heart) following Pfizer and Moderna mRNA vaccines, and Guillain-Barré syndrome and cerebral venous sinus thrombosis (blood clot in the brain) after taking the AstraZeneca shot. 

“The risk of side effects like myocarditis from the vaccine is extremely low; the risk of developing it from COVID can be many times higher. The study is just reinforcing what we already learnt from previous studies,” stressed Professor Nadav Davidovitch, an epidemiologist, public health physician and head of Ben-Gurion University of the Negev’s School of Public Health. 

Rare adverse events

“Anytime a medicine or a vaccine is approved and introduced into wider use, rare adverse events are found in the population that would be impossible to find in clinical trials,” Prof Katrine Wallace, an epidemiologist at the School of Public Health at the University of Illinois at Chicago, told  Health Policy Watch.

COVID-19 vaccines were globally introduced in 2020, just a year after the virus emerged. The swift rollout prompted intense monitoring, surpassing most other vaccines or drugs. 

“The study methodology examined the observed versus expected ratios: observed post-vaccination rates from a pre-specified list of adverse events to the expected rates, or the historical, background rate of the same events calculated from the same populations during 2015-2019, before the vaccines were available,” Wallace explained in a recent op-ed on MedPage Today. 

This observational study looked at 13 adverse events of particular interest across neurological, haematological and cardiac outcomes and found four statistically relevant ones. 

Guillain-Barré syndrome occurred after the first dose of AstraZeneca’s viral vector vaccine. The observed to expected (OE) ratio was 2.49.

Cerebral venous sinus thrombosis, also known as TTS blood clots, happened after the first AstraZeneca dose, with an OE ratio of 3.23.

Acute disseminated encephalomyelitis occurred after the first dose of Moderna’s mRNA vaccine (OE 3.78). However, this wasn’t found in a more thorough follow-up study by the same group.

Myocarditis and pericarditis happened after Pfizer and Moderna’s mRNA vaccines, as well as AstraZeneca’s viral vector vaccine. (OE of slightly over 1.5).

The data was taken from 10 sites across eight countries and processed by researchers from the Global Vaccine Data Network, and the US Centers for Disease Control and Prevention (CDC) funded the study. 

Wallace told Health Policy Watch that myocarditis and pericarditis were more common in young males aged 15 to 24 after the second vaccine dose. However, any myocarditis or pericarditis that did happen was typically mild and resolved independently without requiring extensive treatment like that needed for COVID-induced cases, she added.

One-in-a-million

Cerebral venous sinus thrombosis was linked to the viral vector vaccines AstraZeneca in this study and Johnson & Johnson in various other studies. Wallace noted that in the United States, approximately six cases were attributed to the J&J vaccine early on. When these cases, mainly affecting older women, were identified, the vaccine was deprioritized, indicating the effectiveness of the monitoring system.

“Many people who don’t understand vaccine safety surveillance think this information was hidden or the trials were not long enough,” Wallace said. “If something is one-in-a-million, you would need a million people in a clinical trial to find one case. We only find rare events after rollout.”

There is no vaccine or medical treatment with no risk, explained both Wallace and Davidovitch.

“The bottom line is that no medication or vaccine is 100% effective or 100% safe,” Wallace said. “Everything has risks and benefits. However, any risks from medications and vaccines must be balanced against the dangers of the disease you are trying to prevent.”

She added that “COVID-19 has killed over a million people in the US and has led to permanent disability in many others. The vaccines are very safe overall, and the benefit of the vaccine still definitely outweighs the risks.”

Booster Vaccines for Seniors

On Wednesday, the CDC recommended that adults over 65 receive an updated COVID-19 vaccine shot after previously recommending boosters for people who are immunocompromised. 

The CDC statement highlighted that individuals aged 65 and older are particularly affected by COVID-19. It reported that over half of the COVID-19 hospitalizations from October 2023 to December 2023 involved people in this age bracket.

The CDC “recommendation allows older adults to receive an additional dose of this season’s COVID-19 vaccine to provide added protection,” said CDC Director Mandy Cohen. “Most COVID-19 deaths and hospitalizations last year were among people 65 years and older. An additional vaccine dose can provide added protection that may have decreased over time for those at highest risk.”

