RANA executive director Aggrey Aluso and Pandemic Action Network executive director Eloise Todd.

LUSAKA, Zambia — A new African civil society network to address pandemics and climate crises was introduced publicly on Wednesday on the sidelines of the Conference on Public Health in Africa (CPHIA). The Resilience Action Network Africa (RANA) has been established by over 30 African organizations that are part of the global Pandemic Action Network (PAN), which was formed during COVID-19.

“This journey started a long time ago,” RANA executive director Aggrey Aluso told Health Policy Watch. “The voices of the global South and the concerns of low- and middle-income countries, particularly in Africa, do not inform global policies. But ‘the people who wear the shoe know where it pinches most.’”

The resilience agenda has come to characterise Africa’s challenges, including surging climate change challenges, disease outbreaks, gender inequality, food insecurity, and financial instability, Aluso explained.

“If we continue to address these challenges in isolated silos, we will not be strong enough,” Aluso said.

At the heart of RANA’s strategy to dismantle these silos is a collaboration with the Pandemic Action Network (PAN). Leveraging PAN’s proven track record in networked advocacy for pandemic prevention, preparedness, and response, the partnership will adopt a “whole-of-society” approach to bridging policy gaps at the national and regional levels in Africa, while empowering local institutions and agencies to bolster health systems.

RANA’s partnership with PAN seeks to establish connections between pandemic issues and advocates and networks across the resilience agenda, encompassing gender, climate, finance, food systems, health, and nature. RANA’s affiliates are primarily engaged in pandemic and climate threats, gender and debt.

RANA is more than 30 civil society partners (CSO) strong, and growing — including those representing the gender, climate, finance, food systems, health, and nature agendas.

“The idea is that PAN and RANA will work really closely in the pandemic prevention, preparedness and response, and climate and health crisis space,” PAN executive director Eloise Todd told Health Policy Watch. “We will basically work in lock-step to ensure that community voices and African countries are presented in global processes.” 

“If you think about the INB [Intergovernmental Negotiating Body] negotiating the pandemic treaty, for example, we want to make sure that we insert the voices of the low and middle-income countries,” said Todd. “We want to do that more deliberately and invest more to have this separate, independent entity and really walk the walk and take our lead from an independent, partnered organisation.”

One of RANA’s first campaigns is to advocate for African leaders to commit to an agenda for pandemic action. This includes calling on African countries to allocate long-term domestic financing to “close critical pandemic prevention, preparedness, and response funding gaps in Africa”; to expand the local production of health products including diagnostics, medicines and vaccines; and to make African health systems gender-responsive, and pandemic and climate-resilient.

These demands are part of the Africa Centres for Disease Control and Prevention’s (Africa CDC) Africa’s New Public Health Order, a long-term vision for a more resilient, inclusive, and equitable African public health system.

“Humanity is facing two major existential threats: climate change and pandemics. These global threats are highly interconnected, and their risk to lives, livelihoods, human progress, and human rights is growing,” said Todd. “We must shift our policy thinking and our investments to strengthen the resilience of our countries, our communities, and our people.”

Aluso, who will continue to serve as PAN’s Africa Director and Global Policy Lead, said that the multiple crises “require bold thinking, bold collaboration, and bold action”.

“Our vision is a resilient and healthy Africa, safeguarded by African-led solutions, informed by African needs, and driven by African leadership,” he said.

24th International AIDS Conference, Montreal, Canada.

As donors withdraw from HIV, the Joint United Nations Programme on HIV/AIDS (UNAIDS) has chosen to focus on the importance of community-led interventions to end the AIDS pandemic for World AIDS Day on 1 December.

“There has been an unprecedented backsliding in financial commitments to community-led organisations, and it is costing lives,” according to UNAIDS Executive Director Winnie Byanyima, writing in her organisation’s annual World AIDS Day Report released on Tuesday.

“Crackdowns on civil society and on the human rights of people from marginalised communities are obstructing the progress of HIV prevention and treatment services, putting the fight against AIDS at risk,” she added.

“Harmful laws and policies towards people from populations at risk of HIV threaten the lives of community activists trying to reach them with HIV services. Too often, decision-makers treat communities as problems to be managed, rather than as leaders to be recognised and supported.”

The report is “an urgent call to action for governments and international partners to enable and support communities in their leadership roles”, according to UNAIDS.

People living with and affected by HIV have been particularly influential in the HIV response, according to the report.

“They are the trusted voices. Communities understand what is most needed, what works, and what needs to change.”

A United Nations high-level meeting on AIDS in 2021 adopted a political declaration that contains various commitments to recognise community initiatives. These include that, by 2025, community-led organisations should deliver 30% of testing and treatment services, 80% of HIV prevention services for people from populations at high risk of infection, and 60% of programmes to support societal changes that enable an effective and sustainable HIV response. 

In addition, they agreed on the 10–10–10 targets to remove punitive laws against LGBTQI people, people who use drugs, sex workers and people from other often criminalised populations, and to reduce stigma and discrimination, gender inequality and violence experienced by people living with HIV and people from key populations and priority populations

The report includes nine guest essays by community leaders that show how they have been able to drive change, how they experience obstacles in their way, and the actions they are urging governments and international partners to take to enable communities to lead us to the end of AIDS by 2030.

Image Credits: Marcus Rose/ IAS.

COP28, the 28th Conference of the Parties to the United Nations Framework Convention on Climate Change (UNFCCC), will take place from November 30 to December 12, 2023, at the Expo City complex in Dubai, United Arab Emirates.

