Civil society observers Yassen Tcholakov, MSF’s YuanQiong Hu, and KEI’s Thiru Balasubramaniam and Jamie Love outside the negotiating room

GENEVA – There were claps and cheers from inside Room XXVI of the UN’s Palais des Nations as World Health Organization (WHO) member states finally agreed on amendments to the International Health Regulations (IHR) after over two years of negotiations.

After failing to reach an agreement on the amendments before Monday’s start of the World Health Assembly (WHA), member states agreed to try to race to the finish during this week.

A drafting committee has been in intensive talks ever since, and its co-chair, Dr Ashley Bloomfield, told Health Policy Watch on Saturday that he had barely slept for the past few  days.

The IHR is a legally binding international instrument aimed at preventing the international spread of disease, and require countries to conduct surveillance for potential international health threats of all kinds and report those to WHO.

The COVID-19 pandemic showed weaknesses in the IHR, including that it did not mention “pandemic”. Member states submitted over 300 proposed amendments to the Working Group on Amendments to the IHR (WGIHR), chaired by New Zealand’s Bloomfield and Dr Abdullah Asiri of Saudi Arabia.

When parallel negotiations on a new pandemic agreement sailed into heavy water, there was a risk that the IHR amendments might become a casualty in the bargaining process – particularly from African member states pursuing equitable access to health products in the pandemic agreement.

They fear that the powerful Western countries pushing for the IHR to be passed – the US, European Union, Japan and the UK – will be less inclined to continue negotiating in good faith on the pandemic agreement once the IHR amendments have been passed. 

It is much harder for wealthy nations to buy into an agreement that involves compelling pharmaceutical companies to share their products – and the know-how about to make these – with companies and countries in the global south.

At the time of publication, the WHO still had to outline the process to conclude the pandemic agreement negotiations, but this is expected before the WHA closes at midnight on Saturday.

The fight against malaria is facing a new and urgent challenge as climate change and extreme weather events threaten to undermine decades of progress, according to warnings from several countries at the 77th World Health Assembly this week.

“Recent extreme weather events such as flooding in Malawi and other countries have intensified malaria transmission, disproportionately affecting vulnerable populations,” Dr. Tedros Adhanom Ghebreyesus, the director-general of the World Health Organization, told the assembly on Thursday.

France, a leader in the fight against malaria, expressed concern over the lack of funding for malaria response and called for integrating anti-malaria efforts into national health plans, emphasizing that the need for funding has become more urgent as climate change is “increasingly impacting health systems and making them more fragile.”

“We wish to highlight the importance of the One Health approach and the key role of community health workers in local surveillance and awareness of malaria,” the delegation said.

The introduction of new malaria-causing parasite species due to climate change is also putting populations at risk, particularly transitory migrant groups, Costa Rica warned. “We believe it’s essential for international bodies to take these variables into account when allocating resources, both for dealing with public health problems and regional and extra-regional migration,” the country’s delegation said.

Colombia echoed those concerns, noting that “rapidly changing ecosystems are increasing vulnerability and giving rise to new malaria transmission dynamics,” a problem compounded by “increasing migration patterns.”

Eliminating Malaria

Despite the challenges, several countries, including Egypt, Ecuador and Malawi, renewed their commitment to eliminating the disease. Papua New Guinea said partnerships had been crucial to its malaria control initiatives, which focus on prevention, diagnosis, treatment and community engagement.

Malawi is implementing a plan to eliminate malaria by 2030, while Cabo Verde recently became malaria-free, joining just 43 countries worldwide to achieve the milestone and be recognized with this certification by the WHO.

The WHO is adopting a multi-faceted strategy to fight malaria, including new guidelines for countries to prioritize interventions in resource-limited settings and a focus on emerging threats like drug resistance, Dr. Jérôme Salomon, the organization’s assistant director-general for universal health coverage, communicable and non-communicable diseases, said Thursday.

Salomon, reflecting on the achievements of malaria-free countries, stated that key strategies to accelerate progress include introducing new tools like a malaria vaccine and ensuring wider access to existing ones.

“Recent extreme weather events such as flooding in Malawi and other countries have intensified malaria transmission, disproportionately affecting vulnerable populations,” Salomon said, emphasizing the urgency of addressing climate change through proactive mitigation, adaptation, and research.

Investments in primary health care are fundamental, he added, as are efforts to address various factors impacting malaria transmission, including inequities, conflicts, migration, the Covid-19 pandemic and climate change.

Although new tools are becoming available to fight malaria, several challenges are limiting their use, especially in Africa, said a representative from Chad, speaking on behalf of the 47 member states of the WHO’s African region. Chief among them, the delegate said, are shortfalls in funding.