“We are now dealing with the JN.1 COVID strain, which is very infectious,” Davidovitch said. “We still need to be cautious.”

Image Credits: Ron Cogswell.

Ghana’s parliament passes a draconian anti-LGBTIQ Bill.

Ghana’s Parliament unanimously passed one of the world’s most draconian anti-LGBTIQ Bills on Wednesday, including a mandatory three-year prison sentence for a person who simply “identifies” as lesbian, gay, bisexual, transgender, intersex or queer.

Anyone funding an LGBTIQ organisation also faces five years in prison, while LGBTIQ “advocacy” involving children will result in a 10-year prison sentence – a clause that is so wide it could be applied to sex education in schools.

Any media that reports or broadcasts anything related to LGBTQ+ people or activities also face fines and possible prison sentences.

People who allow same-sex “activity” on properties they “own, occupy or manage”  face six years in prison.

Ghana’s Human Sexual Rights and Family Values Act also prohibits LGBTIQ+ groups, criminalises anyone advocating for these groups and obliges citizens to report “perceived homosexuals or homosexual activity” to the police or community leaders. It also outlaws sex toys

In many ways a copycat of Uganda’s Anti-Homosexuality Act, the MPs behind laws in both countries have been fêted at meetings organised by US far-right Christians, particularly Family Watch International (FWI).

Mostly recently, the MPs met at a meeting in Entebbe in last April at the African Inter-Parliamentary Conference on Family Values and Sovereignty, where they discussed laws to “protect family values”.

Ghana’s Bill, which was championed by MP Sam George as a Private Member’s Bill, will become law only once it has been signed by Ghanaian President Nana Akufo-Addo.

Earlier in the week, a group of Ghanaian lawyers known as the “Big 18” and Human Rights Coalition wrote to the president urging him not to sign the Bill into law as it “violates key fundamental human rights provisions in Ghana’s 1992 Constitution” by infringing on “rights to dignity, freedom of speech, freedom of association, participation in processions, academic freedom, equality, and non-discrimination”.

“Rights are the pillars upon which democracy rests to prevent the tyranny of the majority,” they added.

Noting that Ghana is a secular democratic country, they state that any attempt to criminalise what some regard as a sin through the instrumentality of the state violates the long-standing principle of separation between church and state.

Meanwhile, UNAIDS executive director Winnie Byanyima warned that if the Bill becomes a law “it will exacerbate fear and hatred, could incite violence against fellow Ghanaian citizens, and will negatively impact on free speech, freedom of movement and freedom of association”.

Byanyima added that it “will obstruct access to life-saving services, undercut social protection, and jeopardize Ghana’s development success.Evidence shows that punitive laws like this Bill are a barrier to ending AIDS, and ultimately undermine everyone’s health.”

MPs claim that they introduced the Bill after an LGBTQ office was opened in Accra in January 2021, and have dared developed nations to impose sanctions. 

After Uganda passed its Anti-Homosexuality Act last year, the World Bank suspended new loans and the US halted some HIV-related aid to the government.

This boy  gets vaccinated against measles during a WHO vaccination drive.

Outbreaks of measles have affected parts of the United States, coinciding with the lowest child immunisation rates the country has seen in 10 years, according to a report from the Centers for Disease Control and Prevention (CDC).

By 22 February, 35 measles cases had been reported by 15 states, namely Arizona, California, Florida, Georgia, Indiana, Louisiana, Maryland, Minnesota, Missouri, New Jersey, New York City, Ohio, Pennsylvania, Virginia, and Washington, according to the CDC.

However, unlike other parts of the world where measles is rife because immunisation programmes have been disrupted by conflict or weak health systems, the drop in child immunisation in the US is parent-driven. 

In 2023, the highest number of parents filed for their children to be exempted from school vaccination requirements. Immunisation with the measles, mumps, and rubella vaccine (MMR) dropped in 29 states in 2023, while exemptions increased in 40 states and DC, with 10 states reporting an exemption from at least one vaccine for more than 5% of kindergartners, according to the CDC.