Negotiators at the upcoming UN Climate Change Conference (COP28) must accelerate the end of fossil fuels, eliminate trillions in fossil fuel subsidies, and swiftly transition to clean, renewable energy to reap the health benefits of climate action, senior World Health Organization (WHO) officials urged at a press briefing on Tuesday.

Despite the absence of explicit mention of fossil fuels in the draft “Health Declaration” to be signed by UN member states at the climate conference, which begins on Thursday, negotiators working on the outcome document must recognise that “we need to halt emissions and accelerate the transition to clean, renewable energy for the sake of health,” stated Dr. Maria Neira, director of WHO’s Department of Climate, Environment, and Health.

“The more we postpone action on reducing emissions and accelerating this transition to clean, renewable sources of energy, the more we rely on fossil fuels, the more our health will be paying the price that is very high,” Neira said. 

‘Healthwashing’ or real progress? 

While this year’s COP is poised to host the first-ever ministerial level “Health Day”, with a strong commitment from the COP Presidency and UAE hosts to highlight the issue, civil society groups have expressed concerns that these moves could amount to a “greenwash” of a conference hosted by a petrostate, where oil and gas lobbyists will have a prominent presence.

Meanwhile, other sources have informed Health Policy Watch that the decision to set aside ‘fossil fuels’ language in the health declaration was made deliberately to ensure that the issue is thoroughly addressed in the core negotiations by member states rather than being relegated to a single thematic area, regardless of health’s importance.

Exclusive: COP28 Climate and Health Draft Declaration Ignores Fossil Fuels as Driver of Health Harms 

Addressing the briefing, WHO officials were adamant that they are carrying an unequivocal message on the issue to COP negotiators. 

“What we are telling the negotiators is the more you postpone action, the more you are taking responsibility for not addressing the health consequences,” said Neira.

Dr Diarmid Campbell-Lendrum, who leads the climate change and health unit at WHO, added that achieving the 2015 Paris Agreement’s climate goals sooner rather than later would also save approximately 1 million lives annually by reducing air pollution-related mortality. Conversely, delaying action will result in more avoidable deaths from warming and an increase in air pollution-related deaths.

“We believe that the health argument supports the case for rapid action because there is a significant difference between waiting until 2029 to attempt a rapid reduction in admissions and waiting until 2049 to do the same,” Campbell-Lendrum explained.

“For one thing, you’ve left a lot of carbon in the atmosphere by not starting earlier, accumulating much more carbon in the process. Additionally, you’ve missed the opportunity to save a lot of lives if you leave it until the last minute to intervene. The economics of this are clear,” he stated.

Dr Diarmid Campbell-Lendrum, head of the WHO’s Climate and Health team

“The health argument is also clear on this – the sooner we act, and the more ambitiously we act, the more affordable it is to address the climate crisis but also to save more lives,” Campbell-Lendrum said.

Campbell-Lendrum acknowledged that the financial cost of climate policies is often raised as the main counterargument to action. “it costs money,” he said.

However, he countered that this argument is not valid given the trillions currently allocated to fossil fuel subsidies. Taxpayers worldwide shouldered an additional cost of approximately $600 per household last year to subsidize fossil fuel consumption, Campbell-Lendrum said.

When factoring in the health detriments caused by fossil fuel consumption, the IMF estimates that the true subsidy is closer to $3,500 per household globally.

“The money is there. We’re just not spending it in the right place,” he said. “Part of the message we’re taking to COP is we need to invest in a healthier, greener future for everybody.”

What to expect at COP28

Along with a full-fledged Health Day on December 3, attended by some 65 ministers of health, dozens of health-related events are planned to unfold throughout the two weeks of the climate conference.

At the WHO’s COP28 Pavilion, some 40 thematic events are planned on topics such as climate change and health, while other health-related climate events will be staged in the pavilions of the Climate and Clean Air Coalition, the SDGs, the World Bank, and even the pavilion of the Cryosphere.

An innovative model health clinic powered by renewable energy will also be on display at the COP, showcasing the potential for health facilities to operate sustainably and contribute to climate change mitigation.

“We will be demonstrating that even healthcare facilities that are currently not contributing to a carbon footprint can access clean energy without exacerbating climate change,” said Dr Maria Neira, Director of WHO’s Department of Climate, Environment, and Health.

Approximately one billion people worldwide are served by health facilities that lack access to adequate and reliable electricity for essential health services, including emergency care, disease control, and childbirth according to a WHO report published earlier this year.. Over 430 million people are served by primary care facilities that have no electricity at all.

On the other end of the spectrum, healthcare services in middle- and high-income countries are among the largest energy consumers of any economic sector, accounting for about 5% of global carbon emissions.

WHO’s alliance on transformative action on climate and health (ATACH)

Dr Maria Neira, WHO Director of Climate, Environment and Health, lays out plans for health events at COP28.

WHO also has established a new platform, called the Alliance on Transformative Action on Climate and Health (ATACH). Through ATACH, member states can make voluntary declarations on plans to make health facilities more climate-resilient and sustainable, and they can also access technical support, quality assurance, and financing for decarbonizing health systems.

To date, 78 countries have joined the Alliance, with 71 committing to become “sustainable, low-carbon” health systems and 29 pledging to reach net zero in the health sector by 2030, 2040, or 2050.

“We, as the health sector, can reduce our own carbon footprint by decarbonizing our interventions that at the moment contribute to 5% of the global emissions,” Neira said.

Image Credits: Dennis Sylvester Hurd.

CPHIA co-chair Professor Margaret Gyapong, Africa CDC Director General Dr Jean Kaseya and Zambian Health Minister Sylvia Maseko address the media shortly before the conference opening.

