From Depression to Hypertension: Heat and Air Pollution Exert Heavy Toll on India’s Farmers 09/07/2024 Sanket Jain Farmer Kusum Gaikwad finds it increasingly difficult to work in the fields and finish daily chores because air pollution has severely impacted her health. JAMBHALI, India – Farmer Kusum Gaikwad’s work start at 4 am daily. First, she burns the firewood and farm residue to heat water for 10 family members. By 7 am, she reaches the fields, manoeuvring through thousands of sugarcane plants, removing weeds, and checking for pests and diseases that could hamper their growth. This is followed by tremendous backbreaking labor, where she collects and lifts over 100kg of cattle fodder in the relentless heat. This has been her routine for the past two decades. But in 2017, Gaikwad started to get frequent headaches. Dizziness and severe pain in the chest and abdomen followed. “It was unbearable, but I kept working for four months,” she says. Eventually, when it became difficult for her to even move out of bed, she consulted a doctor and was diagnosed with hypertension. She returned to the same routine within a week. Two years later, she was diagnosed with type 2 diabetes and also reported weakening of her bones. ‘Mountains of smoke’ With the rising exposure to extreme heat and air pollution, Kusum Gaikwad was first diagnosed with hypertension and then type 2 diabetes. Perplexed, Gaikwad, now 66 years old, was determined to find the causes of her illnesses. When she went to the fields again in Jambhali village in India’s Maharashtra state, she met over 20 women who complained of similar symptoms. “Everyone was coughing throughout the day, and that’s when I realized it was the air pollution,” she told Health Policy Watch. Soon, Gaikwad found that almost every family in her village was burning at least 50 kg kilograms of firewood, agricultural residues, plastic bags, and seedling trays every day to heat water and cook food. “Every morning, you can see a mountain of smoke here,” she says. Over the years, a growing number of studies have found air pollution to be a risk factor for several noncommunicable diseases (NCDs), some of which include cardiovascular and respiratory diseases, heart attacks, and lower respiratory infections. A paper published in 2020 analyzed the impact of air pollution on the health of 39,259 Chinese adults, finding that long-term exposure to air pollutants increased blood pressure and hypertension. Similarly, a study from India found that both short and long-term exposure to ambient PM2.5, fine particulate matter smaller than 2.5 micrometers that penetrate deep into the lungs, was associated with increased hypertension. In India, deaths from NCDs have increased from 38% of total mortality in 1990 to 62% in 2016. The annual particulate pollution in India has increased by almost 68% from 1998 to 2021, reducing the average life expectancy by 2.3 years. Extreme heat exacerbates air pollution When chronic asthma becomes severe at night, Rajakka Tasgave leans against the wall, waiting for her labored breathing to ease. Rajakka Tasgave, 65, has become scared of going to the fields, something she has done for over five decades. “Every day, I see at least one woman collapsing because of the extreme heat. Someday, even I can be one of them,” she shared earlier this year. It didn’t take long for her turn, though. After collapsing in the fields in March, when the temperature topped 40 degrees Celsius in Jambhali, the doctor advised her to stop working in extreme heat. “From April to May, I didn’t step out of the house from 10am till evening,” she said. But this meant that she lost a significant chunk of her earnings as most of the farmwork happens during the day. Every day after returning from the fields, she experiences tremendous body aches. “Every week, I visit a doctor and take an injection (epidural steroid injection). Otherwise, I won’t be able to work.” Alongside the unbearable heat, Tasgave frequently comes in contact with air pollutants from the nearby industries and firewood emissions. She has tried covering her face with the end drape of her saree, but that didn’t help. A few years back, she was diagnosed with chronic asthma. “If I forget to carry my inhaler, I will die of an attack,” she confides. During extreme heat, her asthma becomes unbearable. She became breathless in May this year when the night temperatures didn’t drop as normal. “With no one to take me to the hospital, I leaned against the wall in the hope of easing my pain,” she shares. She found relief only the next day when a doctor administered medicines. Heart attacks and pulmonary diseases Researchers have stepped up efforts to understand the combined effects of air pollution and extreme heat in the past few years. In one such paper published in Environment International, they investigated the impact of heat and air pollution on mortality in 36 countries. The study found that heat-related mortality also increased with higher levels of air pollutants like PM, NO2, and O3. Moreover, they also saw an increase in PM—and O3-related mortality for higher air temperature levels. Extreme temperatures and higher concentrations of particulate matter significantly increase the risk of heart attacks, according to a study published in the American Heart Association’s journal, Circulation. The researchers examined 202,678 heart attacks from China’s Jiangsu province between 2015 and 2020. Also, they found that during extreme heat, women were at a greater risk of heart attack than men. In the presence of rising temperatures and high solar radiations, volatile organic compounds react with nitrogen oxides to form ozone, considered a harmful pollutant in the lower atmosphere. Ozone exposure can lead to respiratory infections. As a result, many people from Jambhali are now suffering from chronic obstructive pulmonary disease (COPD), which restricts the airflow and causes breathing issues. The problem is so severe that this year’s State of Global Air Report found that 50% of global ozone-related COPD deaths were reported in India. Many Indian families still rely on open fires to cook food, risking their health. Anxiety and stress rise with air pollution Jambhali’s community healthcare worker Kamal Kore was always curious about why people like Gaikwad, Tasgave and many others have felt anxious and stressed over the past five years. “Year after year, the number of people complaining of anxiety and stress disorders has risen. A few cases had even culminated in cardiovascular ailments and deaths,” she says. After tracking over a thousand such cases, she found that, as air pollution increased, so did the number of people suffering from mental health issues. Her observation isn’t a one-off case. A study published in April 2024 looked at more than 3,000 US counties, spanning over 315 million people, and found PM2.5 to be linked with depression and stress. These mental health issues, in turn, put people at risk of dying from cardiovascular diseases. Its lead author, Dr Shady Abohashem of Massachusetts General Hospital, explains, “Biologically, PM2.5 can enter the bloodstream and induce systemic inflammation, oxidative stress, and neuroinflammation, all known to affect brain function and mood regulation.” The combined effect of PM2.5 and deteriorating mental health amplify the risk of premature cardiovascular mortality. “High PM2.5 exposure leads to systemic inflammation and endothelial dysfunction, critical factors in the development of cardiovascular diseases. When combined with poor mental health, which independently contributes to adverse cardiovascular outcomes through mechanisms like heightened stress response, disrupted sleep, and poor health behaviors, the risk is significantly magnified,” Abohashem explains. Air pollution disrupts sleep, causes depression So severe was the impact that in counties with higher levels of PM2.5, people struggling with poor mental health experienced a threefold rise in premature cardiovascular mortality compared to those with better mental health in areas of lower pollution. The problem isn’t restricted to the outdoor workers. Besides crop residue burning and industrial pollution, another source of PM2.5 is indoor air pollution caused by burning firewood. Many Indian families still rely on burning firewood for cooking. A study from India published in BMC Geriatrics this year found that indoor pollution led to sleep disorders and depression among older adults. “Ambient air pollutants can travel from the nose through the olfactory nerve and reach crucial brain areas like the striatum, frontal cortex, and cerebellum, which are involved in various functions including movement, decision-making, and coordination,” says one of its authors, Dr Aparajita Chattopadhyay, a professor at the International Institute for Population Sciences in Mumbai. These pollutants trigger an inflammatory response which can lead to changes in the levels of neurotransmitters and, hence, disrupt an individual’s sleep and mood. “Sleep plays an important role in maintaining good health, failing which NCDs, including mental health issues, may crop up,” she adds. Limited air quality warnings The health problems caused by air pollution are mounting, as evident from community health worker Kamal Kore’s call records. The past five years have sent a jump in health issues – largely NCDs, especially since the temperature started rising rapidly. “Every day, I get at least 10 calls from the villagers with complaints of cardiovascular and respiratory issues,” she shares, adding that she now spends most of her time making people aware of the harmful effects of air pollution. “Every day, I tell people to switch to clean energy sources for cooking and work during the hours when the pollution is comparatively lesser,” she says. “We don’t have any resources to deal with this.” A major problem healthcare workers like her face is the lack of adequate, real-time data on air pollution to warn patients about peaks. People currently simply observe the times of day when air pollution becomes severe and try to avoid these. Farmer Narayan Gaikwad who is exposed to a lot of air pollution daily says that the lack of real time data on air pollution in the village is a big hindrance to make people aware of air pollution and the hours they shouldn’t work out in the fields. Gaikwad’s husband, Narayan Gaikwad, 77, has written several letters to the district authorities demanding strict measures to curb air pollution. “People don’t understand how much unhealthy air they are breathing because there’s no one monitoring air pollution in the village,” he says. “I am now asking people to stop working during those hours.”. Chattopadhyay suggests that older people avoid major sources of indoor air pollutants, ensure proper ventilation, and use clean fuel. “A positive and strong social circle is also necessary to be mentally fit. Adults must be made aware of cues of contentment in life much before they get old — financial stability, strong social circle, and remaining active daily in various tasks,” she adds. Given Gaikwad’s declining health, her family is considering a solar water heating system despite its crippling cost. While this will help her somewhat, she is worried about the smoke from the neighborhoods. “A solution can never work in isolation. It has to happen at the community level,” she warns. Image Credits: Sanket Jain. Record-Breaking Dengue Infection Persists in the Caribbean 09/07/2024 Sophia Samantaroy Aedes aegypti mosquitoes are the main vectors of dengue virus. Dengue virus cases have reached an all-time high since January in the US territory of Puerto Rico, with 1,729 people infected so far – a more than 300% increase compared to last year. The uptick in the mosquito-borne disease, which causes mild to severe illness, follows a trend across the Caribbean region. The total number of reported cases for the Caribbean has reached nearly 57,000 – a 469% increase as compared to the same period in 2023. Climate change, the El Nino effect, and unplanned urban growth have fueled this year’s surge. While dengue tends to hit Brazil, Argentina, Paraguay and Uruguay the worst, the Caribbean, the Central American isthmus, and Mexico continue to see above-average transmission. Further complicating efforts to control the mosquito-borne disease is the premature start to the hurricane season. Hurricane Beryl has already devastated several small island nations in the Caribbean, damaging water and health infrastructure, thus making residents even more vulnerable to dengue. Halfway into 2024, the total burden of dengue cases in the Americas has exceeded 10.1 million, more than twice the 4.7 million cases in 2023. The Puerto Rican Department of Health recently extended its dengue epidemic alert until December, after this year’s season brought the highest proportion of severe dengue in the Americas. Of the nearly 2,000 cases reported to the territory’s health officials, 92 are severe, meaning patients may suffer from painful symptoms including fever, headaches and vomiting. Three of the dengue serotypes – DENV 1, 2, and 3 – are currently circulating. This alert comes just two weeks after the US Centers for Disease Control and Prevention (CDC) issued a health advisory warning of the increased risk of dengue virus infections in the US. While most cases in the continental US come from overseas travelers, Florida has reported a handful of locally-transmitted cases. Hurricane Beryl sets back health response Debris, abundant rainfall, and inadequate shelter are all hurricane by-products that increase the risk of dengue virus infection. The first category 5 hurricane of the season, Beryl devastated much of Saint Vincent and the Grenadines, Grenada, Dominica, Barbados, and Jamaica. The destruction left in the hurricane’s wake highlights small island nations’ vulnerabilities to climate change and its health effects. The Caribbean region is particularly susceptible to healthcare disruptions from natural disasters. Studies of cyclones in China and hurricanes in Puerto Rico found increases in dengue virus infections in the weeks following hurricanes. “Pre-existing environmental health risk magnified after the pass of Hurricanes Irma and María,” said researcher José Pérez-Ramos, Assistant Professor of Public Health Sciences at the University of Rochester. He notes that in the aftermath of 2017’s devastating hurricanes, participants in the study were worried about frequent dengue outbreaks. While the International Federation of the Red Cross (IFRC) and other relief organizations active in the Caribbean nations are in the early days of response and assessment, the confluence of the hurricane’s destruction and peak dengue season may spell out an increased case burden. “Hygiene kits, cleaning kits, tool kits, kitchen sets, tarpaulins, blankets and mosquito nets have already been dispatched to the hardest hit islands to meet the immediate needs of the affected population,” said Rhea Pierre, IFRC Disaster Manager for the English and Dutch-speaking Caribbean. “Still, rapid damage assessments show that the devastation is massive.” ‘A notable increase’ in cases, but low fatality rate Removing standing water sources is a key tactic in controlling for dengue. Despite this year’s record number of cases, the World Health Organisation’s (WHO) regional office in the Americas, the Pan-American Health Organization (PAHO), notes that the fatality rate for the Americas has not exceeded the regional benchmark of 0.05%. “While we are seeing a notable increase in the number of dengue cases in the region this year, it is important to highlight that the proportion of cases that progress to death remains low thanks to countries’ efforts and the support of PAHO,” said Jarbas Barbosa, PAHO Director, in a recent press release. “This situation highlights the importance of sustaining surveillance, strengthening prevention and control measures, and ensuring timely medical care,” he added. Standing water, seen here in the aftermath of Hurricane Otis, is needed for mosquitoes to breed. Few studies have assessed what causes some patients to progress to severe dengue. The WHO notes that ensuring access to sufficient medical care should remain at the forefront of countries’ priorities to treat severe dengue. PAHO’s Caribbean Mosquito Awareness Week, which took place in May, aimed to raise public awareness about the connection between mosquitoes and the diseases they transmit, such as dengue, chikungunya, and Zika, and to involve the community to prevent mosquito breeding. “The population and household members should be encouraged to eliminate sources of mosquito breeding, both household and peri-household. This is everyone’s task: the family, the community, the public and private sector,” said PAHO in a recent alert on increased cases in Central America, Mexico, and the Caribbean regions. Aedes aegypti, the main mosquito vector, typically breeds in sites such as water containers as well as in urban waste, including plastic wrapping that can accumulate rainwater. As the virus doesn’t have a cure and repeat infections can even be more severe, surveillance and control of mosquito breeding sites is critical to reduce dengue transmission and illness, particularly the most severe form of the disease, dengue hemorrhagic fever. Dengue cases expected to rise in Mexico, Central America and Caribbean Cases have yet to peak fully in the Caribbean, Central America and Mexico. Farther north of the equator, cases have yet to peak in the PAHO regions of the Caribbean, Central America Isthmus and Mexico. “Although there has been a decrease in dengue cases in the Southern Cone [Brazil, Argentina, Paraguay, and Uruguay] and Andean sub-regions in recent epidemiological weeks, the subregions of the Central American isthmus and Mexico, and the Caribbean subregion are entering the period of increased dengue circulation, which could significantly increase the number of cases reported in the Region during the second half of 2024,” said PAHO in their May epidemiological alert. Cases decreasing at tail-end of season Brazil, which accounts for more than 80% of the Americas’ dengue cases, is at the tail-end of its season. The number of dengue cases is finally tapering off for the South American countries hardest hit – Brazil in particular saw an explosive growth in cases earlier this year. PAHO attributes the country’s epidemic conditions to prolonged heat, higher rainfall levels, as well as decreased population immunity following COVID-19-related restrictions. In response, and to avoid losing vaccine stock to expiration, the Brazilian government recently expanded the population eligible for dengue vaccination. Now, children six to sixteen are eligible, rather than just ten to fourteen year-olds. Image Credits: Direct Relief/Felipe Luna, James Gathany/ PHIL, CDC, Public Domain, IFRC, PAHO , PAHO , PAHO. WHO Launches Platform for Standardised Medical Device Information 09/07/2024 Zuzanna Stawiska An online WHO platform gathers information about various medical devices: from simple syringes to complex hospital equipment. To help countries and organisations navigate a complex pool of over 10,000 different medical devices, the World Health Organization (WHO) launched an online platform on Monday that will collect and standardise the information about medical equipment. Medical Devices Information System, or MeDevIS, is inspired by the WHO Priority Medical Devices List (MDL) and the Essential Medicines List, the latter of which will soon have existed for 50 years, serving as an important support for health progress globally. MeDevIS includes 2,301 types of medical devices of varying levels of complexity: from single-use syringes, medical masks, and pulse oximeters, to imaging radiology technologies, implantable prostheses, or defibrillators. “The number of medical technologies used in health care is growing, as is their complexity, which can make it challenging for health care practitioners and patients to navigate,” said Dr Yukiko Nakatani, WHO Assistant Director-General for Access to Medicines and Health Products. The aim is for a “one-stop shop of international information” to help stakeholders to find appropriate equipment. The new platform references both major naming systems for medical devices, renowned internationally: the European Medical Device Nomenclature (EMDN) and the Global Medical Device Nomenclature (GMDN), used in some countries outside of the European region. Both systems facilitate handling specific types of equipment on the regulatory and logistics levels. MeDivIS also features information about the infrastructure required for the device, the healthcare facility level where it is typically used, and links to thematic WHO guidelines connected with the branch of care for which the equipment is made. “The MeDevIS platform can be useful for national policy-makers to develop or update their own national lists for the procurement of health technologies and devices and can contribute to the progress towards universal health coverage,” said Dr Deus Mubangizi, WHO Director for Health Products Policy and Standards. Image Credits: Unsplash. Russia’s Bombing of Ukraine Children Hospital is ‘Abominable’ 08/07/2024 Kerry Cullinan Children with cancer outside Okhmatdyt Hospital after the attack. Russia’s bombing of a children’s hospital and women’s health centre in Ukraine’s capital Kiev on Monday is “abominable”, said UN High Commissioner for Human Rights Volker Türk. “Civilians must be protected, and the laws of war strictly adhered to,” added Türk. “There must be prompt, thorough and independent investigations into these latest grave attacks on civilians and civilian infrastructure, and those responsible must be held to account.” “Shockingly, one of the strikes severely damaged the intensive care, surgical and oncology wards of Okhmatdyt, which is Ukraine’s largest children’s referral hospital, and destroyed its children’s toxicology department, where children receive dialysis,” said Türk. Okhmatdyt Hospital serves more than 20,000 children annually. Monday’s missile attack struck a medical building at the hospital where children were receiving dialysis, while also damaging the intensive care, operating, and oncology departments, according to the Minister of Health of Ukraine. The entire hospital is without electricity, preventing the use of ventilators and other urgent care. Dr Tedros Adhanom Ghebreyesus, Director General of the World Health Organisation (WHO), said that “several floors of the largest children’s hospital in Kyiv were severely impacted today, disrupting the hospital’s operations and affecting its ability to provide critical care to the young patients.” Several floors of the largest children’s hospital in Kyiv were severely impacted today, disruptng the hospital’s operations and affecting its ability to provide critical care to the young patients.@WHO has been working closely with the hospital before and since the war in… pic.twitter.com/9ReGcov71F — Tedros Adhanom Ghebreyesus (@DrTedros) July 8, 2024 Meanwhile, Türk said that OHCHR staff visiting the scene shortly after the attack had “observed children receiving treatment for cancer in hospital beds set up in parks and on streets, where medical workers had quickly established triage areas, amongst chaos, dust and debris.” Health officials said the entire hospital was now without electricity, preventing the use of ventilators and other urgent care. It was not immediately clear how many people were killed in the strike. The ISIDA Medical Centre, one of the largest women’s health and family planning centres in Ukraine, was also affected by the attack, with several casualties. The attack comes the day before a NATO summit in Washington DC. Russia has attacked Ukraine’s health care workers, facilities, and other medical infrastructure at least 1,442 times since its invasion of Ukraine in February 2022 and 13 April 2024,according to data from a partnership made up of the Ukrainian Health Center, Physicians for Human Rights (PHR) and others. Russian attacks on Ukraine health care since February 2022. “Russia’s strategy in Ukraine includes attacking babies and children. Domestic and international actors should intensify efforts to hold perpetrators accountable for these war crimes,” said Uliana Poltavets, PHR’s Ukraine emergency response coordinator in a statement. Researchers have documented 79 attacks that affected children’s health care, including 54 attacks that destroyed or damaged children’s hospitals. “Today’s devastating attack on the largest children’s hospital is emblematic of Russia’s onslaught against Ukraine’s health care system. Again and again, we have witnessed Russian forces attack vulnerable patients, health workers, and hospitals across the country,” said Poltavets. PHR called on “domestic and international prosecutors, including the International Criminal Court, to prioritise the investigation and prosecution of attacks on health care.” Image Credits: Twitter. Sierra Leone Outlaws Child Marriage 08/07/2024 Kerry Cullinan Sierra Leone First Lady Fatima Bio Sierra Leone’s President Julius Maada Bio signed into law the Prohibition of Child Marriage Act last week, introducing a penalty of at least 15 years and a fine of around $4,000 for any man who marries a girl under 18. The law also prohibits cohabiting with a child, and fines for anyone arranging, aiding or attending such marriage ceremonies. First Lady Fatima Bio’s “Hands Off Our Girls” campaign has been instrumental in advocating against child marriage in Sierra Leone. Sierra Leone has one of the highest rates of child marriages in Africa, alongside Niger and Nigeria. According to the 2019 Sierra Leone Demographic and Health Surveys, 30% of girls in Sierra Leone are married before their 18th birthday. In 2020, there were 800,000 child brides, half of whom were married before they turned 15, according to UNICEF. The country of slightly over eight million people also has a high rate of female genital mutilation. “Child marriages fuel the high adolescent pregnancy rate in Sierra Leone where, tragically, pregnancy complications are the leading cause of death for girls aged 15-19,” according to Human Rights Watch (HRW). In 2021, the country introduced a policy of “radical inclusion” in schools, targeting and marginalised groups including girls, particularly pregnant girls and parent learners. Last year, Sierra Leone passed an education law that guarantees children free education, including one year of pre-primary. “The legislation is a milestone in Sierra Leone’s journey towards gender equality and child protection. It also sets a pathway forward for other African nations, such as Tanzania and Zambia, to revoke laws that permit child marriage, and ensure girls can complete primary and secondary education,” said HRW. FDA Approves Eli Lilly’s Kisunla for Early-Stage Alzheimer’s Patients 08/07/2024 Maayan Hoffman Neurons with tau protein highlighted in red. Eli Lilly’s Alzheimer’s therapy, donanemab, has received FDA approval, offering new hope for patients with early symptomatic Alzheimer’s disease. The newly approved treatment, branded Kisunla, is set to challenge existing therapies from Eisai and Biogen. Clinical trials have shown Kisunla to be effective for individuals in the mild cognitive impairment or mild dementia stages of the disease, potentially marking a significant advancement in Alzheimer’s care. The drug is administered as an intravenous infusion every four weeks. Alzheimer’s disease is a degenerative condition of the brain that impacts over 6.5 million Americans and over 55 million people worldwide. It causes a gradual decline in memory, cognitive functions, and, eventually, the ability to perform daily activities. The disease is marked by structural changes in the brain, such as the buildup of amyloid beta plaques and neurofibrillary tangles made of tau protein, which is supposed to help stabilize the internal skeleton of neurons in the brain. The Alzheimer’s Association celebrated the FDA’s decision. “This is real progress,” said Joanne Pike, Alzheimer’s Association president and CEO, in a statement. “Today’s approval allows people more options and greater opportunity to have more time. Having multiple treatment options is the kind of advancement we’ve all been waiting for — all of us who have been touched, even blindsided, by this difficult and devastating disease.” Slows cognitive decline by at least 22% The approval was based on an extensive double-blind, placebo-controlled, parallel-group study evaluating the efficacy of Kisunla in slowing cognitive decline in participants with varying levels of tau protein in the brain. Tau is a protein that helps to stabilise the neurons in the brain. The study, conducted over 72 weeks with 1,736 patients averaging 73 years old, revealed that those receiving Kisunla experienced a 35% reduction in cognitive decline compared to those on placebo among individuals with low to medium tau levels. Even among participants with higher tau levels, the treatment demonstrated a meaningful but slightly reduced effect. Overall, including all tau levels, Kisunla slowed cognitive decline by 22% and reduced the likelihood of progressing to the next stage of the disease by 39% compared to placebo. Additionally, the study monitored amyloid plaque levels using positron emission tomography (PET) scans throughout the treatment period. Results showed substantial reductions in amyloid plaques over time among patients receiving Kisunla, with reductions of 61% at six months, 80% at 12 months, and 84% at 18 months compared to baseline levels. These findings suggest that Kisunla not only targets cognitive decline but also effectively reduces the hallmark amyloid pathology associated with Alzheimer’s disease progression. Potential side effects For some patients, there is a risk of amyloid-related imaging abnormalities (ARIA) developing, the FDA said. ARIA typically manifests as temporary brain swelling, sometimes accompanied by small areas of bleeding on or in the brain. While ARIA often resolves on its own and may not cause symptoms, rare instances of severe and potentially life-threatening events have been reported. ARIA is a recognized side effect of antibody therapies targeting amyloid. Infusion-related reactions are also a concern, including flu-like symptoms, nausea, vomiting, changes in blood pressure, and hypersensitivity reactions such as anaphylaxis (a severe allergic reaction) and angioedema (swelling). Kisunla joins Leqembi, on market since 2023 Kisunla is the third drug to receive FDA approval, although only the second is now available for use. Leqembi, a collaboration between Biogen of the United States and Eisai of Japan, gained approval in July 2023. In an 18-month Phase III trial, Leqembi demonstrated a 27% reduction in cognitive decline among early-stage Alzheimer’s patients compared to those receiving a placebo. Another drug, aducanumab, also developed by Biogen and Eisai, was granted accelerated approval by the FDA in June 2021. However, due to some side effects, the therapy was pulled from the market. The Alzheimer’s Association emphasized the importance of early detection and diagnosis now that multiple FDA-approved treatments for Alzheimer’s are available. The organization stressed that timely access to these treatments is crucial for maximizing their benefits, asserting that no stage or entity should hinder or delay such access. “Too many roadblocks have prevented individuals from getting equitable access to these beneficial treatments for far too long,” said Pike. “It is equally important that clinicians and health care systems are informed and prepared to help the individuals who could benefit. The Alzheimer’s Association is working with health systems and providers to ensure they have the tools and resources to meet the needs of their patients.” Image Credits: Gerry Shaw/ EnCor Biotechnology Inc. Earliest Ever Hurricane Tears Through Caribbean, Highlighting Need for Speedier Climate Action 05/07/2024 Kerry Cullinan Fishing vessels at the Bridgetown Fisheries Complex in Barbados damaged by Hurricane Beryl. Hurricane Beryl, which has destroyed homes and infrastructure in large parts of the eastern Caribbean, is the first first-ever Category 4 hurricane recorded in the region in June – and a portend of devastating changes in weather patterns. It also underscores the need for urgent international assistance to Small Island Developing States (SIDS) to strengthen early warning systems and the climate resilience of key infrastructure – notably water, sanitation and health services, according to experts. The hurricane reached peak speed of 265 km per hour at times as it whipped though Barbados, Grenada, St Vincent and the Grenadines, Haiti, northern Venezuela, the Dominician Republic, Cayman Islands, and Jamaica. “The storm first impacted Barbados, causing severe damage to the south coast and significantly affecting the fishing industry with over 200 fishing vessels damaged or destroyed,” according to the International Federation of Red Cross and Red Crescent Societies (IFRC). On Union Island, part of Saint Vincent and the Grenadines, 90% of infrastructure has been damaged, including houses, roads and the airport. Some 95% of homes in Grenada’s Carriacou and Petite Martinique islands, are damaged, and around 3,000 people are shelters, the IFRC added. Parts of Jamaica’s St Elizabeth region in the south east were also devastated, with around 1,000 people taking refuge in shelters. The Dominican Republic, Cayman Islands reported damage. Venezuela’s President Nicolas Maduro said that 8,000 houses had been destroyed, according to Reuters. More to still come? “Hurricane Beryl, the first hurricane of the 2024 Atlantic hurricane season, rapidly strengthened to a Category 5 storm unusually early in the year,” according to a report from the National Ocean and Atmospheric Administration (NOAA), which is part of the US Department of Commerce “This explosive strengthening was fuelled in part by exceptionally warm ocean temperatures. That heat was one of the factors behind NOAA’s prediction in May of an 85% chance that the 2024 Atlantic hurricane season would be above normal.” Sea surface temperatures were close to those usually found in mid-September, the peak of hurricane season, added NOAA. In late May, NOAA weather forecasters predicted an 85% chance of above-normal hurricane for the 2024 Atlantic hurricane season, which runs from 1 June 1 to 30 November. It also forecast eight to 13 hurricanes, with four to seven likely to be “major” hurricanes (winds of over 178km per hour) in coming months. Early warning systems “The unprecedented hurricane demonstrates the importance of effective multi-hazard early warning systems to save lives,” according to United Nations Disaster Risk Reduction (UNDRR). “Globally, the sustained investments in those systems are making progress in reducing the loss of life in disasters. But economic losses are escalating. Every year millions of households lose their livelihood and risk being pushed into poverty. Ensuring that infrastructure is resilient and that communities ‘build back better’ in the face of future hazards is essential,” added UNDRR. Damage sustained to the airport and surrounding areas on Union Island in the Grenadines during Hurricane Beryl. In late May, the Fourth International Conference on SIDS adopted the Antigua and Barbuda Agenda for SIDS, a 10-year development agenda that appeals for international assistance to address climate change. The Agenda notes that “SIDS are facing the unrelenting and compounding impacts of climate change, biodiversity loss, pollution, disasters and natural hazards, health and other social related challenges and economic vulnerabilities.” Key climate change challenges include “erratic precipitation, increasingly frequent and extreme weather phenomena, more frequent and severe tropical cyclones, floods and drought, diminishing fresh water resources, desertification, coastal erosion, land degradation and sea-level rise.” However, there has been a “progressive deterioration” in SIDS’ ability to “withstand external shocks and enhance their resilience” – largely as a result of the economic impact of COVID-19 and climate challenges. Financial reform to build resilience Protestors call on wealth countries to pay for climate-related loss and damage at COP27. “In the wake of Hurricane Beryl, it is clear that we must redouble our efforts to build resilience and preparedness in the face of growing disaster risk, especially for small island developing states, which have contributed the least to the climate crisis but suffer the greatest costs,” said UNDRR head Kamal Kishore. Kishore appealed for international support for the Antigua and Barbuda Agenda, which “integrates disaster risk reduction as central to climate change adaptation and sustainable development in SIDS with clear calls to action on enhancing multi-hazard early warning systems and resilient infrastructure.” There have also been numerous calls for reform of the international financial architecture to assist developing countries most affected by climate change who are being forced to borrow money to address climate crises largely caused by wealthy nations. The most significant of these is the 2022 Bridgetown Initiative, spearheaded by Prime Minister Mia Mottley of Barbados. This called for key actions including new loan mechanisms, reform of the world’s development banks, and a loss and damages fund to enable developing countries to access to resilient finance to address climate and development crises. The UN climate change conference, COP27, agreed to establish a loss and damage fund during the UN Climate Change Conference (COP27) in 2022. However, there is resistance from a number of wealthier countries to this as the world continues to experience record-breaking extreme weather events. Meanwhile, the International Cort of Justice (ICJ) is expected to hold public hearings and issue an advisory later this year on the international legal obligations countries have to safeguard people against climate change. This follows the adoption last year of a landmark UN resolution to seek such an advisory opinion from the ICJ. While not legally binding, the advisory opinion holds legal and moral weight and will spotlight the human rights impacts of climate policy. Image