The CDC reported that its childhood immunisation rate for all three required childhood vaccines – MMR, polio and diphtheria, tetanus, and acellular pertussis vaccine (DTaP) – is 93%, whereas the threshold for herd immunity is generally regarded as 95%. 

“National MMR coverage among kindergarten students remained below the Healthy People 2030 target of 95% for the third consecutive year,” according to the CDC. Idaho reported the lowest rate (81.3%) and Mississippi, the highest (98%).

“National MMR coverage of 93.1% during the 2022–23 school year translates to approximately 250,000 kindergartners who are at risk for measles infection.”

Most contagious disease

Measles is one of the world’s most contagious diseases, spread by droplets from infected people coughing or sneezing.

“The virus remains active and contagious in the air or on infected surfaces for up to two hours. For this reason, it is very infectious, and one person infected by measles can infect nine out of 10 of their unvaccinated close contacts,” according to the World Health Organization (WHO).

Most deaths from measles are from complications related to the disease, including encephalitis, severe diarrhoea and pneumonia.

It also has a long incubation period, which is why there has been controversy over Florida’s Surgeon General Dr Joseph Ladapo’s decision to allow the parents of unvaccinated children to ignore the CDC’s advice that they should quarantine for 21 days.

Europe has also seen an increase in cases: “Last year, more than 58 000 people in 41 of the 53 member states in the region – straddling Europe and central Asia – were infected with measles, resulting in thousands of hospitalisations and 10 measles-related deaths,” according to WHO Europe.

“The high proportion (nearly half) of cases among children below five years of age reflects, once again, the enormous impact of the COVID-19 pandemic on health systems, including routine immunisation services. This has resulted in a significant accumulation of susceptible children who have missed their routine vaccinations against measles and other vaccine-preventable diseases.”

“Vaccination is the only way to protect children from this potentially dangerous disease. Urgent vaccination efforts are needed to halt transmission and prevent further spread,” explained Dr Hans Henri P.Kluge, WHO Regional Director for Europe.

Image Credits: WHO.

Several hundred representatives of WHO member states, UN agencies and civil society meet in Copenhagen on the intersection of humanitarian crises and non-communicable diseases

COPENHAGEN –  While conflict and natural disasters are usually played out in the media against dramatic scenes of mass casualty response and rescue teams, there’s an iceberg of chronic health conditions that can be even more life threatening and these need far greater attention in emergency response. 

That is the theme of a global high level meeting here this week – which aims to raise the profile of non-communicable diseases (NCDs) in humanitarian settings.

The health officials from most of WHO’s 194 member states, as well as UN non-governmental organizations and relief agencies, convenes as the world faces more humanitarian crises as a result of conflict, climate change and natural disasters, than almost anytime in the last half century. 

The past 10 years has seen a three-fold increase in displaced people – some 117 million people in total as compared to about 40 million only ten years ago, said Sajjad Malik, of the UN High Commission on Refugees (UNHCR) which co-organized the meeting along with WHO. 

More emergencies and displaced people than ever before

In 2023, WHO responded to 63 health emergencies worldwide, up from an average of 40 a year a decade earlier. This includes both acute as well as protracted crises in settings ranging from the massive earthquake that hit Türkiye and Syria in early 2023, to grinding wars in Ukraine, Sudan, and most recently, Gaza.  

At the same time, some 70% of premature deaths [before age 70] are attributable to chronic diseases including diabetes, cardiovascular and lung diseases and cancer, and most of these deaths occur in low- and middle-income countries. 

 “We are facing a tsunami of NCDs,”  declared Dr Faras Hawari, Minister of Health of Jordan, which is co-hosting the meeting together with Denmark. 

People living with NCDs are among the first victims of all disasters

WHO Health Emergencies Executive Director Mike Ryan (left); Dr Bente Mikkelsen, WHO Director of NCDs (seated).

“We are living in a perma-crisis of emergencies and tensions. They also blur  the artificial distinctions that we tend to make between communicable diseases and non communicable disease, between one country and another,” said WHO’s European Regional Director, Hans Kluge, also speaking Tuesday. 

What few may realize, however, is that people living with NCDs are typically “among the first victims of all disasters,” Kluge added later at a press briefing. “They are at increased risk during emergencies. For example, the incidence of stroke and heart attack are up to three times the normal levels.” 

