Dame Barbara Stocking urged negotiators to reach agreement.

At the opening of the final pandemic agreement negotations for 2024 on Monday, a group of long-time observers urged countries to “get it done” after three years of negotiations.

“The finishing line to the pandemic agreement is in sight, and we urge all member states to keep up the momentum and negotiate a final agreement that is equitable, and that has a clear path to adoption and delivery,” said Dame Barbara Stocking of the Panel for Global Public Health Convention, also speaking for the Pandemic Action Network, the Independent panel for Prevention, Preparedness and Response, the Global Preparedness Monitoring Board and Spark Street Advisors.

“It will serve as a baseline for global action against pandemic threats, not just now, but in the future as circumstances change and move. We just urge you to keep it up and get this done. We’re with you and behind you all the way.”

Meanwhile, World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyusus told the Intergovernmental Negotiating Body (INB) that he had addressed them multiple times and “I’m not sure there is anything new that I can say”.

“As I have said repeatedly, for the pandemic agreement to be meaningful, you need provisions of strong prevention, for continued preparedness and for robust, resilient and equitable response,” added Tedros.

“I urge you to be guided by public health. I cannot emphasize this enough, and convergence on outstanding issues is possible if you maintain your focus on public health,” said Tedros, who reiterated that it is possible for the INB to clinch the agreement this week.

Handful of outstanding issues

Yuan Qiong Hu of Medecins sans Frontieres (MSF)

Meanwhile, civil society organisations that addressed the start of the talks raised their concerns about a handful of outstanding issues in the draft agreement.

Addressing Article 9 [research and development], Yuan Qiong Hu of Medecins sans Frontieres (MSF) said that it could be an “essential lever to ensure equity” as it could establish the first international law that makes global access a condition of publicly funded R&D.

The Drugs for Neglected Diseases Initiative (DNDi) wants Article 9 to “clarify the nature of the provision of access to comparative products” for those who take part in clinical trials.

“Do you want an agreement that seriously and practically protects the health and economy of everybody on the planet, or do you want to protect the financial health companies?” asked Oxfam’s Mogha Kamal-Yanni. 

“You would answer the question in the way that you address the remaining key issues, such as on Article 11 [technology transfer]: Would you leave technology transfer to continue being under the control of companies, basically continuing the current system that stopped the mRNA hub from producing COVID vaccine in time to vaccinate developing countries at the same time as people in the north again?” she asked.

“On Article 12 [pathogen access and benefit-sharin]5, would you leave sharing the benefits of sharing pathogens to the whim of pharmaceutical companies? Demanding that countries share the pathogen data immediately while condemning them to wait for the goodwill of pharmaceutical companies does not make sense to 80% of the globe. 

“Moreover, if you really want to protect people, the agreement must clearly spell out serious commitments from all countries to public health through domestic funding, aid and debt relief, with transparency that enables public scrutiny and a legally binding commitment to protect all people, whoever they are, wherever they are.”

IFPMA’s Grega Kumer

The International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) said that a “multi-stakeholder approach is key for managing pandemics effectively”. 

“The pandemic treaty provides a unique opportunity to clarify roles and responsibilities and elaborate how stakeholders can depend on one another to achieve a better outcome in the next pandemic,” said the IFPMA’s Grega Kumer.

“To strengthen equitable access, member states need to address key obstacles such as insufficient funding for procurement in low-income countries, poor demand forecasting,  regulatory challenges, limited absorption capacity and export restrictions,” he added.

“The industry also has an important role to play in equitable access, alongside its role in driving the innovation that will create the pharmaceutical products needed to respond to the next pandemic outbreak,” Kumer added.

Once again stressing that “a strong intellectual property system is essential for enabling that innovation”, Kumer said that industry “has committed to expanding access to its products during a pandemic through a range of options such as donations, tiered pricing and voluntary sub-licensing and technology transfer on mutually agreed terms”. 

Spark Street Advisors once again called for countries’ reporting on their state of pandemic readiness to be mandatory not voluntary, coupled with independent monitoring.

Formal negotiations will proceed alongside informal meetings on outstanding issues, ending on Friday.

Many parties hope for agreement before 20 January, when Donald Trump assumes the US presidency and may withdraw his country from the WHO. 

A policy panel held at the World Vaccine Congress Europe.

From being a largely unknown pathogen, Respiratory Syncytial Virus (RSV) is now almost a household word – and a fearful one for families with infants and young children at risk. But new solutions, such as long-acting monoclonal antibodies (mAbs) and maternal vaccination, both recently recommended by the World Health Organization (WHO), could dramatically alter the RSV landscape.  