Credits: UNDP, AfricaNews. As More US Dairy Herds Infected with Avian Flu, Americans in the Dark on the Risks of Raw Milk 04/07/2024 Zuzanna Stawiska Over one-half of Americans are not sure if pasteurised milk is safer than raw milk. In the time of avian flu epidemics in US cattle, this could even prove dangerous. As the fourth human case of H5N1 avian flu in a US farmworker in Colorado was confirmed Wednesday by the US Centers for Disease Control and Prevention (CDC), so far, only farm workers, and not consumers, have reported avian flu infections. This is likely due, at least in part, to the successful inactivation of the virus during the milk pasteurization process, experts say. And yet one-half or more Americans seem to have little idea about the dangers of drinking raw milk, according to a recent poll conducted by the University of Pennsylvania researchers. The survey, which included a demographically representative sample of the US adult population, found that less than half (47% percent) of the U.S. adults surveyed understood that drinking raw milk not as safe as drinking pasteurized milk. Conversely, 53% of respondents don’t actually believe that pasteurized milk is safer. And 9% of respondents actually believed raw milk is safer, while 15% said it was just as safe and 30% were unsure. Nearly a quarter (24%) of Americans either do not believe that pasteurization is effective at killing bacteria and viruses in milk products (4%) or are not sure whether this is true (20%), according to the survey of over 1000 US adults, conducted by the Annenberg Public Policy Center (APPC). The survey has a 3-3.5% statistical error rate. Around half of US adults failed to recognize that raw milk can be more dangerous than pasteurized milk products. That, despite the fact that studies report that pasteurized milk limits hospitalizations for related illnesses by an order of 45, according to the APPC report. The French Scientist Louis Pasteur invented the pasteurization process 160 years ago, after recognizing that it killed off otherwise dangerous bacteria present in unheated wine. The process, which soon became a milk industry standard in the United States, successfully inactivates the modern-day avian flu virus, significantly limiting the risk of infection for the general public. Politics and milk In fact, only about 2% of Americans report drinking raw milk at least once a month, according to a Food and Drug Administration (FDA) study based on 2019 data. Paradoxically, however, raw milk sales in the US have increased in recent months, according to some US media reports, despite the recent risks posed by a widening circle of avian influenza among dairy cattle. Debate has been spurred by the increased anti-science bent of some US political leaders. Presidential candidate Robert F. Kennedy Jr., for instance, who also has been a staunch opponent of COVID vaccination, has been quoted saying that he drinks raw milk exclusively. The APPC survey also found that Republicans are more likely than Democrats to believe that drinking raw milk is as safe as pasteurized milk (57% vs. 37%). People living in an urban environment also are more likely to believe that pastuerized milk is safer than raw milk as compared to people in a rural environment (49% vs. 32%). “The difference in views of raw milk that we see between Democrats and Republicans is difficult to disentangle from the difference between rural and urban dwellers,” said Kathleen Hall Jamieson, director of the Annenberg Public Policy Center. “Those in rural areas are both more likely to identify as Republicans and to consume raw milk.” 55 more dairy herds reported infected in last 30 days Some 55 more cattle herds in seven states have been infected with the virus over the past 30 days, according to CDC tracking. Infections in the past 30 days represent 40% of the total of 138 cattle herds infected in 12 states since the outbreak in dairy cattle was first reported on 25 March, the CDC reported. States affected by avian flu spread in dairy cattle The real number of infections of both humans and cattle is very likely underestimated, insofar as farmers have been reluctant to have their staff or herds tested, experts warn. Even so, the CDC maintained that infection risks for the general public remain low. “Based on the information available at this time, this infection does not change CDC’s current H5N1 bird flu human health risk assessment for the U.S. general public, which the agency considers to be low,” the CDC said in a statement. Image Credits: Cotonbro studio, APCC, CDC. Even India’s ‘Cleanest’ Cities Have Significant Excess Air Pollution-Related Deaths from NCDs 04/07/2024 Chetan Bhattacharji The air in relatively ‘clean’ Mumbai is still killing citizens. NEW DELHI – On 2 November 2023, extreme air pollution caught Delhi off-guard. It shut down schools and led to flight cancellations, curbs on construction and other emergency responses. That every little increase in air pollution increases the risk of death has been well-established for some years. But till now the effect of short-term air pollution on mortality has remained largely undocumented in detail in India, where most of the world’s most polluted cities are located. In a new, peer-reviewed study published in the Lancet on Thursday (4 July), researchers found that 7.2% (or approximately 33,000) of all deaths each year across 10 cities could be linked to short-term PM 2.5 exposure higher than the World Health Organization (WHO) guideline of 15 micrograms/cubic metre (µg/m³). PM 2.5 is a highly toxic ultra-fine particulate matter with a diameter of 2.5 microns, which is far thinner than a strand of human hair. This is the first multi-city study in India to assess the link between short-term pollution exposure and death with cities spanning different agri-climatological zones. The bottom line, the authors say, is that the current Indian government standard for PM 2.5 of 60 µg/m³ is “substantially higher” than it should be as a measure of ‘safe’ air quality. In comparison, WHO’s 24-hour standard is 15 µg/m³. NCDs are the leading cause for air pollution-related deaths The Lancet paper doesn’t look at the cause of death as that level of primary data isn’t always available. However, many studies including recent ones in India have shown that air pollution triggers or aggravates non-communicable diseases – specifically NCDs like heart attacks, strokes, lung cancer, and chronic lung disease – which can turn fatal. Of the total air pollution deaths, NCDs account for nearly 90% of the disease burden. The researchers are from 14 organisations including Sustainable Futures Collaborative in Delhi, Institute of Environmental Medicine in Stockholm, Indian Institute of Management Ahmedabad, Public Health Foundation of India, Ashoka University in Sonipat, Mount Sinai in New York, and Boston University. To come to their conclusions, the researchers analysed primary data on mortality between 2008 and 2019 in 10 cities of India. They used an advanced system of machine learning-based analysis which, simply put, used factors that would have a bearing on air pollution-related deaths, namely wind speed, atmospheric pressure and mixing height. This causal modelling approach enabled the researchers to isolate the effect of locally generated pollution as these factors are linked to the dispersal and transport of air pollution. Combined with other data from monitors, satellites and other sources, the study looked at over 3.6 million deaths in the 11-year study period. What the more complex causal modelling shows is that the risk of death is greater than what the earlier basic approach showed. No safe level of air pollution The causal modelling estimated an increase in the risk of death by 3.57% for every rise of just 10 µg/m³ metre over a two day period, as compared to 1.42% by a more basic study. Apart from the usual high-pollution suspects like Delhi and Varanasi, the study looked at places commonly perceived as having clean air, like the Himalayan city of Shimla and the coastal metropolises of Chennai and Mumbai. The authors say this is the first such multi-city study on the links between short-term air pollution exposure and deaths in India. Overall, 7.2% of all daily deaths were attributed to PM 2.5 concentrations higher than the WHO guidelines. Annually there are estimated to be approximately 33,000 deaths in these 10 cities. Over a third are in Delhi, where the average annual PM 2.5 level was 113 micrograms which is more than 22 times the WHO’s safe standard. The share of PM 2.5 linked deaths was also the highest in the Capital, at 11.5% compared to the lowest 3.5% in Shimla. The surprises are Mumbai and Kolkata, with deaths numbering around 5,000 each, annually. “We are seeing a high level of risk and a high number of deaths even in cities that have moderate levels of air pollution exposure. Mumbai, for instance, despite being a coastal city with around a third of the annual PM 2.5 levels of Delhi is still seeing over 5,000 deaths yearly from air pollution,” a lead author of the report, Dr Bhargav Krishna, Fellow at the Sustainable Futures Collaborative, explained to Health Policy Watch. “Similarly Hyderabad, Kolkata, Bengaluru, Chennai, Ahmedabad and Pune, all of which have annual PM2.5 levels below the current Indian standard, are still seeing a high number of deaths each year. This should drive us to focus not just on those cities that have high seasonal exposures, but even those that may be considered relatively ‘clean’ but are in reality polluted at a level that causes significant health impacts.” Mumbai air in March 2023. Mumbai, where remarkably the air pollution has been higher than Delhi on some days, was shown to have almost 5,100 deaths, the second highest after the national capital. That is 5.9% of all deaths in what is India’s financial capital. Here, every increase of 10 micrograms of PM 2.5 was associated with a 2.41% increase in daily deaths. Over 7% of daily deaths attributable to increases in short-term PM 2.5 First such study in Indian cities, say authors City Average Annual Pollution (PM2.5, mg/m³) Attributable Fraction of Deaths (%) Attributable Deaths Per Year Delhi 113 11.5 11,964 Varanasi 82.1 10.2 831 Kolkata 55.2 7.3 4,678 Pune 45.3 5.9 1,367 Mumbai 41.7 5.6 5,091 Hyderabad 38.9 5.6 1,597 Ahmedabad 37.9 5.6 2,495 Chennai 33.7 4.9 2,870 Bangalore 33 4.8 2,102 Shimla 28.4 3.7 59 Total 53.6 7.2 33,627 Source: Lancet Shimla proves that there is no safe level of air pollution, according to the report. It has the lowest air pollution level of the 10 cities, yet that was still a risk as 3.7% of all deaths were attributable to short-term PM 2.5 exposure. Impact on policy action The findings are crucial for immediate policy action and further studies to cover hundreds more towns and rural areas. Immediate action would cover sources of pollution like diesel generators, waste burning, and transport, sources that are commonly seen in many urban neighbourhoods. While much of the headline-grabbing focus is on extreme pollution, these findings show the need to act against all sources of air pollution all year round. Acting only on extremely high days of pollution will only yield marginal benefits regarding daily mortality. In particular, the paper calls out the Graded Response Action Plans, largely used in Delhi and its neighbouring cities. GRAPs are usually cited by local governments as their action to cut pollution but are implemented only in peak pollution season which is from October right through winter. Toxicity of local pollution There are some interesting findings which aren’t widely known. The study confirms that the risk of mortality rose more quickly at lower levels of PM 2.5 but plateaued as levels increased. More studies are needed to understand why exactly this happens. The causal modelling showed that the effects of air pollution on deaths were especially strong in cities with lower levels of pollution such as Bengaluru, Chennai and Shimla. The study fills a data and communication gap in addressing the health crisis caused by toxic air. On one hand, it establishes a link between rising air pollution and deaths, on the other, it makes the risks a lot more relatable because it shows the impact over just two days of exposure than over many months or years. So what can residents in these cities do to protect themselves? Bhargav says individual responses could include wearing a mask, choosing when to step outdoors (pollution tends to be highest during the morning and evening when temperatures dip), and reducing pollution sources inside their home. However, the onus lies on governments and policymakers. “The levels of air pollution we see in India are extremely high and this study clearly shows how day-to-day variations in these levels lead to considerable mortality,” said Dr Petter Ljungman of the Karolinska Institute, and one of the researchers involved in the study. “Interestingly we saw that local pollution sources are likely to be more toxic than more distant sources which has implications for policymakers addressing this highly relevant threat to human health.” Image Credits: Chetan Bhattacharji. Positioning the University of Ghana as a ‘Research-Intensive’ Institution on Neglected Diseases 03/07/2024 Jessica Ahedor Scientists at the West African Centre for Cell Biology and Infectious Pathogens (WACCBIP), University of Ghana, setting up a genome sequencing experiment in the laboratory. Almost 15 years ago, when the University of Ghana established its Office of Research, Innovation, and Development, it did so with the goal of bolstering the West African nation’s research capacity. In the African region, where less than 0.5% of GDP is devoted to research, and a significant number of Africa’s educated is siphoned off to other countries, the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR) has spearheaded the effort to make universities like the University of Ghana research-intensive and competitive. TDR support for research capacity-strengthening activities at the University of Ghana focuses on enabling researchers to tackle infectious diseases of poverty through quality implementation research, the study of bridging basic science research and practice. This could mean examining why many patients on antiretroviral therapy drop out of treatment, or identifying barriers to TB treatment adherence – both the subject of recent publications authored by researchers at the University of Ghana. Capacity-building works Professor Gordon A. Awandare at TDR’s Joint Coordinating Board meeting in Geneva, 12 June 2024 “Capacity-building actually works,” remarked Professor Gordon A Awandare, Pro Vice-Cancellor of Academic Student Affairs at the University of Ghana, at a TDR 50th anniversary event in Geneva, where he gave a detailed review of the collaboration before TDR’s Joint Coordinating Board on June 12. He cited, as one example, his own career trajectory. Awandare began a career in research through a TDR grant that allowed him to complete his masters training, and then got an opportunity to study for a PhD at the University of Pittsburgh while attending a conference on malaria with support from TDR. He returned home to the University of Ghana in 2010, founding the West African Centre for Cell Biology of Infectious Pathogens (WACCBIP) in 2014. Since then, the Centre, supported by the Wellcome Trust and the World Bank, has endowed 400 fellowships and received $53 million in grants, thereby directly reducing the “brain drain” across the African region. A decade-long partnership The University of Ghana leads efforts to train students in implementation research. Newly enrolled master’s students during their lab induction at WACCBIP, University of Ghana. In 2014 the University of Ghana’s School of Public Health signed a partnership agreement with TDR to create a regional training center that leads activities in the African region for strengthening capacity in implementation research to tackle infectious diseases of poverty. The initiative has so far trained more than 25,000 individuals across Africa, including health practitioners, decision-makers and researchers. “Looking at how far we’ve come as a training centre, it is our desire to become a centre of excellence where the annual programmes can be extended to say five years,” said Professor Phyllis Dako-Gyeke, who led the TDR-supported research training programmes at University of Ghana until her passing on 11 June. But the success of an almost decade-long relationship is not without its challenges. Sustainable donor support and aligned interests on research priorities remain key, she said. Real-time research Implementation researchers at UG have tackled issues from TB treatment adherence to antiretroviral therapy. Here, a community health worker conducts an interview in Obuasi, Ghana to identify barriers and facilitators for TB control. Dr Emmanuel Asampong, coordinator of the regional training centre at the University of Ghana, notes that “the impact of implementation research on disease themes in Africa and beyond is impressive because the initiative uses real-time research results in various contexts – such as the neglected tropical diseases programme, the national malaria programme, and the tuberculosis control programme – to provide solutions to challenges.” The global program, which has played a significant role in positioning University of Ghana as a research-intensive university, supports seven regional training centres across six WHO regions. With additional partners in Colombia, Indonesia, Kazakhstan, Malaysia, Senegal and Tunisia, the program develops and updates implementation research courses, provides faculty training and supports career development. The global program, which has played a significant role in positioning University of Ghana as a research institution, also supports NTD research in six WHO regions. The University of Ghana also partners with TDR on a postgraduate training scheme, which provides a full academic scholarship for master’s students. The training is specifically focused on implementation research to tackle infectious diseases of poverty. The list of TDR alumni across the world runs long, and the University of Ghana can claim many public health leaders among them. “My postgraduate training at the University of Ghana, supported by TDR, was an invaluable catalyst in shaping my academic and professional journey,” said Dr Mbele Whiteson, Senior Resident Medical Officer at the Ministry of Health in Zambia. “I have learned to recognize the intricate interplay between health outcomes and social determinants.” This is the third article in a series on TDR’s research capacity strengthening programme – building skills of public health researchers, implementers, health practitioners and policy-makers in the fast-developing field of implementation research for improving uptake of effective health interventions. Sophia Samantaroy contributed to the writing and research of this story. Image Credits: WACCBIP, TDR, African Regional Training Centre (ARTC), University of Ghana/TDR. 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Record-Breaking Dengue Infection Persists in the Caribbean 09/07/2024 Sophia Samantaroy Aedes aegypti mosquitoes are the main vectors of dengue virus. Dengue virus cases have reached an all-time high since January in the US territory of Puerto Rico, with 1,729 people infected so far – a more than 300% increase compared to last year. The uptick in the mosquito-borne disease, which causes mild to severe illness, follows a trend across the Caribbean region. The total number of reported cases for the Caribbean has reached nearly 57,000 – a 469% increase as compared to the same period in 2023. Climate change, the El Nino effect, and unplanned urban growth have fueled this year’s surge. While dengue tends to hit Brazil, Argentina, Paraguay and Uruguay the worst, the Caribbean, the Central American isthmus, and Mexico continue to see above-average transmission. Further complicating efforts to control the mosquito-borne disease is the premature start to the hurricane season. Hurricane Beryl has already devastated several small island nations in the Caribbean, damaging water and health infrastructure, thus making residents even more vulnerable to dengue. Halfway into 2024, the total burden of dengue cases in the Americas has exceeded 10.1 million, more than twice the 4.7 million cases in 2023. The Puerto Rican Department of Health recently extended its dengue epidemic alert until December, after this year’s season brought the highest proportion of severe dengue in the Americas. Of the nearly 2,000 cases reported to the territory’s health officials, 92 are severe, meaning patients may suffer from painful symptoms including fever, headaches and vomiting. Three of the dengue serotypes – DENV 1, 2, and 3 – are currently circulating. This alert comes just two weeks after the US Centers for Disease Control and Prevention (CDC) issued a health advisory warning of the increased risk of dengue virus infections in the US. While most cases in the continental US come from overseas travelers, Florida has reported a handful of locally-transmitted cases. Hurricane Beryl sets back health response Debris, abundant rainfall, and inadequate shelter are all hurricane by-products that increase the risk of dengue virus infection. The first category 5 hurricane of the season, Beryl devastated much of Saint Vincent and the Grenadines, Grenada, Dominica, Barbados, and Jamaica. The destruction left in the hurricane’s wake highlights small island nations’ vulnerabilities to climate change and its health effects. The Caribbean region is particularly susceptible to healthcare disruptions from natural disasters. Studies of cyclones in China and hurricanes in Puerto Rico found increases in dengue virus infections in the weeks following hurricanes. “Pre-existing environmental health risk magnified after the pass of Hurricanes Irma and María,” said researcher José Pérez-Ramos, Assistant Professor of Public Health Sciences at the University of Rochester. He notes that in the aftermath of 2017’s devastating hurricanes, participants in the study were worried about frequent dengue outbreaks. While the International Federation of the Red Cross (IFRC) and other relief organizations active in the Caribbean nations are in the early days of response and assessment, the confluence of the hurricane’s destruction and peak dengue season may spell out an increased case burden. “Hygiene kits, cleaning kits, tool kits, kitchen sets, tarpaulins, blankets and mosquito nets have already been dispatched to the hardest hit islands to meet the immediate needs of the affected population,” said Rhea Pierre, IFRC Disaster Manager for the English and Dutch-speaking Caribbean. “Still, rapid damage assessments show that the devastation is massive.” ‘A notable increase’ in cases, but low fatality rate Removing standing water sources is a key tactic in controlling for dengue. Despite this year’s record number of cases, the World Health Organisation’s (WHO) regional office in the Americas, the Pan-American Health Organization (PAHO), notes that the fatality rate for the Americas has not exceeded the regional benchmark of 0.05%. “While we are seeing a notable increase in the number of dengue cases in the region this year, it is important to highlight that the proportion of cases that progress to death remains low thanks to countries’ efforts and the support of PAHO,” said Jarbas Barbosa, PAHO Director, in a recent press release. “This situation highlights the importance of sustaining surveillance, strengthening prevention and control measures, and ensuring timely medical care,” he added. Standing water, seen here in the aftermath of Hurricane Otis, is needed for mosquitoes to breed. Few studies have assessed what causes some patients to progress to severe dengue. The WHO notes that ensuring access to sufficient medical care should remain at the forefront of countries’ priorities to treat severe dengue. PAHO’s Caribbean Mosquito Awareness Week, which took place in May, aimed to raise public awareness about the connection between mosquitoes and the diseases they transmit, such as dengue, chikungunya, and Zika, and to involve the community to prevent mosquito breeding. “The population and household members should be encouraged to eliminate sources of mosquito breeding, both household and peri-household. This is everyone’s task: the family, the community, the public and private sector,” said PAHO in a recent alert on increased cases in Central America, Mexico, and the Caribbean regions. Aedes aegypti, the main mosquito vector, typically breeds in sites such as water containers as well as in urban waste, including plastic wrapping that can accumulate rainwater. As the virus doesn’t have a cure and repeat infections can even be more severe, surveillance and control of mosquito breeding sites is critical to reduce dengue transmission and illness, particularly the most severe form of the disease, dengue hemorrhagic fever. Dengue cases expected to rise in Mexico, Central America and Caribbean Cases have yet to peak fully in the Caribbean, Central America and Mexico. Farther north of the equator, cases have yet to peak in the PAHO regions of the Caribbean, Central America Isthmus and Mexico. “Although there has been a decrease in dengue cases in the Southern Cone [Brazil, Argentina, Paraguay, and Uruguay] and Andean sub-regions in recent epidemiological weeks, the subregions of the Central American isthmus and Mexico, and the Caribbean subregion are entering the period of increased dengue circulation, which could significantly increase the number of cases reported in the Region during the second half of 2024,” said PAHO in their May epidemiological alert. Cases decreasing at tail-end of season Brazil, which accounts for more than 80% of the Americas’ dengue cases, is at the tail-end of its season. The number of dengue cases is finally tapering off for the South American countries hardest hit – Brazil in particular saw an explosive growth in cases earlier this year. PAHO attributes the country’s epidemic conditions to prolonged heat, higher rainfall levels, as well as decreased population immunity following COVID-19-related restrictions. In response, and to avoid losing vaccine stock to expiration, the Brazilian government recently expanded the population eligible for dengue vaccination. Now, children six to sixteen are eligible, rather than just ten to fourteen year-olds. Image Credits: Direct Relief/Felipe Luna, James Gathany/ PHIL, CDC, Public Domain, IFRC, PAHO , PAHO , PAHO. WHO Launches Platform for Standardised Medical Device Information 09/07/2024 Zuzanna Stawiska An online WHO platform gathers information about various medical devices: from simple syringes to complex hospital equipment. To help countries and organisations navigate a complex pool of over 10,000 different medical devices, the World Health Organization (WHO) launched an online platform on Monday that will collect and standardise the information about medical equipment. Medical Devices Information System, or MeDevIS, is inspired by the WHO Priority Medical Devices List (MDL) and the Essential Medicines List, the latter of which will soon have existed for 50 years, serving as an important support for health progress globally. MeDevIS includes 2,301 types of medical devices of varying levels of complexity: from single-use syringes, medical masks, and pulse oximeters, to imaging radiology technologies, implantable prostheses, or defibrillators. “The number of medical technologies used in health care is growing, as is their complexity, which can make it challenging for health care practitioners and patients to navigate,” said Dr Yukiko Nakatani, WHO Assistant Director-General for Access to Medicines and Health Products. The aim is for a “one-stop shop of international information” to help stakeholders to find appropriate equipment. The new platform references both major naming systems for medical devices, renowned internationally: the European Medical Device Nomenclature (EMDN) and the Global Medical Device Nomenclature (GMDN), used in some countries outside of the European region. Both systems facilitate handling specific types of equipment on the regulatory and logistics levels. MeDivIS also features information about the infrastructure required for the device, the healthcare facility level where it is typically used, and links to thematic WHO guidelines connected with the branch of care for which the equipment is made. “The MeDevIS platform can be useful for national policy-makers to develop or update their own national lists for the procurement of health technologies and devices and can contribute to the progress towards universal health coverage,” said Dr Deus Mubangizi, WHO Director for Health Products Policy and Standards. Image Credits: Unsplash. Russia’s Bombing of Ukraine Children Hospital is ‘Abominable’ 08/07/2024 Kerry Cullinan Children with cancer outside Okhmatdyt Hospital after the attack. Russia’s bombing of a children’s hospital and women’s health centre in Ukraine’s capital Kiev on Monday is “abominable”, said UN High Commissioner for Human Rights Volker Türk. “Civilians must be protected, and the laws of war strictly adhered to,” added Türk. “There must be prompt, thorough and independent investigations into these latest grave attacks on civilians and civilian infrastructure, and those responsible must be held to account.” “Shockingly, one of the strikes severely damaged the intensive care, surgical and oncology wards of Okhmatdyt, which is Ukraine’s largest children’s referral hospital, and destroyed its children’s toxicology department, where children receive dialysis,” said Türk. Okhmatdyt Hospital serves more than 20,000 children annually. Monday’s missile attack struck a medical building at the hospital where children were receiving dialysis, while also damaging the intensive care, operating, and oncology departments, according to the Minister of Health of Ukraine. The entire hospital is without electricity, preventing the use of ventilators and other urgent care. Dr Tedros Adhanom Ghebreyesus, Director General of the World Health Organisation (WHO), said that “several floors of the largest children’s hospital in Kyiv were severely impacted today, disrupting the hospital’s operations and affecting its ability to provide critical care to the young patients.” Several floors of the largest children’s hospital in Kyiv were severely impacted today, disruptng the hospital’s operations and affecting its ability to provide critical care to the young patients.@WHO has been working closely with the hospital before and since the war in… pic.twitter.com/9ReGcov71F — Tedros Adhanom Ghebreyesus (@DrTedros) July 8, 2024 Meanwhile, Türk said that OHCHR staff visiting the scene shortly after the attack had “observed children receiving treatment for cancer in hospital beds set up in parks and on streets, where medical workers had quickly established triage areas, amongst chaos, dust and debris.” Health officials said the entire hospital was now without electricity, preventing the use of ventilators and other urgent care. It was not immediately clear how many people were killed in the strike. The ISIDA Medical Centre, one of the largest women’s health and family planning centres in Ukraine, was also affected by the attack, with several casualties. The attack comes the day before a NATO summit in Washington DC. Russia has attacked Ukraine’s health care workers, facilities, and other medical infrastructure at least 1,442 times since its invasion of Ukraine in February 2022 and 13 April 2024,according to data from a partnership made up of the Ukrainian Health Center, Physicians for Human Rights (PHR) and others. Russian attacks on Ukraine health care since February 2022. “Russia’s strategy in Ukraine includes attacking babies and children. Domestic and international actors should intensify efforts to hold perpetrators accountable for these war crimes,” said Uliana Poltavets, PHR’s Ukraine emergency response coordinator in a statement. Researchers have documented 79 attacks that affected children’s health care, including 54 attacks that destroyed or damaged children’s hospitals. “Today’s devastating attack on the largest children’s hospital is emblematic of Russia’s onslaught against Ukraine’s health care system. Again and again, we have witnessed Russian forces attack vulnerable patients, health workers, and hospitals across the country,” said Poltavets. PHR called on “domestic and international prosecutors, including the International Criminal Court, to prioritise the investigation and prosecution of attacks on health care.” Image Credits: Twitter. Sierra Leone Outlaws Child Marriage 08/07/2024 Kerry Cullinan Sierra Leone First Lady Fatima Bio Sierra Leone’s President Julius Maada Bio signed into law the Prohibition of Child Marriage Act last week, introducing a penalty of at least 15 years and a fine of around $4,000 for any man who marries a girl under 18. The law also prohibits cohabiting with a child, and fines for anyone arranging, aiding or attending such marriage ceremonies. First Lady Fatima Bio’s “Hands Off Our Girls” campaign has been instrumental in advocating against child marriage in Sierra Leone. Sierra Leone has one of the highest rates of child marriages in Africa, alongside Niger and Nigeria. According to the 2019 Sierra Leone Demographic and Health Surveys, 30% of girls in Sierra Leone are married before their 18th birthday. In 2020, there were 800,000 child brides, half of whom were married before they turned 15, according to UNICEF. The country of slightly over eight million people also has a high rate of female genital mutilation. “Child marriages fuel the high adolescent pregnancy rate in Sierra Leone where, tragically, pregnancy complications are the leading cause of death for girls aged 15-19,” according to Human Rights Watch (HRW). In 2021, the country introduced a policy of “radical inclusion” in schools, targeting and marginalised groups including girls, particularly pregnant girls and parent learners. Last year, Sierra Leone passed an education law that guarantees children free education, including one year of pre-primary. “The legislation is a milestone in Sierra Leone’s journey towards gender equality and child protection. It also sets a pathway forward for other African nations, such as Tanzania and Zambia, to revoke laws that permit child marriage, and ensure girls can complete primary and secondary education,” said HRW. FDA Approves Eli Lilly’s Kisunla for Early-Stage Alzheimer’s Patients 08/07/2024 Maayan Hoffman Neurons with tau protein highlighted in red. Eli Lilly’s Alzheimer’s therapy, donanemab, has received FDA approval, offering new hope for patients with early symptomatic Alzheimer’s disease. The newly approved treatment, branded Kisunla, is set to challenge existing therapies from Eisai and Biogen. Clinical trials have shown Kisunla to be effective for individuals in the mild cognitive impairment or mild dementia stages of the disease, potentially marking a significant advancement in Alzheimer’s care. The drug is administered as an intravenous infusion every four weeks. Alzheimer’s disease is a degenerative condition of the brain that impacts over 6.5 million Americans and over 55 million people worldwide. It causes a gradual decline in memory, cognitive functions, and, eventually, the ability to perform daily activities. The disease is marked by structural changes in the brain, such as the buildup of amyloid beta plaques and neurofibrillary tangles made of tau protein, which is supposed to help stabilize the internal skeleton of neurons in the brain. The Alzheimer’s Association celebrated the FDA’s decision. “This is real progress,” said Joanne Pike, Alzheimer’s Association president and CEO, in a statement. “Today’s approval allows people more options and greater opportunity to have more time. Having multiple treatment options is the kind of advancement we’ve all been waiting for — all of us who have been touched, even blindsided, by this difficult and devastating disease.” Slows cognitive decline by at least 22% The approval was based on an extensive double-blind, placebo-controlled, parallel-group study evaluating the efficacy of Kisunla in slowing cognitive decline in participants with varying levels of tau protein in the brain. Tau is a protein that helps to stabilise the neurons in the brain. The study, conducted over 72 weeks with 1,736 patients averaging 73 years old, revealed that those receiving Kisunla experienced a 35% reduction in cognitive decline compared to those on placebo among individuals with low to medium tau levels. Even among participants with higher tau levels, the treatment demonstrated a meaningful but slightly reduced effect. Overall, including all tau levels, Kisunla slowed cognitive decline by 22% and reduced the likelihood of progressing to the next stage of the disease by 39% compared to placebo. Additionally, the study monitored amyloid plaque levels using positron emission tomography (PET) scans throughout the treatment period. Results showed substantial reductions in amyloid plaques over time among patients receiving Kisunla, with reductions of 61% at six months, 80% at 12 months, and 84% at 18 months compared to baseline levels. These findings suggest that Kisunla not only targets cognitive decline but also effectively reduces the hallmark amyloid pathology associated with Alzheimer’s disease progression. Potential side effects For some patients, there is a risk of amyloid-related imaging abnormalities (ARIA) developing, the FDA said. ARIA typically manifests as temporary brain swelling, sometimes accompanied by small areas of bleeding on or in the brain. While ARIA often resolves on its own and may not cause symptoms, rare instances of severe and potentially life-threatening events have been reported. ARIA is a recognized side effect of antibody therapies targeting amyloid. Infusion-related reactions are also a concern, including flu-like symptoms, nausea, vomiting, changes in blood pressure, and hypersensitivity reactions such as anaphylaxis (a severe allergic reaction) and angioedema (swelling). Kisunla joins Leqembi, on market since 2023 Kisunla is the third drug to receive FDA approval, although only the second is now available