Traditionally, health sector response to humanitarian emergencies was designed to deliver  “surgical teams and mass casualty management, epidemic prevention, response and immunization campaigns,” remarked WHO’s Executive Director of Health Emergencies, Mike Ryan.

“But what we don’t see is the iceberg of mortality that occurs because people lose access to those long term services that keep people alive and well,” Ryan said. 

Recalling scenes from the early days of Russia’s invasion of Ukraine, Kluge described meeting with “elderly women with heart problems, diabetes, typically which can be managed. But all of a sudden these management conditions become life threatening.”

Calls for Gaza cease/fire continued UNRWA funding 

Dr Feras Hawari, Jordan’s Minister of Health.

The conference takes place as conflicts in Sudan, Gaza and elsewhere continue to create acute disruptions to health services and systems, upon which chronic care, as well as acute disease and injury management, depend. 

“There are about 13,000 cancer patients in Gaza and only about 2000 have been able to get therapy or treatment.  At this point it’s very complex, and difficult to manage these patients,” said Hanan Balkhi, director of WHO’s Eastern Mediterranean region, which covers an arc of  North African and Middle Eastern countries from Libya to Afghanistan, including Israeli-occupied Palestinian territories. 

“We continue to witness in real time one of the most devastating humanitarian crises of the century,” said Hawari, of the Gaza crisis. 

He and Ryan repeated previous calls for an urgent ceasefire, as well as for continued funding for the UN Refugee Works Agency (UNRWA), which they described as a critical backbone of Gaza’s health system.  

“We need to support an immediate end of this bloodshed and allow the entry of humanitarian and medical teams,” Hawari said of the Gaza situation.  

Al-Aqsa Hospital in central Gaza in January.

“Over half of all public health care in Gaza is delivered directly by UNRWA,” asserted Ryan. “Over 1.3 primary health consultations have been delivered by UNRWA since October 7. And they are intimately involved in the delivery of non-communicable disease care, all across Gaza and beyond.”  

UNRWA has faced a crisis of confidence amongst key donors in the wake of Israeli allegations that some employees joined the Hamas forces that led the 7 October invasion of some two dozen Israeli civilian communities, killing over 1200 people. Days afterward, Israel invaded the tiny enclave in a bitter war with Hamas that has now led to the deaths of nearly 30,000 Palestinians. 

Ryan added: “Since the beginning of the conflict and October 7th, and despite the horror of what has befallen the Israeli people in the barbaric attacks on civilians, the reality is that the catastrophe that has unfolded in Gaza must stop,” he concluded, to a round of applause. 

Eastern Mediterranean region is hotbed of crises 

Hanan Balkhy, Director of WHO’s Eastern Mediterranean Region (left) and Jérome Salomon, WHO Assistant Director General NCDs.

“The conflict in Gaza stands as one of the most challenging crises in modern history,” added Balkhy, who took up her post as EMRO regional director a few weeks ago.   

“The conflict has depleted an already under resourced health systems. Thousands were killed or injured and over 1.6 million displaced, including 350,000 people living with chronic conditions.”

But Gaza is not alone. Throughout the eastern Mediterranean region, conflict-related crises abound, and so do NCDs.

“The Eastern Mediterranean region is home to 745 million people. Of those, 140 million require humanitarian assistance. That is almost one in every five people. The region is the source of 58% of the world’s refugees, and 33.7 million people have been forcibly displaced among its 22 countries and territories – 13 are directly or indirectly affected by conflict; nine are classified by the World Bank as fragile state state situations,” Balkhy said.  

“Regionally, two-thirds of annual deaths are attributable to NCDs. The likelihood of premature deaths due to NCDs range from 17.8% in non-fragile or complex affected settings to 25% in fragile and conflict-affected contexts.  Cases of heart attack or stroke, asthma might double or even triple in frequency immediately after a disaster.

Identifying technical bottlenecks to ensure access is important, but only one dimension of a multi-pronged challenge. For instance, the region’s political and economic fragility makes it much more difficult to develop and maintain a robust health workforce, she observed, saying: “Health worker retention is extremely complex. It’s like a sieve with big holes.”