Scientific experts and health policy advocates explored these new preventative tools for RSV and their initial uptake in  Italy and Spain at a recent panel discussion at the recent European World Vaccines Congress.

Lower respiratory tract infections (LRTI) are the leading cause of death, and hospitalisation for infants globally. The global incidence of RSV-associated LRTI is estimated at over 30 million cases in children under the age of five, resulting in 3.2 million hospitalisations.

The impact of RSV in high-income and upper-middle-income countries is best documented insofar as it is associated with high hospitalisation rates and significant healthcare costs. But the impact may be even more severe in low and middle-income countries, but less well-recognized. 

“Almost three-quarters of the deaths associated with severe respiratory diseases in infants occur outside hospitals because of issues of access to care,” said Professor Heather Zar, head of the Department of Paediatrics and Child Health and director of the Unit on Child and Adolescent Health at the University of Cape Town in South Africa.

Impact on families

Hospitalisations for respiratory diseases, particularly RSV, place a considerable financial and emotional burden on families, with stress that extends beyond the child. 

According to a survey conducted by the National Coalition for Infant Health in the US, close to 68% of parents said watching their child suffer from RSV impacted their mental health. More than one-third said the experience strained their relationship with their partner.

The survey also found that many parents had to make difficult sacrifices, with 10% quitting their jobs to care for their child and 7% even being fired for taking time off. These hardships underscore the importance of preventive measures to lessen the multifaceted impacts on families.

Long-term burden of respiratory illnesses

Respiratory illnesses can have lasting consequences on a child’s health. Zar shared insights from research that connects early-life RSV with chronic respiratory issues such as asthma and recurrent lung infections: “Children who experience early RSV infections are more likely to suffer from recurrent pneumonia, and face a significantly higher risk of asthma later in life.”

This chronic burden reinforces the necessity of early intervention.

RSV hospitalisations are longer than those for respiratory viruses such as influenza and rhinovirus, exacerbating the strain on healthcare systems.

The ReSViNET Foundation, an international non-profit organisation that works towards reducing the burden of RSV, observed in its studies that parents often went to their GP multiple times before RSV was recognised, sometimes resulting in a dangerous escalation to the point where the child needed to be taken to hospital by  ambulance. 

New tools to prevent RSV 

With recent advances in preventive care, experts believe that tools such as long-acting monoclonal antibodies (mAbs) and maternal vaccination could dramatically alter the RSV landscape. 

The WHO’s Strategic Advisory Group of Experts (SAGE) has recommended that all countries introduce maternal vaccination and/ or long-acting mAbs for RSV prevention in young infants. 

“Long-acting monoclonal antibodies and maternal vaccines provide passive immunity and last through the RSV season, protecting infants during the most vulnerable period of life,” said Zar.

Spain’s recent RSV immunisation campaign offers a glimpse into the potential effectiveness of these new tools. Professor Federico Martinón-Torres reported that Galicia’s RSV mAbs campaign achieved over 90% uptake in high-risk and newborn cohorts, with an 82% reduction in hospitalisations for severe RSV.

This success showcases the efficacy of long-acting mAbs. It underscores the potential of universal immunisation programmes to mitigate the seasonal burden of infant RSV, reducing the toll on infants and their families.

Italy is now taking steps to introduce RSV mAbs for infant immunisation this season, said Professor Elena Bozzola, national counsellor of the Italian Paediatric Society (SIP).  “Since the national health service fully subsidises the immunisation of children in Italy, it is a great opportunity to protect all infants with RSV mAbs,” she added. 

Challenges in implementing technologies

Barriers persist in ensuring that scientific advances reach all infants. Disparities in access, cultural misconceptions about vaccine safety, and inconsistent national guidelines pose significant roadblocks to the widespread adoption of new tools for RSV prevention. 

For instance, in the US many hospitals do not administer RSV immunisations to newborns due to reimbursement complications. Hospitals receive a bundled payment for each birth, and modifying this to cover RSV immunisations can take years of negotiation with insurers.

Spain’s programme, while effective, also encountered obstacles: “We didn’t know how the population or healthcare providers would accept this. However, following a robust awareness campaign, the results were remarkable,” said Martinón-Torres.

The path to universal access remains challenging, especially in regions with weaker healthcare infrastructure and limited funding.