for use. Leqembi, a collaboration between Biogen of the United States and Eisai of Japan, gained approval in July 2023. In an 18-month Phase III trial, Leqembi demonstrated a 27% reduction in cognitive decline among early-stage Alzheimer’s patients compared to those receiving a placebo. Another drug, aducanumab, also developed by Biogen and Eisai, was granted accelerated approval by the FDA in June 2021. However, due to some side effects, the therapy was pulled from the market. The Alzheimer’s Association emphasized the importance of early detection and diagnosis now that multiple FDA-approved treatments for Alzheimer’s are available. The organization stressed that timely access to these treatments is crucial for maximizing their benefits, asserting that no stage or entity should hinder or delay such access. “Too many roadblocks have prevented individuals from getting equitable access to these beneficial treatments for far too long,” said Pike. “It is equally important that clinicians and health care systems are informed and prepared to help the individuals who could benefit. The Alzheimer’s Association is working with health systems and providers to ensure they have the tools and resources to meet the needs of their patients.” Image Credits: Gerry Shaw/ EnCor Biotechnology Inc. Earliest Ever Hurricane Tears Through Caribbean, Highlighting Need for Speedier Climate Action 05/07/2024 Kerry Cullinan Fishing vessels at the Bridgetown Fisheries Complex in Barbados damaged by Hurricane Beryl. Hurricane Beryl, which has destroyed homes and infrastructure in large parts of the eastern Caribbean, is the first first-ever Category 4 hurricane recorded in the region in June – and a portend of devastating changes in weather patterns. It also underscores the need for urgent international assistance to Small Island Developing States (SIDS) to strengthen early warning systems and the climate resilience of key infrastructure – notably water, sanitation and health services, according to experts. The hurricane reached peak speed of 265 km per hour at times as it whipped though Barbados, Grenada, St Vincent and the Grenadines, Haiti, northern Venezuela, the Dominician Republic, Cayman Islands, and Jamaica. “The storm first impacted Barbados, causing severe damage to the south coast and significantly affecting the fishing industry with over 200 fishing vessels damaged or destroyed,” according to the International Federation of Red Cross and Red Crescent Societies (IFRC). On Union Island, part of Saint Vincent and the Grenadines, 90% of infrastructure has been damaged, including houses, roads and the airport. Some 95% of homes in Grenada’s Carriacou and Petite Martinique islands, are damaged, and around 3,000 people are shelters, the IFRC added. Parts of Jamaica’s St Elizabeth region in the south east were also devastated, with around 1,000 people taking refuge in shelters. The Dominican Republic, Cayman Islands reported damage. Venezuela’s President Nicolas Maduro said that 8,000 houses had been destroyed, according to Reuters. More to still come? “Hurricane Beryl, the first hurricane of the 2024 Atlantic hurricane season, rapidly strengthened to a Category 5 storm unusually early in the year,” according to a report from the National Ocean and Atmospheric Administration (NOAA), which is part of the US Department of Commerce “This explosive strengthening was fuelled in part by exceptionally warm ocean temperatures. That heat was one of the factors behind NOAA’s prediction in May of an 85% chance that the 2024 Atlantic hurricane season would be above normal.” Sea surface temperatures were close to those usually found in mid-September, the peak of hurricane season, added NOAA. In late May, NOAA weather forecasters predicted an 85% chance of above-normal hurricane for the 2024 Atlantic hurricane season, which runs from 1 June 1 to 30 November. It also forecast eight to 13 hurricanes, with four to seven likely to be “major” hurricanes (winds of over 178km per hour) in coming months. Early warning systems “The unprecedented hurricane demonstrates the importance of effective multi-hazard early warning systems to save lives,” according to United Nations Disaster Risk Reduction (UNDRR). “Globally, the sustained investments in those systems are making progress in reducing the loss of life in disasters. But economic losses are escalating. Every year millions of households lose their livelihood and risk being pushed into poverty. Ensuring that infrastructure is resilient and that communities ‘build back better’ in the face of future hazards is essential,” added UNDRR. Damage sustained to the airport and surrounding areas on Union Island in the Grenadines during Hurricane Beryl. In late May, the Fourth International Conference on SIDS adopted the Antigua and Barbuda Agenda for SIDS, a 10-year development agenda that appeals for international assistance to address climate change. The Agenda notes that “SIDS are facing the unrelenting and compounding impacts of climate change, biodiversity loss, pollution, disasters and natural hazards, health and other social related challenges and economic vulnerabilities.” Key climate change challenges include “erratic precipitation, increasingly frequent and extreme weather phenomena, more frequent and severe tropical cyclones, floods and drought, diminishing fresh water resources, desertification, coastal erosion, land degradation and sea-level rise.” However, there has been a “progressive deterioration” in SIDS’ ability to “withstand external shocks and enhance their resilience” – largely as a result of the economic impact of COVID-19 and climate challenges. Financial reform to build resilience Protestors call on wealth countries to pay for climate-related loss and damage at COP27. “In the wake of Hurricane Beryl, it is clear that we must redouble our efforts to build resilience and preparedness in the face of growing disaster risk, especially for small island developing states, which have contributed the least to the climate crisis but suffer the greatest costs,” said UNDRR head Kamal Kishore. Kishore appealed for international support for the Antigua and Barbuda Agenda, which “integrates disaster risk reduction as central to climate change adaptation and sustainable development in SIDS with clear calls to action on enhancing multi-hazard early warning systems and resilient infrastructure.” There have also been numerous calls for reform of the international financial architecture to assist developing countries most affected by climate change who are being forced to borrow money to address climate crises largely caused by wealthy nations. The most significant of these is the 2022 Bridgetown Initiative, spearheaded by Prime Minister Mia Mottley of Barbados. This called for key actions including new loan mechanisms, reform of the world’s development banks, and a loss and damages fund to enable developing countries to access to resilient finance to address climate and development crises. The UN climate change conference, COP27, agreed to establish a loss and damage fund during the UN Climate Change Conference (COP27) in 2022. However, there is resistance from a number of wealthier countries to this as the world continues to experience record-breaking extreme weather events. Meanwhile, the International Cort of Justice (ICJ) is expected to hold public hearings and issue an advisory later this year on the international legal obligations countries have to safeguard people against climate change. This follows the adoption last year of a landmark UN resolution to seek such an advisory opinion from the ICJ. While not legally binding, the advisory opinion holds legal and moral weight and will spotlight the human rights impacts of climate policy. Image Credits: UNDP, AfricaNews. As More US Dairy Herds Infected with Avian Flu, Americans in the Dark on the Risks of Raw Milk 04/07/2024 Zuzanna Stawiska Over one-half of Americans are not sure if pasteurised milk is safer than raw milk. In the time of avian flu epidemics in US cattle, this could even prove dangerous. As the fourth human case of H5N1 avian flu in a US farmworker in Colorado was confirmed Wednesday by the US Centers for Disease Control and Prevention (CDC), so far, only farm workers, and not consumers, have reported avian flu infections. This is likely due, at least in part, to the successful inactivation of the virus during the milk pasteurization process, experts say. And yet one-half or more Americans seem to have little idea about the dangers of drinking raw milk, according to a recent poll conducted by the University of Pennsylvania researchers. The survey, which included a demographically representative sample of the US adult population, found that less than half (47% percent) of the U.S. adults surveyed understood that drinking raw milk not as safe as drinking pasteurized milk. Conversely, 53% of respondents don’t actually believe that pasteurized milk is safer. And 9% of respondents actually believed raw milk is safer, while 15% said it was just as safe and 30% were unsure. Nearly a quarter (24%) of Americans either do not believe that pasteurization is effective at killing bacteria and viruses in milk products (4%) or are not sure whether this is true (20%), according to the survey of over 1000 US adults, conducted by the Annenberg Public Policy Center (APPC). The survey has a 3-3.5% statistical error rate. Around half of US adults failed to recognize that raw milk can be more dangerous than pasteurized milk products. That, despite the fact that studies report that pasteurized milk limits hospitalizations for related illnesses by an order of 45, according to the APPC report. The French Scientist Louis Pasteur invented the pasteurization process 160 years ago, after recognizing that it killed off otherwise dangerous bacteria present in unheated wine. The process, which soon became a milk industry standard in the United States, successfully inactivates the modern-day avian flu virus, significantly limiting the risk of infection for the general public. Politics and milk In fact, only about 2% of Americans report drinking raw milk at least once a month, according to a Food and Drug Administration (FDA) study based on 2019 data. Paradoxically, however, raw milk sales in the US have increased in recent months, according to some US media reports, despite the recent risks posed by a widening circle of avian influenza among dairy cattle. Debate has been spurred by the increased anti-science bent of some US political leaders. Presidential candidate Robert F. Kennedy Jr., for instance, who also has been a staunch opponent of COVID vaccination, has been quoted saying that he drinks raw milk exclusively. The APPC survey also found that Republicans are more likely than Democrats to believe that drinking raw milk is as safe as pasteurized milk (57% vs. 37%). People living in an urban environment also are more likely to believe that pastuerized milk is safer than raw milk as compared to people in a rural environment (49% vs. 32%). “The difference in views of raw milk that we see between Democrats and Republicans is difficult to disentangle from the difference between rural and urban dwellers,” said Kathleen Hall Jamieson, director of the Annenberg Public Policy Center. “Those in rural areas are both more likely to identify as Republicans and to consume raw milk.” 55 more dairy herds reported infected in last 30 days Some 55 more cattle herds in seven states have been infected with the virus over the past 30 days, according to CDC tracking. Infections in the past 30 days represent 40% of the total of 138 cattle herds infected in 12 states since the outbreak in dairy cattle was first reported on 25 March, the CDC reported. States affected by avian flu spread in dairy cattle The real number of infections of both humans and cattle is very likely underestimated, insofar as farmers have been reluctant to have their staff or herds tested, experts warn. Even so, the CDC maintained that infection risks for the general public remain low. “Based on the information available at this time, this infection does not change CDC’s current H5N1 bird flu human health risk assessment for the U.S. general public, which the agency considers to be low,” the CDC said in a statement. Image Credits: Cotonbro studio, APCC, CDC. Even India’s ‘Cleanest’ Cities Have Significant Excess Air Pollution-Related Deaths from NCDs 04/07/2024 Chetan Bhattacharji The air in relatively ‘clean’ Mumbai is still killing citizens. NEW DELHI – On 2 November 2023, extreme air pollution caught Delhi off-guard. It shut down schools and led to flight cancellations, curbs on construction and other emergency responses. That every little increase in air pollution increases the risk of death has been well-established for some years. But till now the effect of short-term air pollution on mortality has remained largely undocumented in detail in India, where most of the world’s most polluted cities are located. In a new, peer-reviewed study published in the Lancet on Thursday (4 July), researchers found that 7.2% (or approximately 33,000) of all deaths each year across 10 cities could be linked to short-term PM 2.5 exposure higher than the World Health Organization (WHO) guideline of 15 micrograms/cubic metre (µg/m³). PM 2.5 is a highly toxic ultra-fine particulate matter with a diameter of 2.5 microns, which is far thinner than a strand of human hair. This is the first multi-city study in India to assess the link between short-term pollution exposure and death with cities spanning different agri-climatological zones. The bottom line, the authors say, is that the current Indian government standard for PM 2.5 of 60 µg/m³ is “substantially higher” than it should be as a measure of ‘safe’ air quality. In comparison, WHO’s 24-hour standard is 15 µg/m³. NCDs are the leading cause for air pollution-related deaths The Lancet paper doesn’t look at the cause of death as that level of primary data isn’t always available. However, many studies including recent ones in India have shown that air pollution triggers or aggravates non-communicable diseases – specifically NCDs like heart attacks, strokes, lung cancer, and chronic lung disease – which can turn fatal. Of the total air pollution deaths, NCDs account for nearly 90% of the disease burden. The researchers are from 14 organisations including Sustainable Futures Collaborative in Delhi, Institute of Environmental Medicine in Stockholm, Indian Institute of Management Ahmedabad, Public Health Foundation of India, Ashoka University in Sonipat, Mount Sinai in New York, and Boston University. To come to their conclusions, the researchers analysed primary data on mortality between 2008 and 2019 in 10 cities of India. They used an advanced system of machine learning-based analysis which, simply put, used factors that would have a bearing on air pollution-related deaths, namely wind speed, atmospheric pressure and mixing height. This causal modelling approach enabled the researchers to isolate the effect of locally generated pollution as these factors are linked to the dispersal and transport of air pollution. Combined with other data from monitors, satellites and other sources, the study looked at over 3.6 million deaths in the 11-year study period. What the more complex causal modelling shows is that the risk of death is greater than what the earlier basic approach showed. No safe level of air pollution The causal modelling estimated an increase in the risk of death by 3.57% for every rise of just 10 µg/m³ metre over a two day period, as compared to 1.42% by a more basic study. Apart from the usual high-pollution suspects like Delhi and Varanasi, the study looked at places commonly perceived as having clean air, like the Himalayan city of Shimla and the coastal metropolises of Chennai and Mumbai. The authors say this is the first such multi-city study on the links between short-term air pollution exposure and deaths in India. Overall, 7.2% of all daily deaths were attributed to PM 2.5 concentrations higher than the WHO guidelines. Annually there are estimated to be approximately 33,000 deaths in these 10 cities. Over a third are in Delhi, where the average annual PM 2.5 level was 113 micrograms which is more than 22 times the WHO’s safe standard. The share of PM 2.5 linked deaths was also the highest in the Capital, at 11.5% compared to the lowest 3.5% in Shimla. The surprises are Mumbai and Kolkata, with deaths numbering around 5,000 each, annually. “We are seeing a high level of risk and a high number of deaths even in cities that have moderate levels of air pollution exposure. Mumbai, for instance, despite being a coastal city with around a third of the annual PM 2.5 levels of Delhi is still seeing over 5,000 deaths yearly from air pollution,” a lead author of the report, Dr Bhargav Krishna, Fellow at the Sustainable Futures Collaborative, explained to Health Policy Watch. “Similarly Hyderabad, Kolkata, Bengaluru, Chennai, Ahmedabad and Pune, all of which have annual PM2.5 levels below the current Indian standard, are still seeing a high number of deaths each year. This should drive us to focus not just on those cities that have high seasonal exposures, but even those that may be considered relatively ‘clean’ but are in reality polluted at a level that causes significant health impacts.” Mumbai air in March 2023. Mumbai, where remarkably the air pollution has been higher than Delhi on some days, was shown to have almost 5,100 deaths, the second highest after the national capital. That is 5.9% of all deaths in what is India’s financial capital. Here, every increase of 10 micrograms of PM 2.5 was associated with a 2.41% increase in daily deaths. Over 7% of daily deaths attributable to increases in short-term PM 2.5 First such study in Indian cities, say authors City Average Annual Pollution (PM2.5, mg/m³) Attributable Fraction of Deaths (%) Attributable Deaths Per Year Delhi 113 11.5 11,964 Varanasi 82.1 10.2 831 Kolkata 55.2 7.3 4,678 Pune 45.3 5.9 1,367 Mumbai 41.7 5.6 5,091 Hyderabad 38.9 5.6 1,597 Ahmedabad 37.9 5.6 2,495 Chennai 33.7 4.9 2,870 Bangalore 33 4.8 2,102 Shimla 28.4 3.7 59 Total 53.6 7.2 33,627 Source: Lancet Shimla proves that there is no safe level of air pollution, according to the report. It has the lowest air pollution level of the 10 cities, yet that was still a risk as 3.7% of all deaths were attributable to short-term PM 2.5 exposure. Impact on policy action The findings are crucial for immediate policy action and further studies to cover hundreds more towns and rural areas. Immediate action would cover sources of pollution like diesel generators, waste burning, and transport, sources that are commonly seen in many urban neighbourhoods. While much of the headline-grabbing focus is on extreme pollution, these findings show the need to act against all sources of air pollution all year round. Acting only on extremely high days of pollution will only yield marginal benefits regarding daily mortality. In particular, the paper calls out the Graded Response Action Plans, largely used in Delhi and its neighbouring cities. GRAPs are usually cited by local governments as their action to cut pollution but are implemented only in peak pollution season which is from October right through winter. Toxicity of local pollution There are some interesting findings which aren’t widely known. The study confirms that the risk of mortality rose more quickly at lower levels of PM 2.5 but plateaued as levels increased. More studies are needed to understand why exactly this happens. The causal modelling showed that the effects of air pollution on deaths were especially strong in cities with lower levels of pollution such as Bengaluru, Chennai and Shimla. The study fills a data and communication gap in addressing the health crisis caused by toxic air. On one hand, it establishes a link between rising air pollution and deaths, on the other, it makes the risks a lot more relatable because it shows the impact over just two days of exposure than over many months or years. So what can residents in these cities do to protect themselves? Bhargav says individual responses could include wearing a mask, choosing when to step outdoors (pollution tends to be highest during the morning and evening when temperatures dip), and reducing pollution sources inside their home. However, the onus lies on governments and policymakers. “The levels of air pollution we see in India are extremely high and this study clearly shows how day-to-day variations in these levels lead to considerable mortality,” said Dr Petter Ljungman of the Karolinska Institute, and one of the researchers involved in the study. “Interestingly we saw that local pollution sources are likely to be more toxic than more distant sources which has implications for policymakers addressing this highly relevant threat to human health.” Image Credits: Chetan Bhattacharji. Positioning the University of Ghana as a ‘Research-Intensive’ Institution on Neglected Diseases 03/07/2024 Jessica Ahedor Scientists at the West African Centre for Cell Biology and Infectious Pathogens (WACCBIP), University of Ghana, setting up a genome sequencing experiment in the laboratory. Almost 15 years ago, when the University of Ghana established its Office of Research, Innovation, and Development, it did so with the goal of bolstering the West African nation’s research capacity. In the African region, where less than 0.5% of GDP is devoted to research, and a significant number of Africa’s educated is siphoned off to other countries, the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR) has spearheaded the effort to make universities like the University of Ghana research-intensive and competitive. TDR support for research capacity-strengthening activities at the University of Ghana focuses on enabling researchers to tackle infectious diseases of poverty through quality implementation research, the study of bridging basic science research and practice. This could mean examining why many patients on antiretroviral therapy drop out of treatment, or identifying barriers to TB treatment adherence – both the subject of recent publications authored by researchers at the University of Ghana. Capacity-building works Professor Gordon A. Awandare at TDR’s Joint Coordinating Board meeting in Geneva, 12 June 2024 “Capacity-building actually works,” remarked Professor Gordon A Awandare, Pro Vice-Cancellor of Academic Student Affairs at the University of Ghana, at a TDR 50th anniversary event in Geneva, where he gave a detailed review of the collaboration before TDR’s Joint Coordinating Board on June 12. He cited, as one example, his own career trajectory. Awandare began a career in research through a TDR grant that allowed him to complete his masters training, and then got an opportunity to study for a PhD at the University of Pittsburgh while attending a conference on malaria with support from TDR. He returned home to the University of Ghana in 2010, founding the West African Centre for Cell Biology of Infectious Pathogens (WACCBIP) in 2014. Since then, the Centre, supported by the Wellcome Trust and the World Bank, has endowed 400 fellowships and received $53 million in grants, thereby directly reducing the “brain drain” across the African region. A decade-long partnership The University of Ghana leads efforts to train students in implementation research. Newly enrolled master’s students during their lab induction at WACCBIP, University of Ghana. In 2014 the University of Ghana’s School of Public Health signed a partnership agreement with TDR to create a regional training center that leads activities in the African region for strengthening capacity in implementation research to tackle infectious diseases of poverty. The initiative has so far trained more than 25,000 individuals across Africa, including health practitioners, decision-makers and researchers. “Looking at how far we’ve come as a training centre, it is our desire to become a centre of excellence where the annual programmes can be extended to say five years,” said Professor Phyllis Dako-Gyeke, who led the TDR-supported research training programmes at University of Ghana until her passing on 11 June. But the success of an almost decade-long relationship is not without its challenges. Sustainable donor support and aligned interests on research priorities remain key, she said. Real-time research Implementation researchers at UG have tackled issues from TB treatment adherence to antiretroviral therapy. Here, a community health worker conducts an interview in Obuasi, Ghana to identify barriers and facilitators for TB control. Dr Emmanuel Asampong, coordinator of the regional training centre at the University of Ghana, notes that “the impact of implementation research on disease themes in Africa and beyond is impressive because the initiative uses real-time research results in various contexts – such as the neglected tropical diseases programme, the national malaria programme, and the tuberculosis control programme – to provide solutions to challenges.” The global program, which has played a significant role in positioning University of Ghana as a research-intensive university, supports seven regional training centres across six WHO regions. With additional partners in Colombia, Indonesia, Kazakhstan, Malaysia, Senegal and Tunisia, the program develops and updates implementation research courses, provides faculty training and supports career development. The global program, which has played a significant role in positioning University of Ghana as a research institution, also supports NTD research in six WHO regions. The University of Ghana also partners with TDR on a postgraduate training scheme, which provides a full academic scholarship for master’s students. The training is specifically focused on implementation research to tackle infectious diseases of poverty. The list of TDR alumni across the world runs long, and the University of Ghana can claim many public health leaders among them. “My postgraduate training at the University of Ghana, supported by TDR, was an invaluable catalyst in shaping my academic and professional journey,” said Dr Mbele Whiteson, Senior Resident Medical Officer at the Ministry of Health in Zambia. “I have learned to recognize the intricate interplay between health outcomes and social determinants.” This is the third article in a series on TDR’s research capacity strengthening programme – building skills of public health researchers, implementers, health practitioners and policy-makers in the fast-developing field of implementation research for improving uptake of effective health interventions. Sophia Samantaroy contributed to the writing and research of this story. Image Credits: WACCBIP, TDR, African Regional Training Centre (ARTC), University of Ghana/TDR. 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WHO Launches Platform for Standardised Medical Device Information 09/07/2024 Zuzanna Stawiska An online WHO platform gathers information about various medical devices: from simple syringes to complex hospital equipment. To help countries and organisations navigate a complex pool of over 10,000 different medical devices, the World Health Organization (WHO) launched an online platform on Monday that will collect and standardise the information about medical equipment. Medical Devices Information System, or MeDevIS, is inspired by the WHO Priority Medical Devices List (MDL) and the Essential Medicines List, the latter of which will soon have existed for 50 years, serving as an important support for health progress globally. MeDevIS includes 2,301 types of medical devices of varying levels of complexity: from single-use syringes, medical masks, and pulse oximeters, to imaging radiology technologies, implantable prostheses, or defibrillators. “The number of medical technologies used in health care is growing, as is their complexity, which can make it challenging for health care practitioners and patients to navigate,” said Dr Yukiko Nakatani, WHO Assistant Director-General for Access to Medicines and Health Products. The aim is for a “one-stop shop of international information” to help stakeholders to find appropriate equipment. The new platform references both major naming systems for medical devices, renowned internationally: the European Medical Device Nomenclature (EMDN) and the Global Medical Device Nomenclature (GMDN), used in some countries outside of the European region. Both systems facilitate handling specific types of equipment on the regulatory and logistics levels. MeDivIS also features information about the infrastructure required for the device, the healthcare facility level where it is typically used, and links to thematic WHO guidelines connected with the branch of care for which the equipment is made. “The MeDevIS platform can be useful for national policy-makers to develop or update their own national lists for the procurement of health technologies and devices and can contribute to the progress towards universal health coverage,” said Dr Deus Mubangizi, WHO Director for Health Products Policy and Standards. Image Credits: Unsplash. Russia’s Bombing of Ukraine Children Hospital is ‘Abominable’ 08/07/2024 Kerry Cullinan Children with cancer outside Okhmatdyt Hospital after the attack. Russia’s bombing of a children’s hospital and women’s health centre in Ukraine’s capital Kiev on Monday is “abominable”, said UN High Commissioner for Human Rights Volker Türk. “Civilians must be protected, and the laws of war strictly adhered to,” added Türk. “There must be prompt, thorough and independent investigations into these latest grave attacks on civilians and civilian infrastructure, and those responsible must be held to account.” “Shockingly, one of the strikes severely damaged the intensive care, surgical and oncology wards of Okhmatdyt, which is Ukraine’s largest children’s referral hospital, and destroyed its children’s toxicology department, where children receive dialysis,” said Türk. Okhmatdyt Hospital serves more than 20,000 children annually. Monday’s missile attack struck a medical building at the hospital where children were receiving dialysis, while also damaging the intensive care, operating, and oncology departments, according to the Minister of Health of Ukraine. The entire hospital is without electricity, preventing the use of ventilators and other urgent care. Dr Tedros Adhanom Ghebreyesus, Director General of the World Health Organisation (WHO), said that “several floors of the largest children’s hospital in Kyiv were severely impacted today, disrupting the hospital’s operations and affecting its ability to provide critical care to the young patients.” Several floors of the largest children’s hospital in Kyiv were severely impacted today, disruptng the hospital’s operations and affecting its ability to provide critical care to the young patients.@WHO has been working closely with the hospital before and since the war in… pic.twitter.com/9ReGcov71F — Tedros Adhanom Ghebreyesus (@DrTedros) July 8, 2024 Meanwhile, Türk said that OHCHR staff visiting the scene shortly after the attack had “observed children receiving treatment for cancer in hospital beds set up in parks and on streets, where medical workers had quickly established triage areas, amongst chaos, dust and debris.” Health officials said the entire hospital was now without electricity, preventing the use of ventilators and other urgent care. It was not immediately clear how many people were killed in the strike. The ISIDA Medical Centre, one of the largest women’s health and family planning centres in Ukraine, was also affected by the attack, with several casualties. The attack comes the day before a NATO summit in Washington DC. Russia has attacked Ukraine’s health care workers, facilities, and other medical infrastructure at least 1,442 times since its invasion of Ukraine in February 2022 and 13 April 2024,according to data from a partnership made up of the Ukrainian Health Center, Physicians for Human Rights (PHR) and others. Russian attacks on Ukraine health care since February 2022. “Russia’s strategy in Ukraine includes attacking babies and children. Domestic and international actors should intensify efforts to hold perpetrators accountable for these war crimes,” said Uliana Poltavets, PHR’s Ukraine emergency response coordinator in a statement. Researchers have documented 79 attacks that affected children’s health care, including 54 attacks that destroyed or damaged children’s hospitals. “Today’s devastating attack on the largest children’s hospital is emblematic of Russia’s onslaught against Ukraine’s health care system. Again and again, we have witnessed Russian forces attack vulnerable patients, health workers, and hospitals across the country,” said Poltavets. PHR called on “domestic and international prosecutors, including the International Criminal Court, to prioritise the investigation and prosecution of attacks on health care.” Image Credits: Twitter. Sierra Leone Outlaws Child Marriage 08/07/2024 Kerry Cullinan Sierra Leone First Lady Fatima Bio Sierra Leone’s President Julius Maada Bio signed into law the Prohibition of Child Marriage Act last week, introducing a penalty of at least 15 years and a fine of around $4,000 for any man who marries a girl under 18. The law also prohibits cohabiting with a child, and fines for anyone arranging, aiding or attending such marriage ceremonies. First Lady Fatima Bio’s “Hands Off Our Girls” campaign has been instrumental in advocating against child marriage in Sierra Leone. Sierra Leone has one of the highest rates of child marriages in Africa, alongside Niger and Nigeria. According to the 2019 Sierra Leone Demographic and Health Surveys, 30% of girls in Sierra Leone are married before their 18th birthday. In 2020, there were 800,000 child brides, half of whom were married before they turned 15, according to UNICEF. The country of slightly over eight million people also has a high rate of female genital mutilation. “Child marriages fuel the high adolescent pregnancy rate in Sierra Leone where, tragically, pregnancy complications are the leading cause of death for girls aged 15-19,” according to Human Rights Watch (HRW). In 2021, the country introduced a policy of “radical inclusion” in schools, targeting and marginalised groups including girls, particularly pregnant girls and parent learners. Last year, Sierra Leone passed an education law that guarantees children free education, including one year of pre-primary. “The legislation is a milestone in Sierra Leone’s journey towards gender equality and child protection. It also sets a pathway forward for other African nations, such as Tanzania and Zambia, to revoke laws that permit child marriage, and ensure girls can complete primary and secondary education,” said HRW. FDA Approves Eli Lilly’s Kisunla for Early-Stage Alzheimer’s Patients 08/07/2024 Maayan Hoffman Neurons with tau protein highlighted in red. Eli Lilly’s Alzheimer’s therapy, donanemab, has received FDA approval, offering new hope for patients with early symptomatic Alzheimer’s disease. The newly approved treatment, branded Kisunla, is set to challenge existing therapies from Eisai and Biogen. Clinical trials have shown Kisunla to be effective for individuals in the mild cognitive impairment or mild dementia stages of the disease, potentially marking a significant advancement in Alzheimer’s care. The drug is administered as an intravenous infusion every four weeks. Alzheimer’s disease is a degenerative condition of the brain that impacts over 6.5 million Americans and over 55 million people worldwide. It causes a gradual decline in memory, cognitive functions, and, eventually, the ability to perform daily activities. The disease is marked by structural changes in the brain, such as the buildup of amyloid beta plaques and neurofibrillary tangles made of tau protein, which is supposed to help stabilize the internal skeleton of neurons in the brain. The Alzheimer’s Association celebrated the FDA’s decision. “This is real progress,” said Joanne Pike, Alzheimer’s Association president and CEO, in a statement. “Today’s approval allows people more options and greater opportunity to have more time. Having multiple treatment options is the kind of advancement we’ve all been waiting for — all of us who have been touched, even blindsided, by this difficult and devastating disease.” Slows cognitive decline by at least 22% The approval was based on an extensive double-blind, placebo-controlled, parallel-group study evaluating the efficacy of Kisunla in slowing cognitive decline in participants with varying levels of tau protein in the brain. Tau is a protein that helps to stabilise the neurons in the brain. The study, conducted over 72 weeks with 1,736 patients averaging 73 years old, revealed that those receiving Kisunla experienced a 35% reduction in cognitive decline compared to those on placebo among individuals with low to medium tau levels. Even among participants with higher tau levels, the treatment demonstrated a meaningful but slightly reduced effect. Overall, including all tau levels, Kisunla slowed cognitive decline by 22% and reduced the likelihood of progressing to the next stage of the disease by 39% compared to placebo. Additionally, the study monitored amyloid plaque levels using positron emission tomography (PET) scans throughout the treatment period. Results showed substantial reductions in amyloid plaques over time among patients receiving Kisunla, with reductions of 61% at six months, 80% at 12 months, and 84% at 18 months compared to baseline levels. These findings suggest that Kisunla not only targets cognitive decline but also effectively reduces the hallmark amyloid pathology associated with Alzheimer’s disease progression. Potential side effects For some patients, there is a risk of amyloid-related imaging abnormalities (ARIA) developing, the FDA said. ARIA typically manifests as temporary brain swelling, sometimes accompanied by small areas of bleeding on or in the brain. While ARIA often resolves on its own and may not cause symptoms, rare instances of severe and potentially life-threatening events have been reported. ARIA is a recognized side effect of antibody therapies targeting amyloid. Infusion-related reactions are also a concern, including flu-like symptoms, nausea, vomiting, changes in blood