Sudan – from reform to collapse

Dispersion of Sudanese refugees around Africa

“Before the war, Sudan was undergoing robust health system reform,” Balkhy added, citing the other great regional hotspot. “However, after 10 months of conflict, the health system is reaching collapse. Over 7 million people remain displaced, while  1.7 million people are seeking refuge in neighboring countries. 

“The conflict has led to over 13,000 deaths and 26,000 injuries. Around 9,000 haemodialysis patients including 240 children, face severe risks due to service disruptions and 4,500 kidney transplant patients require uninterrupted treatment.  Since April 15 WHO has verified 60 attacks on health care leading to 34 deaths and 38 injuries among the health workforce. 

“Attacks on health care include attacks on health facilities, transport personnel, patients, supplies, and warehouses. Refugees and migrants face barriers to accessing health care especially for the management of NCDs during protracted crises.”

 NCD kits and local solutions  

Display of NCD Kits at along with a listing of essential medicines and equipment that they contain.

Despite growing awareness of the need for addressing NCDs in the health emergencies context, ”there remains a considerable journey head to fully integrate NCDs into the [WHO] Health Emergency and Response agenda,” Balkhy said.  

One successful approach has involved the development of NCD kits containing a pre-packaged set of basic healthcare supplies for treating diabetes, cardiovascular issues and strokes. So far these have been distributed in humanitarian settings in 28 countries around the world, Ryan noted. 

But standardized solutions also fall short, stressed Kluge, “We need local solutions for local challenges. In Ukraine, we started dispensers for medicines where health facilities were destroyed. In Turkiye, it was mobile health teams. 

“Each context is unique,” added Ryan. “If you go to a village in the Ukraine, it will be a very different age and disease profile than a refugee camp in Uganda.”

Additionally,  finding  “sustainable resources” to add NCD solutions to packages of humanitarian health care remains the other big  challenge, particularly in light of the burgeoning number of such crises.  While some donor countries, such as Denmark,  continue to make very significant contributions to crisis response, available funds falls far short of the swelling needs, Ryan said. 

Health worker retention and attack  

A severely injured patient is evacuated from Gaza’s Nasser Hospital – healthworkers continue to perform at risk to their lives.

And kits of equipment and medicine are not enough on their own, Ryan stressed, 

Taking diabetes as one example, Ryan explained that preserving the cold chain so as to get  insulin to a crisis zone is only the first step in a much more complex process.  

“It’s not just the insulin,” he said. “It’s the care package that goes around the insulin. It’s the knowledge of the health worker for dosing, it’s the self-testing of the sugar levels. 

“We are doing that right now in Gaza, the advantage that we have despite the huge degradation of the system, we still have health workers who go to work every day. 

However, health workers in some parts of the world, including Gaza, Ukraine and Sudan also face daily threats, just as a result of showing up to work.    

“We don’t have the protection for the health workforce in the field,” said Ryan. “Health is under attack in a way that it has never been before. Our health system has become a target and we have to  stop it.” 

In terms of NCDs, as such, this week’s meeting aims to muster a “coalition of the willing”, in the words of Ryan, as part of the lead up to the fourth high-level UN General Assembly meeting on NCDs, set for 2025. 

“We affirm our commitment to reducing the burden of NCDs in humanitarian settings and strengthening our emergency response at all levels, do joint efforts and leveraging our collective expertise,” Balkhy concluded.

“But at  times the solutions have less to do with medicine.. It has to do with diplomacy,” she added. “Once again, we do need peace.” 

Image Credits: Abdulsalam Jarroud/TNH, E. Fletcher/Health Policy Watch , Democracynow.org, UNHCR, WHO EMRO.

West Virginia National Guard’s Task Force Chemical, Biological, Radiological and Nuclear (CBRN) Response Enterprise (assist staff, medical personnel, and first responders of an Eastbrook Center nursing home with COVID-19 testing in April 2020.

As pressure intensifies on World Health Organization (WHO) member states to finalise a pandemic agreement by May, insiders are concerned by the snails’ pace of negotiations – primarily because they believe the negotiators have spent an inordinate amount of time on contentious issues while neglecting more procedural issues.