Pivotal moment

The emerging tools for RSV prevention represent a pivotal moment in infant health. Their successful implementation will lay the groundwork for future prevention of other diseases using mAbs and could be a model for introducing other new technologies. “The coming years will be exciting to see as more countries explore these technologies for wider adoption,” Zar said.  

Today, effective prevention strategies for RSV can reduce infant mortality and alleviate the broader societal and economic impacts on families, healthcare systems, and communities, the experts in our meeting agreed. 

Our health systems and policies must evolve alongside these innovations. For instance, our thinking needs to extend beyond traditional delivery methods and create additional access points for administration. 

The journey to wider access requires continued advocacy, funding, and collaborative efforts. With a concerted approach from healthcare professionals, policymakers, and society, we can make a major stride in infant health.

This article is based on the discussions of a policy panel held at the World Vaccine Congress Europe, and sponsored by MSD.

Susan Hepworth is executive director of the  National Coalition for Infant Health.

Leyla Kragten-Tabatabaie is on the board of directors of ReSViNET Foundation

A new report cautions that land degradation, if not reversed in time, could harm generations.

The world needs to urgently change the way food is grown and land is used in order to avoid irreparable harm to global food production capacity, according to a major new scientific report released Sunday.

Currently seven out of nine ‘planetary boundaries’ have been negatively impacted by unsustainable land use, mostly related to unsustainable agriculture, warns the report produced by the German-based Potsdam Institute for Climate Impact Research (PIK) along with  the UN Convention to Combat Desertification (UNCCD).

Approximately 15 million km² of land area, or 10% of the world’s terrestrial space, is already severely degraded, as measured by the extent of deforestation, diminished food production capacity, and the disappearance of freshwater resources. And this degraded land area is expanding each year by about 1 million km², according to the report.

“We stand at a precipice and must decide whether to step back and take transformative action, or continue on a path of irreversible environmental change,” said Johan Rockström, Director at PIK who is also the lead author of the report.

There are conflicting figures on the extent of global land degradation, due to differences in definitions and indicators according to a paper by Jiang et al (2024).

Shifting food production to “regenerative agriculture” practices as well as land restoration to improve the health of lakes, rivers and underground aquifers are among the immediate solutions needed to make a course correction.

Without rapid adoption of such measures, the Earth’s capacity to support human life and wellbeing could be irretrievably harmed, the report warns. This harm can be in the form of the collapse of the Arctic ice sheets and the weakening of the land’s ability to act as a carbon sink.

Failure to reverse land degradation trends that result in deforestation and impoverished soils will also have long-term, knock-on impacts with respect to hunger, migration, and conflict, the report warns.

“If we fail to acknowledge the pivotal role of land and take appropriate action, the consequences will ripple through every aspect of life and extend well into the future, intensifying difficulties for future generations,” said Ibrahim Thiaw, Executive Secretary of the UNCCD.

Land is under threat from human activities, climate change

The concept of planetary boundaries is anchored in nine critical thresholds essential for maintaining Earth’s stability. Rockström was the lead author of the study that introduced the concept of planetary boundaries in 2009.

How humanity uses or abuses land directly impacts seven of these planetary boundaries, which include: climate change, species loss and ecosystem viability, freshwater systems, and the circulation of naturally occurring nitrogen and phosphorus, the report said. Land use changes, such as deforestation, also broach a planetary boundary.

“The aim of the planetary boundaries framework is to provide a measure for achieving human wellbeing within Earth’s ecological limits,” said Johan Rockström, lead author of the report.

Currently, the only boundary that is within its “safe operating space” is the stratospheric ozone as that was addressed through a 1989 treaty called the Montreal Protocol that sought to reduce ozone-depleting chemicals in the atmosphere. This also is an example of how taking action can have a positive long-term impact.

Along with unsustainable agricultural practices and the conversion of natural ecosystems to monocultures of cultivation, deforestation and urbanisation all are putting these planetary limits under pressure. Agriculture alone accounts for 23% of the greenhouse gas emissions, 80% deforestation and 70% freshwater use.

In addition, challenges such as climate change and biodiversity loss are worsening land degradation creating a vicious cycle, according to the report.

What governments must do

The report urges the use of ‘regenerative agriculture’ that focuses on improving soil health, carbon sequestration and biodiversity enhancement.

Agroecology that emphasizes holistic land management, including the integration of forestry, crops and livestock management, is another solution.

In addition, woodland regeneration, no-till farming that causes less disturbance to soil, improved grazing, water conservation, efficient irrigation and the use of organic fertilisers, are some of the other solutions that have been highlighted.

