Healthcare workers treat a patient with drug-resistant TB in Myanmar,.

Clinical trial results presented at the Union World Conference on Lung Health in Paris on Wednesday provided evidence to support the use of four new, improved regimens to treat multi-drug resistant tuberculosis or rifampicin-resistant tuberculosis (MDR/RR-TB). 

The endTB clinical trial found three new drug regimens that can deliver similar efficacy and safety to conventional treatments while reducing treatment time by up to two-thirds. It also found a fourth regimen that can be used as an alternative for people who cannot tolerate bedaquiline or linezolid, staples in current World Health Organization (WHO) -recommended regimens for MDR-TB.  

The endTB consortium, made up of Médecins Sans Frontières (MSF), Partners In Health (PIH), and Interactive Research and Development (IRD), began this Phase III randomized controlled trial in 2017.

A diverse group of 754 patients from Georgia, India, Kazakhstan, Lesotho, Pakistan, Peru, and South Africa were enrolled and included teenagers and people with comorbidities like substance-use disorders.

It evaluated five nine-month treatment regimens against the standard of care, with three of the drugs showing favourable outcomes in 85-90% of participants. 

“We stand on the cusp of a significant breakthrough in the battle against MDR, a disease that disproportionately affects impoverished populations around the globe,” said Professor Carole Mitnick, co-principal investigator of the study. 

“But the cost of some drugs remains a barrier. One example is delamanid which is still priced at 12-40 times higher than it should be according to an independently estimated cost to produce the drug,” said Mitnick, Professor of Global Health and Social Medicine at Harvard Medical School.  

MDR/RR-TB is caused by a TB bacterium that is resistant to rifampicin, one of the most powerful first-line antibiotics, and also sometimes resistance to isoniazid as well. Roughly half a million people fall sick with MDR/RR-TB each year, and many die from it. 

Although a range of MDR-TB regimens are now in use around the world, many people are still treated with conventional treatments that take up to 24 months, are ineffective (only 59% treatment success in 2018), and often cause terrible side effects, including acute psychosis and permanent deafness.

All-oral treatments

“For far too long, MDR-TB has loomed as a formidable threat with limited, poorly tolerated treatment options, but today, we unveil evidence for multiple innovative all-oral, shortened regimens that will allow patient-centred, individualized treatment of MDR-TB,” said MSF’s Dr Lorenzo Guglielmetti, co-principal investigator.

“What makes these results even more remarkable is the diversity, and resulting generalizability, of this Phase III randomized controlled trial.”

The trial was funded by Unitaid, whose executive director, Dr Philippe Duneton, praised the “gold-standard research”.

“The drugs are already available where they are needed. If recommended, this high-quality evidence could quickly translate into better treatment options suitable for all people with drug-resistant tuberculosis.” 

Image Credits: The Global Fund / John Rae.

Geothermal
Steam rises from Africa’s first geothermal power plant, which generates electricity from heat in the depths of the earth. Many more such renewable energy projects are necessary, says a new UN report on countries’ climate commitments.

With a fortnight to go before the start of the annual global climate conference, COP28, countries have – by their own admission – made insufficient progress in reducing carbon emissions.

This is according to a report on countries’ nationally determined contributions (NDCs) or goals they’ve set for themselves, released this week by the UN Framework Convention on Climate Change – now being referred to as UN Climate Change. 

A second UN Climate Change report on long-term low-emission targets, also released this week, is slightly more optimistic – saying that by 2050 CO2 emissions could be reduced by two-thirds in comparison to 2019 – but only if countries meet their climate commitments.

Simon Stiell, Executive Secretary of UN Climate Change, said that governments are taking “baby steps” to avert the climate crisis. But they need bolder action to get the world on track to limit global warming to 1.5° C by the end of this century. 

To meet the 2030 goal for slashing climate emissions so as to stick to the Paris Agreement target of 1.5° C , the world needs to cut emissions of carbon dioxide or its equivalent by 43% of the 2019 levels, he said in a press statement. 

But if countries implement their current climate action promises, including conditional ones, the report calculates there will only be a 5.3% reduction in emissions. If the conditional commitments aren’t met, emissions could instead rise by 1.4%.

“COP28 must be a clear turning point. Governments must not only agree on what stronger climate actions will be taken but also start showing exactly how to deliver them,” said Stiell in a media release.

Almost stagnant climate action                           

Oil fields in Bakersfield, California – the USA, Canada, Australia and Norway account for 51% of planned new oil and gas extraction by 2050. COP host UAE is bossting oil production by 1 million barrels per day by 2027.

Even when incorporating the latest commitments made by countries by the end of September, and just ahead COP28, the aggregate effect of the NDCs is “almost stagnant” over the last year.

“A significant increase in the level of ambition of climate action” is needed by countries Stiell said.  

COP28 President Designate, the United Arab Emirates (UAE)’s Sultan Al Jaber, says, “There is simply no time left for delays”, adding that the NDCs report “underscores the need for us to act with greater ambition and urgency to meet the goals of the Paris Agreement”. 

But UAE, COP28’s host, plans to boost its oil production by one million barrels per day by 2027 and triple its natural gas production over the next five years by its national oil company, ADNOC, and Al Jaber is the oil company’s president and CEO.

It’s not just the UAE. The United Nations Environment Programme (UNEP) reported last week that governments are planning to produce 110% more fossil fuels in 2030 than compatible with the 1.5°C limit. 

The US,  Canada, Australia, Norway and the United Kingdom account for 51% of planned new oil and gas extraction by 2050. 

Meanwhile, India, Saudi Arabia, and Russia are leading the global surge for coal, oil and gas, the UNEP report showed last week. 

The Indian government on Monday stated that it would be increasing coal production by 2030 to 1,577 million tonnes, that’s up three-fourths from the current 893 MT. India is the third largest emitter but ranks 126th in per capita emissions, unlike, say, the US which is the second largest emitter and ranked 15th in per capita emissions. 

Long-term plans

Solar panel field in Egypt.

The second report released by UN Climate Change looks at countries’ plans to transition to net-zero emissions by or around 2050. 

It shows that these countries’ greenhouse gas emissions could be roughly 63% lower in 2050 than in 2019, but only if all the long-term strategies are fully implemented on time. 

It looked at the long-term climate action strategies of 75 parties to the Paris Agreement (which recognised the importance of limiting global warming to under 1.5°C). These are among the world’s biggest economies and populations. Today’s report optimistically says, “This is a strong signal that the world is starting to aim for net-zero emissions.”

Stiell stressed that the conclusion of the first global stocktake at COP28 is where nations can regain momentum to scale up their efforts across all areas and get on track with meeting the goals of the Paris Agreement. The stocktake is intended to inform the next round of climate action plans under the Paris Agreement (known as nationally determined contributions, or ‘NDCs’) to be put forward by 2025, paving the way for accelerated action.

“The Global Stocktake report released by UN Climate Change this year clearly shows where progress is too slow. But it also lays out the vast array of tools and solutions put forward by countries. Billions of people expect to see their governments pick up this toolbox and put it to work,” Stiell said.  

WMO’s sobering greenhouse gases report

Another UN body, the World Meteorological Organisation (WMO) put out its Greenhouse Gas (GHG) Bulletin to “inform” COP28, and it makes for bleak reading. 

Emissions of three important GHGs continued to rise in 2022. Carbon dioxide, the biggest chunk, was 50% above the pre-industrial level for the first time, WMO said. Methane, which accounts for about 19% of the warming effect of long-lived greenhouse gases, also grew. 

But the biggest year-on-year jump on record was seen in nitrous oxide from 2021 to 2022. N2O is both a powerful greenhouse gas and ozone-depleting chemical and accounts for about 7% of the warming effect by long-lived greenhouse gases. About 60% is emitted from natural sources and the rest from sources like biomass burning, fertilizer use, and industrial processes, as well as healthcare use of the gas for anesthesia, and so on.