After two years of negotiations, the eighth meeting of the intergovernmental negotiating body’s (INB) entered its seventh day on Tuesday with a number of key discussions still confined to sub-groups rather being presented as text proposals because of disagreements.

A joint meeting between the INB and the Working Group on Amendments to the International Health Regulations (WGIHR) last Friday provided a rare public glimpse into the slow pace of talks. 

The WGIHR is updating the IHR, world’s only binding agreement on public health emergencies with pandemic potential, as these were found wanting during COVID-19 – and some of their work overlaps with the INB. 

The joint meeting was aimed at ironing out how the overlapping areas would be addressed – yet the Bureaux of both groups ended up withdrawing two of their four process proposals because of lack of agreement. 

Some influential outside groups have hosted private meetings with negotiators in an attempt to break the impasse and ensure that the next pandemic is guided by equitable access to vaccines and medicines not the COVID-era vaccine nationalism.

Most recently, the International Peace Institute and the Permanent Mission of Costa Rica in Geneva hosted a retreat for some INB negotiators over the past weekend. But it is too early to tell whether this has resulted in any positive results.

No obligation to ‘right to health’

INB co-chair Precious Matsoso and Pandemic Action Network’s Aggrey Aluso at last week’s civil society hearings.

Meanwhile, voices outside the process have been growing louder with important interventions from civil society and scientists in the past week.

The Pandemic Action Network hosted two short sessions in Geneva last week for civil society to express their views on the draft directly to INB members. Over 100 organisations stepped up to do so – although the first session was marred by a handful of vocal anti-vaxxers opposed to the WHO.

While some civil society organisations used their two-minute slots to lament their exclusion from negotiations, some important interventions were made. These include the draft agreement’s narrow definition of “vulnerable people”, no obligation on countries to ensure citizens’ right to health or human rights monitoring during pandemics, and the potential for national laws to neutralise any pandemic agreement. 

Meanwhile, a group of 290 scientists from 36 countries warned that unless a pathogen access and benefit-sharing (PABS) system is agreed on – currently Article 12 – there will be no vaccine equity in the next pandemic.

At this stage, the INB Bureau has been unable to provide text for an updated Article 12 because of disagreements.

Benefits for information-sharing

“Across all fields, scientists from the global north have frequently extracted data and samples from the global south without the permission of the people there, without collaborating meaningfully — if at all — with local scientists, and without providing any benefit to the countries where they conduct their work,” according to to nine key scientists leading the group in a commentary in Nature.

The group recommends that the negotiations “take lessons” from the 2011 Pandemic Influenza Preparedness (PIP) Framework “to streamline the sharing of influenza viruses with pandemic potential, as well as vaccines and other benefits”.

“Under the PIP Framework, 14 manufacturers have promised that when the next influenza pandemic starts, they will share up to 10% of the vaccines that they make (around 420 million doses) with the WHO. In exchange, these companies have access to a global network of laboratories and their flu samples. The PIP model shows significant promise, but is so far untested and applies only to influenza.”

The scientists propose that under the proposed PABS system, scientists would share pathogen samples and data. In exchange for access to these, manufacturers of vaccines or therapeutics would give at least 20% of their products to the WHO (half for free, and half at affordable prices). 

“If Article 12 is weakened or dismantled, it will be a monumental setback for global health justice – and for the global scientific community,” they warn.

“Although today’s scientific community has embraced the ideals of open data sharing, the world is no closer to a fair system for sharing vaccines and therapeutics. Intellectual property, not benefit-sharing, is the antithesis of open science.”

INB8 ends on Friday afternoon, with the ninth meeting scheduled for 18-29 March. However, a further meeting is likely after this given the slow pace.

Image Credits: U.S. Army National Guard/Edwin L. Wriston.

UNEP executive director Inger Andersen at UNEA-6

The sixth United Nations Environment Assembly (UNEA-6), which opened in the Kenyan capital of Nairobi on Monday, is focusing on multilateral action to tackle climate change, biodiversity loss and pollution.

Around a million species are headed towards extinction, global temperature records were smashed in 2023 and pollution remains one of the world’s leading causes of premature death.