In a joint statement, African countries pressed for greater political commitment and self-reliance in the fight against malaria, appealing for more predictable international aid that aligns with their national policies.

Sudan stressed the importance of tackling security issues to enable far-reaching malaria interventions, while Guinea urged partners to keep supporting immunization efforts and help end repeated malaria outbreaks.

Image Credits: WHO.

Rüdiger Krech, Director of Health Promotion at WHO showing examples of nicotine products with toy-like designs created to attract children.

The tobacco industry is deliberately targeting children with nicotine products, using targeted marketing to lure the younger generation into smoking while publicly promoting e-cigarettes as a less harmful alternative for smokers, according to a new report by the World Health Organization (WHO) and STOP, a tobacco industry watchdog.

The report, released ahead of World No-Tobacco Day on May 31, analyzes ways in which tobacco and nicotine companies design products, implement digital marketing campaigns, and shape policy environments to help them addict youth globally.

“The industry is peddling a narrative that denies or underplays youth addiction,” Jorge Alday, Director of STOP at Vital Strategies, told Health Policy Watch. “If we don’t establish a comprehensive approach and work across agencies, the industry will exploit any loophole or any new opportunity to reach young audiences.”

The report accuses the tobacco industry of targeting children and young people with over 16,000 e-cigarette flavours, employing colourful branding, influencer partnerships, and innovative digital marketing tactics, including the Metaverse.

“The Metaverse could eventually become a virtual shop window like physical or e-commerce stores,” Alday told Health Policy Watch about how the tobacco industry is using new digital forms of marketing.

The tobacco industry is attempting to “replace tobacco users lost to death and disease with a fresh wave of users trapped in addiction,” said Rüdiger Krech, WHO’s Director of Health Promotion, during the report’s launch press conference.

“We see tobacco products taking the shape of chocolates and sweets, candy, taking the form of toys,” Given Kapolyo, the global youth ambassador of the year and an anti-tobacco activist, told reporters. “They’re going out of their way to ensure that they make this product seem very cool.”

The tobacco industry bombards youth with branding, Kapolyo added, targeting areas close to schools, along routes used by young people, and in the digital space.

“These industries are actively targeting schools, children and young people with new products that are essentially a candy-flavoured trap,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General, commenting on the youth-targeting strategies of tobacco firms. “How can they talk about harm reduction when they are marketing these dangerous, highly addictive products to children?”

Fewer smokers, more vapes

Christian Lindmeier, WHO’s Spokesperson and Rüdiger Krech, Director of WHO Health Promotion during a press conference launching a report on tobacco firms targeting children in their marketing

While the global number of smokers is declining, with one in five adults smoking in 2020 compared to one in three in 2000, eight million people still die annually because of tobacco use.

The number of e-cigarette users, meanwhile, is growing, especially among the youngest generation. Globally, 37 million children aged 13–15 years use tobacco, and in many countries, vaping is more popular than traditional cigarettes among adolescents. In the WHO European Region, one in five 15-year-olds surveyed reported using e-cigarettes in the past month.

The tobacco industry often frames vaping as a way to reduce the harmful health effects of carcinogenic substances present in cigarettes, but research shows e-cigarette use actually increases conventional cigarette use nearly three times, according to the WHO.

The US Food and Drug Administration says that nicotine-mimicking substances used in vapes to avoid product regulation can be even more addictive than normal nicotine, Reuters reported.

Curbing the industry’s influence

Introducing tobacco taxes in New Zealand successfully lowered the cigarette consumption, also among the youth

Controlling marketing strategies, including digital ones, is an important way to limit tobacco firms’ influence on youth, the report’s authors said.

“How we define terms like advertising, promotion and sponsorship set the stage for what can be regulated now and in the future. This means that regulators should update rules to cover any and all platforms – physical and virtual,” Alday told Health Policy Watch.

Alday cited the recent example of Nigeria, which announced new regulations that will require health warnings for films that contain tobacco imagery. The regulation covers movies, music videos and skits produced in Nollywood, one of the world’s biggest movie industries, Alday said.

The WHO recommends not only a ban on marketing, advertising, and promotion but also creating 100% smoke-free indoor public places, banning flavoured e-cigarettes, and imposing higher taxes, among other strategies.

The latter strategy has shown significant results, as Vital Strategies’ Jeffrey Drope, co-author of the Tobacco Atlas, demonstrated during the State of Tobacco Control press briefing on May 21.

“Raising taxes [is] arguably the most effective and most straightforward solution,” said Drope. With higher prices, “young people don’t start to use tobacco products [and] people who already smoke or use tobacco stop, or cut down.”