The WMO’s report laments there is no end in sight to the rising trend of GHG emissions. The last time the Earth experienced a comparable concentration of CO2 was 3-5 million years ago, when the temperature was 2-3°C warmer and sea level was 10-20 meters higher than now, it says. 

Frustration is palpable as carbon clock counts down

After three decades of global climate meetings to reduce greenhouse gases, emissions are forecast to increase 55.2% by 2025 over 1990. 

“Despite decades of warnings from the scientific community, thousands of pages of reports and dozens of climate conferences, we are still heading in the wrong direction,” says WMO Secretary-General Prof Petteri Taalas.

Appealing for rapid change Stiell says, “It’s time to show the massive benefits now of bolder climate action: more jobs, higher wages, economic growth, opportunity and stability, less pollution and better health. We can make COP28 a game-changer.”

Image Credits: IRENA, Babette Plana/Flickr.

Two-thirds of countries no longer criminalise consensual same-sex sex, a “remarkable reversal” since the start of the AIDS pandemic that has enabled global progress against the spread of HIV.

This is a key finding of Progress and the Peril, a report on HIV and decriminalisation released this week by Georgetown University’s Global HIV Policy Lab.

While 129 out of the world’s 194 countries, a further 24 countries don’t enforce their criminalising laws, said Professor Matthew Kavanagh, Director of the Center for Global Health Policy & Politics at the university’s O’Neill Institute.

“The reason why we’re talking about the decriminalisation of LGBTQ people around the world is because it has a clear link to HIV outcomes,” Kavanagh said at the launch of the report.

The trend towards decriminalisation has accelerated since 2017, with 13 countries representing 7% of the world, removing criminalising laws. The most progress was made in  2022 when Singapore, Barbados, St. Kitts and Nevis, and Antigua and Barbudan decriminalised consensual same-sex acts. In 2023, the Cook Islands and Mauritius joined them, with Venezuela removing its criminalising military law. 

“Knowledge of HIV status and viral suppression among the whole population is significantly higher where decriminalisation has happened,” added Kavanagh.

Professor Matthew Kavanagh, Director of the Center for Global Health Policy & Politics at the university’s O’Neill Institute.

Not a ‘Western agenda’

“This report shows how the world is increasingly rejecting the criminalisation of LGBTQ people,” said Winnie Byanyima, UNAIDS Executive Director. “Instead of sending a message of condemnation and fear, these governments are encouraging their people to come into the health system and get what they need for their well-being.”

Byanyima noted that progress had accelerated since the United Nations decision two and a half years ago to close the inequalities driving AIDS.

“That included creating enabling legal environments with a goal that, by 2025, less than 10% of countries in the world would have punitive laws standing in the way of ending the AIDS pandemic,” she added.

“There are some who say that this is a Western agenda. But no, look at this report – India, Botswana, Angola, Gabon, Barbados, Venezuela, and just a few weeks ago Mauritius. That is a South. The South is moving,” stressed Byanyima, who is Ugandan.

The Caribbean is the region that’s decriminalising at the fastest rate, she added.

UNAIDS Executive Director Winne Byanyima

Perils in some countries

But the report also warns of the perils, with recent prosecutions of LGBTQ people reported in 41 countries and “recent or pending legislation in several of these countries that make penalties more extreme”.

In May, Uganda passed an Anti-Homosexuality Act (AHA), which is one of the harshest anti-LGBTQ laws ever passed globally. Ghana passed a similar law in July.

“There is a concerted campaign [and] US organisations that are pushing the deepening of criminalisation,” warned Kavanagh, who described this as a well-financed, well-coordinated “neocolonial push”.

Florence Riako Anam, co-executive director of the Global Network of People Living with HIV (GNP+),  expressed deep concern that some countries are “continuing to deepen criminalisation and persecution against the LGBTQ communities”. 

“I’m speaking as a Kenyan and I can share how deeply worried I am about the coordinated efforts that are happening in East Africa to replicate the laws and condone violence and discrimination that we are seeing in Uganda,” said Anam. Kenya’s parliament is considering a Bill that is similar to Uganda’s AHA.

Florence Riako Anam, co-executive director of the Global Network of People Living with HIV (GNP+),

‘Step up and catch up’

Mandeep Dhaliwal, the United National Development Programme (UNDP) director for HIV and Health, said that homophobia and punitive laws cost the world more than $126 billion per year – largely calculated in lost productivity and increased health costs.

“People living with HIV in criminalising countries have 11% lower knowledge of their HIV status and 8% lower viral suppression rates,” said Dhaliwal.

Meanwhile, Byanyima called for the leaders of the one-third of countries that still criminalise to “step up and catch up”.  

“Those who are pushing in the opposite direction, sadly such as my own country, Uganda, towards direct criminalisation, are on the wrong side of public health, on the wrong side of economic growth, and on the wrong side of history,” she stressed.

“Politicians usually make this argument that [being LGBTQ] is unAfrican, really, with the purpose of disenfranchising LGBTQ people from society. Once they put them in the category of not citizens of Africa, then they are denied all their rights. I totally don’t respect it. I am a proud African and I support and promote and respect and cherish LGBTQ people.”

Mandeep Dhaliwal, the United National Development Programme (UNDP) director for HIV and Health,

Anam said that programmes and interventions for people living with HIV would not work “if some of us are not able to come into the room and share what their needs are,” she added, noting that this was a human rights issue that should not be confined to HIV.

“The struggle for our rights and dignity and quality of life has reached fervent urgency now more than ever,” said Anam. “Repressive laws institutionalising the criminalisation, prejudice, and violence against our communities – particularly those based on sexual orientation and gender identities – do not serve us. 

“They cause harm. They lead to the death of friends or getting harmed. All of us people living with HIV must access treatment, get undetectable and achieve quality of life.”

Vivek Divan, Head and Coordinator, Centre for Health Equity, Law & Policy

Vivek Divan, head of the Centre for Health Equity, Law & Policy, said that the effort to decriminalise in India had taken two decades.

“The litigation that led to the decriminalisation of queer people in India was filed in 2001 to an HIV NGO. It had many ups and downs being dismissed on the grounds of local standby in 2004, reinstated in 2005 by the Supreme Court and finally heard in 2008 with a positive decision being adjudicated in 2009 – all by the Delhi High Court,” said Divan.

Dhaliwal noted that progress against criminalisation “is not an accident”. 

“It is the result of the courageous leadership of LGBTQI communities, people living with HIV and other key populations working together with enlightened institutions and allies towards decriminalisation and anti-discrimination. We need much more of this kind of solidarity in a world that is suffering from a solidarity deficit,” said Dhaliwal

Image Credits: Stavrialena Gontzou/ Unsplash.

The 2022 edition of the Lancet Countdown report warned that “global health lies at the mercy of fossil fuels”. The 2023 report, published on Wednesday, finds “few, if any” signs that the world has taken heed of the impending health crisis.

A new report from the Lancet Countdown, an annual assessment of progress toward the climate targets of the 2015 Paris Agreement, paints a grim picture of the escalating health risks associated with a warming planet.

The report, compiled by an international consortium of 114 scientists, health experts, and researchers, warns that the world is on track for a “dangerous future” where climate-linked health crises from extreme weather events, including deadly heatwaves, drought-driven food insecurity, and the spread of infectious diseases, will become the daily reality for millions.

The report’s grim findings underscore the urgent need for immediate and decisive action to curb greenhouse gas emissions and avert the worst consequences of climate change on human health. If the world warms by 2°C above pre-industrial levels, human health faces an “intolerable future with rapidly growing hazards,” the report warns.

Extreme heat is already driving death and food insecurity around the world, with heat-related deaths of people over 65 increasing by 85% since 1990, the report found. The average person now experiences 86 days of “health-threatening high temperatures every year”, 60% of which are attributable to climate change. 