For water conservation the report urges reforestation, floodplain restoration, forest conservation and recharging aquifers, along with improving the delivery of chemical fertilizers – the majority of which currently runs off into freshwater bodies.

Transformative actions can halt land degradation

Numerous multilateral agreements on land-system change exist but have largely failed to deliver. The Glasgow Declaration to halt deforestation and land degradation by 2030 for instance was signed by 145 countries at the Glasgow climate summit in 2021, but deforestation has increased since then.

Keeping forest cover above 75% keeps the planet within safe bounds for instance, but forest cover has already been reduced to only 60% of its original area, according to the most recent update of the planetary boundaries framework by Katherine Richardson and colleagues.

Authors of the report added that the principles of fairness and justice are key when designing and implementing transformative actions to stop land degradation so that the benefits and burdens are equitably distributed.

They also said that action must be supported by an enabling environment, substantial investments, and a closer collaboration between science and policy.

This report was launched ahead of the UNCCD summit that is being called COP16 this year, and is taking place in Riyadh, Saudi Arabia. Following a disappointing COP29 in Baku, there is concern that actions are falling short in the face of climate crisis.

Image Credits: Unsplash, UNCCD report.

Demonstration at the 24th International AIDS Conference, 2022, Montreal, Canada.

This was the question posed to us recently by a young person from our Youth4Health network.  Our answer, both simple and sad: the reasons are not medical.

As we observe World AIDS Day on Sunday, 1 December, the biggest remaining hurdles in the fight against HIV/AIDS in our region, and indeed much of our world, are political. Restrictive and intolerant environments. Stigma, discrimination and even criminalization of HIV transmission. Inconsistent uptake of evidence-based and recommended interventions.

Today we have all the medicines, tools and technologies to end AIDS. An HIV-positive test is no longer a death sentence. Dramatic improvements in antiretroviral therapy, or ART, allow people living with HIV to lead healthy, long lives – especially if they are diagnosed early and stay on antivirals.

Indeed, more people than ever are receiving life-saving medication. New diagnostic algorithms allow same-day diagnosis. Tests can be done in community settings or at home. And, let’s not forget, we have very effective means of prevention such as pre-exposure prophylaxis or PrEP and – not least – condoms.

We need to depoliticise the HIV response

At 30.6 diagnoses/100,000 population, HIV diagnosis is nearly 8 times higher in Russia and central Asia (burgundy) as compared to much of eastern Europe and Turkey (4.2 diagnoses/100,000) and 6.2/100,000 in western Europe. But about 40% of HIV infections in central Asia and eastern Europe are not diagnosed.

Our HIV toolbox is full, but progress on uptake remains uneven and unequal. Prevention, testing and treatment aren’t reaching everyone yet. This becomes clear when we look at the numbers.

In the WHO European Region, covering 53 countries in Europe and Central Asia, the number of new HIV infections in 2024 increased by 7% compared with 2010. Every second person who tests positive for HIV across the Region is diagnosed late.

Half of all people living with HIV in Eastern Europe and Central Asia are still not receiving ART, and only 42% are virally suppressed – meaning they no longer pass on the virus.

To end AIDS once and for all, we have to overcome stubborn hurdles and take action.

First, countries have to depoliticize the HIV response.

Looking across Europe and Central Asia, far too many countries still have discriminatory and regressive approaches towards key populations – including sex workers, men who have sex with men, transgender persons, and people who inject drugs – and, in general, people living with HIV. Many countries still treat sexual health and sexuality as a taboo. While some countries have progressed in this regard, albeit slowly, others have actually regressed over time amid reactionary political trends and patterns.

Half of all people living with HIV in Eastern Europe and Central Asia are still not receiving ART, and only 42% are virally suppressed – meaning they no longer pass on the virus.

HIV-related stigma is a problem almost everywhere

But make no mistake: HIV-related stigma is a problem, to some extent, in every country and society. We need to ensure that HIV-related policies are compassionate, not punitive. We must treat people at risk of, living with or affected by HIV with kindness and dignity – within healthcare settings and in wider society. We must create safe spaces for people – no matter who or where they are – to access services and normalize testing.  

Education and public awareness ultimately remain our best weapons against stigma, including age-appropriate comprehensive sexuality education that provides young people with a foundation for empathy, life, and love.

Second, countries and development partners need to invest in the HIV response to leverage new innovations.

In July this year, UNAIDS reported that the global AIDS pandemic can be ended by 2030, if leaders boost resources, particularly for HIV prevention. By prioritizing combined prevention approaches, we can reduce new infections.