pressure, and hypersensitivity reactions such as anaphylaxis (a severe allergic reaction) and angioedema (swelling). Kisunla joins Leqembi, on market since 2023 Kisunla is the third drug to receive FDA approval, although only the second is now available for use. Leqembi, a collaboration between Biogen of the United States and Eisai of Japan, gained approval in July 2023. In an 18-month Phase III trial, Leqembi demonstrated a 27% reduction in cognitive decline among early-stage Alzheimer’s patients compared to those receiving a placebo. Another drug, aducanumab, also developed by Biogen and Eisai, was granted accelerated approval by the FDA in June 2021. However, due to some side effects, the therapy was pulled from the market. The Alzheimer’s Association emphasized the importance of early detection and diagnosis now that multiple FDA-approved treatments for Alzheimer’s are available. The organization stressed that timely access to these treatments is crucial for maximizing their benefits, asserting that no stage or entity should hinder or delay such access. “Too many roadblocks have prevented individuals from getting equitable access to these beneficial treatments for far too long,” said Pike. “It is equally important that clinicians and health care systems are informed and prepared to help the individuals who could benefit. The Alzheimer’s Association is working with health systems and providers to ensure they have the tools and resources to meet the needs of their patients.” Image Credits: Gerry Shaw/ EnCor Biotechnology Inc. Earliest Ever Hurricane Tears Through Caribbean, Highlighting Need for Speedier Climate Action 05/07/2024 Kerry Cullinan Fishing vessels at the Bridgetown Fisheries Complex in Barbados damaged by Hurricane Beryl. Hurricane Beryl, which has destroyed homes and infrastructure in large parts of the eastern Caribbean, is the first first-ever Category 4 hurricane recorded in the region in June – and a portend of devastating changes in weather patterns. It also underscores the need for urgent international assistance to Small Island Developing States (SIDS) to strengthen early warning systems and the climate resilience of key infrastructure – notably water, sanitation and health services, according to experts. The hurricane reached peak speed of 265 km per hour at times as it whipped though Barbados, Grenada, St Vincent and the Grenadines, Haiti, northern Venezuela, the Dominician Republic, Cayman Islands, and Jamaica. “The storm first impacted Barbados, causing severe damage to the south coast and significantly affecting the fishing industry with over 200 fishing vessels damaged or destroyed,” according to the International Federation of Red Cross and Red Crescent Societies (IFRC). On Union Island, part of Saint Vincent and the Grenadines, 90% of infrastructure has been damaged, including houses, roads and the airport. Some 95% of homes in Grenada’s Carriacou and Petite Martinique islands, are damaged, and around 3,000 people are shelters, the IFRC added. Parts of Jamaica’s St Elizabeth region in the south east were also devastated, with around 1,000 people taking refuge in shelters. The Dominican Republic, Cayman Islands reported damage. Venezuela’s President Nicolas Maduro said that 8,000 houses had been destroyed, according to Reuters. More to still come? “Hurricane Beryl, the first hurricane of the 2024 Atlantic hurricane season, rapidly strengthened to a Category 5 storm unusually early in the year,” according to a report from the National Ocean and Atmospheric Administration (NOAA), which is part of the US Department of Commerce “This explosive strengthening was fuelled in part by exceptionally warm ocean temperatures. That heat was one of the factors behind NOAA’s prediction in May of an 85% chance that the 2024 Atlantic hurricane season would be above normal.” Sea surface temperatures were close to those usually found in mid-September, the peak of hurricane season, added NOAA. In late May, NOAA weather forecasters predicted an 85% chance of above-normal hurricane for the 2024 Atlantic hurricane season, which runs from 1 June 1 to 30 November. It also forecast eight to 13 hurricanes, with four to seven likely to be “major” hurricanes (winds of over 178km per hour) in coming months. Early warning systems “The unprecedented hurricane demonstrates the importance of effective multi-hazard early warning systems to save lives,” according to United Nations Disaster Risk Reduction (UNDRR). “Globally, the sustained investments in those systems are making progress in reducing the loss of life in disasters. But economic losses are escalating. Every year millions of households lose their livelihood and risk being pushed into poverty. Ensuring that infrastructure is resilient and that communities ‘build back better’ in the face of future hazards is essential,” added UNDRR. Damage sustained to the airport and surrounding areas on Union Island in the Grenadines during Hurricane Beryl. In late May, the Fourth International Conference on SIDS adopted the Antigua and Barbuda Agenda for SIDS, a 10-year development agenda that appeals for international assistance to address climate change. The Agenda notes that “SIDS are facing the unrelenting and compounding impacts of climate change, biodiversity loss, pollution, disasters and natural hazards, health and other social related challenges and economic vulnerabilities.” Key climate change challenges include “erratic precipitation, increasingly frequent and extreme weather phenomena, more frequent and severe tropical cyclones, floods and drought, diminishing fresh water resources, desertification, coastal erosion, land degradation and sea-level rise.” However, there has been a “progressive deterioration” in SIDS’ ability to “withstand external shocks and enhance their resilience” – largely as a result of the economic impact of COVID-19 and climate challenges. Financial reform to build resilience Protestors call on wealth countries to pay for climate-related loss and damage at COP27. “In the wake of Hurricane Beryl, it is clear that we must redouble our efforts to build resilience and preparedness in the face of growing disaster risk, especially for small island developing states, which have contributed the least to the climate crisis but suffer the greatest costs,” said UNDRR head Kamal Kishore. Kishore appealed for international support for the Antigua and Barbuda Agenda, which “integrates disaster risk reduction as central to climate change adaptation and sustainable development in SIDS with clear calls to action on enhancing multi-hazard early warning systems and resilient infrastructure.” There have also been numerous calls for reform of the international financial architecture to assist developing countries most affected by climate change who are being forced to borrow money to address climate crises largely caused by wealthy nations. The most significant of these is the 2022 Bridgetown Initiative, spearheaded by Prime Minister Mia Mottley of Barbados. This called for key actions including new loan mechanisms, reform of the world’s development banks, and a loss and damages fund to enable developing countries to access to resilient finance to address climate and development crises. The UN climate change conference, COP27, agreed to establish a loss and damage fund during the UN Climate Change Conference (COP27) in 2022. However, there is resistance from a number of wealthier countries to this as the world continues to experience record-breaking extreme weather events. Meanwhile, the International Cort of Justice (ICJ) is expected to hold public hearings and issue an advisory later this year on the international legal obligations countries have to safeguard people against climate change. This follows the adoption last year of a landmark UN resolution to seek such an advisory opinion from the ICJ. While not legally binding, the advisory opinion holds legal and moral weight and will spotlight the human rights impacts of climate policy. Image Credits: UNDP, AfricaNews. As More US Dairy Herds Infected with Avian Flu, Americans in the Dark on the Risks of Raw Milk 04/07/2024 Zuzanna Stawiska Over one-half of Americans are not sure if pasteurised milk is safer than raw milk. In the time of avian flu epidemics in US cattle, this could even prove dangerous. As the fourth human case of H5N1 avian flu in a US farmworker in Colorado was confirmed Wednesday by the US Centers for Disease Control and Prevention (CDC), so far, only farm workers, and not consumers, have reported avian flu infections. This is likely due, at least in part, to the successful inactivation of the virus during the milk pasteurization process, experts say. And yet one-half or more Americans seem to have little idea about the dangers of drinking raw milk, according to a recent poll conducted by the University of Pennsylvania researchers. The survey, which included a demographically representative sample of the US adult population, found that less than half (47% percent) of the U.S. adults surveyed understood that drinking raw milk not as safe as drinking pasteurized milk. Conversely, 53% of respondents don’t actually believe that pasteurized milk is safer. And 9% of respondents actually believed raw milk is safer, while 15% said it was just as safe and 30% were unsure. Nearly a quarter (24%) of Americans either do not believe that pasteurization is effective at killing bacteria and viruses in milk products (4%) or are not sure whether this is true (20%), according to the survey of over 1000 US adults, conducted by the Annenberg Public Policy Center (APPC). The survey has a 3-3.5% statistical error rate. Around half of US adults failed to recognize that raw milk can be more dangerous than pasteurized milk products. That, despite the fact that studies report that pasteurized milk limits hospitalizations for related illnesses by an order of 45, according to the APPC report. The French Scientist Louis Pasteur invented the pasteurization process 160 years ago, after recognizing that it killed off otherwise dangerous bacteria present in unheated wine. The process, which soon became a milk industry standard in the United States, successfully inactivates the modern-day avian flu virus, significantly limiting the risk of infection for the general public. Politics and milk In fact, only about 2% of Americans report drinking raw milk at least once a month, according to a Food and Drug Administration (FDA) study based on 2019 data. Paradoxically, however, raw milk sales in the US have increased in recent months, according to some US media reports, despite the recent risks posed by a widening circle of avian influenza among dairy cattle. Debate has been spurred by the increased anti-science bent of some US political leaders. Presidential candidate Robert F. Kennedy Jr., for instance, who also has been a staunch opponent of COVID vaccination, has been quoted saying that he drinks raw milk exclusively. The APPC survey also found that Republicans are more likely than Democrats to believe that drinking raw milk is as safe as pasteurized milk (57% vs. 37%). People living in an urban environment also are more likely to believe that pastuerized milk is safer than raw milk as compared to people in a rural environment (49% vs. 32%). “The difference in views of raw milk that we see between Democrats and Republicans is difficult to disentangle from the difference between rural and urban dwellers,” said Kathleen Hall Jamieson, director of the Annenberg Public Policy Center. “Those in rural areas are both more likely to identify as Republicans and to consume raw milk.” 55 more dairy herds reported infected in last 30 days Some 55 more cattle herds in seven states have been infected with the virus over the past 30 days, according to CDC tracking. Infections in the past 30 days represent 40% of the total of 138 cattle herds infected in 12 states since the outbreak in dairy cattle was first reported on 25 March, the CDC reported. States affected by avian flu spread in dairy cattle The real number of infections of both humans and cattle is very likely underestimated, insofar as farmers have been reluctant to have their staff or herds tested, experts warn. Even so, the CDC maintained that infection risks for the general public remain low. “Based on the information available at this time, this infection does not change CDC’s current H5N1 bird flu human health risk assessment for the U.S. general public, which the agency considers to be low,” the CDC said in a statement. Image Credits: Cotonbro studio, APCC, CDC. Even India’s ‘Cleanest’ Cities Have Significant Excess Air Pollution-Related Deaths from NCDs 04/07/2024 Chetan Bhattacharji The air in relatively ‘clean’ Mumbai is still killing citizens. NEW DELHI – On 2 November 2023, extreme air pollution caught Delhi off-guard. It shut down schools and led to flight cancellations, curbs on construction and other emergency responses. That every little increase in air pollution increases the risk of death has been well-established for some years. But till now the effect of short-term air pollution on mortality has remained largely undocumented in detail in India, where most of the world’s most polluted cities are located. In a new, peer-reviewed study published in the Lancet on Thursday (4 July), researchers found that 7.2% (or approximately 33,000) of all deaths each year across 10 cities could be linked to short-term PM 2.5 exposure higher than the World Health Organization (WHO) guideline of 15 micrograms/cubic metre (µg/m³). PM 2.5 is a highly toxic ultra-fine particulate matter with a diameter of 2.5 microns, which is far thinner than a strand of human hair. This is the first multi-city study in India to assess the link between short-term pollution exposure and death with cities spanning different agri-climatological zones. The bottom line, the authors say, is that the current Indian government standard for PM 2.5 of 60 µg/m³ is “substantially higher” than it should be as a measure of ‘safe’ air quality. In comparison, WHO’s 24-hour standard is 15 µg/m³. NCDs are the leading cause for air pollution-related deaths The Lancet paper doesn’t look at the cause of death as that level of primary data isn’t always available. However, many studies including recent ones in India have shown that air pollution triggers or aggravates non-communicable diseases – specifically NCDs like heart attacks, strokes, lung cancer, and chronic lung disease – which can turn fatal. Of the total air pollution deaths, NCDs account for nearly 90% of the disease burden. The researchers are from 14 organisations including Sustainable Futures Collaborative in Delhi, Institute of Environmental Medicine in Stockholm, Indian Institute of Management Ahmedabad, Public Health Foundation of India, Ashoka University in Sonipat, Mount Sinai in New York, and Boston University. To come to their conclusions, the researchers analysed primary data on mortality between 2008 and 2019 in 10 cities of India. They used an advanced system of machine learning-based analysis which, simply put, used factors that would have a bearing on air pollution-related deaths, namely wind speed, atmospheric pressure and mixing height. This causal modelling approach enabled the researchers to isolate the effect of locally generated pollution as these factors are linked to the dispersal and transport of air pollution. Combined with other data from monitors, satellites and other sources, the study looked at over 3.6 million deaths in the 11-year study period. What the more complex causal modelling shows is that the risk of death is greater than what the earlier basic approach showed. No safe level of air pollution The causal modelling estimated an increase in the risk of death by 3.57% for every rise of just 10 µg/m³ metre over a two day period, as compared to 1.42% by a more basic study. Apart from the usual high-pollution suspects like Delhi and Varanasi, the study looked at places commonly perceived as having clean air, like the Himalayan city of Shimla and the coastal metropolises of Chennai and Mumbai. The authors say this is the first such multi-city study on the links between short-term air pollution exposure and deaths in India. Overall, 7.2% of all daily deaths were attributed to PM 2.5 concentrations higher than the WHO guidelines. Annually there are estimated to be approximately 33,000 deaths in these 10 cities. Over a third are in Delhi, where the average annual PM 2.5 level was 113 micrograms which is more than 22 times the WHO’s safe standard. The share of PM 2.5 linked deaths was also the highest in the Capital, at 11.5% compared to the lowest 3.5% in Shimla. The surprises are Mumbai and Kolkata, with deaths numbering around 5,000 each, annually. “We are seeing a high level of risk and a high number of deaths even in cities that have moderate levels of air pollution exposure. Mumbai, for instance, despite being a coastal city with around a third of the annual PM 2.5 levels of Delhi is still seeing over 5,000 deaths yearly from air pollution,” a lead author of the report, Dr Bhargav Krishna, Fellow at the Sustainable Futures Collaborative, explained to Health Policy Watch. “Similarly Hyderabad, Kolkata, Bengaluru, Chennai, Ahmedabad and Pune, all of which have annual PM2.5 levels below the current Indian standard, are still seeing a high number of deaths each year. This should drive us to focus not just on those cities that have high seasonal exposures, but even those that may be considered relatively ‘clean’ but are in reality polluted at a level that causes significant health impacts.” Mumbai air in March 2023. Mumbai, where remarkably the air pollution has been higher than Delhi on some days, was shown to have almost 5,100 deaths, the second highest after the national capital. That is 5.9% of all deaths in what is India’s financial capital. Here, every increase of 10 micrograms of PM 2.5 was associated with a 2.41% increase in daily deaths. Over 7% of daily deaths attributable to increases in short-term PM 2.5 First such study in Indian cities, say authors City Average Annual Pollution (PM2.5, mg/m³) Attributable Fraction of Deaths (%) Attributable Deaths Per Year Delhi 113 11.5 11,964 Varanasi 82.1 10.2 831 Kolkata 55.2 7.3 4,678 Pune 45.3 5.9 1,367 Mumbai 41.7 5.6 5,091 Hyderabad 38.9 5.6 1,597 Ahmedabad 37.9 5.6 2,495 Chennai 33.7 4.9 2,870 Bangalore 33 4.8 2,102 Shimla 28.4 3.7 59 Total 53.6 7.2 33,627 Source: Lancet Shimla proves that there is no safe level of air pollution, according to the report. It has the lowest air pollution level of the 10 cities, yet that was still a risk as 3.7% of all deaths were attributable to short-term PM 2.5 exposure. Impact on policy action The findings are crucial for immediate policy action and further studies to cover hundreds more towns and rural areas. Immediate action would cover sources of pollution like diesel generators, waste burning, and transport, sources that are commonly seen in many urban neighbourhoods. While much of the headline-grabbing focus is on extreme pollution, these findings show the need to act against all sources of air pollution all year round. Acting only on extremely high days of pollution will only yield marginal benefits regarding daily mortality. In particular, the paper calls out the Graded Response Action Plans, largely used in Delhi and its neighbouring cities. GRAPs are usually cited by local governments as their action to cut pollution but are implemented only in peak pollution season which is from October right through winter. Toxicity of local pollution There are some interesting findings which aren’t widely known. The study confirms that the risk of mortality rose more quickly at lower levels of PM 2.5 but plateaued as levels increased. More studies are needed to understand why exactly this happens. The causal modelling showed that the effects of air pollution on deaths were especially strong in cities with lower levels of pollution such as Bengaluru, Chennai and Shimla. The study fills a data and communication gap in addressing the health crisis caused by toxic air. On one hand, it establishes a link between rising air pollution and deaths, on the other, it makes the risks a lot more relatable because it shows the impact over just two days of exposure than over many months or years. So what can residents in these cities do to protect themselves? Bhargav says individual responses could include wearing a mask, choosing when to step outdoors (pollution tends to be highest during the morning and evening when temperatures dip), and reducing pollution sources inside their home. However, the onus lies on governments and policymakers. “The levels of air pollution we see in India are extremely high and this study clearly shows how day-to-day variations in these levels lead to considerable mortality,” said Dr Petter Ljungman of the Karolinska Institute, and one of the researchers involved in the study. “Interestingly we saw that local pollution sources are likely to be more toxic than more distant sources which has implications for policymakers addressing this highly relevant threat to human health.” Image Credits: Chetan Bhattacharji. Positioning the University of Ghana as a ‘Research-Intensive’ Institution on Neglected Diseases 03/07/2024 Jessica Ahedor Scientists at the West African Centre for Cell Biology and Infectious Pathogens (WACCBIP), University of Ghana, setting up a genome sequencing experiment in the laboratory. Almost 15 years ago, when the University of Ghana established its Office of Research, Innovation, and Development, it did so with the goal of bolstering the West African nation’s research capacity. In the African region, where less than 0.5% of GDP is devoted to research, and a significant number of Africa’s educated is siphoned off to other countries, the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR) has spearheaded the effort to make universities like the University of Ghana research-intensive and competitive. TDR support for research capacity-strengthening activities at the University of Ghana focuses on enabling researchers to tackle infectious diseases of poverty through quality implementation research, the study of bridging basic science research and practice. This could mean examining why many patients on antiretroviral therapy drop out of treatment, or identifying barriers to TB treatment adherence – both the subject of recent publications authored by researchers at the University of Ghana. Capacity-building works Professor Gordon A. Awandare at TDR’s Joint Coordinating Board meeting in Geneva, 12 June 2024 “Capacity-building actually works,” remarked Professor Gordon A Awandare, Pro Vice-Cancellor of Academic Student Affairs at the University of Ghana, at a TDR 50th anniversary event in Geneva, where he gave a detailed review of the collaboration before TDR’s Joint Coordinating Board on June 12. He cited, as one example, his own career trajectory. Awandare began a career in research through a TDR grant that allowed him to complete his masters training, and then got an opportunity to study for a PhD at the University of Pittsburgh while attending a conference on malaria with support from TDR. He returned home to the University of Ghana in 2010, founding the West African Centre for Cell Biology of Infectious Pathogens (WACCBIP) in 2014. Since then, the Centre, supported by the Wellcome Trust and the World Bank, has endowed 400 fellowships and received $53 million in grants, thereby directly reducing the “brain drain” across the African region. A decade-long partnership The University of Ghana leads efforts to train students in implementation research. Newly enrolled master’s students during their lab induction at WACCBIP, University of Ghana. In 2014 the University of Ghana’s School of Public Health signed a partnership agreement with TDR to create a regional training center that leads activities in the African region for strengthening capacity in implementation research to tackle infectious diseases of poverty. The initiative has so far trained more than 25,000 individuals across Africa, including health practitioners, decision-makers and researchers. “Looking at how far we’ve come as a training centre, it is our desire to become a centre of excellence where the annual programmes can be extended to say five years,” said Professor Phyllis Dako-Gyeke, who led the TDR-supported research training programmes at University of Ghana until her passing on 11 June. But the success of an almost decade-long relationship is not without its challenges. Sustainable donor support and aligned interests on research priorities remain key, she said. Real-time research Implementation researchers at UG have tackled issues from TB treatment adherence to antiretroviral therapy. Here, a community health worker conducts an interview in Obuasi, Ghana to identify barriers and facilitators for TB control. Dr Emmanuel Asampong, coordinator of the regional training centre at the University of Ghana, notes that “the impact of implementation research on disease themes in Africa and beyond is impressive because the initiative uses real-time research results in various contexts – such as the neglected tropical diseases programme, the national malaria programme, and the tuberculosis control programme – to provide solutions to challenges.” The global program, which has played a significant role in positioning University of Ghana as a research-intensive university, supports seven regional training centres across six WHO regions. With additional partners in Colombia, Indonesia, Kazakhstan, Malaysia, Senegal and Tunisia, the program develops and updates implementation research courses, provides faculty training and supports career development. The global program, which has played a significant role in positioning University of Ghana as a research institution, also supports NTD research in six WHO regions. The University of Ghana also partners with TDR on a postgraduate training scheme, which provides a full academic scholarship for master’s students. The training is specifically focused on implementation research to tackle infectious diseases of poverty. The list of TDR alumni across the world runs long, and the University of Ghana can claim many public health leaders among them. “My postgraduate training at the University of Ghana, supported by TDR, was an invaluable catalyst in shaping my academic and professional journey,” said Dr Mbele Whiteson, Senior Resident Medical Officer at the Ministry of Health in Zambia. “I have learned to recognize the intricate interplay between health outcomes and social determinants.” This is the third article in a series on TDR’s research capacity strengthening programme – building skills of public health researchers, implementers, health practitioners and policy-makers in the fast-developing field of implementation research for improving uptake of effective health interventions. Sophia Samantaroy contributed to the writing and research of this story. Image Credits: WACCBIP, TDR, African Regional Training Centre (ARTC), University of Ghana/TDR. 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Russia’s Bombing of Ukraine Children Hospital is ‘Abominable’ 08/07/2024 Kerry Cullinan Children with cancer outside Okhmatdyt Hospital after the attack. Russia’s bombing of a children’s hospital and women’s health centre in Ukraine’s capital Kiev on Monday is “abominable”, said UN High Commissioner for Human Rights Volker Türk. “Civilians must be protected, and the laws of war strictly adhered to,” added Türk. “There must be prompt, thorough and independent investigations into these latest grave attacks on civilians and civilian infrastructure, and those responsible must be held to account.” “Shockingly, one of the strikes severely damaged the intensive care, surgical and oncology wards of Okhmatdyt, which is Ukraine’s largest children’s referral hospital, and destroyed its children’s toxicology department, where children receive dialysis,” said Türk. Okhmatdyt Hospital serves more than 20,000 children annually. Monday’s missile attack struck a medical building at the hospital where children were receiving dialysis, while also damaging the intensive care, operating, and oncology departments, according to the Minister of Health of Ukraine. The entire hospital is without electricity, preventing the use of ventilators and other urgent care. Dr Tedros Adhanom Ghebreyesus, Director General of the World Health Organisation (WHO), said that “several floors of the largest children’s hospital in Kyiv were severely impacted today, disrupting the hospital’s operations and affecting its ability to provide critical care to the young patients.” Several floors of the largest children’s hospital in Kyiv were severely impacted today, disruptng the hospital’s operations and affecting its ability to provide critical care to the young patients.@WHO has been working closely with the hospital before and since the war in… pic.twitter.com/9ReGcov71F — Tedros Adhanom Ghebreyesus (@DrTedros) July 8, 2024 Meanwhile, Türk said that OHCHR staff visiting the scene shortly after the attack had “observed children receiving treatment for cancer in hospital beds set up in parks and on streets, where medical workers had quickly established triage areas, amongst chaos, dust and debris.” Health officials said the entire hospital was now without electricity, preventing the use of ventilators and other urgent care. It was not immediately clear how many people were killed in the strike. The ISIDA Medical Centre, one of the largest women’s health and family planning centres in Ukraine, was also affected by the attack, with several casualties. The attack comes the day before a NATO summit in Washington DC. Russia has attacked Ukraine’s health care workers, facilities, and other medical infrastructure at least 1,442 times since its invasion of Ukraine in February 2022 and 13 April 2024,according to data from a partnership made up of the Ukrainian Health Center, Physicians for Human Rights (PHR) and others. Russian attacks on Ukraine health care since February 2022. “Russia’s strategy in Ukraine includes attacking babies and children. Domestic and international actors should intensify efforts to hold perpetrators accountable for these war crimes,” said Uliana Poltavets, PHR’s Ukraine emergency response coordinator in a statement. Researchers have documented 79 attacks that affected children’s health care, including 54 attacks that destroyed or damaged children’s hospitals. “Today’s devastating attack on the largest children’s hospital is emblematic of Russia’s onslaught against Ukraine’s health care system. Again and again, we have witnessed Russian forces attack vulnerable patients, health workers, and hospitals across the country,” said Poltavets. PHR called on “domestic and international prosecutors, including the International Criminal Court, to prioritise the investigation and prosecution of attacks on health care.” Image Credits: Twitter. Sierra Leone Outlaws Child Marriage 08/07/2024 Kerry Cullinan Sierra Leone First Lady Fatima Bio Sierra Leone’s President Julius Maada Bio signed into law the Prohibition of Child Marriage Act last week, introducing a penalty of at least 15 years and a fine of around $4,000 for any man who marries a girl under 18. The law also prohibits cohabiting with a child, and fines for anyone arranging, aiding or attending such marriage ceremonies. First Lady Fatima Bio’s “Hands Off Our Girls” campaign has been instrumental in advocating against child marriage in Sierra Leone. Sierra Leone has one of the highest rates of child marriages in Africa, alongside Niger and Nigeria. According to the 2019 Sierra Leone Demographic and Health Surveys, 30% of girls in Sierra Leone are married before their 18th birthday. In 2020, there were 800,000 child brides, half of whom were married before they turned 15, according to UNICEF. The country of slightly over eight million people also has a high rate of female genital mutilation. “Child marriages fuel the high adolescent pregnancy rate in Sierra Leone where, tragically, pregnancy complications are the leading cause of death for girls aged 15-19,” according to Human Rights Watch (HRW). In 2021, the country introduced a policy of “radical inclusion” in schools, targeting and marginalised groups including girls, particularly pregnant girls and parent learners. Last year, Sierra Leone passed an education law that guarantees children free education, including one year of pre-primary. “The legislation is a milestone in Sierra Leone’s journey towards gender equality and child protection. It also sets a pathway forward for other African nations, such as Tanzania and Zambia, to revoke laws that permit child marriage, and ensure girls can complete primary and secondary education,” said HRW. FDA Approves Eli Lilly’s Kisunla for Early-Stage Alzheimer’s Patients 08/07/2024 Maayan Hoffman Neurons with tau protein highlighted in red. Eli Lilly’s Alzheimer’s therapy, donanemab, has received FDA approval, offering new hope for patients with early symptomatic Alzheimer’s disease. The newly approved treatment, branded Kisunla, is set to challenge existing therapies from Eisai and Biogen. Clinical trials have shown Kisunla to be effective for individuals in the mild cognitive impairment or mild dementia stages of the disease, potentially marking a significant advancement in Alzheimer’s care. The drug is administered as an intravenous infusion every four weeks. Alzheimer’s disease is a degenerative condition of the brain that impacts over 6.5 million Americans and over 55 million people worldwide. It causes a gradual decline in memory, cognitive functions, and, eventually, the ability to perform daily activities. The disease is marked by structural changes in the brain, such as the buildup of amyloid beta plaques and neurofibrillary tangles made of tau protein, which is supposed to help stabilize the internal skeleton of neurons in the brain. The Alzheimer’s Association celebrated the FDA’s decision. “This is real progress,” said Joanne Pike, Alzheimer’s Association president and CEO, in a statement. “Today’s approval allows people more options and greater opportunity to have more time. Having multiple treatment options is the kind of advancement we’ve all been waiting for — all of us who have been touched, even blindsided, by this difficult and devastating disease.” Slows cognitive decline by at least 22% The approval was based on an extensive double-blind, placebo-controlled, parallel-group study evaluating the efficacy of Kisunla in slowing cognitive decline in participants with varying levels of tau protein in the brain. Tau is a protein that helps to stabilise the neurons in the brain. The study, conducted over 72 weeks with 1,736 patients averaging 73 years old, revealed that those receiving Kisunla experienced a 35% reduction in cognitive decline compared to those on placebo among individuals with low to medium tau levels. Even among participants with higher tau levels, the treatment demonstrated a meaningful but slightly reduced effect. Overall, including all tau levels, Kisunla slowed cognitive decline by 22% and reduced the likelihood of progressing to the next stage of the disease by 39% compared to placebo. Additionally, the study monitored amyloid plaque levels using positron emission tomography (PET) scans throughout the treatment period. Results showed substantial reductions in amyloid plaques over time among patients receiving Kisunla, with reductions of 61% at six months, 80% at 12 months, and 84% at 18 months compared to baseline levels. These findings suggest that Kisunla not only targets cognitive decline but also effectively reduces the hallmark amyloid pathology associated with Alzheimer’s disease progression. Potential side effects For some patients, there is a risk of amyloid-related imaging abnormalities (ARIA) developing, the FDA said. ARIA typically manifests as temporary brain swelling, sometimes accompanied by small areas of bleeding on or in the brain. While ARIA often resolves on its own and may not cause symptoms, rare instances of severe and potentially life-threatening events have been reported. ARIA is a recognized side effect of antibody therapies targeting amyloid. Infusion-related reactions are also a concern, including flu-like symptoms, nausea, vomiting, changes in blood pressure, and hypersensitivity reactions such as anaphylaxis (a severe allergic reaction) and angioedema (swelling). Kisunla joins Leqembi, on market since 2023 Kisunla is the third drug to receive FDA approval, although only the second is now available for use. Leqembi, a collaboration between Biogen of the United States and Eisai of Japan, gained approval in July 2023. In an 18-month Phase III trial, Leqembi demonstrated a 27% reduction in cognitive decline among early-stage Alzheimer’s patients compared to those receiving a placebo. Another drug, aducanumab, also developed by Biogen and Eisai, was granted accelerated approval by the FDA in June 2021. However, due to some side effects, the therapy was pulled from the market. The Alzheimer’s Association emphasized the importance of early detection and diagnosis now that multiple FDA-approved treatments for Alzheimer’s are available. The organization stressed that timely access to these treatments is crucial for maximizing their benefits, asserting that no stage or entity should hinder or delay such access. “Too many roadblocks have prevented individuals from getting equitable access to these beneficial treatments for far too long,” said Pike. “It is equally important that clinicians and health care systems are informed and prepared to help the individuals who could benefit. The Alzheimer’s Association is working with health systems and providers to ensure they have the tools and resources to meet the needs of their patients.” Image Credits: Gerry Shaw/ EnCor Biotechnology Inc. Earliest Ever Hurricane Tears Through Caribbean, Highlighting Need for Speedier Climate Action 05/07/2024 Kerry Cullinan Fishing vessels at the Bridgetown Fisheries Complex in Barbados damaged by Hurricane Beryl. Hurricane Beryl, which has destroyed homes and infrastructure in large parts of the eastern Caribbean, is the first first-ever Category 4 hurricane recorded in the region in June – and a portend of devastating changes in weather patterns. It also underscores the need