LUSAKA, Zambia – Ensuring that Africa can manufacture its own vaccines will represent “the second independence of Africa”, Dr Jean Kaseya, Director General of the Africa Centre for Disease Control and Prevention (Africa CDC), said at the start of the Conference for Public Health in Africa 2023 (CPHIA) on Monday.

“Many African countries got their independence [from colonisers] in the 1960s, but we saw in COVID that we are not independent,” Kaseya told a media briefing shortly before CPHIA’s opening. “Other continents locked their doors and we were left beyond.” 

With over 5,000 in-person delegates and an additional 20,000 virtual participants in attendance, Kaseya described CPHIA23 as the largest global public health event outside the annual World Health Assembly.

Stung by Africa’s inability to access COVID-19 vaccines during the pandemic’s peak as wealthy countries hoarded supplies, African heads of state have committed the continent to manufacture 60% of the vaccines it needs by 2040. 

This is a mammoth task considering Africa currently produces only 1% of its vaccines. Although many believe this impossible to achieve, Kaseya said he would not be in his current position if he did not believe it was possible.

The Partnerships for African Vaccine Manufacturing (PAVM) is driving this ambition, which recently received a huge shot in the arm from the global vaccines platform, Gavi, according to Kaseya.

Gavi’s policy committee has approved a $1 billion investment in a partnership with the Africa CDC to support the development of African vaccine manufacturers. This decision will be discussed by the body’s board in December, Kaseya added.

The Mastercard Foundation is also playing a major role in supporting Africa CDC and African countries to build their capacity to vaccinate their populations.

The Mastercard-sponsored ‘Saving Lives and Livelihoods initiative’ is focused on vaccinating high-risk populations, integrating the COVID-19 response into routine immunisation and preparing for potential future pandemics.

Full house at the opening of CPHIA2023

One more step to ‘decolonise’ research

However, Dr John-Arne Røttingen, Norway’s Ambassador for Global Health and Wellcome Trust CEO designate, said that improving manufacturing “isn’t enough” as Africa needs to build an entire “biomedical system”.

Addressing the opening plenary, Røttingen said that global health had come a long way since the era of colonial researchers but that this process of “decolonisation” needed one more step – “African health research systems led by Africans”.

“It is not just about the undoing but the doing,” urged Røttingen.

Also addressing the plenary, World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyusus said that he was elected as the first African head of the global body because the continent stood together to support one nomination.

Subsequently, this unity had enabled Africans to be elected to head the World Trade Organization, UNAIDS, the International Labour Organisation and other UN bodies, he added.

“It is very important for Africa to continue to be united,” Tedros urged.

Meanwhile, Kaseya said that the Africa CDC had built “health diplomacy” between African countries.

“Even if you are fighting politically, even if you are fighting military a disease outbreak will cross the border without your permission. This is why Africa CDC has a global diplomacy department to facilitate dialogue between countries between communities and to ensure that all of them have access to support to commodities when they need them.”

African-led health initiatives

Zambia’s Minister of Health, Sylvia Maseko, said that the purpose of the conference is “to reposition Africa in the global health architecture”.

“Some of the key achievements that we have made so far include approval and launch of the Africa CDC strategic plan 2023 to 2027, which outlines a clear roadmap to address the continent’s health challenges, strengthen public health systems, and ensure a coordinated response to emerging threats,” said Maseko.

“Secondly, we have done the formation and inauguration of the new Africa CDC advisory and technical Council and we have inaugurated the new governing board of the Africa CDC, which saw me as the new chairperson,” said Maseko. 

Meanwhile, CPHIA co-chair Professor Margaret Gyapong said that the continent had made major scientific advances in the last few years, including in digital disease surveillance, and building public-private partnerships.

“African scientists and researchers are leading the charge in developing groundbreaking vaccines tailored to address regional disease burdens, including malaria, tuberculosis and HIV and AIDS,” said Gyapong, who directs the Institute of Health Research at the University of Health and Allied Sciences in Ghana.

“Groundbreaking initiatives such as the RTS,S malaria vaccine demonstrates the significant contribution of African scientists and researchers in collaboration with national centres and organising for address regional disease burdens.”

Gavi’s interim CEO, David Marlow, said that the vaccine platform had set up the African Vaccine Manufacturing Accelerator to assist with the development of manufacturing capacity on the continent “and it would be ideal if malaria was a priority antigen”.

Professor Margaret Gyapong, Africa CDC Director General Dr Jean Kaseya and Zambian Health Minister Sylvia Maseko

Massive debt repayment challenges

Despite the upbeat tone of the speakers, some of the challenges facing the continent were also acknowledged. Only 28% of health facilities have electricity, for example, 70% of maternal deaths happen in Africa and the continent has a significant shortage of skilled healthcare workers.

In addition, COVID-19 has decimated the already weak economies of many of the 55 African member states and many simply don’t have money to invest in their health systems. 

In 2021, CPHIA host country Zambia was the first to default on its debt repayments as a result of COVID, although last month announced that it has restructured $3 billion of its international bonds with creditors. Mali briefly defaulted by has resumed payments, but Ghana has also stopped servicing its debt. 

Chad, Ethiopia, and Malawi have opted to restructure their debt. However, in the process of doing so, Malawi devalued its currency by 44% earlier this month and this is likely to drive citizens in one of the world’s poorest countries further into poverty.

Climate change is also a major threat to the continent, with the African Development Bank estimating that it is losing between 5-15% of its GDP due to climate change.

“Do you know that we have 18 countries today affected by cholera, and that is the effect of climate change with 4,000 deaths? Do you know that dengue in West Africa is also the effect of climate change?” Kaseya asked the media briefing.

“You saw the flooding in Libya. Climate change is affecting us. And this is why Africa CDC decided to implement a One Health approach to address the issue of climate change, animal health and human health.”