Reaching the  ’95 goals’

Challenging AIDS stigmatization in Uzbekistan

We must also keep our foot on the accelerator to reach the “95 goals” across the WHO European Region as a whole. Developed by UNAIDS as a marker for the 2030 Sustainable Development Goals, and incorporated into a 2021 UN political declaration on AIDS, 95-95-95 means the following: 

  • 95% of people living with HIV knowing their status;
  • 95% of people with diagnosed HIV infection receiving sustained ART;
  • and 95% of people receiving ART having viral suppression.

We cannot prevail over a 40-year-old epidemic solely with old tools and models – such as unrealistic messaging on abstinence or relying exclusively on condoms – when we have new ones, including PrEP, self-tests and the latest generation of ART. Only by acting differently can we get ahead of the curve.

Third, we need to reach people with information, prevention, testing. and treatment.

The fact that the majority of HIV diagnoses are made too late shows that we need to change our testing strategies and reach people far earlier. Every early diagnosis can help prevent severe disease and further transmission. This means key populations in particular must feel confident they can avail of information, prevention and testing in safe environments. The shocking fact remains that healthcare settings, and personnel, can often exhibit some of the worst HIV-related stigma and discrimination – scaring people away and effectively ensuring they do not access lifesaving services. We need to make sure awareness campaigns counter these deeply rooted misconceptions.

The human right to health

Consultation in Hospital in Chisinau, Moldova.

In the end, access to HIV prevention, treatment and care services are all part of the human right to health. Everyone should have access to the health services they need, when and where they need them. Our societies have the necessary medicines and tools to end AIDS. Now we need to use them to make sure that everyone can benefit.

In early 2025, the WHO Regional Office for Europe will consult with countries in the EURO region on joint efforts to reach the 95 goals. Our continuous efforts on HIV/AIDS response will not stand alone but be integrated in the control of infectious diseases more broadly including other sexually transmitted infections.

We have multiple public health crises knocking on our door, vying for attention, from climate change to growing resistance against lifesaving antibiotics. These are enormous, daunting challenges with no easy answers – compared to HIV where we know exactly what needs to be done.

But do we have the political will necessary to double down on HIV? To do away with health sector stigma? To invest optimally in diagnostics and therapeutics? To reach out all the better to key populations and connect them to the continuum of care they need?

In the next decade, the AIDS pandemic should become a thing of the past. Future generations should not have to worry about it. We must strive ever harder for a Region and a world where the question ‘Why are people still dying from AIDS?’ is confined to the history books – as, ultimately, is HIV itself.

Hans Kluge is the WHO Regional Director for Europe. Robb Butler is WHO/Europe’s Director for Communicable Diseases, Environment and Health.

Image Credits: Marcus Rose/ IAS, WHO/European Region , UNAIDS 2024 Update, UNAIDS, – Eelena Covalenco-UNAIDS.

WHO’s Dr Maria Von Kerkhove warns against drinking raw milk.

“Much stronger surveillance” of deadly H5N1 and other avian influenza strains in both domestic and wild animals is needed both in The United States as well as globally so as to head off pandemic risks from variants that could mutate to infect humans more directly. 

A senior World Health Organization official, Dr Maria Van Kerkkove, issued the appeal at a WHO press briefing on Thursday. She also said that WHO ‘always’ recommends drinking pasteurized, instead of raw, milk – due to the risks of contamination by a number of pathogens, including H5N1 virus.

At the briefing, WHO Director General Dr Tedros Adhanom Ghebreyesus also welcomed  the new cease-fire between Israel and Lebanon.  But he said that much more still needs to be done to end hostilities between Israel and Hamas in Gaza – where 90% of Gaza Palestinians are now facing winter in tents, with risks of respiratory diseases, cold exposure and malnutrition even more acute than last year. See related story:

WHO Welcomes Israel-Lebanon Ceasefire – But Onset of Winter Increasing Desperation in Gaza   

‘Epizotic’ of Avian flu in animals worldwide 

While the number of human infections from H5N1 is “still small, relatively speaking,” it is also growing  “not only in the US, but around the world over the last several years,”  Van Kerkhove told journalists.

But what is really “concerning” she added, is the “massive epizootic of avian influenza, including H5N1, but not just H5N1, in wild birds, in poultry, expanding to other animals, livestock, dairy cattle in the United States, but also land mammals, marine mammals. 

“And over the last couple of years, this expansion of H5N1 of avian influenza is putting more people at risk,” she added.  