“Global mean temperatures are rising and we’re increasingly exposed to extreme heat,” said Dr Marina Romanello, executive director of the Lancet Countdown and lead author of the report. “Extreme heat is particularly dangerous for elderly populations, populations living with underlying health conditions such as heart disease, lung disease and kidney disease, and pregnant women, their unborn children, [as well as] very young children and those with neurological conditions.”

The higher frequency and intensity of heatwaves are also exacerbating food insecurity, with an estimated 127 million more people experiencing moderate or severe food insecurity compared to the 1981 to 2010 period, placing “millions of people at risk of malnutrition and potentially irreversible health effects”, according to the report.

A devastating drought in Somalia, part of a wider crisis across the Horn of Africa, has claimed the lives of 43,000 people, with half of those deaths being children under five, according to a March report by Somalia’s Ministry of Health. The drought has also pushed nearly half of the country’s children under five – 1.4 million children – into acute malnutrition, according to UNICEF.

The report further highlights the contributions of climate change to the proliferation of infectious vector-borne diseases such as Dengue and West Nile Virus, as climate change makes people more vulnerable to the diseases and the world more hospitable to the mosquitoes that carry them. Warmer temperatures are extending the geographical range where disease-borne mosquitoes can survive and thrive, as well as extending their mating season, allowing them to reproduce in greater numbers.

“The climate crisis is escalating the severity of extreme weather events, increasing food insecurity, exacerbating respiratory diseases, and fueling the spread of infectious diseases,” declared Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO). “The world is moving in the wrong direction, unable to curb its addiction to fossil fuels and leaving vulnerable communities behind in the much-needed energy transition.” 

The World Health Organization (WHO) has long advocated for a more prominent role for health considerations in international climate negotiations, emphasizing the substantial health benefits of decisive climate action. In the wake of the Paris Agreement’s ratification in 2015, the UN health agency hailed the treaty as ‘potentially the strongest public health agreement of the century.’

However, the 1.5°C temperature goal enshrined in the agreement is swiftly fading from reach. The health consequences of the already elevated global temperature, averaging 1.14°C above pre-industrial levels, are already impacting millions of lives worldwide.

“Our data shows us that a thriving future still lies within our reach,” said Romanello. “The most concerning thing is that we’re accelerating in the wrong direction.”

Developing countries excluded from green transition as finance falters

As developing nations bear the brunt of climate change’s devastating impacts, financial support from wealthy countries for climate adaptation remains woefully inadequate, leaving them ill-equipped to cope with intensifying extreme weather events and rising health risks. The report highlights the persistent lack of “access to funding and technical capacity” in low- and middle-income countries, further exacerbating deep-seated health inequities within and between nations.

The Lancet’s findings echo the conclusions of the UN Environment Programme’s Adaptation Gap report, released last week, which found that adaptation finance flows to developing countries fell to just $21 billion in 2022, compared to the $367 billion required every year through 2030.

“The most vulnerable and minoritised communities are left the least protected, and the deep within-country and between-country health inequities are further exacerbated,” the report states. “This scarcity is aggravated by the rising economic losses from climate change impacts, and the persistent failure of wealthier countries reach the promised sum of $100 billion annually to support countries most affected by climate change.”

The consequences of this financial shortfall are stark: developing countries are being largely excluded from the accelerating shift to green energy technologies, despite their urgent need for these solutions. While clean renewable energy sources are gaining ground globally, their share in the world’s electricity generation still stands at a mere 9.5%. In low Human Development Index (HDI) countries, this figure plummets to just 2-3%, with 92% of domestic energy still derived from polluting fossil fuels.

“By and large, it is the very high human development index countries that are leading the way in the adoption of these green technologies in this new economic [era],” said Romanello. “Once again, we’re seeing that it is the most vulnerable countries that are being left behind in the zero-carbon transition and remain reliant on dirty fuels and exposed to health homes and energy poverty.”

Fossil fuel expansion threatens perilous future for human health

Change in fossil fuel lending in the years after the Paris Agreement, compared to the years preceding it. More than half of the 40 banks that lend most to the fossil fuel sector have increased lending since the Paris Agreement was signed.

The report’s predictive section, a new addition this year which projects the future impact of a warming climate on human health worldwide, underscores the alarming trajectory of global emissions which is “putting our collective future at risk”.

“Last year, the 2022 report said that our health was at the mercy of fossil fuels. Well, this report shows us is that it is even worse today,” said Romanello. “Looking at the 20 largest oil and gas companies around the world, we see that their plans today would lead to their share of emissions exceeding the targets of the Paris Agreement by 173% in 2040 – this is 61 percentage points more and last year when they were on track to exceed [1.5C levels] by 112%.”

This unabated fossil fuel expansion has placed the world on a perilous path towards a catastrophic 2.7 degrees Celsius of warming by the end of the century. The Lancet findings echo those of the UN Environment Programme, which said in its Production Gap report last week that government plans to expand fossil fuel production despite the climate crisis were “throwing humanity’s future into question”. 

The health implications of this scenario are profound and far-reaching. Even a 2-degree Celsius warming scenario would bring unbearable health consequences, with heat-related deaths projected to surge by 370%, heat-related labour loss by 50%, and an additional 524.9 million people facing moderate to severe food insecurity, according to the report. The potential for dengue transmission is also expected to rise by up to 37%.

The health threats posed by fossil fuel burning are further exacerbated by government subsidies, which effectively incentivize the industry. Moreover, agricultural emissions continue to rise, alongside a global food system that promotes unhealthy, carbon-intensive diets.

Health consequences of a 2C warming scenario in 2040.

The finance sector is playing a significant role in perpetuating this crisis. Average annual lending to the fossil fuel sector grew from $549 billion in 2010–16 to $572 billion in 2017–21. More than half of the 40 banks that lend most to the fossil fuel sector have increased lending since the Paris Agreement was signed.

This expansion of fossil fuel production has also been driven by high energy prices, which have yielded $4 trillion in profits for oil and gas companies in recent years. As a result, these companies are allocating more capital to fossil fuel projects than to renewables, on which they spend just 4% of their budgets.

Despite the mounting evidence of the climate crisis, the world remains woefully off track. A U.N. assessment of global climate commitments published on Tuesday found that even if all were met, which is a significant uncertainty, emissions may only be about 5% lower in 2030 than in 2019. The world is currently on track to reduce emissions by just 2% by 2030, according to the report. To limit global warming to 1.5 degrees Celsius above pre-industrial levels, emissions need to be 43% lower.

“The world remains massively off track,” U.N. chief Antonio Guterres said.

The Lancet Countdown report’s findings further align with those of a concurrent World Meteorological Organization (WMO) report, which revealed on Wednesday that greenhouse gas concentrations in the atmosphere reached a new record high in 2022.  

Another major climate report released concurrently, State of Climate Action 2023, concluded that “global efforts to limit warming to 1.5°C are failing across the board.” Across 42 indicators tracked in the report, published by Climate Action Tracker, only one – electric vehicle sales – is on track, while six – including deforestation, the carbon intensity of steel, and public financing for fossil fuels – are accelerating in the wrong direction.

“There is no end in sight to this trend,” warned WMO Secretary-General Petteri Taalas. “Despite decades of warnings from the scientific community, thousands of pages of reports and dozens of climate conferences, we are still heading in the wrong direction.”

“It takes thousands of years to remove carbon from the system once it’s emitted into the atmosphere,” said Taalas. “We must reduce the consumption of fossil fuels as a matter of urgency.”

Image Credits: Matt Howard/ Unslash.

Triage areas at Al-Shifa hospital courtyard, one of the largest hospitals in the Gaza Strip on October 10 before fighting around the health facility escalated.