New Zealand’s tax policy effectively drove down youth smoking prevalence as prices doubled between 2009 and 2019. It was also able to make a step towards bridging societal gaps between the general and Maori smoking populations.

The UK’s total ban on cigarettes for people born after 2009 is another example of an ambitious health policy, aiming to gradually raise the minimum age required for buying cigarettes until eventually, they become illegal. The regulation law passed its second reading in April, but has been postponed until after the general elections, BBC reported.  The bill has support from the opposition Labour party, a likely winner of the vote, which gives it much chance to be passed in the next term.

“This really has an enormous effect on consumption,” Drope said.

In their closing remarks, speakers at the press conference emphasized the essential role of youth leaders in shaping the future of global tobacco consumption and policy. “Youth leaders have a key role to play in communicating their reality to policymakers, that use of nicotine products is growing rapidly and these products are harming youth, now,” Alday told Health Policy Watch.

“What young people have is … they have each other,” Kapolyo added. “When young voices unite, even governments listen.”

Gavi, the Vaccine Alliance, addresses countries at the 77th World Health Assembly.

At the 77th World Health Assembly, Gavi, The Vaccine Alliance, urged nations to prioritize vaccinating “zero-dose” children, particularly those in regions affected by humanitarian crises and complex emergencies. These children have not received any shots, putting them at a higher risk of preventable diseases.

“We are scaling up routine immunization and reaching the estimated 14.3 million zero-dose children worldwide, recognizing that most polio cases are in subnational areas with the highest proportion of unvaccinated and under-vaccinated children,” Gavi representatives told the assembly.

Gavi’s 2021-2025 strategy focuses on reaching zero-dose children and missed communities who have not received any vaccinations. The organization aims to reduce the number of zero-dose children by 25% by 2025 and by 50% by 2030.

The World Health Organization reported a decline in the number of zero-dose children from 18.1 million in 2021 to 14.3 million in 2022, nearing the pre-pandemic level of 12.9 million in 2019. The percentage of children receiving their first dose of the measles vaccine increased from 81% in 2021 to 83% in 2022, still falling short of the 86% achieved in 2019.

During Committee A’s discussion on poliomyelitis, Gavi called on member states to integrate polio funding into existing national health systems to promote and accelerate essential polio and broader immunization functions.

Progress and challenges in the Eastern Mediterranean

Dr Hanan Balkhy, WHO Regional Director for the Eastern Mediterranean, highlighted the region’s progress in ending poliovirus transmission but noted that the poliovirus persists in mobile, border, and migrant populations.

“To end polio, we must reach all children, keep strengthening surveillance, address community resistance and disinformation, and continue leveraging polio resources as we build a resilient health workforce across our region,” Balkhy said.

Iraq and Libya have taken full financial responsibility for sustaining polio essential functions, demonstrating what can be achieved when countries commit to transition. In Yemen, the WHO is negotiating with northern authorities to stop outbreaks of polio and other vaccine-preventable diseases this year.

Global efforts and country commitments

Australia pledged $43.5 million to bolster the Polio Eradication Strategy (2022-2026), underscoring the urgency to ramp up efforts to halt vaccine-derived transmission and concentrate on critical regions. The nation also backed routine immunization, emphasizing the importance of partnering with WHO, UNICEF, and Gavi to expedite advancements in achieving the Immunization Agenda 2030 objectives.

Countries spanning the globe, from Sudan and Chad to Guinea, Senegal, Pakistan, India, the Philippines, Kenya, Bangladesh, and Morocco, shared their initiatives, obstacles, and advancements in the fight against polio. All stressed the importance of integrated strategies, community involvement, targeting zero-dose children, and fortifying immunization systems.

African member states, having ended the wild poliovirus outbreak, remain uneasy about polio’s persistent status as a public health emergency of international concern. avi noted that “the 47 countries remain concerned by the ongoing transmission of circulatory poliovirus and by the low level of vaccination in areas that are difficult to access.” Vaccine supply problems and financial limitations were partly to blame for the type two poliomyelitis outbreaks.

African nations have started transition planning for poliomyelitis and post-certification activities, prioritizing indicators for monitoring and evaluation to uphold program quality. However, unstable health systems, coupled with political and economic challenges, may slow down several countries in the region from assuming complete technical and financial responsibility for all polio eradication functions.

United for Self-Care Coalition hosts a WHA side-event in Geneva.
United for Self-Care Coalition hosts a WHA side-event in Geneva.

Costa Rica’s and Malawi’s ministers of health, along with global health and policy experts, gathered in Geneva to discuss self-care.

At an event organized by the Global Self-Care Federation (GSCF), participants advocated for a World Health Organization (WHO) resolution on self-care. Costa Rica, Egypt, and Malawi, the three countries that co-hosted the event, are working to elevate self-care.