So far, there have been about 55 human infections reported in 2024, she said, 52 in the United States. All but two of others had “known exposure” to infected animals. And there are extensive investigations that are underway looking at the pathway of exposures in the different cases, to see how people were in fact infected, she added. 

“But what we really need globally, in the US and abroad, is much stronger surveillance in animals, in wild birds, in poultry, in animals that are known to be susceptible to infection, which includes swine, which include dairy cattle to better understand the circulation in these animals, ,” stressed Van Kerkhove. And, she added, “we need much stronger efforts in terms of reducing the risk of infection between animals to new species and to humans.”

The US Department of Agriculture has confirmed cases of infected cattle in some 505 dairy herds in 15 US states since the outbreak was first reported in March, as well as in 50 commercial poultry flocks, according to the latest government data.

H5N1 outbreaks in cattle since beginning of outbreak in March 2024.

More protection of people occupationally exposed also needed

Van Kerkhove also called for more protection of people most at risk – those working with, or handling animals, “making sure that they have the right personal protective equipment, that it’s worn appropriately and properly when they are handling infected animals or even suspected infected animals. 

“We need to make sure that they have testing, that they have access to care, so that we can mitigate any potential spread. We have not seen evidence of human to human infection, but again, for each of these human detected cases, we want to see a very thorough investigation taking place, including further testing of context.

Finally, she added that WHO recommends that the public always drink pasteurized milk rather than raw milk products “for a number of different health benefits…. This is just as important for H5N1 as it is for other pathogens, other bacteria.”

WHO appeals risk a chilly reception from the new US administration 

Robert Kennedy Junior’s photo on X. The nominee for US Secretary of Health and Human Services advocates raw milk consumption and has promised to shift attention from infectious to chronic disases.

The recommendations for stepped-up surveillance of H5N1 in animals and people, as well as  avoidance of raw milk consumption, are likely to meet with a chilly reception in the new US administration of President-elect Donald Trump, who will be inaugurated on 20 January 2024.  

Although US dairy cattle are currently at the epicenter of an outbreak of H5N1 surveillance of both human and animal cases has so far been based largely on voluntary testing and reporting. 

And Robert F Kennedy Jr, Trump’s nominee for the head of the US Department of Health and Human Services (HHS), has long been a proponent of expanding raw milk consumption, and he wants to put a bigger focus on the US epidemic of non-communicable diseases, as compared to infectious disease risks.  

At the same time, concerns over raw milk contamination are rising after some state and county health officials, notably in California, recently began testing bulk milk supplies – finding traces of avian flu in one lot just last week, produced by Raw Farm LLC of Fresno. The company voluntarily recalled the lot.  

A lot of raw milk, was voluntarily recalled by a California manufacturer after Fresno County authorities reportedly found traces of H5N1 virus during bulk testing.

The enhanced testing followed an announcement by the US Department of Agriculture, 30 October, that it would support more bulk milk sampling as well as enhanced testing of dairy cattle herds’ milk samples for H5N1 nationally, in collaboration with veterinarian groups.  

But it remains unclear if Trump’s new DOA nominee, Brooke Rollins, a conservative lawyer and Trump loyalist who grew up on a Texas cattle farm, would continue to expand or restrict such surveillance.  

Meanwhile, Trump’s nominee for the head of the US Food and Drug Administration, Johns Hopkins Professor Martin Makary, is a more conventional pick. But his track record during the COVID-19 pandemic, when he argued against lockdowns, masking, questioned the benefits of vaccine boosters, and incorrectly predicted in February 2021 that “COVID-19  will be mostly gone by April” due to acquired herd immunity, bodes ill for closer tracking of H1N1 infections, or future pandemic preparedness measures. 

Image Credits: Raw_farm_USA, US Department of Agriculture.

Most families in Gaza facing winter cold and rain in tents.

WHO’s Director General Dr Tedros Adhanom Ghebreyesus welcomed the new ceasefire deal between Israel and Lebanon, which took effect Wednesday, but he noted that health needs in Gaza remain huge and “will only increase” with the onset of winter cold and rains.  

While there is an opportunity now to rebuild southern Lebanon’s shattered health infrastructure, the plight of Gazans is only getting worse, he said: 

“A year ago, almost all those displaced by the conflict were sheltered in public buildings or by family members. Now, 90% are living in tents,” Tedros observed, referring to the massive military destruction of schools and other public spaces that has since occurred over the course of the war. 

“This leaves them vulnerable to respiratory and other diseases, cold weather, rain and flooding are expected to exacerbate food insecurity and malnutrition,” Tedros said. 