Israel launched what it described as a “targeted operation” into Gaza’s besieged Shifa Hospital early Wednesday morning – which was immediately denounced by the World Health Organization as “unacceptable” and contrary to international law – regardless of whether Hamas made use of the facility for military purposes. 

Meanwhile, on Tuesday, an Israeli delegation visiting Geneva on behalf of the estimated 229 people held hostage by Hamas, met with WHO’s Director General Dr Tedros Adhanom Ghebreyesus as well as the president of the International Committee of the Red Cross, pleading with them to intervene more forcefully on the release of the captives, including 30 children, a pregnant woman, and 20 older people, with a range of injuries and chronic health conditions.  

‘Hospitals are not battlegrounds’ – WHO DG 

WHO Director General Dr Tedros Adhanom Ghebreyesus speaking at a WHO media briefing on Wednesday.

In statements early Wednesday morning, Israel’s military spokesman said that elite troops had entered the hospital, ostensibly to root out Hamas operatives, weapons and entrances to an extensive underground tunnel system – that may have been used to hide and transport some of the 240 Israeli hostages to other parts of Gaza.  

Speaking at a Wednesday afternoon press briefing, Tedros condemned the entry, saying:   

“Israel’s military incursion into Al Shifa hospital in Gaza City is totally unacceptable.. Hospitals are not battlegrounds.  We are extremely worried about the safety of staff and patients. 

“WHO has lost contact with health workers at Shifa Hospital. But one thing is clear – under international humanitarian law, health facilities, health workers, ambulances and patients must be safe-guarded and protected against all acts of war. 

“Not only that, but they must be actively protected during military planning.  

“Even if health facilities are used for military purposes, the principles of distinction, precaution and proportionality always apply,” added Tedros. “The safety of patients and staff, as well as the integrity of the health care systems in the wider community, are of paramount concern,” he added. 

Israel’s military said that the entry of troops was accompanied with Arabic-speaking medics, incubators and other supplies to address the plight of some 36 premature babies teetering between life and death. 

Aching relief needs everywhere in Gaza

Dr Richard Peeperkorn, WHO Representative to the West Bank and Gaza, at Wednesday’s WHO press briefing.

For the first time since the conflict began, fuel began to move into Gaza via the Egyptian Rafah crossing. A truck with 23,000 litres of fuel was permitted to cross to resupply the depleted reserves of the UN Refugee Agency, which is sheltering hundreds of thousands of Palestinians displaced by the fighting in tent camps and other temporary locations in the south of the tiny enclave – whose largest city in the north now lies in ruins. 

The Jerusalem-based Representative WHO’s Office for the West Bank and Gaza, Richard Peeperkorn, described the fuel entry, previously opposed by Israel, as a “promising step.”

But the supplies, which were approved for the re-supply of UNRWA installations only, are nowhere sufficient to meet the broader needs of Gazans, Peeperkorn and the WHO Director-General both said.  

“At least 120,000 litres a day are needed to operate hospital generators, ambulances, desalination plants, sewage treatment plans and telecommunications,” pointed out Tedros.  

“The problem can be easily fixed, the supply of electricity must be restored and sufficient fuel must be allowed to enter, to run vital infrastructure and distribute lifesaving aid,” he added.

Infectious diseases rising

Khan Younis refugee camp, Gaza. Hundreds of thousands of internally displaced people (IDPs) are sheltering in 90 UNRWA shelters in the Middle, Khan Younis and Rafah areas of the Gaza – where the onset of winter rainfall is exacerbating environmental health risks.

“What’s critically important is the water and sanitation,” said Peeperkorn, saying that some 4000 tons of rubbish per day was piling up in overcrowded camps in southern Gaza where solid waste removal services ceased functioning yesterday due to a lack of fuel. 

Sewage pumping stations, water wells, and Gaza’s two main water desalination plants in Rafah and the middle portion of Gaza also were not functioning due to a lack of fuel, Peeperkorn noted. 

In addition, said Tedros, heavy rains have flooded makeshift camps, “making conditions even worse” for those displaced. 

“We see a real problem in that disease surveillance is interrupted,” added Pepperkorn, noting that official reports on deaths and injuries had not been made for the past three days. 

But regardless of the limited reporting capacity, WHO is seeing sharp rises in acute respiratory infections, diarrhea, as well as skin diseases, scabies and Hepatitis A, he said. 

“And I want to really be clear that over the last three days, we have not received updates to date on injuries and deaths due to the intensifying hostilities and levels  of connectivity so it makes it much harder to evaluate,” he said.

The latest reports are of 11,078 Palestinian casualties since the original 7 October Hamas incursion into Israel, in which some 1200 Israelis and foreigners were killed, mostly civilians.   Since then, Israel has conducted one of the most intensive aerial bombing campaigns in modern history devasting large parts of Gaza City. Hamas has fired over 9,500 missiles into Israel, including a direct hit on the coastal city of Ashkelon Wednesday.  

Meanwhile, only about 10 hospitals are still operating on the strip out of the original 36, Tedros said, with about 1400 beds available out of an original 3500.  

And movement of critically ill patients to treatment across the border in Egypt remains challenging, Peeperkorn said. 

“We need to establish a mechanism that a medevac  becomes operational over the next three months,” Peeperkorn said, referring to the timely and efficient evacuation of critically ill patients. On Wednesday, some 30-50 critically-ill patients were evacuated to Egypt, he said. But thousands more will require medical transport over the next several months. 

WHO and ICRC meetings with Israeli delegation of hostage families

Ofri Bibas Levy, whose brother, wife and two young children were kidnapped to Gaza.

On Tuesday, four hostage families, accompanied by Israel’s Foreign Minister and Health Minister, were in Geneva to plead with WHO’s Tedros and Mirjana Spolijaric, president of the International Red Cross Committee, for more forceful international intervention on the fate of the captives. 

It was the first high-level meeting between Israeli ministers, the ICRC and WHO’s leadership on the matter since the conflict began. 

Spoljaric said in a statement that the ICRC was “doing everything in our power to gain access” to the hostages but “cannot force its way into where hostages are held” and “can only visit them when agreements, including safe access, are in place”.

Tedros, in his remarks on the meeting, stated, ” I heard and felt their pain and heartache. WHO continues to call for the hostages to be released unharmed, without any condition. We are deeply concerned for their health and well-being, just as we are concerned for the health and well-being of the people of Gaza, which is becoming more precarious every hour.”

At a briefing for Geneva’s UN press, the families appealed to the UN and international community to do more to obtain the release of their family members, beginning with  “even a sign of life”.  

Ilan Regev Gerby, the father of two children in their twenties kidnapped together from a weekend festival, fought back tears as he replayed a tape of his last phone conversion with his hysterical children, as Hamas forces entered the festival grounds on 7 October.  

Idit Ohel, mother of 22 year old Alon Ohel, described learning about her son’s fate from a Hamas video, uploaded to social media. The video, aired at the briefing, showed him and two other friends being hauled away by Hamas forces in a truck from the same outdoor festival, holding a tourniquet to the lower part of his arm, which was blown off by a grenade thrown into his hiding place, according to one eyewitness who survived.

“I ask the UN for security, for freedom and humanity,” said Ofri Bibas Levy, whose brother, sister-in law and their two children, ages four and 10 months, were kidnapped from their home  in a community near Gaza on 7 October. “Where is the humanity of two boys being held underground for 40 days?”

There have been reports of progress on a Qatari- brokered deal for the release of 50 hostages, mainly women and children held by Hamas, in exchange for the release of Palestinian female prisoners and a three-day truce – something that could unlock a humanitarian cease-fire allowing more health and humanitarian aid to flow into the besieged strip. 

A breakthrough has so far remained elusive insofar as Israel has been calling for the simultaneous release of all hostages, while Hamas is clearly interested in a staged release of the captives, in a bid to slow down and eventually halt  Israel’s military advances which aim at its overthrow. 