Mpox lesions – new reports of clade I mpox transmission in DR Congo raise alarm bells

There has been a two-fold increase in the number of suspected mpox cases reported in the Democratic Republic of Congo so far this year as compared to 2020, which marked the year for the most reports of the virus, WHO has said.

Just as worrisome,  DRC has been the first country globally to see confirmed reports of sexual transmission of Clade 1 of the virus, which is known to be the most deadly with fatality rates as high as 10%. And the circle of mpox transmission more generally has expanded significantly, to include cases as far west as the capital Kinshasa and south Kivu in the eastern part of the country.

From 1 January to 12 DRC reported 12 569 suspected mpox cases, as compared to 6216 in 2020, the highest annual number previously reported.

“The reasons for this expansion, affecting men, women and children, remain unknown,” stated the WHO Disease Outbreak News, published Thursday.

Eleven of the 26 provinces of the Democratic Republic of the Congo are as endemic for mpox, but in recent years the number of provinces reporting mpox has been expanding, to 22 provinces as of November 2023, WHO stated.

Sexual transmission now reported in DRC of deadlier clade 1

Since 2022, an epidemic of the milder clade II of mpox has been ongoing globally, affecting many countries outside of Africa that had never reported mpox previously. “The spread of this epidemic was mainly driven by transmission via sexual contact among men who have sex with men,” WHO noted.

The first-ever globally confirmed case of sexual transmission of Clade 1 was reported in March. It involved a Belgium resident who tested positive for the virus during a visit to the DRC, where he had also had multiple sexual contacts at men’s clubs and elsewhere.

“Thereafter, sexual contacts of this case in the Democratic Republic of the Congo also tested positive for clade I MPXV [severe mpox infection], with closely related viral sequences. This is the first time that reported clade I MPXV infection is linked to sexual transmission within a cluster. Another outbreak in the country is also being reported with multiple cases of mpox among sex workers,” stated WHO.

In July, another case was reported in Kenge [Kwango province], involving a man who had sex with  men – and with apparently no links to the first cluster. Then in August, local transmission of the first severe mpox (MPXV) cases were confirmed in Kinshasa for the first time. Since then, some 102 suspected cases have been reported, two-thirds among men, and with a fatality rate for confirmed cases of 5.6%.

As of 22 November 2023, a total of 80 suspected and 34 confirmed cases of mpox (including 20 sex workers) of mpox have been reported in South Kivu – with no deaths. “Currently South Kivu province is grappling with conflict, displacement, food insecurity, and challenges in providing adequate humanitarian assistance, all of which have a profound impact on the local population, especially vulnerable groups, and might represent fertile ground for further spread of mpox.”

Patterns of transmission still porly understood

While human-to-human transmission of mpox through close contact has been reported since the 1970s, outbreaks were confined mostly to “small household or community outbreaks,” often around heavily forested areas and “presumed to be primarily due to zoonotic transmission.”

“These new features of sexual and unknown modes of transmission now raise additional concerns over the continuing rapid expansion of the outbreak in the country”  – and potential spread abroad, WHO stated, noting that the global outbreak of clade IIb mpox transmission between humans is ongoing in most WHO regions.

In addition, clade I mpox community outbreaks occur regularly in two other countries – Cameroon and the Central African Republic – as well as sporadically in others, including Sudan and South Sudan.

While transmission from animals to humans is also presumed to occur, the natural reservoir of the virus remains “unknown; while various small mammals such as squirrels and monkeys are known to be susceptible, they have rarely been linked to outbreaks,” WHO said.

Limited testing, few drugs and no immunization programmes

monkeypox
Patient participating in a clinical trial of TPOXX, an antiviral treatment for the mpox virus, in the Democratic Republic of Congo.

In terms of the risks of further sexual transmission, WHO note that “there are clubs in Kenge for men who have sex with men, some of whose members travel to visit other clubs within the country and outside the country, particularly in Europe and within Central Africa. In the city of Kinshasa, there are more than 50 such clubs. Some members of these clubs also reside outside the Democratic Republic of the Congo. This event is unusual and highlights the risk that MPXV clade I could also widely spread among sexual networks, as seen for clade II during the 2022-23 global outbreak.”

At the same time, DRC response capacities for mpox remains highly limited, WHO pointed out. “Surveillance and laboratory capacities remain suboptimal: only 9% (1106 / 12 569, as of week 44) of suspected cases this year have been tested by PCR. There are no immunization programmes for populations at risk of mpox in the Democratic Republic of the Congo outside of research projects.

Similarly, “access to the antiviral medication tecovirimat also remains limited to a few clinical research studies in the country.”

Following the 2022 declaration of the global mpox health emergency, involving clade II of the virus, developed countries launched an intensive vaccination campapign among groups at risk, to bring the epidemic under control. Indeed, WHO declared the global public health emergency to be over in May. 

However, the best-known mpox vaccine, MVA-BN, remains the monopoly of just one pharma company, Bavarian Nordic, which has demonstrated limited ability to rapidly expand production due to a manufacturing plant overhaul last year.

The manufacturer of TPOXX, the US based SIGA pharma company, pledged last year to make large quantities of the drug available for use by WHO and partners, including in developing countries.  The drug has been approved by the US Food and Drug Agency (FDA) and other regulators. However, major clinical trials on efficacy against severe mpox infection [MPXV] are yet to be undertaken, even though victims of severe forms of the virus are the most in need of supportive therapies, a group of Indian and Bangali researchers noted in a recent journal article, stating:

Mpox “only receives international attention when it spreads to high-income nations,” the researchers stated, noting that it is “thus becoming a risk to populations all over the world. There is an immediate and urgent need for conducting explorative researches to understand MPXV and the disease it causes (MPX), and develop effective and specific vaccines and antivirals.”