Northern Gaza ‘blockade’ still limiting access to aid – Tedros

WHO Director General Dr Tedros Adhanom Ghebreyesus.

A continuing Israeli blockade of northern Gaza is limiting the entry of essential resources, “including blankets, fuel and food, all of which are already in short supply,” Tedros added.   

Israel has denied that it is limiting aid deliveries to the area, but it admits that aid distribution is a growing challenge due to the hijacking of deliveries by criminal gangs. Some 101 Israeli and foreign hostages also remain in Hamas captivity in Gaza, for the 14th month, with dwindling prospects for their survival as time goes on. 

Over the past month, Israel leveled thousands of homes and ordered the relocation of tens of thousands of Palestinians away from the sprawling Jabaliya refugee camp and other northernmost Gazan communities in the course of fierce battles with still-active Hamas forces in the area. 

The displacement has occured amidst growing signs that Israel’s hard right leadership bloc and its settler supporters are planning to reoccupy depopulated areas of northern Gaza, contrary to international law – and despite the denials of Prime Minister Benjamin Netanyahu and other top military and foreign ministry officials. 

Critical shortages of medicine and fuel  

Al Shifa hospital 23 November: WHO describes critical shortages of medicines and fuel following recent visit to northern Gaza hospitals.

Most immediately, however,  severe shortages of fuel and medicines, as well as food, in the besieged area pose continued challenges even to the limited functionality of the area’s hospitals, said WHO officials.  

“This week, WHO and our partners conducted a three day visit to the north of Gaza,” Tedros said. “The team visited 17 health facilities, including five hospitals. They saw a high number of trauma patients and increasing numbers of patients with chronic disease needing treatment. 

“There are critical shortages of essential medicines,” he asserted adding, “WHO and our partners are doing everything we can, everything Israel allows us to do, to deliver health services and supplies.”  

Tens of thousands of Palestinians who were displaced from Jabaliya and areas along the border with Israel have now moved south to Gaza City, added said Rick Peeperkorn, head of WHO’s Office in the Occupied Palestinian Territory (OPT). 

“There’s between 100 to 150,000 people from the north who are now actually camping in Gaza City,” he said. 

Huge increase in insecurity, crime and looting

Dr Rick Peeperkorn, head of WHO’s Office for the Occupied Palestinian Territory (OPT)

“There’s a huge need for mental health, psychosocial support, especially also for the health workers,” Peeperkorn said. “And of course, the shortages in supplies, staffing, but also the high influx of trauma patients. And the shortages remain in the key area, energy, as well as antibiotics, surgical supplies, oxygen, IV fluids, etc.” 

In the wake of the progressive destruction of Hamas,  “we have seen a huge increase in insecurity, crime and looting,” Peeperkorn admitted, compounding the problems with delivery of aid.  

On a faintly positive note, WHO this week facilitated the medical evacuation of some 70 patients to Jordan and elsewhere abroad for medical treatment – one of the largest groups to be moved out of the conflict zone since the  Rafah crossing closed, Peeperkorn noted. 

But he called for the re-establishment of more “consistent” medical corridors abroad, noting that with 12,000 chronically ill or injured people waiting to be referred out of Gaza  “if we continue at this pace, we’ll be busy for the next 10 years.” 

Added Tedros, “Once again, the ultimate solution to the suffering is not aid but peace. As we always say, the best medicine is peace.”

Image Credits: @WHO.

Burundi health officials conduct medical consultations and awareness sessions about sexual and reproductive health and mpox with displaced people in camps in Mubimbi and Rumonge.

Despite having the second biggest mpox outbreak in Africa, Burundi has no immediate plans to vaccinate those at risk.

Donated vaccine doses are available to Burundi for free but “vaccine hesitancy” might be playing a part in the government’s reluctance to vaccinate people, according to Dr Ngashi Ngongo, mpox lead for the Africa Centres for Disease Control and Prevention.

Over the past week, Burundi has registered 273 new mpox cases – an 13.8% increase over the previous week – and its first death. Overall, it has over 2,000 cases.

“The problem is not really the availability of vaccines. The problem is more on the country’s side,” Ngongo told an Africa CDC briefing on Thursday.

“During the COVID-19 time, it was a similar experience, where there was hesitancy to embrace vaccination. But toward the end of the response, the government of Burundi had accepted for vaccinations to be introduced in Burundi. We are hoping that it will be the same here.”

Ngongo confirmed that “there was really some hesitation” from the government, who wanted more information. 