for urgent international assistance to Small Island Developing States (SIDS) to strengthen early warning systems and the climate resilience of key infrastructure – notably water, sanitation and health services, according to experts. The hurricane reached peak speed of 265 km per hour at times as it whipped though Barbados, Grenada, St Vincent and the Grenadines, Haiti, northern Venezuela, the Dominician Republic, Cayman Islands, and Jamaica. “The storm first impacted Barbados, causing severe damage to the south coast and significantly affecting the fishing industry with over 200 fishing vessels damaged or destroyed,” according to the International Federation of Red Cross and Red Crescent Societies (IFRC). On Union Island, part of Saint Vincent and the Grenadines, 90% of infrastructure has been damaged, including houses, roads and the airport. Some 95% of homes in Grenada’s Carriacou and Petite Martinique islands, are damaged, and around 3,000 people are shelters, the IFRC added. Parts of Jamaica’s St Elizabeth region in the south east were also devastated, with around 1,000 people taking refuge in shelters. The Dominican Republic, Cayman Islands reported damage. Venezuela’s President Nicolas Maduro said that 8,000 houses had been destroyed, according to Reuters. More to still come? “Hurricane Beryl, the first hurricane of the 2024 Atlantic hurricane season, rapidly strengthened to a Category 5 storm unusually early in the year,” according to a report from the National Ocean and Atmospheric Administration (NOAA), which is part of the US Department of Commerce “This explosive strengthening was fuelled in part by exceptionally warm ocean temperatures. That heat was one of the factors behind NOAA’s prediction in May of an 85% chance that the 2024 Atlantic hurricane season would be above normal.” Sea surface temperatures were close to those usually found in mid-September, the peak of hurricane season, added NOAA. In late May, NOAA weather forecasters predicted an 85% chance of above-normal hurricane for the 2024 Atlantic hurricane season, which runs from 1 June 1 to 30 November. It also forecast eight to 13 hurricanes, with four to seven likely to be “major” hurricanes (winds of over 178km per hour) in coming months. Early warning systems “The unprecedented hurricane demonstrates the importance of effective multi-hazard early warning systems to save lives,” according to United Nations Disaster Risk Reduction (UNDRR). “Globally, the sustained investments in those systems are making progress in reducing the loss of life in disasters. But economic losses are escalating. Every year millions of households lose their livelihood and risk being pushed into poverty. Ensuring that infrastructure is resilient and that communities ‘build back better’ in the face of future hazards is essential,” added UNDRR. Damage sustained to the airport and surrounding areas on Union Island in the Grenadines during Hurricane Beryl. In late May, the Fourth International Conference on SIDS adopted the Antigua and Barbuda Agenda for SIDS, a 10-year development agenda that appeals for international assistance to address climate change. The Agenda notes that “SIDS are facing the unrelenting and compounding impacts of climate change, biodiversity loss, pollution, disasters and natural hazards, health and other social related challenges and economic vulnerabilities.” Key climate change challenges include “erratic precipitation, increasingly frequent and extreme weather phenomena, more frequent and severe tropical cyclones, floods and drought, diminishing fresh water resources, desertification, coastal erosion, land degradation and sea-level rise.” However, there has been a “progressive deterioration” in SIDS’ ability to “withstand external shocks and enhance their resilience” – largely as a result of the economic impact of COVID-19 and climate challenges. Financial reform to build resilience Protestors call on wealth countries to pay for climate-related loss and damage at COP27. “In the wake of Hurricane Beryl, it is clear that we must redouble our efforts to build resilience and preparedness in the face of growing disaster risk, especially for small island developing states, which have contributed the least to the climate crisis but suffer the greatest costs,” said UNDRR head Kamal Kishore. Kishore appealed for international support for the Antigua and Barbuda Agenda, which “integrates disaster risk reduction as central to climate change adaptation and sustainable development in SIDS with clear calls to action on enhancing multi-hazard early warning systems and resilient infrastructure.” There have also been numerous calls for reform of the international financial architecture to assist developing countries most affected by climate change who are being forced to borrow money to address climate crises largely caused by wealthy nations. The most significant of these is the 2022 Bridgetown Initiative, spearheaded by Prime Minister Mia Mottley of Barbados. This called for key actions including new loan mechanisms, reform of the world’s development banks, and a loss and damages fund to enable developing countries to access to resilient finance to address climate and development crises. The UN climate change conference, COP27, agreed to establish a loss and damage fund during the UN Climate Change Conference (COP27) in 2022. However, there is resistance from a number of wealthier countries to this as the world continues to experience record-breaking extreme weather events. Meanwhile, the International Cort of Justice (ICJ) is expected to hold public hearings and issue an advisory later this year on the international legal obligations countries have to safeguard people against climate change. This follows the adoption last year of a landmark UN resolution to seek such an advisory opinion from the ICJ. While not legally binding, the advisory opinion holds legal and moral weight and will spotlight the human rights impacts of climate policy. Image Credits: UNDP, AfricaNews. As More US Dairy Herds Infected with Avian Flu, Americans in the Dark on the Risks of Raw Milk 04/07/2024 Zuzanna Stawiska Over one-half of Americans are not sure if pasteurised milk is safer than raw milk. In the time of avian flu epidemics in US cattle, this could even prove dangerous. As the fourth human case of H5N1 avian flu in a US farmworker in Colorado was confirmed Wednesday by the US Centers for Disease Control and Prevention (CDC), so far, only farm workers, and not consumers, have reported avian flu infections. This is likely due, at least in part, to the successful inactivation of the virus during the milk pasteurization process, experts say. And yet one-half or more Americans seem to have little idea about the dangers of drinking raw milk, according to a recent poll conducted by the University of Pennsylvania researchers. The survey, which included a demographically representative sample of the US adult population, found that less than half (47% percent) of the U.S. adults surveyed understood that drinking raw milk not as safe as drinking pasteurized milk. Conversely, 53% of respondents don’t actually believe that pasteurized milk is safer. And 9% of respondents actually believed raw milk is safer, while 15% said it was just as safe and 30% were unsure. Nearly a quarter (24%) of Americans either do not believe that pasteurization is effective at killing bacteria and viruses in milk products (4%) or are not sure whether this is true (20%), according to the survey of over 1000 US adults, conducted by the Annenberg Public Policy Center (APPC). The survey has a 3-3.5% statistical error rate. Around half of US adults failed to recognize that raw milk can be more dangerous than pasteurized milk products. That, despite the fact that studies report that pasteurized milk limits hospitalizations for related illnesses by an order of 45, according to the APPC report. The French Scientist Louis Pasteur invented the pasteurization process 160 years ago, after recognizing that it killed off otherwise dangerous bacteria present in unheated wine. The process, which soon became a milk industry standard in the United States, successfully inactivates the modern-day avian flu virus, significantly limiting the risk of infection for the general public. Politics and milk In fact, only about 2% of Americans report drinking raw milk at least once a month, according to a Food and Drug Administration (FDA) study based on 2019 data. Paradoxically, however, raw milk sales in the US have increased in recent months, according to some US media reports, despite the recent risks posed by a widening circle of avian influenza among dairy cattle. Debate has been spurred by the increased anti-science bent of some US political leaders. Presidential candidate Robert F. Kennedy Jr., for instance, who also has been a staunch opponent of COVID vaccination, has been quoted saying that he drinks raw milk exclusively. The APPC survey also found that Republicans are more likely than Democrats to believe that drinking raw milk is as safe as pasteurized milk (57% vs. 37%). People living in an urban environment also are more likely to believe that pastuerized milk is safer than raw milk as compared to people in a rural environment (49% vs. 32%). “The difference in views of raw milk that we see between Democrats and Republicans is difficult to disentangle from the difference between rural and urban dwellers,” said Kathleen Hall Jamieson, director of the Annenberg Public Policy Center. “Those in rural areas are both more likely to identify as Republicans and to consume raw milk.” 55 more dairy herds reported infected in last 30 days Some 55 more cattle herds in seven states have been infected with the virus over the past 30 days, according to CDC tracking. Infections in the past 30 days represent 40% of the total of 138 cattle herds infected in 12 states since the outbreak in dairy cattle was first reported on 25 March, the CDC reported. States affected by avian flu spread in dairy cattle The real number of infections of both humans and cattle is very likely underestimated, insofar as farmers have been reluctant to have their staff or herds tested, experts warn. Even so, the CDC maintained that infection risks for the general public remain low. “Based on the information available at this time, this infection does not change CDC’s current H5N1 bird flu human health risk assessment for the U.S. general public, which the agency considers to be low,” the CDC said in a statement. Image Credits: Cotonbro studio, APCC, CDC. Even India’s ‘Cleanest’ Cities Have Significant Excess Air Pollution-Related Deaths from NCDs 04/07/2024 Chetan Bhattacharji The air in relatively ‘clean’ Mumbai is still killing citizens. NEW DELHI – On 2 November 2023, extreme air pollution caught Delhi off-guard. It shut down schools and led to flight cancellations, curbs on construction and other emergency responses. That every little increase in air pollution increases the risk of death has been well-established for some years. But till now the effect of short-term air pollution on mortality has remained largely undocumented in detail in India, where most of the world’s most polluted cities are located. In a new, peer-reviewed study published in the Lancet on Thursday (4 July), researchers found that 7.2% (or approximately 33,000) of all deaths each year across 10 cities could be linked to short-term PM 2.5 exposure higher than the World Health Organization (WHO) guideline of 15 micrograms/cubic metre (µg/m³). PM 2.5 is a highly toxic ultra-fine particulate matter with a diameter of 2.5 microns, which is far thinner than a strand of human hair. This is the first multi-city study in India to assess the link between short-term pollution exposure and death with cities spanning different agri-climatological zones. The bottom line, the authors say, is that the current Indian government standard for PM 2.5 of 60 µg/m³ is “substantially higher” than it should be as a measure of ‘safe’ air quality. In comparison, WHO’s 24-hour standard is 15 µg/m³. NCDs are the leading cause for air pollution-related deaths The Lancet paper doesn’t look at the cause of death as that level of primary data isn’t always available. However, many studies including recent ones in India have shown that air pollution triggers or aggravates non-communicable diseases – specifically NCDs like heart attacks, strokes, lung cancer, and chronic lung disease – which can turn fatal. Of the total air pollution deaths, NCDs account for nearly 90% of the disease burden. The researchers are from 14 organisations including Sustainable Futures Collaborative in Delhi, Institute of Environmental Medicine in Stockholm, Indian Institute of Management Ahmedabad, Public Health Foundation of India, Ashoka University in Sonipat, Mount Sinai in New York, and Boston University. To come to their conclusions, the researchers analysed primary data on mortality between 2008 and 2019 in 10 cities of India. They used an advanced system of machine learning-based analysis which, simply put, used factors that would have a bearing on air pollution-related deaths, namely wind speed, atmospheric pressure and mixing height. This causal modelling approach enabled the researchers to isolate the effect of locally generated pollution as these factors are linked to the dispersal and transport of air pollution. Combined with other data from monitors, satellites and other sources, the study looked at over 3.6 million deaths in the 11-year study period. What the more complex causal modelling shows is that the risk of death is greater than what the earlier basic approach showed. No safe level of air pollution The causal modelling estimated an increase in the risk of death by 3.57% for every rise of just 10 µg/m³ metre over a two day period, as compared to 1.42% by a more basic study. Apart from the usual high-pollution suspects like Delhi and Varanasi, the study looked at places commonly perceived as having clean air, like the Himalayan city of Shimla and the coastal metropolises of Chennai and Mumbai. The authors say this is the first such multi-city study on the links between short-term air pollution exposure and deaths in India. Overall, 7.2% of all daily deaths were attributed to PM 2.5 concentrations higher than the WHO guidelines. Annually there are estimated to be approximately 33,000 deaths in these 10 cities. Over a third are in Delhi, where the average annual PM 2.5 level was 113 micrograms which is more than 22 times the WHO’s safe standard. The share of PM 2.5 linked deaths was also the highest in the Capital, at 11.5% compared to the lowest 3.5% in Shimla. The surprises are Mumbai and Kolkata, with deaths numbering around 5,000 each, annually. “We are seeing a high level of risk and a high number of deaths even in cities that have moderate levels of air pollution exposure. Mumbai, for instance, despite being a coastal city with around a third of the annual PM 2.5 levels of Delhi is still seeing over 5,000 deaths yearly from air pollution,” a lead author of the report, Dr Bhargav Krishna, Fellow at the Sustainable Futures Collaborative, explained to Health Policy Watch. “Similarly Hyderabad, Kolkata, Bengaluru, Chennai, Ahmedabad and Pune, all of which have annual PM2.5 levels below the current Indian standard, are still seeing a high number of deaths each year. This should drive us to focus not just on those cities that have high seasonal exposures, but even those that may be considered relatively ‘clean’ but are in reality polluted at a level that causes significant health impacts.” Mumbai air in March 2023. Mumbai, where remarkably the air pollution has been higher than Delhi on some days, was shown to have almost 5,100 deaths, the second highest after the national capital. That is 5.9% of all deaths in what is India’s financial capital. Here, every increase of 10 micrograms of PM 2.5 was associated with a 2.41% increase in daily deaths. Over 7% of daily deaths attributable to increases in short-term PM 2.5 First such study in Indian cities, say authors City Average Annual Pollution (PM2.5, mg/m³) Attributable Fraction of Deaths (%) Attributable Deaths Per Year Delhi 113 11.5 11,964 Varanasi 82.1 10.2 831 Kolkata 55.2 7.3 4,678 Pune 45.3 5.9 1,367 Mumbai 41.7 5.6 5,091 Hyderabad 38.9 5.6 1,597 Ahmedabad 37.9 5.6 2,495 Chennai 33.7 4.9 2,870 Bangalore 33 4.8 2,102 Shimla 28.4 3.7 59 Total 53.6 7.2 33,627 Source: Lancet Shimla proves that there is no safe level of air pollution, according to the report. It has the lowest air pollution level of the 10 cities, yet that was still a risk as 3.7% of all deaths were attributable to short-term PM 2.5 exposure. Impact on policy action The findings are crucial for immediate policy action and further studies to cover hundreds more towns and rural areas. Immediate action would cover sources of pollution like diesel generators, waste burning, and transport, sources that are commonly seen in many urban neighbourhoods. While much of the headline-grabbing focus is on extreme pollution, these findings show the need to act against all sources of air pollution all year round. Acting only on extremely high days of pollution will only yield marginal benefits regarding daily mortality. In particular, the paper calls out the Graded Response Action Plans, largely used in Delhi and its neighbouring cities. GRAPs are usually cited by local governments as their action to cut pollution but are implemented only in peak pollution season which is from October right through winter. Toxicity of local pollution There are some interesting findings which aren’t widely known. The study confirms that the risk of mortality rose more quickly at lower levels of PM 2.5 but plateaued as levels increased. More studies are needed to understand why exactly this happens. The causal modelling showed that the effects of air pollution on deaths were especially strong in cities with lower levels of pollution such as Bengaluru, Chennai and Shimla. The study fills a data and communication gap in addressing the health crisis caused by toxic air. On one hand, it establishes a link between rising air pollution and deaths, on the other, it makes the risks a lot more relatable because it shows the impact over just two days of exposure than over many months or years. So what can residents in these cities do to protect themselves? Bhargav says individual responses could include wearing a mask, choosing when to step outdoors (pollution tends to be highest during the morning and evening when temperatures dip), and reducing pollution sources inside their home. However, the onus lies on governments and policymakers. “The levels of air pollution we see in India are extremely high and this study clearly shows how day-to-day variations in these levels lead to considerable mortality,” said Dr Petter Ljungman of the Karolinska Institute, and one of the researchers involved in the study. “Interestingly we saw that local pollution sources are likely to be more toxic than more distant sources which has implications for policymakers addressing this highly relevant threat to human health.” Image Credits: Chetan Bhattacharji. Positioning the University of Ghana as a ‘Research-Intensive’ Institution on Neglected Diseases 03/07/2024 Jessica Ahedor Scientists at the West African Centre for Cell Biology and Infectious Pathogens (WACCBIP), University of Ghana, setting up a genome sequencing experiment in the laboratory. Almost 15 years ago, when the University of Ghana established its Office of Research, Innovation, and Development, it did so with the goal of bolstering the West African nation’s research capacity. In the African region, where less than 0.5% of GDP is devoted to research, and a significant number of Africa’s educated is siphoned off to other countries, the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR) has spearheaded the effort to make universities like the University of Ghana research-intensive and competitive. TDR support for research capacity-strengthening activities at the University of Ghana focuses on enabling researchers to tackle infectious diseases of poverty through quality implementation research, the study of bridging basic science research and practice. This could mean examining why many patients on antiretroviral therapy drop out of treatment, or identifying barriers to TB treatment adherence – both the subject of recent publications authored by researchers at the University of Ghana. Capacity-building works Professor Gordon A. Awandare at TDR’s Joint Coordinating Board meeting in Geneva, 12 June 2024 “Capacity-building actually works,” remarked Professor Gordon A Awandare, Pro Vice-Cancellor of Academic Student Affairs at the University of Ghana, at a TDR 50th anniversary event in Geneva, where he gave a detailed review of the collaboration before TDR’s Joint Coordinating Board on June 12. He cited, as one example, his own career trajectory. Awandare began a career in research through a TDR grant that allowed him to complete his masters training, and then got an opportunity to study for a PhD at the University of Pittsburgh while attending a conference on malaria with support from TDR. He returned home to the University of Ghana in 2010, founding the West African Centre for Cell Biology of Infectious Pathogens (WACCBIP) in 2014. Since then, the Centre, supported by the Wellcome Trust and the World Bank, has endowed 400 fellowships and received $53 million in grants, thereby directly reducing the “brain drain” across the African region. A decade-long partnership The University of Ghana leads efforts to train students in implementation research. Newly enrolled master’s students during their lab induction at WACCBIP, University of Ghana. In 2014 the University of Ghana’s School of Public Health signed a partnership agreement with TDR to create a regional training center that leads activities in the African region for strengthening capacity in implementation research to tackle infectious diseases of poverty. The initiative has so far trained more than 25,000 individuals across Africa, including health practitioners, decision-makers and researchers. “Looking at how far we’ve come as a training centre, it is our desire to become a centre of excellence where the annual programmes can be extended to say five years,” said Professor Phyllis Dako-Gyeke, who led the TDR-supported research training programmes at University of Ghana until her passing on 11 June. But the success of an almost decade-long relationship is not without its challenges. Sustainable donor support and aligned interests on research priorities remain key, she said. Real-time research Implementation researchers at UG have tackled issues from TB treatment adherence to antiretroviral therapy. Here, a community health worker conducts an interview in Obuasi, Ghana to identify barriers and facilitators for TB control. Dr Emmanuel Asampong, coordinator of the regional training centre at the University of Ghana, notes that “the impact of implementation research on disease themes in Africa and beyond is impressive because the initiative uses real-time research results in various contexts – such as the neglected tropical diseases programme, the national malaria programme, and the tuberculosis control programme – to provide solutions to challenges.” The global program, which has played a significant role in positioning University of Ghana as a research-intensive university, supports seven regional training centres across six WHO regions. With additional partners in Colombia, Indonesia, Kazakhstan, Malaysia, Senegal and Tunisia, the program develops and updates implementation research courses, provides faculty training and supports career development. The global program, which has played a significant role in positioning University of Ghana as a research institution, also supports NTD research in six WHO regions. The University of Ghana also partners with TDR on a postgraduate training scheme, which provides a full academic scholarship for master’s students. The training is specifically focused on implementation research to tackle infectious diseases of poverty. The list of TDR alumni across the world runs long, and the University of Ghana can claim many public health leaders among them. “My postgraduate training at the University of Ghana, supported by TDR, was an invaluable catalyst in shaping my academic and professional journey,” said Dr Mbele Whiteson, Senior Resident Medical Officer at the Ministry of Health in Zambia. “I have learned to recognize the intricate interplay between health outcomes and social determinants.” This is the third article in a series on TDR’s research capacity strengthening programme – building skills of public health researchers, implementers, health practitioners and policy-makers in the fast-developing field of implementation research for improving uptake of effective health interventions. Sophia Samantaroy contributed to the writing and research of this story. Image Credits: WACCBIP, TDR, African Regional Training Centre (ARTC), University of Ghana/TDR. 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Sierra Leone Outlaws Child Marriage 08/07/2024 Kerry Cullinan Sierra Leone First Lady Fatima Bio Sierra Leone’s President Julius Maada Bio signed into law the Prohibition of Child Marriage Act last week, introducing a penalty of at least 15 years and a fine of around $4,000 for any man who marries a girl under 18. The law also prohibits cohabiting with a child, and fines for anyone arranging, aiding or attending such marriage ceremonies. First Lady Fatima Bio’s “Hands Off Our Girls” campaign has been instrumental in advocating against child marriage in Sierra Leone. Sierra Leone has one of the highest rates of child marriages in Africa, alongside Niger and Nigeria. According to the 2019 Sierra Leone Demographic and Health Surveys, 30% of girls in Sierra Leone are married before their 18th birthday. In 2020, there were 800,000 child brides, half of whom were married before they turned 15, according to UNICEF. The country of slightly over eight million people also has a high rate of female genital mutilation. “Child marriages fuel the high adolescent pregnancy rate in Sierra Leone where, tragically, pregnancy complications are the leading cause of death for girls aged 15-19,” according to Human Rights Watch (HRW). In 2021, the country introduced a policy of “radical inclusion” in schools, targeting and marginalised groups including girls, particularly pregnant girls and parent learners. Last year, Sierra Leone passed an education law that guarantees children free education, including one year of pre-primary. “The legislation is a milestone in Sierra Leone’s journey towards gender equality and child protection. It also sets a pathway forward for other African nations, such as Tanzania and Zambia, to revoke laws that permit child marriage, and ensure girls can complete primary and secondary education,” said HRW. FDA Approves Eli Lilly’s Kisunla for Early-Stage Alzheimer’s Patients 08/07/2024 Maayan Hoffman Neurons with tau protein highlighted in red. Eli Lilly’s Alzheimer’s therapy, donanemab, has received FDA approval, offering new hope for patients with early symptomatic Alzheimer’s disease. The newly approved treatment, branded Kisunla, is set to challenge existing therapies from Eisai and Biogen. Clinical trials have shown Kisunla to be effective for individuals in the mild cognitive impairment or mild dementia stages of the disease, potentially marking a significant advancement in Alzheimer’s care. The drug is administered as an intravenous infusion every four weeks. Alzheimer’s disease is a degenerative condition of the brain that impacts over 6.5 million Americans and over 55 million people worldwide. It causes a gradual decline in memory, cognitive functions, and, eventually, the ability to perform daily activities. The disease is marked by structural changes in the brain, such as the buildup of amyloid beta plaques and neurofibrillary tangles made of tau protein, which is supposed to help stabilize the internal skeleton of neurons in the brain. The Alzheimer’s Association celebrated the FDA’s decision. “This is real progress,” said Joanne Pike, Alzheimer’s Association president and CEO, in a statement. “Today’s approval allows people more options and greater opportunity to have more time. Having multiple treatment options is the kind of advancement we’ve all been waiting for — all of us who have been touched, even blindsided, by this difficult and devastating disease.” Slows cognitive decline by at least 22% The approval was based on an extensive double-blind, placebo-controlled, parallel-group study evaluating the efficacy of Kisunla in slowing cognitive decline in participants with varying levels of tau protein in the brain. Tau is a protein that helps to stabilise the neurons in the brain. The study, conducted over 72 weeks with 1,736 patients averaging 73 years old, revealed that those receiving Kisunla experienced a 35% reduction in cognitive decline compared to those on placebo among individuals with low to medium tau levels. Even among participants with higher tau levels, the treatment demonstrated a meaningful but slightly reduced effect. Overall, including all tau levels, Kisunla slowed cognitive decline by 22% and reduced the likelihood of progressing to the next stage of the disease by 39% compared to placebo. Additionally, the study monitored amyloid plaque levels using positron emission tomography (PET) scans throughout the treatment period. Results showed substantial reductions in amyloid plaques over time among patients receiving Kisunla, with reductions of 61% at six months, 80% at 12 months, and 84% at 18 months compared to baseline levels. These findings suggest that Kisunla not only targets cognitive decline but also effectively reduces the hallmark amyloid pathology associated with Alzheimer’s disease progression. Potential side effects For some patients, there is a risk of amyloid-related imaging abnormalities (ARIA) developing, the FDA said. ARIA typically manifests as temporary brain swelling, sometimes accompanied by small areas of bleeding on or in the brain. While ARIA often resolves on its own and may not cause symptoms, rare instances of severe and potentially life-threatening events have been reported. ARIA is a recognized side effect of antibody therapies targeting amyloid. Infusion-related reactions are also a concern, including flu-like symptoms, nausea, vomiting, changes in blood pressure, and hypersensitivity reactions such as anaphylaxis (a severe allergic reaction) and angioedema (swelling). Kisunla joins Leqembi, on market since 2023 Kisunla is the third drug to receive FDA approval, although only the second is now available for use. Leqembi, a collaboration between Biogen of the United States and Eisai of Japan, gained approval in July 2023. In an 18-month Phase III trial, Leqembi demonstrated a 27% reduction in cognitive decline among early-stage Alzheimer’s patients compared to those receiving a placebo. Another drug, aducanumab, also developed by Biogen and Eisai, was granted accelerated approval by the FDA in June 2021. However, due to some side effects, the therapy was pulled from the market. The Alzheimer’s Association emphasized the importance of early detection and diagnosis now that multiple FDA-approved treatments for Alzheimer’s are available. The organization stressed that timely access to these treatments is crucial for maximizing their benefits, asserting that no stage or entity should hinder or delay such access. “Too many roadblocks have prevented individuals from getting equitable access to these beneficial treatments for far too long,” said Pike. “It is equally important that clinicians and health care systems are informed and prepared to help the individuals who could benefit. The Alzheimer’s Association is working with health systems and providers to ensure they have the tools and resources to meet the needs of their patients.” Image Credits: Gerry Shaw/ EnCor Biotechnology Inc. Earliest Ever Hurricane Tears Through Caribbean, Highlighting Need for Speedier Climate Action 05/07/2024 Kerry Cullinan Fishing vessels at the Bridgetown Fisheries Complex in Barbados damaged by Hurricane Beryl. Hurricane Beryl, which has destroyed homes and infrastructure in large parts of the eastern Caribbean, is the first first-ever Category 4 hurricane recorded in the region in June – and a portend of devastating changes in weather patterns. It also underscores the need for urgent international assistance to Small Island Developing States (SIDS) to strengthen early warning systems and the climate resilience of key infrastructure – notably water, sanitation and health services, according to experts. The hurricane reached peak speed of 265 km per hour at times as it whipped though Barbados, Grenada, St Vincent and the Grenadines, Haiti, northern Venezuela, the Dominician Republic, Cayman Islands, and Jamaica. “The storm first impacted Barbados, causing severe damage to the south coast and significantly affecting the fishing industry with over 200 fishing vessels damaged or destroyed,” according to the International Federation of Red Cross and Red Crescent Societies (IFRC). On Union Island, part of Saint Vincent and the Grenadines, 90% of infrastructure has been damaged, including houses, roads and the airport. Some 95% of homes in Grenada’s Carriacou and Petite Martinique islands, are damaged, and around 3,000 people are shelters, the IFRC added. Parts of Jamaica’s St Elizabeth region in the south east were also devastated, with around 1,000 people taking refuge in shelters. The Dominican Republic, Cayman Islands reported damage. Venezuela’s President Nicolas Maduro said that 8,000 houses had been destroyed, according to Reuters. More to still come? “Hurricane Beryl, the first hurricane of the 2024 Atlantic hurricane season, rapidly strengthened to a Category 5 storm unusually early in the year,” according to a report from the National Ocean and Atmospheric Administration (NOAA), which is part of the US Department of Commerce “This explosive strengthening was fuelled in part by exceptionally warm ocean temperatures. That heat was one of the factors behind NOAA’s prediction in May of an 85% chance that the 2024 Atlantic hurricane season would be above normal.” Sea surface temperatures were close to those usually found in mid-September, the peak of hurricane season, added NOAA. In late May, NOAA weather forecasters predicted an 85% chance of above-normal hurricane for the 2024 Atlantic hurricane season, which runs from 1 June 1 to 30 November. It also forecast eight to 13 hurricanes, with four to seven likely to be “major” hurricanes (winds of over 178km per hour) in coming months. Early warning systems “The unprecedented hurricane demonstrates the importance of effective multi-hazard early warning systems to save lives,” according to United Nations Disaster Risk Reduction (UNDRR). “Globally, the sustained investments in those systems are making progress in reducing the loss of life in disasters. But economic losses are escalating. Every year millions of households lose their livelihood and risk being pushed into poverty. Ensuring that infrastructure is resilient and that communities ‘build back better’ in the face of future hazards is essential,” added UNDRR. Damage sustained to the airport and surrounding areas on Union Island in the Grenadines during Hurricane Beryl. In late May, the Fourth International Conference on SIDS adopted the Antigua and Barbuda Agenda for SIDS, a 10-year development agenda that appeals for international assistance to address climate change. The Agenda notes that “SIDS are facing the unrelenting and compounding impacts of climate change, biodiversity loss, pollution, disasters and natural hazards, health and other social related challenges and economic vulnerabilities.” Key climate change challenges include “erratic precipitation, increasingly frequent and extreme weather phenomena, more frequent and severe tropical cyclones, floods and drought, diminishing fresh water resources, desertification, coastal erosion, land degradation and sea-level rise.” However, there has been a “progressive deterioration” in SIDS’ ability to “withstand external shocks and enhance their resilience” – largely as a result of the economic impact of COVID-19 and climate challenges. Financial reform to build resilience Protestors call on wealth countries to pay for climate-related loss and damage at COP27. “In the wake of Hurricane Beryl, it is clear that we must redouble our efforts to build resilience and preparedness in the face of growing disaster risk, especially for small island developing states, which have contributed the least to the climate crisis but suffer the greatest costs,” said UNDRR head Kamal Kishore. Kishore appealed for international support for the Antigua and Barbuda Agenda, which “integrates disaster risk reduction as central to climate change adaptation and sustainable development in SIDS with clear calls to action on enhancing multi-hazard early warning systems and resilient infrastructure.” There have also been numerous calls for reform of the international financial architecture to assist developing countries most affected by climate change who are being forced to borrow money to address climate crises largely caused by wealthy nations. The most significant of these is the 2022 Bridgetown Initiative, spearheaded by Prime Minister Mia Mottley of Barbados. This called for key actions including new loan mechanisms, reform of the world’s development banks, and a loss and damages fund to enable developing countries to access to resilient finance to address climate and development crises. The UN climate change conference, COP27, agreed to establish a loss and damage fund during the UN Climate Change Conference (COP27) in 2022. However, there is resistance from a number of wealthier countries to this as the world continues to experience record-breaking extreme weather events. Meanwhile, the International Cort of Justice (ICJ) is expected to hold public hearings and issue an advisory later this year on the international legal obligations countries have to safeguard people against climate change. This follows the adoption last year of a landmark UN resolution to seek such an advisory opinion from the ICJ. While not legally binding, the advisory