Even so, US President Joe Biden sounded an optimistic note Tuesday evening in a press briefing in Washington DC, where he send a message to hostage families saying, “hang in there we are coming.”

Image Credits: WHO/EMRO, WHO/EMRO, E. Fletcher/Health Policy Watch.

Director Generals Ngozi Okonjo Iweala (WTO), Dr Tedros Adhanom Ghebreyesus (WHO) and Daren Tang (WIPO) at their trilateral meeting on climate and health.

In anticipation of coming climate crises, developing countries should put in place “effective mechanisms in their domestic laws” that allow them to use the TRIPS flexibilities, asserted Dr Ngozi Okonjo Iweala, Director-General of the World Trade Organization (WTO) on Tuesday.

TRIPS flexibility refers to space allowed in the WTO’s Trade-related Aspects of Intellectual Property (TRIPS) Agreement for governments to relax patent rights to address public health needs, including issuing compulsory licenses to make medicines without the permission of a patent-holder.

“Let me emphasise that many developing country governments have not yet put in place the legal mechanisms or tools that allow the use of existing or future flexibilities. With the impact of climate change on health becoming more evident, this is the time to get ready,” Iweala told the trilateral climate change and health symposium convened by the WTO, World Health Organization (WHO) and World Intellectual Property Organization (WIPO).

 

The three bodies have agreed to step up their support for developing countries to “analyse their options to use TRIPS flexibilities” and update their laws to enable the use of these flexibilities alongside “enhanced procurement programmes”, she added.

“As you all know, at the WTO we have also been grappling with sensitive issues around intellectual property (IP) and technology transfer,” added Iweala.

“To solve problems in public health and the climate, breakthrough technologies must be incentivized, invented, developed and widely diffused. Innovation and access must go together. That is why the IP system was designed with ideas of balance and public interest at its core. Governments have legitimate scope to intervene when necessary to protect the public interest.”

Ngozi Okonjo Iweala, Director-General of the World Trade Organization (WTO)

Fossil fuel addiction ‘an act of self-harm’

WHO Director-General Dr Tedros Adhanom Ghebreyesus appealed for both “advanced technologies” and “trade arrangements” to protect lives in the event of climate crises.

“In the same way that we have been fighting for global equitable access to COVID-19 vaccines, we need to ensure that intellectual property and trade rules are not a barrier to accessing greener and healthier technologies,” said Tedros.

“The world’s addiction to fossil fuels is an act of self-harm,” he added. “This addiction not only drives the climate crisis but is a major contributor to air pollution, which kills almost seven million people every year – a death every five seconds. The health community has a critical role to play in protecting people from the escalating climate threats to health.”

However, countries had the responsibility to build health systems that can both withstand climate shocks and reduce their carbon footprint, added Tedros, referring to the WHO’s framework for building climate-resilient and low carbon health systems released last week. 

WIPO Director General Daren Tang

Warning that Africa would bear the brunt of climate-related deaths, projected to account for over half these deaths by 2050, WIPO Director-General Daren Tang said that “this cannot be our future”.

Tang added that, while some saw IP rights as an obstacle to achieving a better, fairer and more sustainable world, WIPO hopes that IP will “unleash the innovative and creative potential of our people around the world” to realise the sustainable development goals (SDGs).

Tang also referred to WIPO Green, a free online platform matching providers and seekers of green technologies around the world to address climate change.

“In the past 10 years, this platform has grown to cover 130,000 technologies from over 140 countries, becoming the biggest green tech exchange matching platform that the UN offers today,” said Tang. 

However, the challenge is to ensure that these technologies “create impact on the ground”, said Tang. 

“WIPO will continue to build innovation and tech transfer capabilities in member states so that tech transfer can lead to actual deployment on the ground, and homegrown innovation solutions can move from mind to market and be deployed and diffused across the world.”

Tobacco industry interference in governments’ tobacco control policies has increased in 43 out of 90 countries analysed over the past two years.

This is according to the Global Tobacco Industry Interference Index 2023 released on Tuesday by tobacco watchdog STOP, and the Global Center for Good Governance in Tobacco Control (GGTC).

“No country has been spared from the interference, and there is a worsening trend,” said Mary Assunta, CGTC’s head of research and advocacy. “More countries deteriorated in their scores compared to countries that improved” – with only 29 countries improving efforts to push back against industry.

Countries with the highest level of interference are the Dominican Republic, Switzerland, Japan, Indonesia and Georgia – and this is also reflected in “poor tobacco control measures in their countries”, according to the report.

Governments that are party to the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) are obliged to protect their health policies from the commercial and other vested interests of the tobacco industry.

But the report exposes a range of interfering behaviour – including governments accepting tobacco corporate social responsibility (CSR) contributions, politicians accepting campaign contributions and officials weakening controls in the face of industry scare tactics.

The CSR handouts focused on post-COVID recovery programmes, environmental protection, such as cigarette butt cleanups and tree planting. 

“Non-health departments, especially finance, commerce and customs, continued to be targeted by the industry and were persuaded by exaggerated claims of industry’s contributions to the economy,” Assunta told the media briefing to launch the report.

“They believed the industry’s narrative that illicit trade will worsen if taxes are increased. Hence, in some countries – Colombia, Mongolia, Malaysia and Turkey – there was no [cigarette] tax increase, while in others there were delays in tax payments.”

Global Tobacco Industry Interference Index 2023

Politically compromised

“Policymakers in many countries became vulnerable to industry interference when they placed themselves in situations of conflict of interest. This happens either through accepting industry donations for political campaigns or investing in the tobacco business, a revolving door situation of retiring senior government officials joining tobacco companies, or industry executives taking up senior government positions,” said Assunta.

In Uruguay, although tobacco sponsorship including political donations is outlawed,  Montepaz, which controls 85% of the Uruguayan tobacco market, contributed to the financing of the president’s election campaign.

In Colombia, the former Director of Regulation at the Ministry of Commerce joined Philip Morris International (PMI) as its head of external affairs for Colombia and Perú.

In Bangladesh, a British American Tobacco (BAT) director is the senior secretary in the Prime Minister’s Office. In Gabon, the chair of the board of a tobacco body, CECA-GADIS, is currently a political advisor to the Head of State. In Switzerland, a member of the National Council (the larger house of the Swiss legislature) is also the salaried president of the Swiss Tobacco Trade Association. Switzerland has not ratified the FCTC, neither has the US.

Mary Assunta, CGTC’s head of research and advocacy.

The governments of Bangladesh, Jamaica, Korea and Zambia still invest their pension funds or national insurance funds in the tobacco business. The Bangladeshi government holds a total of 9.4% shares in BAT Bangladesh, the Korean government owns 7.7% shares in tobacco company KT&G,  and Zambia’s pension schemes have shares in BAT Zambia.

Meanwhile, in many African countries, tobacco companies gain prominence through charity.

“In countries like Zambia, Uganda, Tanzania, Nigeria, Madagascar, Gabon, Ghana, Cameroon and Nigeria, the tobacco industry engages in activities like granting scholarships, providing classrooms, training young people in agriculture or promoting young entrepreneurship,” said Leonce Sessou, executive secretary of the African Tobacco Control Alliance.

Sessou added that the industry supported a number of NGOs to promote itself, particularly in the youth sector.

Impact of industry influence

The growing influence of industry was experienced very directly in many countries.

Malaysia’s Wency Bui told the launch that her government had de-listed nicotine as a poison after lobbying by Japan Tobacco International (JIT). This enabled the company to market nicotine products such as e-cigarettes.

Tobacco companies also successfully lobbied for the end of bans on e-cigarettes, heated tobacco products (HTPs) and/or nicotine pouches in Egypt, Kenya and Uruguay. In Uruguay, the Ministry of Public Health even used information provided by Philip Morris International (PMI) instead of its own experts.