Ministerial representatives from Guatemala, Belize, Panama and El Salvador were also in attendance.

“The potentials for self-care are enormous,” Iain Chapple, Professor of Periodontology at the University of Birmingham and one of the summit’s panelists, told Health Policy Watch. However, he said the approach “needs to be multidimensional,” with collaboration from different fields.

“We need self-care embedded in public health policy,” said GSCF Director-General, Judy Stenmark. She explained that a WHO resolution “could lead to meaningful policy change” and cost-savings for healthcare systems.

“We want to save time and money for individuals, healthcare professionals and healthcare systems, and we have the evidence and data that demonstrates that self-care can do all that,” Stenmark said.

According to a policy brief published by the United for Self-Care Coalition, implementing self-care protocols can generate as much as $119 billion annually in savings for health systems.

The WHO estimates that there will be a global shortage of 18 million health workers by 2030. In 2022, WHO said at least 400 million people worldwide lacked access to the most essential health services. The organization put self-care among “the most promising and exciting approaches to improve health and well-being.”

One key aspect of the conversation this week was making self-care accessible to all. Every year, 100 million people are plunged into poverty because of high healthcare expenses, WHO has said.

“A comprehensive approach to self-care should encompass cultural sensitivities, holistic practices and community engagement,” said Wendy Olayiwola, president of the Nigerian Nurses Association UK and Professional Midwifery Advocate.

Self-care can complement other public health services by being integrated into general health coverage plans, especially for people who “fall through the cracks” of the system, said Dr Manjulaa Narasimhan, WHO’s Sexual and Reproductive Health and Research Unit head.

She said that making menstrual products more available across different contexts is a powerful example of self-care implementation.

“Self-care is about how people lead their lives and can care for themselves,” Narasimhan said.

Dr Mary Munive Angermüller, Vice President of Costa Rica and Minister of Health added: “Self-care is not an individual action, it requires a confluence of different circumstances from health literacy to public health policy, in order to realise its potential.”

Putting People at the Center

Another “concrete” benefit of self-care is that “patients take an active role in their health,” said another summit panelist, Ellos Lodzeni, Chair of the International Alliance of Patients’ Organisation. He said patients also make more informed decisions.

“When we put people in the center of healthcare, self-care is inherent,” added Narasimhan.

A big focus of the Global Self-Care Federation’s efforts is education.

Educating people about ways to take care of their health and new tools that can help them with it brings many advantages, said Chapple, who spoke with Health Policy Watch.

Moreover, Narasimhan said that education about where to find accurate health information is essential. She said that sometimes people can find false information online, for example. She said it would be better to provide “good education on self-care, starting from the very beginning.” This means across the life course from the prenatal stage to older adulthood.

Benefits of Self-Care

Various benefits of improved self-care enumerated in the WHO guidelines
Various benefits of improved self-care enumerated in the WHO guidelines

“Self-care can also be discussed in the context of health insurance,” said Dr Mariam Jashi, Chair of the Eastern Europe and Central Asia chapters of UNITE, an international consortium of present and ex-parliamentarians.

She spoke to Health Policy Watch. She said she sees much potential for policy-making regarding health coverage and prevention as essential components of self-care. Screening, for instance, for breast cancer, is “a classic example of self-care. It makes it possible to identify potentially deadly diseases with timely detection [and] increase the chance of survival and quality of life.”

Yet Jashi said we need to agree, “specifically on the international level,” about defining self-care. The summit was an excellent start, Jashi said, “but more work is needed for better framing.”

To find out more about self-care and the work of the United Self-Care Coalition, visit www.unitedforselfcare.org.

Image Credits: Zuzanna Stawiska, World Health Organization.

Palestine’s delegate, Ryad Awaja, a counsellor in Geneva’s UN Mission, applauded as he moves to a seat for member states at final WHA Plenary Saturday evening after Friday’s vote to elevate Palestine’s status to that of a member state – except for voting rights.

Palestine moved close to full recognition by WHO on Friday evening- with the broad approval of a World Health Assembly resolution that gives the Ramallah-based Palestinian Authority, which has limited governing authority in parts of the Israeli-occupied West Bank, all the rights of WHO member states – short of the vote.

The resolution, on “aligning Palestine” status in the WHO with its newly elevated status in the UN General Assembly, was approved Friday by a vote of 101 in favor, five against and 21 abstaining.  

The vote signified an important diplomatic victory for the Ramallah, West Bank-based Palestinian National Authority – which holds the official reins of internationally-recognized Palestinian institutions.  Until now, the Palestinian delegation had been attending WHA as “observers” by special invitation of the WHO Director General Dr Tedros Adhanom Ghebreyesus. The same status  was held by Taiwan until 2016- when WHO ceased issuing invitations under pressure from Beijing. 