opinion holds legal and moral weight and will spotlight the human rights impacts of climate policy. Image Credits: UNDP, AfricaNews. As More US Dairy Herds Infected with Avian Flu, Americans in the Dark on the Risks of Raw Milk 04/07/2024 Zuzanna Stawiska Over one-half of Americans are not sure if pasteurised milk is safer than raw milk. In the time of avian flu epidemics in US cattle, this could even prove dangerous. As the fourth human case of H5N1 avian flu in a US farmworker in Colorado was confirmed Wednesday by the US Centers for Disease Control and Prevention (CDC), so far, only farm workers, and not consumers, have reported avian flu infections. This is likely due, at least in part, to the successful inactivation of the virus during the milk pasteurization process, experts say. And yet one-half or more Americans seem to have little idea about the dangers of drinking raw milk, according to a recent poll conducted by the University of Pennsylvania researchers. The survey, which included a demographically representative sample of the US adult population, found that less than half (47% percent) of the U.S. adults surveyed understood that drinking raw milk not as safe as drinking pasteurized milk. Conversely, 53% of respondents don’t actually believe that pasteurized milk is safer. And 9% of respondents actually believed raw milk is safer, while 15% said it was just as safe and 30% were unsure. Nearly a quarter (24%) of Americans either do not believe that pasteurization is effective at killing bacteria and viruses in milk products (4%) or are not sure whether this is true (20%), according to the survey of over 1000 US adults, conducted by the Annenberg Public Policy Center (APPC). The survey has a 3-3.5% statistical error rate. Around half of US adults failed to recognize that raw milk can be more dangerous than pasteurized milk products. That, despite the fact that studies report that pasteurized milk limits hospitalizations for related illnesses by an order of 45, according to the APPC report. The French Scientist Louis Pasteur invented the pasteurization process 160 years ago, after recognizing that it killed off otherwise dangerous bacteria present in unheated wine. The process, which soon became a milk industry standard in the United States, successfully inactivates the modern-day avian flu virus, significantly limiting the risk of infection for the general public. Politics and milk In fact, only about 2% of Americans report drinking raw milk at least once a month, according to a Food and Drug Administration (FDA) study based on 2019 data. Paradoxically, however, raw milk sales in the US have increased in recent months, according to some US media reports, despite the recent risks posed by a widening circle of avian influenza among dairy cattle. Debate has been spurred by the increased anti-science bent of some US political leaders. Presidential candidate Robert F. Kennedy Jr., for instance, who also has been a staunch opponent of COVID vaccination, has been quoted saying that he drinks raw milk exclusively. The APPC survey also found that Republicans are more likely than Democrats to believe that drinking raw milk is as safe as pasteurized milk (57% vs. 37%). People living in an urban environment also are more likely to believe that pastuerized milk is safer than raw milk as compared to people in a rural environment (49% vs. 32%). “The difference in views of raw milk that we see between Democrats and Republicans is difficult to disentangle from the difference between rural and urban dwellers,” said Kathleen Hall Jamieson, director of the Annenberg Public Policy Center. “Those in rural areas are both more likely to identify as Republicans and to consume raw milk.” 55 more dairy herds reported infected in last 30 days Some 55 more cattle herds in seven states have been infected with the virus over the past 30 days, according to CDC tracking. Infections in the past 30 days represent 40% of the total of 138 cattle herds infected in 12 states since the outbreak in dairy cattle was first reported on 25 March, the CDC reported. States affected by avian flu spread in dairy cattle The real number of infections of both humans and cattle is very likely underestimated, insofar as farmers have been reluctant to have their staff or herds tested, experts warn. Even so, the CDC maintained that infection risks for the general public remain low. “Based on the information available at this time, this infection does not change CDC’s current H5N1 bird flu human health risk assessment for the U.S. general public, which the agency considers to be low,” the CDC said in a statement. Image Credits: Cotonbro studio, APCC, CDC. Even India’s ‘Cleanest’ Cities Have Significant Excess Air Pollution-Related Deaths from NCDs 04/07/2024 Chetan Bhattacharji The air in relatively ‘clean’ Mumbai is still killing citizens. NEW DELHI – On 2 November 2023, extreme air pollution caught Delhi off-guard. It shut down schools and led to flight cancellations, curbs on construction and other emergency responses. That every little increase in air pollution increases the risk of death has been well-established for some years. But till now the effect of short-term air pollution on mortality has remained largely undocumented in detail in India, where most of the world’s most polluted cities are located. In a new, peer-reviewed study published in the Lancet on Thursday (4 July), researchers found that 7.2% (or approximately 33,000) of all deaths each year across 10 cities could be linked to short-term PM 2.5 exposure higher than the World Health Organization (WHO) guideline of 15 micrograms/cubic metre (µg/m³). PM 2.5 is a highly toxic ultra-fine particulate matter with a diameter of 2.5 microns, which is far thinner than a strand of human hair. This is the first multi-city study in India to assess the link between short-term pollution exposure and death with cities spanning different agri-climatological zones. The bottom line, the authors say, is that the current Indian government standard for PM 2.5 of 60 µg/m³ is “substantially higher” than it should be as a measure of ‘safe’ air quality. In comparison, WHO’s 24-hour standard is 15 µg/m³. NCDs are the leading cause for air pollution-related deaths The Lancet paper doesn’t look at the cause of death as that level of primary data isn’t always available. However, many studies including recent ones in India have shown that air pollution triggers or aggravates non-communicable diseases – specifically NCDs like heart attacks, strokes, lung cancer, and chronic lung disease – which can turn fatal. Of the total air pollution deaths, NCDs account for nearly 90% of the disease burden. The researchers are from 14 organisations including Sustainable Futures Collaborative in Delhi, Institute of Environmental Medicine in Stockholm, Indian Institute of Management Ahmedabad, Public Health Foundation of India, Ashoka University in Sonipat, Mount Sinai in New York, and Boston University. To come to their conclusions, the researchers analysed primary data on mortality between 2008 and 2019 in 10 cities of India. They used an advanced system of machine learning-based analysis which, simply put, used factors that would have a bearing on air pollution-related deaths, namely wind speed, atmospheric pressure and mixing height. This causal modelling approach enabled the researchers to isolate the effect of locally generated pollution as these factors are linked to the dispersal and transport of air pollution. Combined with other data from monitors, satellites and other sources, the study looked at over 3.6 million deaths in the 11-year study period. What the more complex causal modelling shows is that the risk of death is greater than what the earlier basic approach showed. No safe level of air pollution The causal modelling estimated an increase in the risk of death by 3.57% for every rise of just 10 µg/m³ metre over a two day period, as compared to 1.42% by a more basic study. Apart from the usual high-pollution suspects like Delhi and Varanasi, the study looked at places commonly perceived as having clean air, like the Himalayan city of Shimla and the coastal metropolises of Chennai and Mumbai. The authors say this is the first such multi-city study on the links between short-term air pollution exposure and deaths in India. Overall, 7.2% of all daily deaths were attributed to PM 2.5 concentrations higher than the WHO guidelines. Annually there are estimated to be approximately 33,000 deaths in these 10 cities. Over a third are in Delhi, where the average annual PM 2.5 level was 113 micrograms which is more than 22 times the WHO’s safe standard. The share of PM 2.5 linked deaths was also the highest in the Capital, at 11.5% compared to the lowest 3.5% in Shimla. The surprises are Mumbai and Kolkata, with deaths numbering around 5,000 each, annually. “We are seeing a high level of risk and a high number of deaths even in cities that have moderate levels of air pollution exposure. Mumbai, for instance, despite being a coastal city with around a third of the annual PM 2.5 levels of Delhi is still seeing over 5,000 deaths yearly from air pollution,” a lead author of the report, Dr Bhargav Krishna, Fellow at the Sustainable Futures Collaborative, explained to Health Policy Watch. “Similarly Hyderabad, Kolkata, Bengaluru, Chennai, Ahmedabad and Pune, all of which have annual PM2.5 levels below the current Indian standard, are still seeing a high number of deaths each year. This should drive us to focus not just on those cities that have high seasonal exposures, but even those that may be considered relatively ‘clean’ but are in reality polluted at a level that causes significant health impacts.” Mumbai air in March 2023. Mumbai, where remarkably the air pollution has been higher than Delhi on some days, was shown to have almost 5,100 deaths, the second highest after the national capital. That is 5.9% of all deaths in what is India’s financial capital. Here, every increase of 10 micrograms of PM 2.5 was associated with a 2.41% increase in daily deaths. Over 7% of daily deaths attributable to increases in short-term PM 2.5 First such study in Indian cities, say authors City Average Annual Pollution (PM2.5, mg/m³) Attributable Fraction of Deaths (%) Attributable Deaths Per Year Delhi 113 11.5 11,964 Varanasi 82.1 10.2 831 Kolkata 55.2 7.3 4,678 Pune 45.3 5.9 1,367 Mumbai 41.7 5.6 5,091 Hyderabad 38.9 5.6 1,597 Ahmedabad 37.9 5.6 2,495 Chennai 33.7 4.9 2,870 Bangalore 33 4.8 2,102 Shimla 28.4 3.7 59 Total 53.6 7.2 33,627 Source: Lancet Shimla proves that there is no safe level of air pollution, according to the report. It has the lowest air pollution level of the 10 cities, yet that was still a risk as 3.7% of all deaths were attributable to short-term PM 2.5 exposure. Impact on policy action The findings are crucial for immediate policy action and further studies to cover hundreds more towns and rural areas. Immediate action would cover sources of pollution like diesel generators, waste burning, and transport, sources that are commonly seen in many urban neighbourhoods. While much of the headline-grabbing focus is on extreme pollution, these findings show the need to act against all sources of air pollution all year round. Acting only on extremely high days of pollution will only yield marginal benefits regarding daily mortality. In particular, the paper calls out the Graded Response Action Plans, largely used in Delhi and its neighbouring cities. GRAPs are usually cited by local governments as their action to cut pollution but are implemented only in peak pollution season which is from October right through winter. Toxicity of local pollution There are some interesting findings which aren’t widely known. The study confirms that the risk of mortality rose more quickly at lower levels of PM 2.5 but plateaued as levels increased. More studies are needed to understand why exactly this happens. The causal modelling showed that the effects of air pollution on deaths were especially strong in cities with lower levels of pollution such as Bengaluru, Chennai and Shimla. The study fills a data and communication gap in addressing the health crisis caused by toxic air. On one hand, it establishes a link between rising air pollution and deaths, on the other, it makes the risks a lot more relatable because it shows the impact over just two days of exposure than over many months or years. So what can residents in these cities do to protect themselves? Bhargav says individual responses could include wearing a mask, choosing when to step outdoors (pollution tends to be highest during the morning and evening when temperatures dip), and reducing pollution sources inside their home. However, the onus lies on governments and policymakers. “The levels of air pollution we see in India are extremely high and this study clearly shows how day-to-day variations in these levels lead to considerable mortality,” said Dr Petter Ljungman of the Karolinska Institute, and one of the researchers involved in the study. “Interestingly we saw that local pollution sources are likely to be more toxic than more distant sources which has implications for policymakers addressing this highly relevant threat to human health.” Image Credits: Chetan Bhattacharji. Positioning the University of Ghana as a ‘Research-Intensive’ Institution on Neglected Diseases 03/07/2024 Jessica Ahedor Scientists at the West African Centre for Cell Biology and Infectious Pathogens (WACCBIP), University of Ghana, setting up a genome sequencing experiment in the laboratory. Almost 15 years ago, when the University of Ghana established its Office of Research, Innovation, and Development, it did so with the goal of bolstering the West African nation’s research capacity. In the African region, where less than 0.5% of GDP is devoted to research, and a significant number of Africa’s educated is siphoned off to other countries, the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR) has spearheaded the effort to make universities like the University of Ghana research-intensive and competitive. TDR support for research capacity-strengthening activities at the University of Ghana focuses on enabling researchers to tackle infectious diseases of poverty through quality implementation research, the study of bridging basic science research and practice. This could mean examining why many patients on antiretroviral therapy drop out of treatment, or identifying barriers to TB treatment adherence – both the subject of recent publications authored by researchers at the University of Ghana. Capacity-building works Professor Gordon A. Awandare at TDR’s Joint Coordinating Board meeting in Geneva, 12 June 2024 “Capacity-building actually works,” remarked Professor Gordon A Awandare, Pro Vice-Cancellor of Academic Student Affairs at the University of Ghana, at a TDR 50th anniversary event in Geneva, where he gave a detailed review of the collaboration before TDR’s Joint Coordinating Board on June 12. He cited, as one example, his own career trajectory. Awandare began a career in research through a TDR grant that allowed him to complete his masters training, and then got an opportunity to study for a PhD at the University of Pittsburgh while attending a conference on malaria with support from TDR. He returned home to the University of Ghana in 2010, founding the West African Centre for Cell Biology of Infectious Pathogens (WACCBIP) in 2014. Since then, the Centre, supported by the Wellcome Trust and the World Bank, has endowed 400 fellowships and received $53 million in grants, thereby directly reducing the “brain drain” across the African region. A decade-long partnership The University of Ghana leads efforts to train students in implementation research. Newly enrolled master’s students during their lab induction at WACCBIP, University of Ghana. In 2014 the University of Ghana’s School of Public Health signed a partnership agreement with TDR to create a regional training center that leads activities in the African region for strengthening capacity in implementation research to tackle infectious diseases of poverty. The initiative has so far trained more than 25,000 individuals across Africa, including health practitioners, decision-makers and researchers. “Looking at how far we’ve come as a training centre, it is our desire to become a centre of excellence where the annual programmes can be extended to say five years,” said Professor Phyllis Dako-Gyeke, who led the TDR-supported research training programmes at University of Ghana until her passing on 11 June. But the success of an almost decade-long relationship is not without its challenges. Sustainable donor support and aligned interests on research priorities remain key, she said. Real-time research Implementation researchers at UG have tackled issues from TB treatment adherence to antiretroviral therapy. Here, a community health worker conducts an interview in Obuasi, Ghana to identify barriers and facilitators for TB control. Dr Emmanuel Asampong, coordinator of the regional training centre at the University of Ghana, notes that “the impact of implementation research on disease themes in Africa and beyond is impressive because the initiative uses real-time research results in various contexts – such as the neglected tropical diseases programme, the national malaria programme, and the tuberculosis control programme – to provide solutions to challenges.” The global program, which has played a significant role in positioning University of Ghana as a research-intensive university, supports seven regional training centres across six WHO regions. With additional partners in Colombia, Indonesia, Kazakhstan, Malaysia, Senegal and Tunisia, the program develops and updates implementation research courses, provides faculty training and supports career development. The global program, which has played a significant role in positioning University of Ghana as a research institution, also supports NTD research in six WHO regions. The University of Ghana also partners with TDR on a postgraduate training scheme, which provides a full academic scholarship for master’s students. The training is specifically focused on implementation research to tackle infectious diseases of poverty. The list of TDR alumni across the world runs long, and the University of Ghana can claim many public health leaders among them. “My postgraduate training at the University of Ghana, supported by TDR, was an invaluable catalyst in shaping my academic and professional journey,” said Dr Mbele Whiteson, Senior Resident Medical Officer at the Ministry of Health in Zambia. “I have learned to recognize the intricate interplay between health outcomes and social determinants.” This is the third article in a series on TDR’s research capacity strengthening programme – building skills of public health researchers, implementers, health practitioners and policy-makers in the fast-developing field of implementation research for improving uptake of effective health interventions. Sophia Samantaroy contributed to the writing and research of this story. Image Credits: WACCBIP, TDR, African Regional Training Centre (ARTC), University of Ghana/TDR. 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FDA Approves Eli Lilly’s Kisunla for Early-Stage Alzheimer’s Patients 08/07/2024 Maayan Hoffman Neurons with tau protein highlighted in red. Eli Lilly’s Alzheimer’s therapy, donanemab, has received FDA approval, offering new hope for patients with early symptomatic Alzheimer’s disease. The newly approved treatment, branded Kisunla, is set to challenge existing therapies from Eisai and Biogen. Clinical trials have shown Kisunla to be effective for individuals in the mild cognitive impairment or mild dementia stages of the disease, potentially marking a significant advancement in Alzheimer’s care. The drug is administered as an intravenous infusion every four weeks. Alzheimer’s disease is a degenerative condition of the brain that impacts over 6.5 million Americans and over 55 million people worldwide. It causes a gradual decline in memory, cognitive functions, and, eventually, the ability to perform daily activities. The disease is marked by structural changes in the brain, such as the buildup of amyloid beta plaques and neurofibrillary tangles made of tau protein, which is supposed to help stabilize the internal skeleton of neurons in the brain. The Alzheimer’s Association celebrated the FDA’s decision. “This is real progress,” said Joanne Pike, Alzheimer’s Association president and CEO, in a statement. “Today’s approval allows people more options and greater opportunity to have more time. Having multiple treatment options is the kind of advancement we’ve all been waiting for — all of us who have been touched, even blindsided, by this difficult and devastating disease.” Slows cognitive decline by at least 22% The approval was based on an extensive double-blind, placebo-controlled, parallel-group study evaluating the efficacy of Kisunla in slowing cognitive decline in participants with varying levels of tau protein in the brain. Tau is a protein that helps to stabilise the neurons in the brain. The study, conducted over 72 weeks with 1,736 patients averaging 73 years old, revealed that those receiving Kisunla experienced a 35% reduction in cognitive decline compared to those on placebo among individuals with low to medium tau levels. Even among participants with higher tau levels, the treatment demonstrated a meaningful but slightly reduced effect. Overall, including all tau levels, Kisunla slowed cognitive decline by 22% and reduced the likelihood of progressing to the next stage of the disease by 39% compared to placebo. Additionally, the study monitored amyloid plaque levels using positron emission tomography (PET) scans throughout the treatment period. Results showed substantial reductions in amyloid plaques over time among patients receiving Kisunla, with reductions of 61% at six months, 80% at 12 months, and 84% at 18 months compared to baseline levels. These findings suggest that Kisunla not only targets cognitive decline but also effectively reduces the hallmark amyloid pathology associated with Alzheimer’s disease progression. Potential side effects For some patients, there is a risk of amyloid-related imaging abnormalities (ARIA) developing, the FDA said. ARIA typically manifests as temporary brain swelling, sometimes accompanied by small areas of bleeding on or in the brain. While ARIA often resolves on its own and may not cause symptoms, rare instances of severe and potentially life-threatening events have been reported. ARIA is a recognized side effect of antibody therapies targeting amyloid. Infusion-related reactions are also a concern, including flu-like symptoms, nausea, vomiting, changes in blood pressure, and hypersensitivity reactions such as anaphylaxis (a severe allergic reaction) and angioedema (swelling). Kisunla joins Leqembi, on market since 2023 Kisunla is the third drug to receive FDA approval, although only the second is now available for use. Leqembi, a collaboration between Biogen of the United States and Eisai of Japan, gained approval in July 2023. In an 18-month Phase III trial, Leqembi demonstrated a 27% reduction in cognitive decline among early-stage Alzheimer’s patients compared to those receiving a placebo. Another drug, aducanumab, also developed by Biogen and Eisai, was granted accelerated approval by the FDA in June 2021. However, due to some side effects, the therapy was pulled from the market. The Alzheimer’s Association emphasized the importance of early detection and diagnosis now that multiple FDA-approved treatments for Alzheimer’s are available. The organization stressed that timely access to these treatments is crucial for maximizing their benefits, asserting that no stage or entity should hinder or delay such access. “Too many roadblocks have prevented individuals from getting equitable access to these beneficial treatments for far too long,” said Pike. “It is equally important that clinicians and health care systems are informed and prepared to help the individuals who could benefit. The Alzheimer’s Association is working with health systems and providers to ensure they have the tools and resources to meet the needs of their patients.” Image Credits: Gerry Shaw/ EnCor Biotechnology Inc. Earliest Ever Hurricane Tears Through Caribbean, Highlighting Need for Speedier Climate Action 05/07/2024 Kerry Cullinan Fishing vessels at the Bridgetown Fisheries Complex in Barbados damaged by Hurricane Beryl. Hurricane Beryl, which has destroyed homes and infrastructure in large parts of the eastern Caribbean, is the first first-ever Category 4 hurricane recorded in the region in June – and a portend of devastating changes in weather patterns. It also underscores the need for urgent international assistance to Small Island Developing States (SIDS) to strengthen early warning systems and the climate resilience of key infrastructure – notably water, sanitation and health services, according to experts. The hurricane reached peak speed of 265 km per hour at times as it whipped though Barbados, Grenada, St Vincent and the Grenadines, Haiti, northern Venezuela, the Dominician Republic, Cayman Islands, and Jamaica. “The storm first impacted Barbados, causing severe damage to the south coast and significantly affecting the fishing industry with over 200 fishing vessels damaged or destroyed,” according to the International Federation of Red Cross and Red Crescent Societies (IFRC). On Union Island, part of Saint Vincent and the Grenadines, 90% of infrastructure has been damaged, including houses, roads and the airport. Some 95% of homes in Grenada’s Carriacou and Petite Martinique islands, are damaged, and around 3,000 people are shelters, the IFRC added. Parts of Jamaica’s St Elizabeth region in the south east were also devastated, with around 1,000 people taking refuge in shelters. The Dominican Republic, Cayman Islands reported damage. Venezuela’s President Nicolas Maduro said that 8,000 houses had been destroyed, according to Reuters. More to still come? “Hurricane Beryl, the first hurricane of the 2024 Atlantic hurricane season, rapidly strengthened to a Category 5 storm unusually early in the year,” according to a report from the National Ocean and Atmospheric Administration (NOAA), which is part of the US Department of Commerce “This explosive strengthening was fuelled in part by exceptionally warm ocean temperatures. That heat was one of the factors behind NOAA’s prediction in May of an 85% chance that the 2024 Atlantic hurricane season would be above normal.” Sea surface temperatures were close to those usually found in mid-September, the peak of hurricane season, added NOAA. In late May, NOAA weather forecasters predicted an 85% chance of above-normal hurricane for the 2024 Atlantic hurricane season, which runs from 1 June 1 to 30 November. It also forecast eight to 13 hurricanes, with four to seven likely to be “major” hurricanes (winds of over 178km per hour) in coming months. Early warning systems “The unprecedented hurricane demonstrates the importance of effective multi-hazard early warning systems to save lives,” according to United Nations Disaster Risk Reduction (UNDRR). “Globally, the sustained investments in those systems are making progress in reducing the loss of life in disasters. But economic losses are escalating. Every year millions of households lose their livelihood and risk being pushed into poverty. Ensuring that infrastructure is resilient and that communities ‘build back better’ in the face of future hazards is essential,” added UNDRR. Damage sustained to the airport and surrounding areas on Union Island in the Grenadines during Hurricane Beryl. In late May, the Fourth International Conference on SIDS adopted the Antigua and Barbuda Agenda for SIDS, a 10-year development agenda that appeals for international assistance to address climate change. The Agenda notes that “SIDS are facing the unrelenting and compounding impacts of climate change, biodiversity loss, pollution, disasters and natural hazards, health and other social related challenges and economic vulnerabilities.” Key climate change challenges include “erratic precipitation, increasingly frequent and extreme weather phenomena, more frequent and severe tropical cyclones, floods and drought, diminishing fresh water resources, desertification, coastal erosion, land degradation and sea-level rise.” However, there has been a “progressive deterioration” in SIDS’ ability to “withstand external shocks and enhance their resilience” – largely as a result of the economic impact of COVID-19 and climate challenges. Financial reform to build resilience Protestors call on wealth countries to pay for climate-related loss and damage at COP27. “In the wake of Hurricane Beryl, it is clear that we must redouble our efforts to build resilience and preparedness in the face of growing disaster risk, especially for small island developing states, which have contributed the least to the climate crisis but suffer the greatest costs,” said UNDRR head Kamal Kishore. Kishore appealed for international support for the Antigua and Barbuda Agenda, which “integrates disaster risk reduction as central to climate change adaptation and sustainable development in SIDS with clear calls to action on enhancing multi-hazard early warning systems and resilient infrastructure.” There have also been numerous calls for reform of the international financial architecture to assist developing countries most affected by climate change who are being forced to borrow money to address climate crises largely caused by wealthy nations. The most significant of these is the 2022 Bridgetown Initiative, spearheaded by Prime Minister Mia Mottley of Barbados. This called for key actions including new loan mechanisms, reform of the world’s development banks, and a loss and damages fund to enable developing countries to access to resilient finance to address climate and development crises. The UN climate change conference, COP27, agreed to establish a loss and damage fund during the UN Climate Change Conference (COP27) in 2022. However, there is resistance from a number of wealthier countries to this as the world continues to experience record-breaking extreme weather events. Meanwhile, the International Cort of Justice (ICJ) is expected to hold public hearings and issue an advisory later this year on the international legal obligations countries have to safeguard people against climate change. This follows the adoption last year of a landmark UN resolution to seek such an advisory opinion from the ICJ. While not legally binding, the advisory opinion holds legal and moral weight and will spotlight the human rights impacts of climate policy. Image Credits: UNDP, AfricaNews. As More US Dairy Herds Infected with Avian Flu, Americans in the Dark on the Risks of Raw Milk 04/07/2024 Zuzanna Stawiska Over one-half of Americans are not sure if pasteurised milk is safer than raw milk. In the time of avian flu epidemics in US cattle, this could even prove dangerous. As the fourth human case of H5N1 avian flu in a US farmworker in Colorado was confirmed Wednesday by the US Centers for Disease Control and Prevention (CDC), so far, only farm workers, and not consumers, have reported avian flu infections. This is likely due, at least in part, to the successful inactivation of the virus during the milk pasteurization process, experts say. And yet one-half or more Americans seem to have little idea about the dangers of drinking raw milk, according to a recent poll conducted by the University of Pennsylvania researchers. The survey, which included a demographically representative sample of the US adult population, found that less than half (47% percent) of the U.S. adults surveyed understood that drinking raw milk not as safe as drinking pasteurized milk. Conversely, 53% of respondents don’t actually believe that pasteurized milk is safer. And 9% of respondents actually believed raw milk is safer, while 15% said it was just as safe and 30% were unsure. Nearly a quarter (24%) of Americans either do not believe that pasteurization is effective at killing bacteria and viruses in milk products (4%) or are not sure whether this is true (20%), according to the survey of over 1000 US adults, conducted by the Annenberg Public Policy Center (APPC). The survey has a 3-3.5% statistical error rate. Around half of US adults failed to recognize that raw milk can be more dangerous than pasteurized milk products. That, despite the fact that studies report that pasteurized milk limits hospitalizations for related illnesses by an order of 45, according to the APPC report. The French Scientist Louis Pasteur invented the pasteurization process 160 years ago, after recognizing that it killed off otherwise dangerous bacteria present in unheated wine. The process, which soon became a milk industry standard in the United States, successfully inactivates the modern-day avian flu virus, significantly limiting the risk of infection for the general public. Politics and milk In fact, only about 2% of Americans report drinking raw milk at least once a month, according to a Food and Drug Administration (FDA) study based on 2019 data. Paradoxically, however, raw milk sales in the US have increased in recent months, according to some US media reports, despite the recent risks posed by a widening circle of avian influenza among dairy cattle. Debate has been spurred by the increased anti-science bent of some US political leaders. Presidential candidate Robert F. Kennedy Jr., for instance, who also has been a staunch opponent of COVID vaccination, has been quoted saying that he drinks raw milk exclusively. The APPC survey also found that Republicans are more likely than Democrats to believe that drinking raw milk is as safe as pasteurized milk (57% vs. 37%). People living in an urban environment also are more likely to believe that pastuerized milk is safer than raw milk as compared to people in a rural environment (49% vs. 32%). “The difference in views of raw milk that we see between Democrats and Republicans is difficult to disentangle from the difference between rural and urban dwellers,” said Kathleen Hall Jamieson, director of the Annenberg Public Policy Center. “Those in rural areas are both more likely to identify as Republicans and to consume raw milk.” 55 more dairy herds reported infected in last 30 days Some 55 more cattle herds in seven states have been infected with the virus over the past 30 days, according to CDC tracking. Infections in the past 30 days represent 40% of the total of 138 cattle herds infected in 12 states since the outbreak in dairy cattle was first reported on 25 March, the CDC reported. States affected by avian flu spread in dairy cattle The real number of infections of both humans and cattle is very likely underestimated, insofar as farmers have been reluctant to have their staff or herds tested, experts warn. Even so, the CDC maintained that infection risks for the general public remain low. “Based on the information available at this time, this infection does not change CDC’s current H5N1 bird flu human health risk assessment for the U.S. general public, which the agency considers to be low,” the CDC said in a statement. Image Credits: Cotonbro studio, APCC, CDC. Even India’s ‘Cleanest’ Cities Have Significant Excess Air Pollution-Related Deaths from NCDs 04/07/2024 Chetan Bhattacharji The air in relatively ‘clean’ Mumbai is still killing citizens. NEW DELHI – On 2 November 2023, extreme air pollution caught Delhi off-guard. It shut down schools and led to flight cancellations, curbs on construction and other emergency responses. That every little increase in air pollution increases the risk of death has been well-established for some years. But till now the effect of short-term air pollution on mortality has remained largely undocumented in detail in India, where most of the world’s most polluted cities are located. In a new, peer-reviewed study published in the Lancet on Thursday (4 July), researchers found that 7.2% (or approximately 33,000) of all deaths each year across 10 cities could be linked to short-term PM 2.5 exposure higher than the World Health Organization (WHO) guideline of 15 micrograms/cubic metre (µg/m³). PM 2.5 is a highly toxic ultra-fine particulate matter with a diameter of 2.5 microns, which is far thinner than a strand of human hair. This is the first multi-city study in India to assess the link between short-term pollution exposure and death with cities spanning different agri-climatological zones. The bottom line, the authors say, is that the current Indian government standard for PM 2.5 of 60 µg/m³ is “substantially higher” than it should be as a measure of ‘safe’ air quality. In comparison, WHO’s 24-hour standard is 15 µg/m³. NCDs are the leading cause for air pollution-related deaths The Lancet paper doesn’t look at the cause of death as that level of primary data isn’t always available. However, many studies including recent ones in India have shown that air pollution triggers or aggravates non-communicable diseases – specifically NCDs like heart attacks, strokes, lung cancer, and chronic lung disease – which can turn fatal. Of the total air pollution deaths, NCDs account for nearly 90% of the disease burden. The researchers are from 14 organisations including Sustainable Futures Collaborative in Delhi, Institute of Environmental Medicine in Stockholm, Indian Institute of Management Ahmedabad, Public Health Foundation of India, Ashoka University in Sonipat, Mount Sinai in New York, and Boston University. To come to their conclusions, the researchers analysed primary data on mortality between 2008 and 2019 in 10 cities of India. They used an advanced system of machine learning-based analysis which, simply put, used factors that would have a bearing on air pollution-related deaths, namely wind speed, atmospheric pressure and mixing height. This causal modelling approach enabled the researchers to isolate the effect of locally generated pollution as these factors are linked to the dispersal and transport of air pollution. Combined with other data from monitors, satellites and other sources, the study looked at over 3.6 million deaths in the 11-year study period. What the more complex causal modelling shows is that the risk of