Five countries – Bolivia, Guatemala, Jamaica, Tanzania, and Zambia – reported that the tobacco industry sabotaged efforts to pass comprehensive tobacco control legislation. 

Applying pictorial health warnings on tobacco packs was delayed in Chad, Bangladesh, Laos and Nigeria, and the implementation of standardised tobacco packaging has been undermined by the tobacco industry in Georgia, Myanmar and Uruguay. 

Some progress

Global Tobacco Industry Interference Index 2023

However, Brunei, New Zealand, France, the Netherlands and Botswana are the top five countries that performed well in pushing back against the industry. Meanwhile, Ukraine improved the most in its push-back against industry despite fighting the Russian invasion.

The Netherlands has a protocol for civil servants interacting with the tobacco industry their  Code of Conduct on Integrity (Gedragscode Integriteit Rijk) contains guidelines on interacting with tobacco lobbyists.

Botswana is in the process of finalising regulations to implement its Tobacco Control Act in 2021, which prohibits any partnership, agreement or contributions from the industry to any public body. 

The report was launched at the start of the 10th Conference of the Parties (COP10) meeting on the Framework Convention on Tobacco Control (FCTC) in Panama City, which will assess countries’ progress on tobacco control.

Image Credits: PAHO.

Bombed out ruins of Tel Al Zaatar neighborhood in northern Gaza City, near the Indonesian Hospital.

Fierce gun battles between Israeli and Hamas forces raged in the vicinity of several strategically located hospitals in northern Gaza over the weekend and into Monday – leaving the fate of the remaining patients hanging in the balance. 

At Al Shifa hospital, hospital staff were reportedly trying to keep some 37 premature babies warm by wrapping them in foil in an operating room – after electricity in the nursery housing their incubators failed due to a lack of fuel.  Three babies had already died, the hospital director Mohammed Abu Salmiya told Al Jazeera in a phone interview early Monday, and others were at risk as oxygen supplies dwindled.

“Premature and new-born babies on life support are reportedly dying due to power, oxygen, and water cuts at Al-Shifa Hospital, while others are at risk. Staff across a number of hospitals are reporting lack of fuel, water and basic medical supplies, putting the lives of all patients at immediate risk,” the regional directors of WHO, UNICEF and the UNFPA reported in a joint statement Sunday

“We have no electricity except in the emergency section. The nursery section is out of service, maternity hospital is out of service,” Salmiya said, “The oxygen generator is not working. Water, we don’t have a single drop,” he said, describing the situation as “catastrophic.” 

“The world cannot stand silent while hospitals, which should be safe havens, are transformed into scenes of death, devastation and despair,” said WHO chief Tedros Adhanom Ghebreyesus, reiterating calls for an immediate stop to the fighting.

The appeals were echoed by US President Joe Biden who said Monday that Gaza’s hospitals “must be protected”

Partial evacuation of Al Shifa  

Al Shifa Hospital – 15 October. Emergency Medical Teams (EMTs) deployed in tents outside of the compound alongside displaced people sheltering in the area.

Thousands of people sheltering at the hospital left the compound over the weekend. But many still remain on the hospital grounds, aerial photos published Monday by the New York Times suggested.

“An unconfirmed number of IDPs, along with several staff and patients have reportedly fled the Shifa hospital over the past few days, amid the intensified attacks and Israeli calls to evacuate it,” OCHA reported in its  latest newsflash, noting that the Israeli military had opened a “corridor” for people to leave.

“However, reports cited by the WHO indicated that some of those fleeing have come under fire, resulting in casualties. Humanitarian agencies have received desperate calls from staff and patients’ relatives willing to leave but fearing reported snipers around the hospital. Others, particularly people with disabilities, are physically unable to leave by themselves,” OCHA added.

Israel has said that Hamas forces are trying to discourage people from fleeing Shifa and other hospitals in the area – where it says Hamas maintains key command and control centers underground. Hamas has denied the claims.

Israeli military spokesman Daniel Harari told a Sunday evening media briefing that it had offered help to the Shifa hospital director in the evacuation of the remaining patients, but Hamas was preventing them from leaving. Troops also brought some 300 litres of fuel to the hospital entrance Sunday night, but Hamas intercepted the delivery, he said. 

OCHA said in response,“Shifa’s director has stated to the media that the amount delivered would have been sufficient for 15-30 minutes only.” It added that “the hospital would have accepted if it was delivered through the International Committee of the Red Cross (ICRC).”  

Fighting interrupts Al Kuds Hospital evacuation – Israel says weapons found at Rantisi Hospital

View of Rantisi Hospital from the entry point to a nearby tunnel, as displayed by Israel’s military spokesman in a video tour of the now vacant hospital grounds.

There were also fire exchanges with Hamas at the entrance to Gaza City’s Al Kuds Hospital, according to Palestinian and Israeli reports;, the latter displayed aerial video footage of Hamas gunmen by the hospital walls facing off against an Israeli tank. 

The Palestinian Red Crescent later said that Al Kuds Hospital was no longer operational – but it could not reach the installation to evacuate it either due to the fighting in the area. 

At Al Rantisi Children’s Hospital, evacuated by patients and staff over the weekend following an earlier standoff between Hamas and Israel, a video of the now-emptied grounds, released by Israel’s military, revealed an array of weapons in a room decked with childrens posters in what appeared to be the hospital basement. Mounted on the wall was an electronic device bearing a World Health Organization logo.  In other videos and photo footage, a deep, steel-reinforced tunnel was displayed, some 200 meters from the hospital walls. 

Recent Palestinian casualties now unclear

Due to a collapse in communications, the Hamas-controlled Ministry of Health in Gaza did not update casualty figures over the weekend, OCHA also added. 

“The latest updated, provided on Friday, showed showed that 11,078 people had been killed in the Strip since 7 October. According to Israeli official sources, 47 soldiers have been killed since the start of [Gaza] ground operations,” OCHA said.  

Around 1300 Israelis have been killed since the original Hamas incursion into Israel on 7 October, including about 300 soldiers and police.  Over the weekend, Israel revised its estimate of Israeli casualties from the 7 October raids downward from 1400 to 1200, saying that extensive forensic investigations had been required to identify the precise number of victims, some of whom had been so badly burned that even DNA samples were difficult to extract.     

Humanitarian aid deliveries in south – inferno in north  

UN water truck at Khan Younis refugee camp, in southern Gaza where hundreds of thousands of displaced people are sheltering. UNRWA has said a fuel shortage will force it to cease operations in 48 hours.

While Israeli forces tightened its chokehold on northern Gaza, the pace of humanitarian aid deliveries increased slightly in the south, with some 140 trucks entering Gaza from Egypts Rafah crossing with fuel, medicines and water supplies. But that is still a fraction of the aid that arrived daily before the war began. 

UNRWA said that its humanitarian operations in Gaza would grind to a halt within 48 hours without fuel resupplies. 

Israel has imposed a total ban on fuel deliveries to Gaza, although there were unconfirmed reports that fuel had recently been delivered to the city’s desalination plant, which forms a vital part of the region’s fresh water supplies.  

Two other water pipelines from Israel to the southern Gaza strip were also restored last week, Israel has said. But supplies to the enclave, which suffers from water scarcity in the best of times, remained desperate, particularly in the northern part of the enclave where battles continue to rage.   

Jebalya refugee in the northern strip was the scene of an inferno Monday evening as an Israeli anti-bunker munitions collapsed buildings and triggered multiple fires.  

Not too far away, the once posh Rimal neighborhood, home to a number of Palestinian government insitutions, malls and a UN Beach club, along with Al Shifa Hospital, was also a scene of devastation, with fires burning in some bombed out buildings. 

Sexual violence on 7 October  – Israeli women publish evidence of assaults

Report on gender-based violence in connection with the 7 October Hamas attacks, presented in Tel Aviv, attended by WHO Representative to Israel Michel Tieran (center right).