The PNA has been progressively marginalised over the past two decades by a succession of hardline Israeli governments as well as by its Hamas rivals in Gaza –  which expelled its leadership in 2007 and launched the bloody invasion of Israel on 7 October 2023, triggering Israel’s devastating invasion of Gaza. The PNA’s ageing political leadership also hasn’t held elections in the West Bank for over a decade. 

Paradoxically, the vote to enhance Palestine’s status also came on a day which began with the appointment of Israel to a new three-year term at the WHO Executive Board – following its nomination by WHO member states of the European Region. Despite protests, bitter critics and rival member states in the Health Assembly agreed to go with protocol and let the decision stand. 

Friday’s WHA – framed by the Gaza crisis and Israeli-Palestinian conflict

WHA member states raising their name plates in the air in a show of “ayes” for expanding Palestine’s membership rights

And this all happened in a day at the WHA that was bookended by over 10 hours of debate over two different resolutions, including four competing amendments, on the humanitarian crisis in Gaza. 

One motion co-sponsored by a coalition of Algeria, Russia, China, Cuba, Iran, Egypt and other regional allies, slammed the “wanton destruction” of Gaza’s health and other infrastructure by Israel.  But the final version also carried an Israeli-backed amendment calling for the Hamas release of some 121 hostages still in captivity, and condemning Hamas militarization of Gazan health facilities.

A second resolution approved by consensus in December at a special meeting of WHO’s 34-member Executive Board, including EU countries and the United States, called for a “humanitarian ceasefire”, using more neutral language but without any mention of the hostages. 

Both measures ultimately passed with large majorities – but also with a raft of abstentions as well as objections on all sides of the deeply divided WHA member state body.  

Applause upon expanded role 

Egypt says vote by WHA member states on expanded rights for Palestine places them at the “right side of history.”

The expansion of Palestine’s role in the WHO, won a round of applause by WHA member states, with countries such as Egypt saying that the WHA had stood on the “right side of history.”

The Palestinian Ambassador to the UN in Geneva, Ibrahim Khraishi, pledged to “cooperate and work alongside WHO, whose role we highly value… even [working] with those who say that Palestine doesn’t have the right to vote.”

He was referring to the risk that any bolder move by WHO member states to grant full rights could also jeopardise funding from the United States. In 2011, a Republican-controlled Congress cut off financial support to UNESCO, after the UN body recognised Palestine as a member with full voting rights. The US left the UN Educational, Scientific and Cultural Organization altogether in 2017, under the administration of former President Donald Trump, which accused it of anti-Israel bias.

Although the US committed to rejoin the Paris-based organization in June 2023, WHO’s leadership would be wary of teasing fate on the issue, given the Republican majority in the US House of Representatives and an uncertain horizon for Democrats in the looming November US elections. WHO also needs to raise some $11.1 billion more in donor funds from member states for its four-year budget plan – part of which will have to be recruited from the US and allies.

Bitter Israeli-Palestinian exchange during the vote

Israel’s Ambassador Meirav Eilon Shahar says Palestinians have failed to show leadership.

At Friday’s vote, the United States opposed the WHA move to enhance Palestine’s status right now, saying that while it supports the eventual creation of a Palestinian state alongside Israel, Palestine’s aspirations for statehood can only be realized as a result of negotiations – rather than unilateral moves.

Meanwhile, Israel’s Ambassador, Meirav Eilon Shahar, deplored the WHO move, saying that PNA had failed to offer “a true alternative” to Hamas, which rejects Israel’s right to exist.      

“What the Palestinian people need is leadership,” Shahar declared. “Leadership means educating your children for peace instead of indoctrinating them to hate…investing and not rewarding them for martyrdom. 

“Not a single Palestinian leader has condemned the October 7 massacre, not the slaughter of families, the sexual violence, the mutilation and torture by Hamas. We have yet to hear the Palestinian delegation question why Hamas builds terror tunnels instead of building a future for Palestinian children,” she said. “The Palestinian delegation and all those who support this today will pat themselves on the back for this World Health Assembly decision.” 

“But in reality, until the Palestinian leadership offers their people a true alternative, rather than supporting Hamas, a symbolic gesture in this UN Forum will do little to better the lives of Palestinians.” 

‘Don’t give us lessons in ethics’ 

Palestinian Ambassador Ibrahim Khairshi at the WHA vote expanding Palestinian rights in the WHO

Khraishi retorted that Israel “should stop giving us lessons in ethics… seeing the way in which they [Israelis] educate their children…

“We’ve seen with our own eyes the violations perpetrated by Israeli settlers. These things have been clearly documented and shown in the media,” he said, referring to the recent, sharp increase in attacks by extremist Israelis on Palestinians – particularly Orthodox Jewish settler youths in the West Bank.  