Image Credits: ET Times Lifestyle/Twitter, Tessa Davis/Twitter .

Aerial view of Accra, Ghana. Traffic, waste burning and desert dust all combine to make pollution a problem in this fast-growing city.

Africa is home to many of the world’s fastest-growing urban centres – and a crisis of air pollution faces the continent’s rapidly expanding cities, according to a new Clean Air Fund report released Thursday. 

Africa, home to the world’s youngest population, is expected to see its population nearly double by mid-century, reaching 3.9 billion by 2100. 

Over 65% of Africa’s population will reside in urban areas by 2060, with the continent potentially hosting five of the world’s ten largest megacities by the end of the century, according to the report. The 600-mile coastline stretching from the Nigerian capital of Lagos to Abidjan in Cote d’Ivoire alone is projected to be home to around half a billion people by 2100. 

Africa’s rapid urbanization is providing an engine for its fast-growing economies, but there is a significant hidden cost: air pollution.

“The challenges that flow from rapid urbanization across the continent are immense, including drastic increases in air pollution and greenhouse gas emissions, which if unchecked will bring disastrous consequences for human and economic health,” Kevin Urama, Chief Economist at the African Development Bank, explained in a statement accompanying the report’s launch. 

Across the six cities, potential reductions in greenhouse gas emissions vary, with some achieving a reduction of up to 35%, resulting in a collective avoidance of 0.8 Gt CO2e. (BAU = business as usual)

The study focuses on six major and rapidly expanding African cities—Accra, Cairo, Johannesburg, Lagos, Nairobi, and Yaoundé. Air pollution led to over 56,400 premature deaths across the six cities in 2022, costing a minimum of $2 billion, the report found. Toxic air claimed an estimated 1.1 million lives across Africa in 2019—surpassing the combined toll of tobacco, alcohol, motor vehicle accidents, and unsafe water. 

Road traffic is identified as the largest contributor to PM2.5 air pollution concentrations across the six cities studied, accounting for 30% and 40% of PM2.5 concentrations in Lagos and Accra, respectively.

Other culprits include industrial activities, power plants, biomass fuels, and waste mismanagement. As the cities grow and their populations rise, emissions from these sources are set to skyrocket. More people will require more cars, energy, and fuels, and create more waste, leading to a spike in air pollution. 

If current trends persist, the financial toll of air pollution in Africa’s major cities could surge more than eightfold by 2040, the report found. The cost will also be paid in over one million premature deaths by 2040 – 109,000 of which can be saved by implementing policies to combat air pollution. 

“On the current trajectory, following a ‘business as usual’ approach means air pollution will collectively cost Accra, Cairo, Johannesburg, Lagos, Nairobi, and Yaoundé an estimated $138 billion in premature deaths and worker absenteeism over the next two decades,” said Urama.

Opportunities to change track 

Implementing policies to reduce air pollution could prevent a total of 109,000 premature deaths across the six cities between 2023 – 2040, according to the report.

Despite the grim outlook, the report presents a roadmap to avert the potentially catastrophic consequences of air pollution . It emphasizes the potential for substantial economic benefits—billions of dollars saved, reduced deaths, improved public health, lower emissions, and decreased poverty—of implementing policies promoting green growth.

The report urges African governments to review high-emitting sectors at the national level, including energy, transport, industry, power production, agriculture, and waste management.

By identifying ways to reduce air pollution in these sectors, governments can simultaneously address climate change, and create opportunities for green economic growth. The report emphasizes the need to enshrine air quality targets into national and district-level laws, ensuring long-term commitment beyond political cycles.

City mayors and local government leaders are urged to adopt low-cost, low-maintenance air quality monitoring devices to gather comprehensive data for evidence-based decision-making. These devices will enable cities to pinpoint pollution hotspots, track trends, and assess the effectiveness of mitigation strategies.

As more governments and municipalities embrace air monitoring technologies, data sharing can also be enhanced across borders and within countries, empowering local and national authorities to formulate evidence-based policies on air quality-related public health matters.

Accra could unlock $25m, Johannesburg $55m, Nairobi $23m and Yaoundé $27m in 2040 alone by implementing clean air measures.

Across Accra, Cairo, Johannesburg, Lagos, Nairobi, and Yaoundé, implementing clean air measures such as upgrading public transport and adopting cleaner cookstoves could save over $19.2 billion across the six cities by 2040.

In Accra, which will host the first-ever World Health Organization (WHO) air pollution summit in 2024, the economic impact of air pollution, including absenteeism and premature mortality, is expected to quadruple between 2019 and 2040. However, the city could unlock over $25 million in 2040 alone through implementing measures to reduce air pollution.

While the report’s financial projections are significant, it acknowledges that the true benefits could be even greater, considering the positive ripple effects on healthcare, agriculture, productivity, and the environment.

“The projected benefits from air quality action are expressed in this study in financial terms, but these financialised benefits should not be understood to mean tangible funds raised or costs saved,” the report notes. “The co-benefits gained from air quality action provide greater cost-effectiveness that recycles into local economies, strengthening health systems, businesses and government finances.”

By implementing clean air measures, such as upgrading public transport and cleaner cookstoves, these six cities could save over $19.2 billion between 2023 – 2040.

The report also highlights the startling lack of international and multilateral development funding to fight air pollution in Africa, with only 5% of total aid directed at reducing air pollution on the continent.