“It is time to lay political differences aside and focus on this little blue planet, teeming with life. Time to lift our sights to our common goal: a pathway to a sustainable and safe future,” said Inger Andersen, Executive Director of UN Environment Programme (UNEP). “We do this by agreeing on the resolutions before UNEA-6 to boost multilateral action for today and tomorrow, and secure intergenerational justice and equity.”

The assembly, the world’s highest-level decision-making body on the environment,  will consider some 19 resolutions on issues including pesticides, land degradation and drought, the environmental aspects of minerals and metals, and, support to the Global South to mitigate to the triple crisis.

“We are living in a time of turmoil. And I know that in this room, there are people who are, or who know, those deeply affected by this turmoil. Our response must demonstrate that multilateral diplomacy can deliver,” said Leila Benali, president of UNEA-6 and Morocco’s Minister of Energy Transition and Sustainable Development. 

“As we meet here in 2024, we must be self-critical and work towards inclusive, networked and effective multilateralism that can make a tangible difference to people’s lives,” she told the record-breaking 7000 delegates from all 193 UN member states at the start of the assembly.

 

 

“We must also include voices beyond government, of youth, indigenous peoples and local communities, by focusing on issues of gender and human rights, and leaving no one behind,” Benali added.

“It is time to lay political differences aside and focus on this little blue planet, teeming with life. Time to lift our sights to our common goal: a pathway to a sustainable and safe future,” said Inger Andersen, Executive Director of UNEP. “We do this by agreeing on the resolutions before UNEA-6 to boost multilateral action for today and tomorrow, and secure intergenerational justice and equity.”

 “UNEA-6 comes at a time when the world is also called upon to accelerate the implementation of the UN 2030 Agenda if we are to stay course on sustainable development. Unfortunately, for millions in the developing regions of the world, including here in Africa, poverty still remains a daily reality while economic inequality is increasing globally,” said Soipan Tuya, Kenya’s Cabinet Secretary for the Environment, Climate Change and Forestry. 

“It is against this backdrop that the world will be looking to us here in Nairobi this week to renew hope. And hope we must provide.”

UNEP is advocating for nature-based solutions and ecosystem-based approaches to meet Social Development Goals. The organisation is working with governments and organisations that are looking at projects ranging from afforestation to river revivals.

The Assembly is set to have more than 30 official side-events and associated events, ending on 1 March.

Image Credits: X.

Dr Jackline Kisota (centre) and colleagues involved in making eco-friendly sanitary towels.

After Kenya banned plastic bags back in 2018, an academic’s quest for alternative packaging has led to the development of eco-friendly sanitary towels.

Dr Jackline Kisota wants her product to empower young girls while also conserving the environment she told the launch last October, which was graced by potential investors and UN representatives.

According to the Kenyatta University academic, her product is expected to favourably compete with products already on the market in terms of cost, health impact and environmental concerns.

In 2018, the Kenyan government banned single-use plastic bags to align with climate change mitigation protocols, and this caused difficulties for shops and market vendors who did not know how to package their goods for sale.

Kisato’s venture started out as a project to find a commercial use for banana stems, which were considered useless by farmers and would usually be left to rot away on farms. 

‘’I started looking at this project from an entrepreneurship point of view, on how I could commercialise banana stem fibres. The government had just banned single use plastic bags and market vendors needed alternatives to serve their customers,’’ Kisato said.

Period poverty

But Kisato had already noted the struggles that some university students had to access sanitary towels, but it was not until she started her banana stem fibre project did she realise that she could tackle the girls’ plight. 

‘’While walking along the hallways one day, a student on campus stopped me and asked if I could help her with a packet of sanitary pads. This incident shocked me as, for a long time, I had assumed ‘period poverty’ was only experienced amongst high school girls,’’ Kisato said.

‘’My research also found that poorly disposed sanitary towels also formed part of the pollution problem since they were composed of plastic,’’ she explained.

Kisato applied to the Kenyan National Research Fund (NRF) in 2018 for help to develop eco-friendly plastic bags and sanitary towels, and in 2020 the NRF granted Kenyatta University $61,625  for the project with Kisota as principal investigator.

Her research team is made up of scholars from different departments and institutions, including PHD and Masters students.