Meanwhile, in twin events in Tel Aviv and Boston, reports by victims and their famlies of the 7 October incursions into Israelis communities around Gaza provided grisly testimonies of alleged gender-based violence faced at the hands of Hamas gunmen that entered villages and homes early that morning.   

“Women were violently tortured… murdered and raped. Mothers were separated from their young children who were kidnapped to Gaza, Others were abducted from their homes in front of their children,” said the Israeli civil society group “Bring them Home Now,” in a report of their findings, launched in the presence of Michel Tieran, WHO Representative to Israel.

“There is a wide variety of evidence of sexual violence and horrific gender-based crimes among them videos of survivors, eyewitness, first responders… and forensic evidence,” said Dr Cochav Elkayam-Levy, an expert in international human rights law, at another event sponsored by an association of Harvard University medical students. She said videos released by Hamas and eyewitness accounts by responders described how some women were stripped, bound, and bloodied by acts of sexual violence before being killed or taken captive. 

Later in the day, Hamas’ armed wing, the Al Qassam Brigades, published a statement and video footage claiming that one Israeli female hostage, 19-year-old soldier Noa Marciano, had been killed in an Israeli airstrike, while another captive soldier was wounded.    

There are still no clues as to the whereabouts or condition of the hostages still presumed to be alive.  But some of the women are elderly and require medicines for chronic diseases; others are under treatment for breast cancer, the families noted in the event in Tel Aviv. They called upon UN Women, the International Committee of the Red Cross, and other UN organizations to review the evidence of sexual violence against victims and to demand access to the hostages in captivity, including not only women but some 30 children.   

Image Credits: @GazaReport, WHO/EMRO, @idfonline.

Alcohol has had a fairly easy pass from public health authorities – although the World Health Organization (WHO) recently asserted that there is no safe level of drinking, upending many people’s cherished illusion that a glass of alcohol at the end of the day is harmless.

RESET Alcohol, a new public health initiative led by Vital Strategies, aims to tackle alcohol’s ubiquitous influence primarily by working with governments to increase taxes.

The $15 million initiative will focus initially on Brazil, Colombia, Mexico, Kenya, the Philippines and Sri Lanka.

“We were looking for governments that are committed to doing alcohol policy work and could demonstrate that they were willing to go forward and, particularly, raise taxes,” said RESET director Jacqui Drope of the choice of countries. 

Population size and alcohol abuse burden were also factors, she added in an interview with Health Policy Watch.

Most of these countries already have alcohol taxes. In the Philippines, for example, alcohol taxes already help to pay for universal health care, while in Kenya, civil society advocates are fighting to make sure alcohol tax rates keep pace with inflation.

Following the tobacco control example

“The primary focus has always been on increasing alcohol taxation as it’s one of the most effective things you can do,” added Drope, who has a long history in tobacco control.

Cigarette taxes have been shown to curb smoking, particularly in young people. For example, in New York state cigarette taxes are the highest in the US and the state has seen youth smoking rates drop by more than 90% since 2000 as a result. 

RESET Alcohol will work mainly by supporting governments, civil society and research groups to build their capacity to implement and strengthen alcohol policy. 

It will do so in part by mentoring people in policy and regulation development, taxation research, strategic communication and advocacy, and alcohol data and monitoring systems.

RESET Alcohol Director Jacqui Drope

Not prohibition

The initiative isn’t about prohibition, Drope stressed: “We’re coming at this from a harm-reduction standpoint. That is why it is about policy and what we can do at the population level. We aren’t working at the individual level and prescribing what individuals do.

“We know this is an unhealthy product, and there’s good evidence from the WHO to show that there is no safe level [of consumption]. What we’re trying to do is reduce the harms through policy, rather than saying that people should never drink again. This isn’t what we’re trying to accomplish.”

‘War of perception’

For adults aged between 25 and 49, alcohol is the leading cause of death and disability globally based on the Global Burden of Disease analysis. 

“Often the underlying connection of alcohol consumption between these deaths – from liver disease, heart disease, cancer, violence, vehicle crashes, falls, tuberculosis, HIV/ AIDS, and other conditions – is overlooked,” according to Vital Strategies.

People calling for more alcohol oversight is “cast as a buzzkill”, according to the global health organisation.

“It’s a war of perception that claims millions of lives each year. Alcohol use remains stubbornly rooted as a cultural norm in most of the world, and few recognise it as a public health threat.”

Drope acknowledged that alcohol is so deeply entrenched that even the health sector has been complicit in perpetuating the notion that moderate alcohol consumption is healthy: “We have a lot of work to do and think about to change norms, and change how we talk about alcohol.”

At risk ‘from the first drop’

Recent data that shows half of all alcohol-attributable cancers in the WHO European Region are caused by “light” and “moderate” alcohol consumption – less than 1.5 litres of wine or less than 3.5 litres of beer or less than 450 millilitres of spirits per week. 

“This drinking pattern is responsible for the majority of alcohol-attributable breast cancers in women, with the highest burden observed in countries of the European Union (EU),” according to the WHO European Region.

“We cannot talk about a so-called safe level of alcohol use. It doesn’t matter how much you drink – the risk to the drinker’s health starts from the first drop of any alcoholic beverage. The only thing that we can say for sure is that the more you drink, the more harmful it is,” explained Dr Carina Ferreira-Borges, WHO regional advisor for alcohol and illicit drugs. 

Alcohol consumption and related deaths in different regions of the world

Globally, the WHO European Region – which includes heavy-drinking countries such as Czechia, Latvia, Lithuania, Russia and Germany – has the highest alcohol consumption level and the highest proportion of drinkers in the population. Over 200 million people in the region are at risk of developing alcohol-attributable cancer.

“Although it is well established that alcohol can cause cancer, this fact is still not widely known to the public in most countries. We need cancer-related health information messages on labels of alcoholic beverages, following the example of tobacco products; we need empowered and trained health professionals who would feel comfortable informing their patients about alcohol and cancer risk; and we need overall wide awareness of this topic in countries and communities,” added Ferreira-Borges.

In early November, WHO Europe Regional Director Dr Hans Kluge and the Director of the International Agency for Research on Cancer (IARC), Dr Elisabete Weiderpass, issued a joint statement to the European Parliament calling for more awareness about the link between alcohol and cancer.

“The contribution of alcohol consumption to cancer incidence and mortality should be clearly recognized without the use of any qualifiers or misleading adjectives such as ‘harmful’ or ‘heavy’ consumption of alcohol or ‘responsible drinking’,” they noted.

“Measures should be taken to clearly inform the public of this risk, which is not well known among the general population,” they added, pointing out that two WHO health plans “recommend the use of health warning labels on alcoholic beverage containers to inform the public about the health consequences of alcohol use”.

Image Credits: Unsplash, WHO .

Lab technicians at work in Cape Town’s Afrigen Vaccines & Biologics, one of the core partners in the WHO co-sponsored mRNA vaccine technology transfer hub, founded by WHO in 2021.  Much more needs to be done to foster local manufacturing of vaccines and health products, said participants at the Second World Forum.

A new Health Technology Access Pool (H-TAP), which aims to broaden the scope of IP and patent-sharing with low- and middle-income countries and a new African Union co-sponsored ‘manufacturing support platform’ were among the initiatives announced this week at the Second World Local Production forum in The Hague.

The global forum, the second ever to be convened, brought together industry, governments, civil society and multilateral organizations, including WHO, in a quest to bolster the local production of medicines and vaccines in underserved regions, particularly Africa, which was last in line to get COVID treatments during the pandemic.

The new H-TAP aims to overcome the shortcomings of the COVID-19 Technology Access Pool, C-TAP, which failed to gain significant buy-in from the industry. It also will include medicines and vaccines beyond COVID products, said Dr Yukiko Nakatani, Assistant Director-General for Access to Medicines and Health Products, at the Forum.  However, whether the new mechanism can really overcome the shortfalls seen in C-TAP, which drew little industry support, remains to be seen.