The Ambassador added that he was also perplexed by the United States’ position that Palestinian statehood could only be achieved through negotiations. 

“I am also perplexed with regard to the position with regard to the two-state solution that can only be through negotiation,” Khraishi said. 

“As we know we are now approaching the Fourth of July of 1776, when the US was able to get his independence without having negotiated with the occupier, with the colonial state. 

“This is an inalienable right and an absolute right for us when we are faced with genocide, for us to be able to exercise our right to self-determination. 

“And we are calling for cooperation. We are against this viciousness that is being perpetrated by the State of Israel and their supporters -where they are trying to disfigure the image of the Palestinian people. We are the indigenous people of this land, before even all religions, and we shall remain there. And soon enough we will celebrate with you [WHO] the end of this vicious and brutal occupation.”

Wellcome Trust CEO John-Arne Røttingen and Africa CDC executive director Dr Jean Kaseya

GENEVA – For two years, the family of a soldier in the DRC army could not trace him until they discovered that he had been imprisoned – not for doing anything wrong but because he had a mental illness.

“When we speak of disorders, we forget these affect human beings. People who need to be in hospital should not end up in prison,” said the soldier’s brother, Dr Jean Kaseya, the executive director of Africa Centres for Disease Control and Prevention (Africa CDC).

Kaseya spoke at the launch of an African mental health leadership programme to establish a cohort of mental health advocates across the continent, held on the sidelines of the World Health Assembly in Geneva this week. Supported by Wellcome Trust, the goal of the initiative is to train leaders in the health sector to understand and address mental health “through a public health and human rights lens”.

Although the program cannot help Kaseya’s brother, who died soon after his family found him in 2020, it hopes to benefit some of the estimated 120 million Africans struggling with mental health.

Mental health is the stepchild of health programmes on the African continent, receiving just 2% of health budgets. This neglect is reflected in the significantly lower annual outpatient mental health visits in Africa, with only 14 per 100,000 people, compared to the global average of 1,051 per 100,000.

The result of this lack of investment is a vast shortage of mental health workers – 1.4 for every 100,000 people compared to the global average of 9 per 100,000.

Burkina Faso, for example, has only 12 psychologists.

Outdated policies

Cabo Verde Health Minister Filomena Gonçalves

“Mental health policies in Africa are mostly outdated and poorly implemented,” Kaseya told the launch, attended by several African health ministers including those from Burkina Faso, Burundi and Cabo Verde.

“This programme will create a cohort of leaders who understand and can advocate for context-specific, evidence-based approaches to mental health in their countries,” said Wellcome Trust CEO John-Arne Røttingen.

Wellcome’s mental health programme, which has funded numerous African mental health research projects and initiatives, concentrates on anxiety, depression, and psychosis. Røttingen stressed that an integrated approach, with scientists working hand-in-hand with policymakers, is essential to ensure research addresses the right questions and breakthroughs are implemented when tackling these conditions.

“That’s why we are so excited to be working with Africa CDC on this programme,” Røttingen said. 

Cross-sectoral, human rights approach

The World Health Organization’s (WHO) Mark van Ommeren told the launch that effectively addressing mental health required cross-sectoral collaboration across different departments.

Addressing suicide, he explained, means engaging with the Department of Justice for gun control and Agriculture to restrict access to hazardous pesticides that are banned in many countries but still available on the continent, and education to ensure young people have life skills to cope with life challenges.

David Bainbridge and Michael Njenga from CBM Global

David Bainbridge, the executive director of CBM Global, an international organisation that advocates for the involvement of people with disabilities, said the programme could “make a significant impact not only on the wide treatment gap in access to mental health services but also to apply good public health practice to reduce the drivers of mental health conditions and the negative impact on well being.”

“We underscore the need to take a human rights approach to mental health which means that, in addition to the personal suffering that results from experience of mental health symptoms, we’re particularly concerned about the experiences of stigma, social exclusion and abuse experienced by people affected. You’re often denied access to basic rights like family life, livelihoods, even personal autonomy and freedom,” explained Bainbridge.

Michael Njenga, the Africa co-ordinator for CBM Global, said the inclusion of people with lived experience of mental illness in policy making was critical for successful implementation.

Some countries barred those with mental illness from voting or standing for office, while Kenya classified a suicide attempt as a “misdemeanour”, added Njenga.