In Lagos, a city home to nearly 16 million people, the official development funding directed toward air pollution from 2015 to 2020 amounted to a mere $0.25 million. Air pollution claimed 70,000 in the city in 2019 alone. 

Between 2015 and 2021, donor governments provided a stunning 36 times more aid for prolonging fossil fuel use in Africa than tackling air pollution, despite the continent facing temperatures warming faster than the global average.

The report calls on international and multilateral development banks to provide increased technical support to assist countries in accessing green funds, dedicated funds for financing air quality data monitoring capacities are recommended, acknowledging the critical role such data plays in obtaining other climate financing.

“It is well understood that tackling poverty, bringing clean water to people everywhere, and investing in education are all critical to Africa’s development,” said Urama. “Ensuring our citizens can breathe clean air is also a vital, but too often neglected, piece of this puzzle.”

Image Credits: WHO/Blink Media, Nana Kofi Acquah.

Dr Margaret Chan former director of the World Health Organization, in a University of Geneva panel session with public health students Youjia Liu and Tingkai Zhang,

On her first visit back to Geneva since leaving her post as WHO Director-General in 2017, Dr Margaret Chan urged public health students to recognize “the power of collaboration” and to  “use their voice” to hold policymakers accountable for the changes that the promises that they make. 

“When I was in WHO, there were a lot of negotiations, a lot of resolutions.  But do you think countries kept their promises?” she asked. “We are waiting for the day when leaders of countries walk their talk. But you have a voice. Use your voice in a system that you know well, to advocate.” 

Chan, now Dean of the Vanke School of Public Health in China, was speaking at last week’s event “One Planet One Health”  co-sponsored by the University of Geneva and the Geneva Health Forum.  

The event brought together Chinese students from Vanke with counterparts from the University of Geneva’s Institute of Global Health – as part of an academic collaboration forged between the two institutions after Vanke opened its doors under Chan’s leadership in 2020.   

Geneva at the heart of ‘One Health’ efforts 

In a presentation preceding her panel discussion with three Geneva and China-based students, Chan declared that Geneva, home of the WHO, the World Meteorological Organization and countless other civil society and research institutions, needs to also be the heart of One Health efforts. 

Those efforts bring together action on climate change with action on new disease threats that are emerging at an evermore rapid pace, with changes in climate, deforestation and the loss of biodiversity, she said.  

“One cherished memory I have of my time in Geneva was the sight of my friends heading to ski,” she recalls, of her 15 years living in Switzerland, beginning with her first WHO appointment in 2003 as the director of the Department of Public Health and Environment.  

“Their faces were aglow with excitement as the world around them was painted in a pristine blanket of white. 

“Yet this year paints a different picture,” she said, referring to the weeks of rain that the city has seen this November. “The familiar white landscape … and the thrill of skiing is replaced by a visible absence of snow. 

“This … my friends, is climate change, reshaping the city and the world we all love. This is a reflection of a broader global shift -from the dwindling expenses of the Amazon rainforest and the melting Siberian permafrost to the receding snow cover of the Tibetan plateau and the vanishing ice sheets in West Antarctica. And these aren’t isolated incidents. They are interconnected sides of our earth’s transformation.

“As of 2023, we have surpassed nine out of the 14 tipping points of our earth’s system, changes that are irreversible and leading to abrupt shifts in our environment. 

“Climate change, as I have said many times, is a defining issue of the 21st century. Climate variables affect the air we all breathe, the water we drink, the food we eat and even where we are able to live.  Extreme weather events are becoming the norm and records are constantly being broken, she said ravages of the past summer in the northern hemisphere. 

“Beijing, the city I know better, suffered record-breaking heat waves. Then, Beijing again was inundated by the heaviest rainfall in 140 years. Another example. Hawaii. It is known for its beauty.  Now it is scarred by wildfires that ravaged Maui. Florida’s ocean temperature reaches a staggering 38 °C. And right here in Geneva, the World Meteorological Organization delivers sobering news of the hottest June ever recorded. 

“As UN Secretary-General Antonio Guterres commented, ‘The era of global warming has ended. The era of global boiling has arrived’.”

Nature never deceives us

From left to right: Dr. Ilona Kickbusch, moderator, with students Kailing Marcus, Youjia Liu, Tingkai Zhang, and former WHO Director General, Dr Margaret Chan.

“Grand challenges require grand actions,” Chan added. “In the historic 2015 Paris Agreement on climate change, countries made important commitments to cut greenhouse gas emissions and scale up adaptation, adaptation to climate change. 

“The Paris Agreement is not just a treaty for saving the planet from severe and irreversible damages. It is also a significant public health treaty with a huge potential to save lives worldwide,” added Chan, speaking just two weeks before the UN Climate Conference COP 28 in Dubai launches the third global “stocktake” of progress made, eight years on.  

And despite the critical importance of a more rapid fossil fuel phase-out, “the energy transition, switching from fossil fuels to renewable renewable energy are just a part of the solution,” Chan pointed out. 

Interconnected web

The other side of the climate coin is a ‘One Health’ approach recognizing that “humans along with the animals and plants around us, and the environment that nurtures us, are all part of a single interconnected web, Chan said. 

Even before arriving in Geneva, Chan had considerable experience with the threats that nature can unleash on human health.  As the Director of Public Health in Hong Kong, she had to meet the challenges there of the first H5N1 (Avian flu) outbreak in 1997, followed by the SARS outbreak in 2003.  

Arriving at WHO in 2003, she oversaw some of the agency’s early initiatives on climate, health and biodiversity as head of the Department of Public Health and Environment. Later, as Director-General, she was faced with the unprecedented challenge of the West African Ebola outbreak between 2014 and 2016, one of the most deadly seen on the continent in modern times. 