Engineering

‘’I lead a team of engineers from the Kenya Industrial Research and Development Institute (KIRDI), whose task is to reverse engineer machines that can extract fibre from banana stems and use them to create eco-friendly packaging material and sanitary towels,’’ she said. 

“I also have researchers from Moi University whose work was to turn the extracted fibre into soft materials for use.”

The project also interviewed 400 high school girls from low-income areas of Gatundu, Kibera and Kawangware where they found out that more than half the girls in these areas could hardly afford sanitary pads.

Kisato’s research also found that, due to affordability and limited access, African girls used each  sanitary towel for longer than girls from developed countries, and were thus at greater risk of getting bacterial infection.

‘’The recommended period for one to have on a sanitary pad is about three hours, which means that it should be changed at least three times a day to avoid any risk of infections. This is, however, not the case for many girls in Africa due to poverty,’’ Kisato explained.

‘’We decided that adding anti-microbial properties to our product would make it as good or even better than what was in the market,’’ said Kisato.

Menstrual myths

The research team also found out that there was a lot of myth surrounding menstrual flow amongst young girls, a fact that led to a lot of stigmatizations which made it difficult for them to properly understand how to use sanitary towels.

Some of the notable ideas that the young girls told each other concerning menstrual flow including that it is a curse from God, girls who had periods were considered dirty and impure and their faces would become pale from losing blood.

‘’These are beliefs that need to be done away with by encouraging parents and the government to openly speak about monthly periods with young girls,’’ Kisato said.

These substances have been extracted from banana stems to make eco-friendly sanitary towels

‘’The sanitary towels in the market have a component in them called hydrogel which enables them to retain fluids for longer and are also lined with plastic sheets to prevent any leakage. Our intention is to replicate the same but use bioplastic materials which can degrade as opposed to the normal plastic that is being used’’.

To ensure this, they sought the expertise of Edwin Madivoli, a chemistry lecturer at the Jomo Kenyatta University of Agriculture and Technology (JKUAT).

‘’My role is to ensure our sanitary pads are of the same quality as what is in the market while maintaining an eco-friendly nature, which is the main agenda of this whole project,’’ Madivoli said.

‘’I am tasked with the development of bioplastic hydrogel and finding a way to incorporate anti-microbial properties into our products to protect the users from possible infections,’’ he added.

‘’As they are left to dry up on the farms, banana stems are known to produce large amounts of methane which is a harmful greenhouse gas that contributes to the climate change problems that we are trying to tackle, added Madivoli. ‘’Having an alternative use for the stems therefore limits the greenhouse effect in the atmosphere.’’

Madivoli said that most banana farmers usually do not know what to do with the stems once they have done their harvest and this project gives them a way to earn some extra income as they expect to buy the stems from them at 25 cents per stem.

‘’This project will not only be environmentally friendly but will also create jobs for the people who go to cut the stems from the farms while also finding use for the biomass that the farmers thought was useless,’’ he concluded.

The Research Scholarship and Innovation Fund (RSIF) has contributed $56,250 to enable Madivoli’s research, while the Kenya National Innovation Agency (KENIA) has made a $5000 contribution.

Eco-friendly packaging

Stephany Musombi, one of Kisato’s students who specialises in textiles, has been tasked with coming up with quality packaging materials.

‘’Apart from the banana fibre, I am also experimenting with other biomass such as pineapple and seaweed,’’ Musombi said. If I can find a way to make this work, the project will open up a market for seaweed and pineapple biomass.

Once it is up and running, they intend to source banana stems from counties such as Kisii, Muranga, Embu, Meru and parts of western Kenya.

Kisato expects her product to hit the market this October, where she plans to make it more affordable for all. Her intention is to team up with startups or established companies that deal with toiletries.

‘’The cheapest sanitary packet in the market costs Ksh 140 ($1). We expect ours to go as low as Ksh100 (70 cents),” Kisato concluded. 

Kisato’s products are currently awaiting the approval by the Kenya Bureau of Standards (KEBS) before they can finally start mass production.

Kenyatta University’s Vice Chancellor, Paul Wainaina, lauded the project stating that it will enable the country to meet its industrial needs while conserving the environment.