death is greater than what the earlier basic approach showed. No safe level of air pollution The causal modelling estimated an increase in the risk of death by 3.57% for every rise of just 10 µg/m³ metre over a two day period, as compared to 1.42% by a more basic study. Apart from the usual high-pollution suspects like Delhi and Varanasi, the study looked at places commonly perceived as having clean air, like the Himalayan city of Shimla and the coastal metropolises of Chennai and Mumbai. The authors say this is the first such multi-city study on the links between short-term air pollution exposure and deaths in India. Overall, 7.2% of all daily deaths were attributed to PM 2.5 concentrations higher than the WHO guidelines. Annually there are estimated to be approximately 33,000 deaths in these 10 cities. Over a third are in Delhi, where the average annual PM 2.5 level was 113 micrograms which is more than 22 times the WHO’s safe standard. The share of PM 2.5 linked deaths was also the highest in the Capital, at 11.5% compared to the lowest 3.5% in Shimla. The surprises are Mumbai and Kolkata, with deaths numbering around 5,000 each, annually. “We are seeing a high level of risk and a high number of deaths even in cities that have moderate levels of air pollution exposure. Mumbai, for instance, despite being a coastal city with around a third of the annual PM 2.5 levels of Delhi is still seeing over 5,000 deaths yearly from air pollution,” a lead author of the report, Dr Bhargav Krishna, Fellow at the Sustainable Futures Collaborative, explained to Health Policy Watch. “Similarly Hyderabad, Kolkata, Bengaluru, Chennai, Ahmedabad and Pune, all of which have annual PM2.5 levels below the current Indian standard, are still seeing a high number of deaths each year. This should drive us to focus not just on those cities that have high seasonal exposures, but even those that may be considered relatively ‘clean’ but are in reality polluted at a level that causes significant health impacts.” Mumbai air in March 2023. Mumbai, where remarkably the air pollution has been higher than Delhi on some days, was shown to have almost 5,100 deaths, the second highest after the national capital. That is 5.9% of all deaths in what is India’s financial capital. Here, every increase of 10 micrograms of PM 2.5 was associated with a 2.41% increase in daily deaths. Over 7% of daily deaths attributable to increases in short-term PM 2.5 First such study in Indian cities, say authors City Average Annual Pollution (PM2.5, mg/m³) Attributable Fraction of Deaths (%) Attributable Deaths Per Year Delhi 113 11.5 11,964 Varanasi 82.1 10.2 831 Kolkata 55.2 7.3 4,678 Pune 45.3 5.9 1,367 Mumbai 41.7 5.6 5,091 Hyderabad 38.9 5.6 1,597 Ahmedabad 37.9 5.6 2,495 Chennai 33.7 4.9 2,870 Bangalore 33 4.8 2,102 Shimla 28.4 3.7 59 Total 53.6 7.2 33,627 Source: Lancet Shimla proves that there is no safe level of air pollution, according to the report. It has the lowest air pollution level of the 10 cities, yet that was still a risk as 3.7% of all deaths were attributable to short-term PM 2.5 exposure. Impact on policy action The findings are crucial for immediate policy action and further studies to cover hundreds more towns and rural areas. Immediate action would cover sources of pollution like diesel generators, waste burning, and transport, sources that are commonly seen in many urban neighbourhoods. While much of the headline-grabbing focus is on extreme pollution, these findings show the need to act against all sources of air pollution all year round. Acting only on extremely high days of pollution will only yield marginal benefits regarding daily mortality. In particular, the paper calls out the Graded Response Action Plans, largely used in Delhi and its neighbouring cities. GRAPs are usually cited by local governments as their action to cut pollution but are implemented only in peak pollution season which is from October right through winter. Toxicity of local pollution There are some interesting findings which aren’t widely known. The study confirms that the risk of mortality rose more quickly at lower levels of PM 2.5 but plateaued as levels increased. More studies are needed to understand why exactly this happens. The causal modelling showed that the effects of air pollution on deaths were especially strong in cities with lower levels of pollution such as Bengaluru, Chennai and Shimla. The study fills a data and communication gap in addressing the health crisis caused by toxic air. On one hand, it establishes a link between rising air pollution and deaths, on the other, it makes the risks a lot more relatable because it shows the impact over just two days of exposure than over many months or years. So what can residents in these cities do to protect themselves? Bhargav says individual responses could include wearing a mask, choosing when to step outdoors (pollution tends to be highest during the morning and evening when temperatures dip), and reducing pollution sources inside their home. However, the onus lies on governments and policymakers. “The levels of air pollution we see in India are extremely high and this study clearly shows how day-to-day variations in these levels lead to considerable mortality,” said Dr Petter Ljungman of the Karolinska Institute, and one of the researchers involved in the study. “Interestingly we saw that local pollution sources are likely to be more toxic than more distant sources which has implications for policymakers addressing this highly relevant threat to human health.” Image Credits: Chetan Bhattacharji. Positioning the University of Ghana as a ‘Research-Intensive’ Institution on Neglected Diseases 03/07/2024 Jessica Ahedor Scientists at the West African Centre for Cell Biology and Infectious Pathogens (WACCBIP), University of Ghana, setting up a genome sequencing experiment in the laboratory. Almost 15 years ago, when the University of Ghana established its Office of Research, Innovation, and Development, it did so with the goal of bolstering the West African nation’s research capacity. In the African region, where less than 0.5% of GDP is devoted to research, and a significant number of Africa’s educated is siphoned off to other countries, the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR) has spearheaded the effort to make universities like the University of Ghana research-intensive and competitive. TDR support for research capacity-strengthening activities at the University of Ghana focuses on enabling researchers to tackle infectious diseases of poverty through quality implementation research, the study of bridging basic science research and practice. This could mean examining why many patients on antiretroviral therapy drop out of treatment, or identifying barriers to TB treatment adherence – both the subject of recent publications authored by researchers at the University of Ghana. Capacity-building works Professor Gordon A. Awandare at TDR’s Joint Coordinating Board meeting in Geneva, 12 June 2024 “Capacity-building actually works,” remarked Professor Gordon A Awandare, Pro Vice-Cancellor of Academic Student Affairs at the University of Ghana, at a TDR 50th anniversary event in Geneva, where he gave a detailed review of the collaboration before TDR’s Joint Coordinating Board on June 12. He cited, as one example, his own career trajectory. Awandare began a career in research through a TDR grant that allowed him to complete his masters training, and then got an opportunity to study for a PhD at the University of Pittsburgh while attending a conference on malaria with support from TDR. He returned home to the University of Ghana in 2010, founding the West African Centre for Cell Biology of Infectious Pathogens (WACCBIP) in 2014. Since then, the Centre, supported by the Wellcome Trust and the World Bank, has endowed 400 fellowships and received $53 million in grants, thereby directly reducing the “brain drain” across the African region. A decade-long partnership The University of Ghana leads efforts to train students in implementation research. Newly enrolled master’s students during their lab induction at WACCBIP, University of Ghana. In 2014 the University of Ghana’s School of Public Health signed a partnership agreement with TDR to create a regional training center that leads activities in the African region for strengthening capacity in implementation research to tackle infectious diseases of poverty. The initiative has so far trained more than 25,000 individuals across Africa, including health practitioners, decision-makers and researchers. “Looking at how far we’ve come as a training centre, it is our desire to become a centre of excellence where the annual programmes can be extended to say five years,” said Professor Phyllis Dako-Gyeke, who led the TDR-supported research training programmes at University of Ghana until her passing on 11 June. But the success of an almost decade-long relationship is not without its challenges. Sustainable donor support and aligned interests on research priorities remain key, she said. Real-time research Implementation researchers at UG have tackled issues from TB treatment adherence to antiretroviral therapy. Here, a community health worker conducts an interview in Obuasi, Ghana to identify barriers and facilitators for TB control. Dr Emmanuel Asampong, coordinator of the regional training centre at the University of Ghana, notes that “the impact of implementation research on disease themes in Africa and beyond is impressive because the initiative uses real-time research results in various contexts – such as the neglected tropical diseases programme, the national malaria programme, and the tuberculosis control programme – to provide solutions to challenges.” The global program, which has played a significant role in positioning University of Ghana as a research-intensive university, supports seven regional training centres across six WHO regions. With additional partners in Colombia, Indonesia, Kazakhstan, Malaysia, Senegal and Tunisia, the program develops and updates implementation research courses, provides faculty training and supports career development. The global program, which has played a significant role in positioning University of Ghana as a research institution, also supports NTD research in six WHO regions. The University of Ghana also partners with TDR on a postgraduate training scheme, which provides a full academic scholarship for master’s students. The training is specifically focused on implementation research to tackle infectious diseases of poverty. The list of TDR alumni across the world runs long, and the University of Ghana can claim many public health leaders among them. “My postgraduate training at the University of Ghana, supported by TDR, was an invaluable catalyst in shaping my academic and professional journey,” said Dr Mbele Whiteson, Senior Resident Medical Officer at the Ministry of Health in Zambia. “I have learned to recognize the intricate interplay between health outcomes and social determinants.” This is the third article in a series on TDR’s research capacity strengthening programme – building skills of public health researchers, implementers, health practitioners and policy-makers in the fast-developing field of implementation research for improving uptake of effective health interventions. Sophia Samantaroy contributed to the writing and research of this story. Image Credits: WACCBIP, TDR, African Regional Training Centre (ARTC), University of Ghana/TDR. 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Earliest Ever Hurricane Tears Through Caribbean, Highlighting Need for Speedier Climate Action 05/07/2024 Kerry Cullinan Fishing vessels at the Bridgetown Fisheries Complex in Barbados damaged by Hurricane Beryl. Hurricane Beryl, which has destroyed homes and infrastructure in large parts of the eastern Caribbean, is the first first-ever Category 4 hurricane recorded in the region in June – and a portend of devastating changes in weather patterns. It also underscores the need for urgent international assistance to Small Island Developing States (SIDS) to strengthen early warning systems and the climate resilience of key infrastructure – notably water, sanitation and health services, according to experts. The hurricane reached peak speed of 265 km per hour at times as it whipped though Barbados, Grenada, St Vincent and the Grenadines, Haiti, northern Venezuela, the Dominician Republic, Cayman Islands, and Jamaica. “The storm first impacted Barbados, causing severe damage to the south coast and significantly affecting the fishing industry with over 200 fishing vessels damaged or destroyed,” according to the International Federation of Red Cross and Red Crescent Societies (IFRC). On Union Island, part of Saint Vincent and the Grenadines, 90% of infrastructure has been damaged, including houses, roads and the airport. Some 95% of homes in Grenada’s Carriacou and Petite Martinique islands, are damaged, and around 3,000 people are shelters, the IFRC added. Parts of Jamaica’s St Elizabeth region in the south east were also devastated, with around 1,000 people taking refuge in shelters. The Dominican Republic, Cayman Islands reported damage. Venezuela’s President Nicolas Maduro said that 8,000 houses had been destroyed, according to Reuters. More to still come? “Hurricane Beryl, the first hurricane of the 2024 Atlantic hurricane season, rapidly strengthened to a Category 5 storm unusually early in the year,” according to a report from the National Ocean and Atmospheric Administration (NOAA), which is part of the US Department of Commerce “This explosive strengthening was fuelled in part by exceptionally warm ocean temperatures. That heat was one of the factors behind NOAA’s prediction in May of an 85% chance that the 2024 Atlantic hurricane season would be above normal.” Sea surface temperatures were close to those usually found in mid-September, the peak of hurricane season, added NOAA. In late May, NOAA weather forecasters predicted an 85% chance of above-normal hurricane for the 2024 Atlantic hurricane season, which runs from 1 June 1 to 30 November. It also forecast eight to 13 hurricanes, with four to seven likely to be “major” hurricanes (winds of over 178km per hour) in coming months. Early warning systems “The unprecedented hurricane demonstrates the importance of effective multi-hazard early warning systems to save lives,” according to United Nations Disaster Risk Reduction (UNDRR). “Globally, the sustained investments in those systems are making progress in reducing the loss of life in disasters. But economic losses are escalating. Every year millions of households lose their livelihood and risk being pushed into poverty. Ensuring that infrastructure is resilient and that communities ‘build back better’ in the face of future hazards is essential,” added UNDRR. Damage sustained to the airport and surrounding areas on Union Island in the Grenadines during Hurricane Beryl. In late May, the Fourth International Conference on SIDS adopted the Antigua and Barbuda Agenda for SIDS, a 10-year development agenda that appeals for international assistance to address climate change. The Agenda notes that “SIDS are facing the unrelenting and compounding impacts of climate change, biodiversity loss, pollution, disasters and natural hazards, health and other social related challenges and economic vulnerabilities.” Key climate change challenges include “erratic precipitation, increasingly frequent and extreme weather phenomena, more frequent and severe tropical cyclones, floods and drought, diminishing fresh water resources, desertification, coastal erosion, land degradation and sea-level rise.” However, there has been a “progressive deterioration” in SIDS’ ability to “withstand external shocks and enhance their resilience” – largely as a result of the economic impact of COVID-19 and climate challenges. Financial reform to build resilience Protestors call on wealth countries to pay for climate-related loss and damage at COP27. “In the wake of Hurricane Beryl, it is clear that we must redouble our efforts to build resilience and preparedness in the face of growing disaster risk, especially for small island developing states, which have contributed the least to the climate crisis but suffer the greatest costs,” said UNDRR head Kamal Kishore. Kishore appealed for international support for the Antigua and Barbuda Agenda, which “integrates disaster risk reduction as central to climate change adaptation and sustainable development in SIDS with clear calls to action on enhancing multi-hazard early warning systems and resilient infrastructure.” There have also been numerous calls for reform of the international financial architecture to assist developing countries most affected by climate change who are being forced to borrow money to address climate crises largely caused by wealthy nations. The most significant of these is the 2022 Bridgetown Initiative, spearheaded by Prime Minister Mia Mottley of Barbados. This called for key actions including new loan mechanisms, reform of the world’s development banks, and a loss and damages fund to enable developing countries to access to resilient finance to address climate and development crises. The UN climate change conference, COP27, agreed to establish a loss and damage fund during the UN Climate Change Conference (COP27) in 2022. However, there is resistance from a number of wealthier countries to this as the world continues to experience record-breaking extreme weather events. Meanwhile, the International Cort of Justice (ICJ) is expected to hold public hearings and issue an advisory later this year on the international legal obligations countries have to safeguard people against climate change. This follows the adoption last year of a landmark UN resolution to seek such an advisory opinion from the ICJ. While not legally binding, the advisory opinion holds legal and moral weight and will spotlight the human rights impacts of climate policy. Image Credits: UNDP, AfricaNews. As More US Dairy Herds Infected with Avian Flu, Americans in the Dark on the Risks of Raw Milk 04/07/2024 Zuzanna Stawiska Over one-half of Americans are not sure if pasteurised milk is safer than raw milk. In the time of avian flu epidemics in US cattle, this could even prove dangerous. As the fourth human case of H5N1 avian flu in a US farmworker in Colorado was confirmed Wednesday by the US Centers for Disease Control and Prevention (CDC), so far, only farm workers, and not consumers, have reported avian flu infections. This is likely due, at least in part, to the successful inactivation of the virus during the milk pasteurization process, experts say. And yet one-half or more Americans seem to have little idea about the dangers of drinking raw milk, according to a recent poll conducted by the University of Pennsylvania researchers. The survey, which included a demographically representative sample of the US adult population, found that less than half (47% percent) of the U.S. adults surveyed understood that drinking raw milk not as safe as drinking pasteurized milk. Conversely, 53% of respondents don’t actually believe that pasteurized milk is safer. And 9% of respondents actually believed raw milk is safer, while 15% said it was just as safe and 30% were unsure. Nearly a quarter (24%) of Americans either do not believe that pasteurization is effective at killing bacteria and viruses in milk products (4%) or are not sure whether this is true (20%), according to the survey of over 1000 US adults, conducted by the Annenberg Public Policy Center (APPC). The survey has a 3-3.5% statistical error rate. Around half of US adults failed to recognize that raw milk can be more dangerous than pasteurized milk products. That, despite the fact that studies report that pasteurized milk limits hospitalizations for related illnesses by an order of 45, according to the APPC report. The French Scientist Louis Pasteur invented the pasteurization process 160 years ago, after recognizing that it killed off otherwise dangerous bacteria present in unheated wine. The process, which soon became a milk industry standard in the United States, successfully inactivates the modern-day avian flu virus, significantly limiting the risk of infection for the general public. Politics and milk In fact, only about 2% of Americans report drinking raw milk at least once a month, according to a Food and Drug Administration (FDA) study based on 2019 data. Paradoxically, however, raw milk sales in the US have increased in recent months, according to some US media reports, despite the recent risks posed by a widening circle of avian influenza among dairy cattle. Debate has been spurred by the increased anti-science bent of some US political leaders. Presidential candidate Robert F. Kennedy Jr., for instance, who also has been a staunch opponent of COVID vaccination, has been quoted saying that he drinks raw milk exclusively. The APPC survey also found that Republicans are more likely than Democrats to believe that drinking raw milk is as safe as pasteurized milk (57% vs. 37%). People living in an urban environment also are more likely to believe that pastuerized milk is safer than raw milk as compared to people in a rural environment (49% vs. 32%). “The difference in views of raw milk that we see between Democrats and Republicans is difficult to disentangle from the difference between rural and urban dwellers,” said Kathleen Hall Jamieson, director of the Annenberg Public Policy Center. “Those in rural areas are both more likely to identify as Republicans and to consume raw milk.” 55 more dairy herds reported infected in last 30 days Some 55 more cattle herds in seven states have been infected with the virus over the past 30 days, according to CDC tracking. Infections in the past 30 days represent 40% of the total of 138 cattle herds infected in 12 states since the outbreak in dairy cattle was first reported on 25 March, the CDC reported. States affected by avian flu spread in dairy cattle The real number of infections of both humans and cattle is very likely underestimated, insofar as farmers have been reluctant to have their staff or herds tested, experts warn. Even so, the CDC maintained that infection risks for the general public remain low. “Based on the information available at this time, this infection does not change CDC’s current H5N1 bird flu human health risk assessment for the U.S. general public, which the agency considers to be low,” the CDC said in a statement. Image Credits: Cotonbro studio, APCC, CDC. Even India’s ‘Cleanest’ Cities Have Significant Excess Air Pollution-Related Deaths from NCDs 04/07/2024 Chetan Bhattacharji The air in relatively ‘clean’ Mumbai is still killing citizens. NEW DELHI – On 2 November 2023, extreme air pollution caught Delhi off-guard. It shut down schools and led to flight cancellations, curbs on construction and other emergency responses. That every little increase in air pollution increases the risk of death has been well-established for some years. But till now the effect of short-term air pollution on mortality has remained largely undocumented in detail in India, where most of the world’s most polluted cities are located. In a new, peer-reviewed study published in the Lancet on Thursday (4 July), researchers found that 7.2% (or approximately 33,000) of all deaths each year across 10 cities could be linked to short-term PM 2.5 exposure higher than the World Health Organization (WHO) guideline of 15 micrograms/cubic metre (µg/m³). PM 2.5 is a highly toxic ultra-fine particulate matter with a diameter of 2.5 microns, which is far thinner than a strand of human hair. This is the first multi-city study in India to assess the link between short-term pollution exposure and death with cities spanning different agri-climatological zones. The bottom line, the authors say, is that the current Indian government standard for PM 2.5 of 60 µg/m³ is “substantially higher” than it should be as a measure of ‘safe’ air quality. In comparison, WHO’s 24-hour standard is 15 µg/m³. NCDs are the leading cause for air pollution-related deaths The Lancet paper doesn’t look at the cause of death as that level of primary data isn’t always available. However, many studies including recent ones in India have shown that air pollution triggers or aggravates non-communicable diseases – specifically NCDs like heart attacks, strokes, lung cancer, and chronic lung disease – which can turn fatal. Of the total air pollution deaths, NCDs account for nearly 90% of the disease burden. The researchers are from 14 organisations including Sustainable Futures Collaborative in Delhi, Institute of Environmental Medicine in Stockholm, Indian Institute of Management Ahmedabad, Public Health Foundation of India, Ashoka University in Sonipat, Mount Sinai in New York, and Boston University. To come to their conclusions, the researchers analysed primary data on mortality between 2008 and 2019 in 10 cities of India. They used an advanced system of machine learning-based analysis which, simply put, used factors that would have a bearing on air pollution-related deaths, namely wind speed, atmospheric pressure and mixing height. This causal modelling approach enabled the researchers to isolate the effect of locally generated pollution as these factors are linked to the dispersal and transport of air pollution. Combined with other data from monitors, satellites and other sources, the study looked at over 3.6 million deaths in the 11-year study period. What the more complex causal modelling shows is that the risk of death is greater than what the earlier basic approach showed. No safe level of air pollution The causal modelling estimated an increase in the risk of death by 3.57% for every rise of just 10 µg/m³ metre over a two day period, as compared to 1.42% by a more basic study. Apart from the usual high-pollution suspects like Delhi and Varanasi, the study looked at places commonly perceived as having clean air, like the Himalayan city of Shimla and the coastal metropolises of Chennai and Mumbai. The authors say this is the first such multi-city study on the links between short-term air pollution exposure and deaths in India. Overall, 7.2% of all daily deaths were attributed to PM 2.5 concentrations higher than the WHO guidelines. Annually there are estimated to be approximately 33,000 deaths in these 10 cities. Over a third are in Delhi, where the average annual PM 2.5 level was 113 micrograms which is more than 22 times the WHO’s safe standard. The share of PM 2.5 linked deaths was also the highest in the Capital, at 11.5% compared to the lowest 3.5% in Shimla. The surprises are Mumbai and Kolkata, with deaths numbering around 5,000 each, annually. “We are seeing a high level of risk and a high number of deaths even in cities that have moderate levels of air pollution exposure. Mumbai, for instance, despite being a coastal city with around a third of the annual PM 2.5 levels of Delhi is still seeing over 5,000 deaths yearly from air pollution,” a lead author of the report, Dr Bhargav Krishna, Fellow at the Sustainable Futures Collaborative, explained to Health Policy Watch. “Similarly Hyderabad, Kolkata, Bengaluru, Chennai, Ahmedabad and Pune, all of which have annual PM2.5 levels below the current Indian standard, are still seeing a high number of deaths each year. This should drive us to focus not just on those cities that have high seasonal exposures, but even those that may be considered relatively ‘clean’ but are in reality polluted at a level that causes significant health impacts.” Mumbai air in March 2023. Mumbai, where remarkably the air pollution has been higher than Delhi on some days, was shown to have almost 5,100 deaths, the second highest after the national capital. That is 5.9% of all deaths in what is India’s financial capital. Here, every increase of 10 micrograms of PM 2.5 was associated with a 2.41% increase in daily deaths. Over 7% of daily deaths attributable to increases in short-term PM 2.5 First such study in Indian cities, say authors City Average Annual Pollution (PM2.5, mg/m³) Attributable Fraction of Deaths (%) Attributable Deaths Per Year Delhi 113 11.5 11,964 Varanasi 82.1 10.2 831 Kolkata 55.2 7.3 4,678 Pune 45.3 5.9 1,367 Mumbai 41.7 5.6 5,091 Hyderabad 38.9 5.6 1,597 Ahmedabad 37.9 5.6 2,495 Chennai 33.7 4.9 2,870 Bangalore 33 4.8 2,102 Shimla 28.4 3.7 59 Total 53.6 7.2 33,627 Source: Lancet Shimla proves that there is no safe level of air pollution, according to the report. It has the lowest air pollution level of the 10 cities, yet that was still a risk as 3.7% of all deaths were attributable to short-term PM 2.5 exposure. Impact on policy action The findings are crucial for immediate policy action and further studies to cover hundreds more towns and rural areas. Immediate action would cover sources of pollution like diesel generators, waste burning, and transport, sources that are commonly seen in many urban neighbourhoods. While much of the headline-grabbing focus is on extreme pollution, these findings show the need to act against all sources of air pollution all year round. Acting only on extremely high days of pollution will only yield marginal benefits regarding daily mortality. In particular, the paper calls out the Graded Response Action Plans, largely used in Delhi and its neighbouring cities. GRAPs are usually cited by local governments as their action to cut pollution but are implemented only in peak pollution season which is from October right through winter. Toxicity of local pollution There are some interesting findings which aren’t widely known. The study confirms that the risk of mortality rose more quickly at lower levels of PM 2.5 but plateaued as levels increased. More studies are needed to understand why exactly this happens. The causal modelling showed that the effects of air pollution on deaths were especially strong in cities with lower levels of pollution such as Bengaluru, Chennai and Shimla. The study fills a data and communication gap in addressing the health crisis caused by toxic air. On one hand, it establishes a link between rising air pollution and deaths, on the other, it makes the risks a lot more relatable because it shows the impact over just two days of exposure than over many months or years. So what can residents in these cities do to protect themselves? Bhargav says individual responses could include wearing a mask, choosing when to step outdoors (pollution tends to be highest during the morning and evening when temperatures dip), and reducing pollution sources inside their home. However, the onus lies on governments and policymakers. “The levels of air pollution we see in India are extremely high and this study clearly shows how day-to-day variations in these levels lead to considerable mortality,” said Dr Petter Ljungman of the Karolinska Institute, and one of the researchers involved in the study. “Interestingly we saw that local pollution sources are likely to be more toxic than more distant sources which has implications for policymakers addressing this highly relevant threat to human health.” Image Credits: Chetan Bhattacharji. Positioning the University of Ghana as a ‘Research-Intensive’ Institution on Neglected Diseases 03/07/2024 Jessica Ahedor Scientists at the West African Centre for Cell Biology and Infectious Pathogens (WACCBIP), University of Ghana, setting up a genome sequencing experiment in the laboratory. Almost 15 years ago, when the University of Ghana established its Office of Research, Innovation, and Development, it did so with the goal of bolstering the West African nation’s research capacity. In the African region, where less than 0.5% of GDP is devoted to research, and a significant number of Africa’s educated is siphoned off to other countries, the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR) has spearheaded the effort to make universities like the University of Ghana research-intensive and competitive. TDR support for research capacity-strengthening activities at the University of Ghana focuses on enabling researchers to tackle infectious diseases of poverty through quality implementation research, the study of bridging basic science research and practice. This could mean examining why many patients on antiretroviral therapy drop out of treatment, or identifying barriers to TB treatment adherence – both the subject of recent publications authored by researchers at the University of Ghana. Capacity-building works Professor Gordon A. Awandare at TDR’s Joint Coordinating Board meeting in Geneva, 12 June 2024 “Capacity-building actually works,” remarked Professor Gordon A Awandare, Pro Vice-Cancellor of Academic Student Affairs at the University of Ghana, at a TDR 50th anniversary event in Geneva, where he gave a detailed review of the collaboration before TDR’s Joint Coordinating Board on June 12. He cited, as one example, his own career trajectory. Awandare began a career in research through a TDR grant that allowed him to complete his masters training, and then got an opportunity to study for a PhD at the University of Pittsburgh while attending a conference on malaria with support from TDR. He returned home to the University of Ghana in 2010, founding the West African Centre for Cell Biology of Infectious Pathogens (WACCBIP) in 2014. Since then, the Centre, supported by the Wellcome Trust and the World Bank, has endowed 400 fellowships and received $53 million in grants, thereby directly reducing the “brain drain” across the African region. A decade-long partnership The University of Ghana leads efforts to train students in implementation research. Newly enrolled master’s students during their lab induction at WACCBIP, University of Ghana. In 2014 the University of Ghana’s School of Public Health signed a partnership agreement with TDR to create a regional training center that leads activities in the African region for strengthening capacity in implementation research to tackle infectious diseases of poverty. The initiative has so far trained more than 25,000 individuals across Africa, including health practitioners, decision-makers and researchers. “Looking at how far we’ve come as a training centre, it is our desire to become a centre of excellence where the annual programmes can be extended to say five years,” said Professor Phyllis Dako-Gyeke, who led the TDR-supported research training programmes at University of Ghana until her passing on 11 June. But the success of an almost decade-long relationship is not without its challenges. Sustainable donor support and aligned interests on research priorities remain key, she said. Real-time research Implementation researchers at UG have tackled issues from TB treatment adherence to antiretroviral therapy. Here, a community health worker conducts an interview in Obuasi, Ghana to identify barriers and facilitators for TB control. Dr Emmanuel Asampong, coordinator of the regional training centre at the University of Ghana, notes that “the impact of implementation research on disease themes in Africa and beyond is impressive because the initiative uses real-time research results in various contexts – such as the neglected tropical diseases programme, the national malaria programme, and the tuberculosis control programme – to provide solutions to challenges.” The global program, which has played a significant role in positioning University of Ghana as a research-intensive university, supports seven regional training centres across six WHO regions. With additional partners in Colombia, Indonesia, Kazakhstan, Malaysia, Senegal and Tunisia, the program develops and updates implementation research courses, provides faculty training and supports career development. The global program, which has played a significant role in positioning University of Ghana as a research institution, also supports NTD research in six WHO regions. The University of Ghana also partners with TDR on a postgraduate training scheme, which provides a full academic scholarship for master’s students. The training is specifically focused on implementation research to tackle infectious diseases of poverty. The list of TDR alumni across the world runs long, and the University of Ghana can claim many public health leaders among them. “My postgraduate training at the University of Ghana, supported by TDR, was an invaluable catalyst in shaping my academic and professional journey,” said Dr Mbele Whiteson, Senior Resident Medical Officer at the Ministry of Health in Zambia. “I have learned to recognize the intricate interplay between health outcomes and social determinants.” This is the third article in a series on TDR’s research capacity strengthening programme – building skills of public health researchers, implementers, health practitioners and policy-makers in the fast-developing field of implementation research for improving uptake of effective health interventions. Sophia Samantaroy contributed to the writing and research of this story. Image Credits: WACCBIP, TDR, African Regional Training Centre (ARTC), University of Ghana/TDR. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