Recognizing the intricate relationship between animal-borne pathogens and human infections, she helped advance the early phases of the  “Tripartite” Collaboration on One Health involving  WHO, the Food and Agriculture Organization and the World Organization for Animal Health. 

“The majority of new pathogens are caused by diseases of animals that spread to humans, such as flu, rabies, SARS and COVID 19,” said Chan in her lecture. “This is especially an issue in the context of climate change.  Why?  Because climate change is a threat multiplier.  Existing threats can be spread to a new geographically area.  

“For instance, the emergence of Nipah virus and Hantavirus as human pathogens has been traced to extreme weather events that forced more animal hosts to leave their ecological niches and invade human settlements.

“In the past 30 years. of the new human pathogens identified, and an astonishing 75% can be traced back to animals,” she said.

“The message is loud and clear. We need to adopt the One Health approach recognizing and respecting a symbiotic relationship between humans, animals and our shared environment. 

“The one health approach is an integrated approach to tackle global health threats,” Chan declared. “Prevent, predict, and respond. It is high time we adopt a holistic perspective.”

Along with climate action and action to preserve the integrity of the natural world that is the fundamental basis for human life, equity is yet one more dimension to the One Health approach, said Chan. 

“We often delve into the deep interconnections between humans, animals and the ecosystem. Yet, at the core of this idea, lies another profound truth – the essence of not distinguishing one human from another,” she said. 

“Regardless of our diverse backgrounds, culture and beliefs, we are all Homo sapiens. It is high time we adopt a holistic perspective, looking at humanity as one cohesive unit right here in the heart of Geneva.

Dr Margaret Chan

From dean to student  

In a subsequent panel discussion, Chan and three students from Tsinghua University exchanged views on how they, as young people, could act on the challenges in public health, their own professional path and facing their generation. 

Youjia Liu, a student at Tsinghua University, described her experience last summer carrying out public health research in the remote mountain villages of Cambodia, which sensitized her to the difficulties of people accessing regular health care at a time when there is also a lot of migration along the border and changing patterns of malaria.

“We always talk about this access to health care,” she said. “And it seems like something that only local governments can really work on. But what can we do? This is related to the topic, One Climate, One Health. People live in remote areas and are actually very vulnerable groups.”

“I don’t really have a good answer for you,” said Chan, noting that the lack of healthcare workers in ‘last mile’ regions of the world is a longstanding problem happening in many countries of the world. 

“But you mentioned the local government. These people need to speak out. And your duty is to teach them to speak up. Okay? Don’t take things for granted. And of course, that is easier said than done. This is the reality we live in. 

Citing the collaboration between the two universities as an example of cross-cultural collaborations, Chan urged students to “take the lead to address these global challenges.

“In English, Tsinghua’s University’s motto translates into ‘self discipline and social commitment’,” Chan stated. 

“Young people in universities are privileged, and it is their duty to confront these challenges. The path may be arduous, but with determination and unity, there is no summit we cannot reach. 

“I urge you, don’t give up hope.  Can you imagine? I was Director-General in the era of the MDGs [Millennium Development Goals] remember? The world is a better world now compared to the time when we were dealing with MDGs. So continue to make the effort. Don’t give up.”

Shoppers wear masks in Guangzhou, China.

Unusual outbreaks of respiratory illness and pneumonia in Chinese children have prompted the World Health Organization (WHO) to ask the country for detailed information. 

Children’s hospitals in Beijing and Liaoning Province, some 800km apart, are “overwhelmed with sick children, and schools and classes were on the verge of suspension”,  according to local Chinese media, as reported by ProMed International Society for Infectious Diseases.

Beijing Children’s Hospital was overcrowded with parents and children with pneumonia, according to ProMed.

 “Many, many are hospitalized. They don’t cough and have no symptoms. They just have a high temperature (fever) and many develop pulmonary nodules,” according to a resident quoted in the report.

The lobby of Dalian Children’s Hospital in Liaoning Province is full of sick children receiving intravenous drips, according to ProMed.

Meanwhile, local authorities in Shandong Province in north-eastern China have advised people to wear masks and get influenza vaccinations, according to Nikkei Asia.

At a press conference on 13 November 2023, the Chinese National Health Commission reported an increase in the incidence of respiratory diseases in China at a media briefing on 13 November, according to the WHO.

They attributed this to “the lifting of COVID-19 restrictions and the circulation of known pathogens such as influenza, mycoplasma pneumoniae (a common bacterial infection which typically affects younger children), respiratory syncytial virus (RSV), and SARS-CoV-2 (the virus that causes COVID-19)”.

On Wednesday, the WHO “requested additional epidemiologic and clinical information, as well as laboratory results from these reported clusters among children, through the International Health Regulations mechanism”, said the WHO in a statement.  

Influenza-like

“We have also requested further information about recent trends in the circulation of known pathogens including influenza, SARS-CoV-2, RSV and mycoplasma pneumoniae, and the current burden on health care systems. WHO is also in contact with clinicians and scientists through our existing technical partnerships and networks in China.”

The WHO also notes that since October, northern China has reported an increase in influenza-like illness compared to the same period in the previous three years. 

“While WHO seeks this additional information, we recommend that people in China follow measures to reduce the risk of respiratory illness, which include recommended vaccination; keeping distance from people who are ill; staying home when ill; getting tested and medical care as needed; wearing masks as appropriate; ensuring good ventilation; and regular hand-washing,” said the WHO.

The first cases of COVID-19 were detected in Wuhan in central China in December 2019, and by March 2020, the WHO declared a pandemic. That was caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which originated in bats.

Image Credits: China News Service／中国新闻网, Flickr: ZhiZhou Deng.