“Six license agreements for 15 health products have been agreed upon with Covid-19 technology holders – including from one private sector manufacturer. A serological test license from the Spanish National Research Center (CSIC) led to a sub-license to Biotech Africa to develop their diagnostic technology,” said Nakatani at the Local Production Forum, in his review of the slim achievements of the C-TAP pool.

“A review of C-TAP has been undertaken and a new technology access pool operating model is being developed and will be launched end of 2023. Stakeholders consultations will be held to help in the refinement and implementation of the model,” Nakatani said.

H-TAP and the WHO Pandemic Accord – interface unclear

As for further details on the H-TAP initiative, WHO did not comment.  However Ellen ‘t Hoen, head of the non-profit Medicines Law and Policy,  said that she expected the ongoing WHO member state negotiations on a new pandemic accord would also have to “address the need for the expansion of such a mechanism to enable the sharing of IP, including know-how and trade secrets.”

Meanwhile, in an open letter published at the start of the three-day Forum, a coalition of 30 prominent medicines access organizations, including Oxfam, the People’s Vaccine Alliance, Unitaid, and Public Citizen, warned that efforts to strengthen local medicines production in LMICs without addressing IP to “building a bridge to nowhere”.

“Plans and seed resources for building a bridge to local manufacturing abound, but they all have one feature in common – they systematically refuse to address the intellectual property barriers,” the open letter states.

At the World Health Summit in Berlin last month, German Health Minister Karl Lauterbach stated that any agreement without strong IP protections would “not fly” for Germany and its fellow EU countries, comparing IP to part of the EU’s “DNA.”

That stance was further reinforced at the start of the seventh round of INB negotiations on Monday when European countries asserted that any changes to IP rights should be thrashed out at the World Trade Organization (WTO) – not the WHO.

Tedros acknowledges the shortcomings of C-TAP model

WHO Director-General Dr Tedros Adhanom Ghebreyesus and Dutch Minister of Health Ernst Kuipers at the second World Local Production Forum in The Hague, Netherlands.

It took a staggering three years for a vaccine license to be shared with C-TAP, long after its potential to save lives had diminished. Aside from one Taiwanese firm, noit’s some private pharmaceutical company shared vaccines or therapeutics with the platform.

In his opening remarks, WHO Director General Dr Tedros Adhanom Ghebreyesus acknowledged the shortcomings of the C-TAP, the WHO’s ambitious platform aimed at facilitating patent-sharing for COVID-19 vaccines, treatments and medical technologies during the pandemic.

“The COVID-19 pandemic demonstrated the incredible power of vaccines, tests, treatments, and other medical technologies to save lives, but it also exposed the vast inequalities in our world,” Dr. Tedros stated. “Of course, this is not the first time.

“When HIV emerged over 40 years ago, life-saving medicines were developed, but more than a decade passed before the world’s poor got access to them,” he lamented. “When the H1N1 influenza pandemic struck 14 years ago, vaccines were developed, but by the time the world’s poor got access, the pandemic was over.”

However, the wakeup call provided by the pandemic also marked a turning point, Tedros and other speakers noted. That led to the creation of WHO’s mRNA vaccine technology transfer hub, launched in 2021 in South Africa.  Another global training hub in biomanufacturing capacity was also launched by WHO in collaboration with The Republic of Korea.

Local manufacturing has become more prominent on agenda now

Mapping of existing and planned manufacturing initiatives in Africa, as of December 2022.

The issue of local manufacturing was ignored for decades when UN-backed initiatives like The Global Fund to Fight TB, HIV/AIDS and Malaria, and Gavi, The Vaccine Alliance, channeled most contracts to a handful of large, well-established manufacturers in China, India, Europe or North America – ostensibly to reduce costs.  The concentration of their procurement, however, also tended to disadvantage local startups in other low- and middle-income countries, which could not compete with pharma giants in economies of scale, or pricing.   

Technology transfer and local production of medicines was first included on the agenda of the World Health Assembly (WHA) in 2018. During the WHA that year, Medecins Sans Frontières representative Elena Villanueva-Olivo condemned the failure of global research and development efforts and unequal access to affordable health technologies as “crises of international concern.”

Belatedly the pandemic cast a sharp light on the dearth of local manufacturing, particularly in Africa. It highlighted the long-term damage of concentrating procurement amongst only a handful of manufacturers, and highlighted how over time, more local manufacturing of essential medicines and vaccines could offer greater affordability and improved access to life-saving treatments, as compared to reliance on imports.

Since then, a flurry of new initiatives have been announced by WHO, the African Union and pharma companies themselves, including giants like Pfizer.  Big questions remain, however, regarding the durability and sustainability of the new projects in planning or already underway. 

New platform launched to support African manufacturers

The new Health Products Manufacturing Support Platform, launched at the Forum by Unitaid, the African Union Development Agency, and WHO aims to address some of those sustainability issues.

The platform will provide technical assitance to African manufacturers along the entire “health products manufacturing value chain,” its promoters said.

The support could range from technical assistance in “business management, sales and operations”, to support for the acquisition and development of active pharmaceutical products, and preparation of drug dossiers to ensure compliance with regulatory standards, the project initiators said.

The initiative calls upon African manufacturers, R&D centers and centers of excellence, as well as “market actors” including industry associations to collaborate in the initiative.

Over 79% of African pharma products are imported, while Africa supplies only 3% of global production of medicines and vaccines, it’s developers note.

Sidestepping IP issues? 

Filling vials for vaccine R&D at South African’s vaccine manufacturer Afrigen.

While developed countries and the private sector have emphasized the need to create a broad “ecosystem” to foster local manufacturing of health products, including investments in training, knowledge transfer and procurement preferences of global agencies and countries, civil society have long contended that IP restrictions constitute the key barriers:

“All of these hopes for local and regional production hinge on whether low- and middle-income countries (LMICs) have access to IP-protected research tools, technology platforms, product and process inventions, trade secrets, regulatory data, biologic resources (such as cell lines), and other knowledge essential to product development,” said the CSO  signatories to Monday’s letter. 

“We cannot be complacent – or resigned – to the siren song of purely voluntary measures and continued private hegemony over tools and knowledge by which the right to health is realized,” the letter states.

“We learned the painful costs of knowledge privatisation during the COVID-19 pandemic when major vaccine producers, including leading participants in the World Local Production Forum, refused to license their IP and share their breakthrough technologies and manufacturing know-how with capable producers in LMIC regions,” the coalition of civil society groups wrote in their letter to the forum.

“Instead of building bridges to nowhere, international and multilateral institutions … must finally commit to supporting countries in their collaborative efforts to overcome IP barriers that will otherwise stifle local manufacturing,” the signatories added.

A draft set of recommendations from the Forum, seen by Health Policy Watch recommends “four interrelated elements to an ecosystem that need to be present,” to stimulate local manufacturing, including:

  • The essential components of supplies, infrastructure, skills and technologies for manufacturing capacity.
  • Financial investments for procurement, the scaling up of production and the equitable distribution of health products.
  • Skilled and trained policy makers and regulatory authorities for product quality, safety and predictability.
  • Information on, for example, actual production capacity and market demand.

It also recommends the “establishment of a network for synchronizing training resources and facilities for building private and public sector capacity in manufacturing, technology transfer, R&D, policy, regulation and implementation. For the moment, access to IP and other know-how needed for R&D and manufacturing is not on the map.

Stefan Anderson contributed reporting for this story. 

Image Credits: Rodger Bosch for MPP/WHO, Netherlands MoH, Clinton Health Access Intiative , Health Products Manufacturing Support PlatformMSP , Rodger Bosch/ MPP & WHO.