The closing panel of the Diagnostics Day. From left to right: Dr Sanjay Sarin
Access division Vice-President, FIND, Dr Fatim Cham-Jallow Technical Advice and Partnerships Department at The Global Fund, Renuka Gadde, Senior Advisor of the Clinton Health Access Initiative, Dr Daniel Townsend, Global Fund Advocates Network and Jan Willem Scheijgrond of the Global Diagnostic Imaging Healthcare IT and Radiation Therapy Trade Association

A new generation of portable molecular testing devices unveiled by the global non-profit FIND on Thursday has achieved accuracy levels previously only attainable in lab testing, a potential game-changer for healthcare in regions with limited access to clinics. 

These compact devices can test for multiple diseases using cartridges that analyze tissue, blood, or other bodily fluid samples to detect the presence of molecules characteristic of a particular illness. The devices can perform tests like the polymerase chain reaction (PCR) test, used for diagnosing COVID-19, influenza, HIV, and Ebola. 

“With these innovations, it’s not necessarily the patients that need to go to the clinic,” said Sara Fröjdö, Senior Technology Officer at FIND. “It’s testing that goes to the patients.”

With shortened development times that cut PCR test times from 60-90 minutes to just 15-30 minutes, patients could receive their results during the same consultation, Fröjdö added.

”All of that is made possible, and still with maintained performance, Fröjdö said. “You can really diagnose the patients where they are, not just screen to then send them to a hospital,” 

While these innovations offer convenience for healthcare systems with a dense network of local facilities, they have the potential to revolutionize access to lab-quality testing in rural regions. In 2020, nearly 9% of the global population lived more than an hour away from their closest healthcare centre by motorized transport, according to Nature Medicine. When considering on-foot travel time, this number skyrockets to 3.16 billion, or 43.3% of the world’s population.

Distance to the nearest healthcare facility with access to a motorised vehicle. Gaps in accessible healthcare clearly visible in many remote areas.

However, the technology still faces hurdles to being truly accessible. Commute time is only one of the many barriers to healthcare access, with others including difficulties in securing transportation and lengthy waiting periods before seeing a doctor.

Affordability remains a key challenge. Test cartridges cost approximately €100, with an additional €5-6 per test. FIND scientists say they are carefully designing cartridges to balance affordability, reliability, and ease of use in remote areas.

Manufacturers  must also address cold chain limitations, which hindered low- and middle-income countries’ access to mRNA vaccines favored by wealthy nations.

“[You need] to ensure you don’t end up having a small device that can be really useful in an outreach setting but you need to store it in -20°C,” Ms. Fröjdö said.

Shortened development times also contribute to the cost-effectiveness of this new technology, as the cost per patient decreases when a large number of tests are conducted.

“The product becomes n-times more efficient,” said Jan Willem Scheijgrond from the Global Diagnostic Imaging Healthcare IT and Radiation Therapy Trade Association. “The cost per patient drops suddenly by 90%.”

While the upgraded cartridges are being used in several countries, including the United States, India, and China, manufacturers are looking to extend their reach to serve a larger number of patients and a larger market.

“It’s difficult to put ‘a small lab’ inside, but also be mindful of keeping the price affordable in low- and middle-income countries,” Fröjdö said.

WHO is advocating for improving access to Universal Healthcare to improve maternal and child health.

The World Health Organization’s 77th World Health Assembly passed a resolution on Wednesday calling on countries to bolster maternal and child health by expanding universal healthcare and strengthening primary healthcare, as progress in reducing maternal and child deaths has stagnated globally.

The resolution, led by Somalia, commits countries to tackle the leading causes of maternal and child deaths, particularly in the hardest-hit nations. They agreed to improve access to maternal, sexual, reproductive and comprehensive child health services through stronger primary healthcare and expand access to emergency services, including urgent obstetric care and units for small and sick newborns.

“The political will has been expressed, now the focus must be on implementation by countries and the technical support WHO provides in the context of universal health coverage,” said Dr. Flavia Bustreo, Governance and Ethical Committee Chair at PMNCH, a global alliance for women’s, children’s and adolescents’ rights. “We cannot accept preventable and treatable causes claiming women’s lives.”

Maternal mortality rates stagnated in 131 countries and increased in 17 between 2016 and 2020, putting over 80% of nations on track to miss the Sustainable Development Goals’ target of reducing maternal deaths to under 70 per 100,000 live births by 2030. Gains in newborn and child survival have also slowed.

To meet the Sustainable Development Goals, the world must accelerate progress on reducing maternal mortality by a staggering nine times and slash newborn and under-five mortality by a factor of four, according to the WHO.  

“Prioritizing women’s and children’s health is crucial. This requires increased leadership, commitment and investment in all levels of maternal, neonatal, child and adolescent health. To accelerate progress future strategies to address inequality ensuring no one is left behind,” said a representative for Saima Wazed, WHO Regional Director for South-East Asia, during the discussions.