One-third of people in 14 countries in the Western Balkans, the Caucasus and Central Asia used antibiotics without a medical prescription, according to a survey released on Wednesday by the World Health Organization’s (WHO) European Region.

The survey involved 8221 participants, half of whom reported taking oral antibiotics in the past 12 months. 

Participants came from Albania, Armenia, Azerbaijan, Belarus, Bosnia and Herzegovina, Georgia, Kazakhstan, Kyrgyzstan, Montenegro, North Macedonia, Moldova, Tajikistan, Türkiye and Uzbekistan. 

The most common reasons cited for taking the antibiotics were colds (24%), flu-like symptoms (16%), sore throat (21%) and cough (18%). These are often caused by viruses unaffected by antibiotics. 

Across the 14 countries, a third (33%) of respondents consumed antibiotics without a medical prescription, in contrast to 8% of residents in the European Union polled in a similar survey in 2022.

In some countries, more than 40% of the antibiotics were obtained without medical advice.

“Medical expertise is essential to make a correct diagnosis and determine whether antibiotics are the right course of treatment,” WHO Europe stressed.

For some years, the WHO has urged cautious use of antibiotics as pathogens are increasingly developing resistance to them, known as antimicrobial resistance (AMR).

This week is Global AMR Awareness Week. AMR causes an estimated five million deaths annually, with more than half a million deaths occurring in the WHO European Region, which comprises 53 Member States in Europe and Central Asia.  

Different types of antimicrobials – such as antibiotics for bacteria, antivirals for viruses and antifungals for fungi – target specific types of microorganisms. While AMR is a natural phenomenon, the development and spread of superbugs are being accelerated by the misuse of antimicrobials, rendering infections more challenging to treat effectively.  

“The alarming reality is that, without immediate intervention, AMR could result in up to 10 million deaths a year by 2050. Moreover, this burden falls disproportionately on low- and middle-income countries, exacerbating global health inequalities,” according to WHO Europe.

“This research clearly shows the need for education and awareness raising,” said Robb Butler, Director of WHO Europe’s Division of Communicable Diseases, Environment and Health. “All countries in our region have regulations in place to protect precious antibiotics from misuse, for example, preventing over-the-counter sales without a prescription. Enforcing these regulations would solve most antibiotic misuse among humans.”

Image Credits: AMR Industry Alliance.


Almost all countries (91%) have included health considerations in their latest climate-mitigation plans – called nationally determined contributions (NDCs) – but those that have already felt the effects of extreme weather events appear more likely to have more detailed plans.

This is according to an analysis of countries’ 2022 NDCs, the main policy instrument to reduce emissions and build climate resilience as set out by the Paris Agreement, by the World Health Organization (WHO) released on Wednesday.

While almost two-thirds (63%) of countries had health adaptation priorities, virtually all the low- and lower-middle-income countries (87%) had done so. For example, Papua New Guinea and Uganda include measures to improve early warning systems for health risks such as vector-borne diseases. Fiji and Lao include measures to increase the resilience of public health infrastructure.

The health adaptation component least often included is the health workforce (13%). But  Georgia, Haiti and Namibia committed to strengthening the capacity of health professionals to respond to climate impacts and stressors, while the Seychelles committed to integrating climate change into the curriculum for health professionals. 

“Countries have made significant progress in recognising climate change’s threat to human and planetary health in their national plans to tackle climate change, but we need to see these commitments scaled up, accelerated, and adequately funded to ensure an equitable response that protects the health and livelihoods of current and future generations,” said Dr Maria Neira, WHO’s Director of Environment, Climate Change and Health.

Air pollution

Only 16% of plans have stand-alone targets, measures or policies to address air pollution and short-lived pollutants – described by the WHO as a “huge gap”. 

“Air pollution is one of the greatest environmental risks to health. Ambient (outdoor) and household air pollution together cause around seven million premature deaths each year from ischemic heart disease, stroke, lung cancer and respiratory diseases like asthma and pneumonia, which disproportionately affects children in low- and middle-income countries,” according to WHO.

However, the United Kingdom asserts that air pollution is the top environmental risk to human health in the UK and sets out a clean air strategy to tackle all types of air pollution. 

Bangladesh, Benin, the Central African Republic, Chile, Colombia, Côte d’Ivoire, Dominican Republic, Mexico, Nigeria, Togo and Zimbabwe all include numeric targets to reduce short-lived pollutants by 2030.

Only 10% NDCs quantify the health co-benefits of climate mitigation, although this represents a significant increase compared with the 2019 NDCs when only 1% did so. Pakistan uses a low emission analysis benefit calculator tool to assess the multiple benefits of reducing emissions, including health benefits, while Moldova prioritizes climate investments based on the social and health co-benefits of various mitigation measures.

COVID undermines plans

The COVID-19 pandemic has had a severe impact on economies, often worsened existing social and economic inequalities, and impacted countries’ climate mitigation plans.

Just over a quarter (28%) of NDCs recognize the pandemic’s impact on their level of ambition and/or implementation of national climate goals. For example, the Seychelles points out that its revised national climate plan should be understood in the context of the severe economic impacts of the pandemic on the country’s tourism and fisheries sectors, while Oman asserts that the pandemic has plunged the national economy into an unprecedented recession. 

Some 17% of countries recognise the role of nature-based solutions and/or a One Health approach in addressing both climate change and the COVID-19 pandemic. For example, the European Union recognizes that “nature-based solutions” play an important role in solving global challenges such as biodiversity loss and ecosystem degradation, poverty, hunger, health, water scarcity and drought, gender inequality, disaster risk reduction, and climate change. 

Image Credits: CNN.