As More US Dairy Herds Infected with Avian Flu, Americans in the Dark on the Risks of Raw Milk 04/07/2024 Zuzanna Stawiska Over one-half of Americans are not sure if pasteurised milk is safer than raw milk. In the time of avian flu epidemics in US cattle, this could even prove dangerous. As the fourth human case of H5N1 avian flu in a US farmworker in Colorado was confirmed Wednesday by the US Centers for Disease Control and Prevention (CDC), so far, only farm workers, and not consumers, have reported avian flu infections. This is likely due, at least in part, to the successful inactivation of the virus during the milk pasteurization process, experts say. And yet one-half or more Americans seem to have little idea about the dangers of drinking raw milk, according to a recent poll conducted by the University of Pennsylvania researchers. The survey, which included a demographically representative sample of the US adult population, found that less than half (47% percent) of the U.S. adults surveyed understood that drinking raw milk not as safe as drinking pasteurized milk. Conversely, 53% of respondents don’t actually believe that pasteurized milk is safer. And 9% of respondents actually believed raw milk is safer, while 15% said it was just as safe and 30% were unsure. Nearly a quarter (24%) of Americans either do not believe that pasteurization is effective at killing bacteria and viruses in milk products (4%) or are not sure whether this is true (20%), according to the survey of over 1000 US adults, conducted by the Annenberg Public Policy Center (APPC). The survey has a 3-3.5% statistical error rate. Around half of US adults failed to recognize that raw milk can be more dangerous than pasteurized milk products. That, despite the fact that studies report that pasteurized milk limits hospitalizations for related illnesses by an order of 45, according to the APPC report. The French Scientist Louis Pasteur invented the pasteurization process 160 years ago, after recognizing that it killed off otherwise dangerous bacteria present in unheated wine. The process, which soon became a milk industry standard in the United States, successfully inactivates the modern-day avian flu virus, significantly limiting the risk of infection for the general public. Politics and milk In fact, only about 2% of Americans report drinking raw milk at least once a month, according to a Food and Drug Administration (FDA) study based on 2019 data. Paradoxically, however, raw milk sales in the US have increased in recent months, according to some US media reports, despite the recent risks posed by a widening circle of avian influenza among dairy cattle. Debate has been spurred by the increased anti-science bent of some US political leaders. Presidential candidate Robert F. Kennedy Jr., for instance, who also has been a staunch opponent of COVID vaccination, has been quoted saying that he drinks raw milk exclusively. The APPC survey also found that Republicans are more likely than Democrats to believe that drinking raw milk is as safe as pasteurized milk (57% vs. 37%). People living in an urban environment also are more likely to believe that pastuerized milk is safer than raw milk as compared to people in a rural environment (49% vs. 32%). “The difference in views of raw milk that we see between Democrats and Republicans is difficult to disentangle from the difference between rural and urban dwellers,” said Kathleen Hall Jamieson, director of the Annenberg Public Policy Center. “Those in rural areas are both more likely to identify as Republicans and to consume raw milk.” 55 more dairy herds reported infected in last 30 days Some 55 more cattle herds in seven states have been infected with the virus over the past 30 days, according to CDC tracking. Infections in the past 30 days represent 40% of the total of 138 cattle herds infected in 12 states since the outbreak in dairy cattle was first reported on 25 March, the CDC reported. States affected by avian flu spread in dairy cattle The real number of infections of both humans and cattle is very likely underestimated, insofar as farmers have been reluctant to have their staff or herds tested, experts warn. Even so, the CDC maintained that infection risks for the general public remain low. “Based on the information available at this time, this infection does not change CDC’s current H5N1 bird flu human health risk assessment for the U.S. general public, which the agency considers to be low,” the CDC said in a statement. Image Credits: Cotonbro studio, APCC, CDC. Even India’s ‘Cleanest’ Cities Have Significant Excess Air Pollution-Related Deaths from NCDs 04/07/2024 Chetan Bhattacharji The air in relatively ‘clean’ Mumbai is still killing citizens. NEW DELHI – On 2 November 2023, extreme air pollution caught Delhi off-guard. It shut down schools and led to flight cancellations, curbs on construction and other emergency responses. That every little increase in air pollution increases the risk of death has been well-established for some years. But till now the effect of short-term air pollution on mortality has remained largely undocumented in detail in India, where most of the world’s most polluted cities are located. In a new, peer-reviewed study published in the Lancet on Thursday (4 July), researchers found that 7.2% (or approximately 33,000) of all deaths each year across 10 cities could be linked to short-term PM 2.5 exposure higher than the World Health Organization (WHO) guideline of 15 micrograms/cubic metre (µg/m³). PM 2.5 is a highly toxic ultra-fine particulate matter with a diameter of 2.5 microns, which is far thinner than a strand of human hair. This is the first multi-city study in India to assess the link between short-term pollution exposure and death with cities spanning different agri-climatological zones. The bottom line, the authors say, is that the current Indian government standard for PM 2.5 of 60 µg/m³ is “substantially higher” than it should be as a measure of ‘safe’ air quality. In comparison, WHO’s 24-hour standard is 15 µg/m³. NCDs are the leading cause for air pollution-related deaths The Lancet paper doesn’t look at the cause of death as that level of primary data isn’t always available. However, many studies including recent ones in India have shown that air pollution triggers or aggravates non-communicable diseases – specifically NCDs like heart attacks, strokes, lung cancer, and chronic lung disease – which can turn fatal. Of the total air pollution deaths, NCDs account for nearly 90% of the disease burden. The researchers are from 14 organisations including Sustainable Futures Collaborative in Delhi, Institute of Environmental Medicine in Stockholm, Indian Institute of Management Ahmedabad, Public Health Foundation of India, Ashoka University in Sonipat, Mount Sinai in New York, and Boston University. To come to their conclusions, the researchers analysed primary data on mortality between 2008 and 2019 in 10 cities of India. They used an advanced system of machine learning-based analysis which, simply put, used factors that would have a bearing on air pollution-related deaths, namely wind speed, atmospheric pressure and mixing height. This causal modelling approach enabled the researchers to isolate the effect of locally generated pollution as these factors are linked to the dispersal and transport of air pollution. Combined with other data from monitors, satellites and other sources, the study looked at over 3.6 million deaths in the 11-year study period. What the more complex causal modelling shows is that the risk of death is greater than what the earlier basic approach showed. No safe level of air pollution The causal modelling estimated an increase in the risk of death by 3.57% for every rise of just 10 µg/m³ metre over a two day period, as compared to 1.42% by a more basic study. Apart from the usual high-pollution suspects like Delhi and Varanasi, the study looked at places commonly perceived as having clean air, like the Himalayan city of Shimla and the coastal metropolises of Chennai and Mumbai. The authors say this is the first such multi-city study on the links between short-term air pollution exposure and deaths in India. Overall, 7.2% of all daily deaths were attributed to PM 2.5 concentrations higher than the WHO guidelines. Annually there are estimated to be approximately 33,000 deaths in these 10 cities. Over a third are in Delhi, where the average annual PM 2.5 level was 113 micrograms which is more than 22 times the WHO’s safe standard. The share of PM 2.5 linked deaths was also the highest in the Capital, at 11.5% compared to the lowest 3.5% in Shimla. The surprises are Mumbai and Kolkata, with deaths numbering around 5,000 each, annually. “We are seeing a high level of risk and a high number of deaths even in cities that have moderate levels of air pollution exposure. Mumbai, for instance, despite being a coastal city with around a third of the annual PM 2.5 levels of Delhi is still seeing over 5,000 deaths yearly from air pollution,” a lead author of the report, Dr Bhargav Krishna, Fellow at the Sustainable Futures Collaborative, explained to Health Policy Watch. “Similarly Hyderabad, Kolkata, Bengaluru, Chennai, Ahmedabad and Pune, all of which have annual PM2.5 levels below the current Indian standard, are still seeing a high number of deaths each year. This should drive us to focus not just on those cities that have high seasonal exposures, but even those that may be considered relatively ‘clean’ but are in reality polluted at a level that causes significant health impacts.” Mumbai air in March 2023. Mumbai, where remarkably the air pollution has been higher than Delhi on some days, was shown to have almost 5,100 deaths, the second highest after the national capital. That is 5.9% of all deaths in what is India’s financial capital. Here, every increase of 10 micrograms of PM 2.5 was associated with a 2.41% increase in daily deaths. Over 7% of daily deaths attributable to increases in short-term PM 2.5 First such study in Indian cities, say authors City Average Annual Pollution (PM2.5, mg/m³) Attributable Fraction of Deaths (%) Attributable Deaths Per Year Delhi 113 11.5 11,964 Varanasi 82.1 10.2 831 Kolkata 55.2 7.3 4,678 Pune 45.3 5.9 1,367 Mumbai 41.7 5.6 5,091 Hyderabad 38.9 5.6 1,597 Ahmedabad 37.9 5.6 2,495 Chennai 33.7 4.9 2,870 Bangalore 33 4.8 2,102 Shimla 28.4 3.7 59 Total 53.6 7.2 33,627 Source: Lancet Shimla proves that there is no safe level of air pollution, according to the report. It has the lowest air pollution level of the 10 cities, yet that was still a risk as 3.7% of all deaths were attributable to short-term PM 2.5 exposure. Impact on policy action The findings are crucial for immediate policy action and further studies to cover hundreds more towns and rural areas. Immediate action would cover sources of pollution like diesel generators, waste burning, and transport, sources that are commonly seen in many urban neighbourhoods. While much of the headline-grabbing focus is on extreme pollution, these findings show the need to act against all sources of air pollution all year round. Acting only on extremely high days of pollution will only yield marginal benefits regarding daily mortality. In particular, the paper calls out the Graded Response Action Plans, largely used in Delhi and its neighbouring cities. GRAPs are usually cited by local governments as their action to cut pollution but are implemented only in peak pollution season which is from October right through winter. Toxicity of local pollution There are some interesting findings which aren’t widely known. The study confirms that the risk of mortality rose more quickly at lower levels of PM 2.5 but plateaued as levels increased. More studies are needed to understand why exactly this happens. The causal modelling showed that the effects of air pollution on deaths were especially strong in cities with lower levels of pollution such as Bengaluru, Chennai and Shimla. The study fills a data and communication gap in addressing the health crisis caused by toxic air. On one hand, it establishes a link between rising air pollution and deaths, on the other, it makes the risks a lot more relatable because it shows the impact over just two days of exposure than over many months or years. So what can residents in these cities do to protect themselves? Bhargav says individual responses could include wearing a mask, choosing when to step outdoors (pollution tends to be highest during the morning and evening when temperatures dip), and reducing pollution sources inside their home. However, the onus lies on governments and policymakers. “The levels of air pollution we see in India are extremely high and this study clearly shows how day-to-day variations in these levels lead to considerable mortality,” said Dr Petter Ljungman of the Karolinska Institute, and one of the researchers involved in the study. “Interestingly we saw that local pollution sources are likely to be more toxic than more distant sources which has implications for policymakers addressing this highly relevant threat to human health.” Image Credits: Chetan Bhattacharji. Positioning the University of Ghana as a ‘Research-Intensive’ Institution on Neglected Diseases 03/07/2024 Jessica Ahedor Scientists at the West African Centre for Cell Biology and Infectious Pathogens (WACCBIP), University of Ghana, setting up a genome sequencing experiment in the laboratory. Almost 15 years ago, when the University of Ghana established its Office of Research, Innovation, and Development, it did so with the goal of bolstering the West African nation’s research capacity. In the African region, where less than 0.5% of GDP is devoted to research, and a significant number of Africa’s educated is siphoned off to other countries, the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR) has spearheaded the effort to make universities like the University of Ghana research-intensive and competitive. TDR support for research capacity-strengthening activities at the University of Ghana focuses on enabling researchers to tackle infectious diseases of poverty through quality implementation research, the study of bridging basic science research and practice. This could mean examining why many patients on antiretroviral therapy drop out of treatment, or identifying barriers to TB treatment adherence – both the subject of recent publications authored by researchers at the University of Ghana. Capacity-building works Professor Gordon A. Awandare at TDR’s Joint Coordinating Board meeting in Geneva, 12 June 2024 “Capacity-building actually works,” remarked Professor Gordon A Awandare, Pro Vice-Cancellor of Academic Student Affairs at the University of Ghana, at a TDR 50th anniversary event in Geneva, where he gave a detailed review of the collaboration before TDR’s Joint Coordinating Board on June 12. He cited, as one example, his own career trajectory. Awandare began a career in research through a TDR grant that allowed him to complete his masters training, and then got an opportunity to study for a PhD at the University of Pittsburgh while attending a conference on malaria with support from TDR. He returned home to the University of Ghana in 2010, founding the West African Centre for Cell Biology of Infectious Pathogens (WACCBIP) in 2014. Since then, the Centre, supported by the Wellcome Trust and the World Bank, has endowed 400 fellowships and received $53 million in grants, thereby directly reducing the “brain drain” across the African region. A decade-long partnership The University of Ghana leads efforts to train students in implementation research. Newly enrolled master’s students during their lab induction at WACCBIP, University of Ghana. In 2014 the University of Ghana’s School of Public Health signed a partnership agreement with TDR to create a regional training center that leads activities in the African region for strengthening capacity in implementation research to tackle infectious diseases of poverty. The initiative has so far trained more than 25,000 individuals across Africa, including health practitioners, decision-makers and researchers. “Looking at how far we’ve come as a training centre, it is our desire to become a centre of excellence where the annual programmes can be extended to say five years,” said Professor Phyllis Dako-Gyeke, who led the TDR-supported research training programmes at University of Ghana until her passing on 11 June. But the success of an almost decade-long relationship is not without its challenges. Sustainable donor support and aligned interests on research priorities remain key, she said. Real-time research Implementation researchers at UG have tackled issues from TB treatment adherence to antiretroviral therapy. Here, a community health worker conducts an interview in Obuasi, Ghana to identify barriers and facilitators for TB control. Dr Emmanuel Asampong, coordinator of the regional training centre at the University of Ghana, notes that “the impact of implementation research on disease themes in Africa and beyond is impressive because the initiative uses real-time research results in various contexts – such as the neglected tropical diseases programme, the national malaria programme, and the tuberculosis control programme – to provide solutions to challenges.” The global program, which has played a significant role in positioning University of Ghana as a research-intensive university, supports seven regional training centres across six WHO regions. With additional partners in Colombia, Indonesia, Kazakhstan, Malaysia, Senegal and Tunisia, the program develops and updates implementation research courses, provides faculty training and supports career development. The global program, which has played a significant role in positioning University of Ghana as a research institution, also supports NTD research in six WHO regions. The University of Ghana also partners with TDR on a postgraduate training scheme, which provides a full academic scholarship for master’s students. The training is specifically focused on implementation research to tackle infectious diseases of poverty. The list of TDR alumni across the world runs long, and the University of Ghana can claim many public health leaders among them. “My postgraduate training at the University of Ghana, supported by TDR, was an invaluable catalyst in shaping my academic and professional journey,” said Dr Mbele Whiteson, Senior Resident Medical Officer at the Ministry of Health in Zambia. “I have learned to recognize the intricate interplay between health outcomes and social determinants.” This is the third article in a series on TDR’s research capacity strengthening programme – building skills of public health researchers, implementers, health practitioners and policy-makers in the fast-developing field of implementation research for improving uptake of effective health interventions. Sophia Samantaroy contributed to the writing and research of this story. Image Credits: WACCBIP, TDR, African Regional Training Centre (ARTC), University of Ghana/TDR. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
Even India’s ‘Cleanest’ Cities Have Significant Excess Air Pollution-Related Deaths from NCDs 04/07/2024 Chetan Bhattacharji The air in relatively ‘clean’ Mumbai is still killing citizens. NEW DELHI – On 2 November 2023, extreme air pollution caught Delhi off-guard. It shut down schools and led to flight cancellations, curbs on construction and other emergency responses. That every little increase in air pollution increases the risk of death has been well-established for some years. But till now the effect of short-term air pollution on mortality has remained largely undocumented in detail in India, where most of the world’s most polluted cities are located. In a new, peer-reviewed study published in the Lancet on Thursday (4 July), researchers found that 7.2% (or approximately 33,000) of all deaths each year across 10 cities could be linked to short-term PM 2.5 exposure higher than the World Health Organization (WHO) guideline of 15 micrograms/cubic metre (µg/m³). PM 2.5 is a highly toxic ultra-fine particulate matter with a diameter of 2.5 microns, which is far thinner than a strand of human hair. This is the first multi-city study in India to assess the link between short-term pollution exposure and death with cities spanning different agri-climatological zones. The bottom line, the authors say, is that the current Indian government standard for PM 2.5 of 60 µg/m³ is “substantially higher” than it should be as a measure of ‘safe’ air quality. In comparison, WHO’s 24-hour standard is 15 µg/m³. NCDs are the leading cause for air pollution-related deaths The Lancet paper doesn’t look at the cause of death as that level of primary data isn’t always available. However, many studies including recent ones in India have shown that air pollution triggers or aggravates non-communicable diseases – specifically NCDs like heart attacks, strokes, lung cancer, and chronic lung disease – which can turn fatal. Of the total air pollution deaths, NCDs account for nearly 90% of the disease burden. The researchers are from 14 organisations including Sustainable Futures Collaborative in Delhi, Institute of Environmental Medicine in Stockholm, Indian Institute of Management Ahmedabad, Public Health Foundation of India, Ashoka University in Sonipat, Mount Sinai in New York, and Boston University. To come to their conclusions, the researchers analysed primary data on mortality between 2008 and 2019 in 10 cities of India. They used an advanced system of machine learning-based analysis which, simply put, used factors that would have a bearing on air pollution-related deaths, namely wind speed, atmospheric pressure and mixing height. This causal modelling approach enabled the researchers to isolate the effect of locally generated pollution as these factors are linked to the dispersal and transport of air pollution. Combined with other data from monitors, satellites and other sources, the study looked at over 3.6 million deaths in the 11-year study period. What the more complex causal modelling shows is that the risk of death is greater than what the earlier basic approach showed. No safe level of air pollution The causal modelling estimated an increase in the risk of death by 3.57% for every rise of just 10 µg/m³ metre over a two day period, as compared to 1.42% by a more basic study. Apart from the usual high-pollution suspects like Delhi and Varanasi, the study looked at places commonly perceived as having clean air, like the Himalayan city of Shimla and the coastal metropolises of Chennai and Mumbai. The authors say this is the first such multi-city study on the links between short-term air pollution exposure and deaths in India. Overall, 7.2% of all daily deaths were attributed to PM 2.5 concentrations higher than the WHO guidelines. Annually there are estimated to be approximately 33,000 deaths in these 10 cities. Over a third are in Delhi, where the average annual PM 2.5 level was 113 micrograms which is more than 22 times the WHO’s safe standard. The share of PM 2.5 linked deaths was also the highest in the Capital, at 11.5% compared to the lowest 3.5% in Shimla. The surprises are Mumbai and Kolkata, with deaths numbering around 5,000 each, annually. “We are seeing a high level of risk and a high number of deaths even in cities that have moderate levels of air pollution exposure. Mumbai, for instance, despite being a coastal city with around a third of the annual PM 2.5 levels of Delhi is still seeing over 5,000 deaths yearly from air pollution,” a lead author of the report, Dr Bhargav Krishna, Fellow at the Sustainable Futures Collaborative, explained to Health Policy Watch. “Similarly Hyderabad, Kolkata, Bengaluru, Chennai, Ahmedabad and Pune, all of which have annual PM2.5 levels below the current Indian standard, are still seeing a high number of deaths each year. This should drive us to focus not just on those cities that have high seasonal exposures, but even those that may be considered relatively ‘clean’ but are in reality polluted at a level that causes significant health impacts.” Mumbai air in March 2023. Mumbai, where remarkably the air pollution has been higher than Delhi on some days, was shown to have almost 5,100 deaths, the second highest after the national capital. That is 5.9% of all deaths in what is India’s financial capital. Here, every increase of 10 micrograms of PM 2.5 was associated with a 2.41% increase in daily deaths. Over 7% of daily deaths attributable to increases in short-term PM 2.5 First such study in Indian cities, say authors City Average Annual Pollution (PM2.5, mg/m³) Attributable Fraction of Deaths (%) Attributable Deaths Per Year Delhi 113 11.5 11,964 Varanasi 82.1 10.2 831 Kolkata 55.2 7.3 4,678 Pune 45.3 5.9 1,367 Mumbai 41.7 5.6 5,091 Hyderabad 38.9 5.6 1,597 Ahmedabad 37.9 5.6 2,495 Chennai 33.7 4.9 2,870 Bangalore 33 4.8 2,102 Shimla 28.4 3.7 59 Total 53.6 7.2 33,627 Source: Lancet Shimla proves that there is no safe level of air pollution, according to the report. It has the lowest air pollution level of the 10 cities, yet that was still a risk as 3.7% of all deaths were attributable to short-term PM 2.5 exposure. Impact on policy action The findings are crucial for immediate policy action and further studies to cover hundreds more towns and rural areas. Immediate action would cover sources of pollution like diesel generators, waste burning, and transport, sources that are commonly seen in many urban neighbourhoods. While much of the headline-grabbing focus is on extreme pollution, these findings show the need to act against all sources of air pollution all year round. Acting only on extremely high days of pollution will only yield marginal benefits regarding daily mortality. In particular, the paper calls out the Graded Response Action Plans, largely used in Delhi and its neighbouring cities. GRAPs are usually cited by local governments as their action to cut pollution but are implemented only in peak pollution season which is from October right through winter. Toxicity of local pollution There are some interesting findings which aren’t widely known. The study confirms that the risk of mortality rose more quickly at lower levels of PM 2.5 but plateaued as levels increased. More studies are needed to understand why exactly this happens. The causal modelling showed that the effects of air pollution on deaths were especially strong in cities with lower levels of pollution such as Bengaluru, Chennai and Shimla. The study fills a data and communication gap in addressing the health crisis caused by toxic air. On one hand, it establishes a link between rising air pollution and deaths, on the other, it makes the risks a lot more relatable because it shows the impact over just two days of exposure than over many months or years. So what can residents in these cities do to protect themselves? Bhargav says individual responses could include wearing a mask, choosing when to step outdoors (pollution tends to be highest during the morning and evening when temperatures dip), and reducing pollution sources inside their home. However, the onus lies on governments and policymakers. “The levels of air pollution we see in India are extremely high and this study clearly shows how day-to-day variations in these levels lead to considerable mortality,” said Dr Petter Ljungman of the Karolinska Institute, and one of the researchers involved in the study. “Interestingly we saw that local pollution sources are likely to be more toxic than more distant sources which has implications for policymakers addressing this highly relevant threat to human health.” Image Credits: Chetan Bhattacharji. Positioning the University of Ghana as a ‘Research-Intensive’ Institution on Neglected Diseases 03/07/2024 Jessica Ahedor Scientists at the West African Centre for Cell Biology and Infectious Pathogens (WACCBIP), University of Ghana, setting up a genome sequencing experiment in the laboratory. Almost 15 years ago, when the University of Ghana established its Office of Research, Innovation, and Development, it did so with the goal of bolstering the West African nation’s research capacity. In the African region, where less than 0.5% of GDP is devoted to research, and a significant number of Africa’s educated is siphoned off to other countries, the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR) has spearheaded the effort to make universities like the University of Ghana research-intensive and competitive. TDR support for research capacity-strengthening activities at the University of Ghana focuses on enabling researchers to tackle infectious diseases of poverty through quality implementation research, the study of bridging basic science research and practice. This could mean examining why many patients on antiretroviral therapy drop out of treatment, or identifying barriers to TB treatment adherence – both the subject of recent publications authored by researchers at the University of Ghana. Capacity-building works Professor Gordon A. Awandare at TDR’s Joint Coordinating Board meeting in Geneva, 12 June 2024 “Capacity-building actually works,” remarked Professor Gordon A Awandare, Pro Vice-Cancellor of Academic Student Affairs at the University of Ghana, at a TDR 50th anniversary event in Geneva, where he gave a detailed review of the collaboration before TDR’s Joint Coordinating Board on June 12. He cited, as one example, his own career trajectory. Awandare began a career in research through a TDR grant that allowed him to complete his masters training, and then got an opportunity to study for a PhD at the University of Pittsburgh while attending a conference on malaria with support from TDR. He returned home to the University of Ghana in 2010, founding the West African Centre for Cell Biology of Infectious Pathogens (WACCBIP) in 2014. Since then, the Centre, supported by the Wellcome Trust and the World Bank, has endowed 400 fellowships and received $53 million in grants, thereby directly reducing the “brain drain” across the African region. A decade-long partnership The University of Ghana leads efforts to train students in implementation research. Newly enrolled master’s students during their lab induction at WACCBIP, University of Ghana. In 2014 the University of Ghana’s School of Public Health signed a partnership agreement with TDR to create a regional training center that leads activities in the African region for strengthening capacity in implementation research to tackle infectious diseases of poverty. The initiative has so far trained more than 25,000 individuals across Africa, including health practitioners, decision-makers and researchers. “Looking at how far we’ve come as a training centre, it is our desire to become a centre of excellence where the annual programmes can be extended to say five years,” said Professor Phyllis Dako-Gyeke, who led the TDR-supported research training programmes at University of Ghana until her passing on 11 June. But the success of an almost decade-long relationship is not without its challenges. Sustainable donor support and aligned interests on research priorities remain key, she said. Real-time research Implementation researchers at UG have tackled issues from TB treatment adherence to antiretroviral therapy. Here, a community health worker conducts an interview in Obuasi, Ghana to identify barriers and facilitators for TB control. Dr Emmanuel Asampong, coordinator of the regional training centre at the University of Ghana, notes that “the impact of implementation research on disease themes in Africa and beyond is impressive because the initiative uses real-time research results in various contexts – such as the neglected tropical diseases programme, the national malaria programme, and the tuberculosis control programme – to provide solutions to challenges.” The global program, which has played a significant role in positioning University of Ghana as a research-intensive university, supports seven regional training centres across six WHO regions. With additional partners in Colombia, Indonesia, Kazakhstan, Malaysia, Senegal and Tunisia, the program develops and updates implementation research courses, provides faculty training and supports career development. The global program, which has played a significant role in positioning University of Ghana as a research institution, also supports NTD research in six WHO regions. The University of Ghana also partners with TDR on a postgraduate training scheme, which provides a full academic scholarship for master’s students. The training is specifically focused on implementation research to tackle infectious diseases of poverty. The list of TDR alumni across the world runs long, and the University of Ghana can claim many public health leaders among them. “My postgraduate training at the University of Ghana, supported by TDR, was an invaluable catalyst in shaping my academic and professional journey,” said Dr Mbele Whiteson, Senior Resident Medical Officer at the Ministry of Health in Zambia. “I have learned to recognize the intricate interplay between health outcomes and social determinants.” This is the third article in a series on TDR’s research capacity strengthening programme – building skills of public health researchers, implementers, health practitioners and policy-makers in the fast-developing field of implementation research for improving uptake of effective health interventions. Sophia Samantaroy contributed to the writing and research of this story. Image Credits: WACCBIP, TDR, African Regional Training Centre (ARTC), University of Ghana/TDR. 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Positioning the University of Ghana as a ‘Research-Intensive’ Institution on Neglected Diseases 03/07/2024 Jessica Ahedor Scientists at the West African Centre for Cell Biology and Infectious Pathogens (WACCBIP), University of Ghana, setting up a genome sequencing experiment in the laboratory. Almost 15 years ago, when the University of Ghana established its Office of Research, Innovation, and Development, it did so with the goal of bolstering the West African nation’s research capacity. In the African region, where less than 0.5% of GDP is devoted to research, and a significant number of Africa’s educated is siphoned off to other countries, the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR) has spearheaded the effort to make universities like the University of Ghana research-intensive and competitive. TDR support for research capacity-strengthening activities at the University of Ghana focuses on enabling researchers to tackle infectious diseases of poverty through quality implementation research, the study of bridging basic science research and practice. This could mean examining why many patients on antiretroviral therapy drop out of treatment, or identifying barriers to TB treatment adherence – both the subject of recent publications authored by researchers at the University of Ghana. Capacity-building works Professor Gordon A. Awandare at TDR’s Joint Coordinating Board meeting in Geneva, 12 June 2024 “Capacity-building actually works,” remarked Professor Gordon A Awandare, Pro Vice-Cancellor of Academic Student Affairs at the University of Ghana, at a TDR 50th anniversary event in Geneva, where he gave a detailed review of the collaboration before TDR’s Joint Coordinating Board on June 12. He cited, as one example, his own career trajectory. Awandare began a career in research through a TDR grant that allowed him to complete his masters training, and then got an opportunity to study for a PhD at the University of Pittsburgh while attending a conference on malaria with support from TDR. He returned home to the University of Ghana in 2010, founding the West African Centre for Cell Biology of Infectious Pathogens (WACCBIP) in 2014. Since then, the Centre, supported by the Wellcome Trust and the World Bank, has endowed 400 fellowships and received $53 million in grants, thereby directly reducing the “brain drain” across the African region. A decade-long partnership The University of Ghana leads efforts to train students in implementation research. Newly enrolled master’s students during their lab induction at WACCBIP, University of Ghana. In 2014 the University of Ghana’s School of Public Health signed a partnership agreement with TDR to create a regional training center that leads activities in the African region for strengthening capacity in implementation research to tackle infectious diseases of poverty. The initiative has so far trained more than 25,000 individuals across Africa, including health practitioners, decision-makers and researchers. “Looking at how far we’ve come as a training centre, it is our desire to become a centre of excellence where the annual programmes can be extended to say five years,” said Professor Phyllis Dako-Gyeke, who led the TDR-supported research training programmes at University of Ghana until her passing on 11 June. But the success of an almost decade-long relationship is not without its challenges. Sustainable donor support and aligned interests on research priorities remain key, she said. Real-time research Implementation researchers at UG have tackled issues from TB treatment adherence to antiretroviral therapy. Here, a community health worker conducts an interview in Obuasi, Ghana to identify barriers and facilitators for TB control. Dr Emmanuel Asampong, coordinator of the regional training centre at the University of Ghana, notes that “the impact of implementation research on disease themes in Africa and beyond is impressive because the initiative uses real-time research results in various contexts – such as the neglected tropical diseases programme, the national malaria programme, and the tuberculosis control programme – to provide solutions to challenges.” The global program, which has played a significant role in positioning University of Ghana as a research-intensive university, supports seven regional training centres across six WHO regions. With additional partners in Colombia, Indonesia, Kazakhstan, Malaysia, Senegal and Tunisia, the program develops and updates implementation research courses, provides faculty training and supports career development. The global program, which has played a significant role in positioning University of Ghana as a research institution, also supports NTD research in six WHO regions. The University of Ghana also partners with TDR on a postgraduate training scheme, which provides a full academic scholarship for master’s students. The training is specifically focused on implementation research to tackle infectious diseases of poverty. The list of TDR alumni across the world runs long, and the University of Ghana can claim many public health leaders among them. “My postgraduate training at the University of Ghana, supported by TDR, was an invaluable catalyst in shaping my academic and professional journey,” said Dr Mbele Whiteson, Senior Resident Medical Officer at the Ministry of Health in Zambia. “I have learned to recognize the intricate interplay between health outcomes and social determinants.” This is the third article in a series on TDR’s research capacity strengthening programme – building skills of public health researchers, implementers, health practitioners and policy-makers in the fast-developing field of implementation research for improving uptake of effective health interventions. Sophia Samantaroy contributed to the writing and research of this story. Image Credits: WACCBIP, TDR, African Regional Training Centre (ARTC), University of Ghana/TDR. Posts navigation Older postsNewer posts