What the countries have agreed to do

The WHA resolution marks the WHO’s first significant action on maternal mortality in nearly a decade, following the adoption of the Global Strategy for Women’s, Children’s and Adolescents’ Health in 2015. The resolution emphasizes the need for well-stocked facilities, trained health workers, safe water and sanitation, and comprehensive sexual and reproductive healthcare services.

Discussions before the vote focused on improving care quality, leveraging technology and strengthening primary healthcare. The UK highlighted the need to address adolescent pregnancies, unsafe abortions and the growing impact of climate change.

“Political leadership is critical to accelerate progress on maternal, newborn and child health,” said Margot Nauleau, Health and Nutrition Senior Advocacy Advisor from Save the Children. “Now we need to see this resolution translated into action at national and local levels with increased investments and effective interventions to improve health outcomes for women and children,” she added.

WHO’s new resolution commits to tackling the leading causes of maternal and child deaths.

China makes progress, quality of care a concern for India

The global effort to reduce maternal mortality is marked by wide disparities, with some countries making significant progress while others struggle to keep pace. China, recently surpassed by India as the world’s most populous nation, has already met the 2030 Sustainable Development Goals (SDG) targets for maternal mortality.

“Since 2009, China has been providing systematic care to all pregnant women and newborns. In 2023, China’s maternal mortality decreased to 15.1 per 100,000,” a Chinese representative said.

India, despite reducing its maternal mortality ratio (MMR) from 130 in 2015-16 to 97 per 100,000 live births, remains far from the SDG targets. Given India’s population size, its progress significantly impacts global figures. The country maintained at the WHA that it is on track, but the quality of care remains poor, particularly for women from rural, impoverished, and marginalized communities.

African countries, which bear a disproportionate burden of maternal deaths, highlighted the challenges of improving care amidst humanitarian crises.

“Maternal mortality is especially high in fragile, conflict-affected, and vulnerable settings,” said the Ethiopian representative whose country co-sponsored the resolution. She noted that Africa’s maternal mortality ratio remains the highest worldwide, accounting for roughly 66% of maternal deaths in 2020.

Humanitarian crises and increasingly frequent extreme weather events tied to climate change are pushing fragile health systems to the brink, and taking a heavy toll on maternal and child health globally as a result, according to the WHO. Despite the challenges, African nations reaffirmed their commitment to improving maternal health.

“This is an absolute priority for our government. Senegal is committed to addressing more causes of neonatal, child, and maternal mortality,” the country’s representative said. “We’ve strengthened our health system to deal with this issue, and we need accountability to achieve these goals.”

Additional inputs from Elaine Ruth Fletcher

Image Credits: Twitter, Twitter.

A woman carries supplies through a flooded street in Haiti.

GENEVA – A resolution aimed at strengthening countries’ capacity to deal with “natural hazards” faced unexpected opposition over gender-related terminology at the World Health Assembly (WHA) on Thursday.

This is despite the urgency of countries adapting their health services to address extreme weather events, which are becoming more common globally thanks to climate change.

The resolution, proposed by 50 countries from all regions, sought to ensure that countries can provide essential health services, including primary healthcare, surgical and anaesthesia services, sexual and reproductive health, and gender-based violence services, during and after natural disasters.

It also urged the WHO Director-General to provide technical guidance and support to member states, upon request, to “strengthen sustainable local, subnational, national, and regional capacities for gender- and age-responsive, and disability-inclusive health emergency preparedness and response”.

However, a last-minute amendment proposed by the conservative alliance of Egypt, Nigeria, Russia, and Saudi Arabia attempted to replace the term “gender-responsive” with “taking into account gender equality considerations and different needs.” The amendment was defeated in a vote, with 27 in favor and 67 against, with nine abstentions and 75 absent.

When the original resolution was put to the WHA, it passed by 76 votes to eight, with 15 abstentions and 78 absent. The eight countries voted against the term “gender-responsive.”

Following the vote, several countries spoke strongly in support of addressing the unequal impacts of disasters on women and girls, emphasizing that “gender-responsive” is an established term in international language with a clear definition.

Earlier in the day, during discussions on universal health coverage (UHC), various countries stressed the importance of including sexual and reproductive health (SRH) services as an essential part of UHC.

US Health and Human Services Secretary Xavier Becerra specifically noted that SRH services should include those for LGBTQI+ communities, highlighting one of the most contentious issues in the ongoing gender-based debates across nearly all UN agencies, including the WHO.

Image Credits: IFRC, Logan Abassi UN/MINUSTAH.