“That information is being provided in order to get to the point where we can then convince the government of Burundi to move ahead with vaccines,” said Ngongo.

“The vaccines are ready. As soon as they accept, we should be able to deploy them.”

Burundi is one of the poorest countries on earth and two-thirds of the population live below the poverty line, according to the World Bank.

While 44 of the country’s 49 districts have registered mpox cases, the heart of the outbreak is in the economic capital of Bujumbura, where almost 60% of cases are, according to Ngongo.

Children under the age of 15 account for 42.9% of the country’s cases, the highest percentage on the continent. Clade 1B is dominant. 

Former President Pierre Nkurunziza failed to impose public health measures to control COVID-19. But after his death in 2020, his successor, Évariste Ndayishimiye, gave the go-ahead to vaccinations.

Misinformation campaign

However, vaccination campaigns particularly in Francophone Africa have become the target of disinformation campaigns allegedly fueled by Russia, according to The New York Times. 

Pro-Russian social media influencer Egountchi Behanzin has campaigned against malaria vaccines solely because they were developed in Western countries.

More recently, Behanzin – who has a large social media following and posts daily videos – took aim at mpox vaccines and urged Congolese people to reject them.

He claimed Western countries were involved in “health terrorism”.

Steady growth of mpox

In the past week, Africa has recorded 2,680 new cases (492 have been confirmed) and 22 deaths.

Some 84% of cases are located in the Democratic Republic of Congo (DRC), which recorded 2,261 new cases. The country also recorded 21 deaths, representing 95% of the continental total. 

Burundi and Uganda account for most of the remaining cases, while there are smaller outbreaks in Cameroon, Central African Republic and Liberia.

Gabon, Guinea and South Africa have moved from “active” to controlled, with no new cases in the past six weeks.

Meanwhile, the US and Canada have recorded their first mpox cases in people who have traveled to African countries with outbreaks.

Vaccination campaigns

In contrast to Burundi, Rwanda, DRC and Nigeria have started to vaccinate people at risk. Almost 56,000 people have been vaccinated in seven provinces of the DRC.

Rwanda has already reached 44% of its initial target, and is planning a new strategy for the next phase – “cluster vaccination in hot spots”, said Ngongo.

“Given that in some of the areas, the identification of contacts has remained a challenge, I think entire households are also being considered where there’s clear evidence of proximity and increased risk to those around the confirmed case,” said Ngongo.

The Japanese LC16 has now been included in the World Health Organization’s (WHO) emergency use listing for people aged one year and above.

“Now we are just waiting for the confirmation now from the Japanese government when the three million doses going to arrive in the DRC,” Ngongo noted.

Still a public health emergency

The International Health Regulations (IHR) Emergency Committee has resolved that mpox is still an public health emergency of international concern (PHEIC), WHO Director-General Dr Tedros Adhanom Ghebreyesus told a media briefing on Thursday.

According to a statement from the emergency committee meeting held last Friday (22 November), the “observed dynamics of transmission” of mpox clade 1b in DRC “are changing over time and are diverse across affected health zones”.

Infections have “shifted from adults, where transmission was first observed and appears to have been sustained by contact within commercial sexual networks, to younger age groups, including children, and sustained by household and likely broader community transmission through close physical contact”, it notes.

“Regardless of the circulating mpox clades, adults of 50 years of age or older are less affected, likely due to the immunity conferred by prior vaccination against smallpox,” it notes.

“As we have said many times, we’re not dealing with one outbreak of one virus, but several simultaneous and overlapping outbreaks of different strains or clades of the virus affecting different groups in different places,” added Tedros.

“We still face many challenges to bring these outbreaks under control. We need stronger political commitment to scale up responses activities. We need fully resourced preparedness and response plans. We need further contributions of medical countermeasures, including diagnostics and vaccines. And we need continued transparency and collaboration between affected countries and partners.”

Ipas CEO Dr Anu Kumar at a meeting in Mozambique.

Dr Anu Kumar, CEO of the global reproductive justice organisation Ipas, outlines the impact of a global clampdown on abortion

“Unsafe abortion remains a leading cause of maternal mortality, and it is entirely preventable,” says Dr Anu Kumar, CEO of Ipas, an international reproductive justice organisation. “So there is something we can do about it. We know what to do and we know how to do it. We just need to do it.”

But Kumar concedes that the election of Donald Trump as United States (US) President has ushered in a “pretty grave and serious moment” for reproductive rights.

Trump draws significant support from vehemently anti-abortion Christian conservatives and is widely expected to entrench more anti-abortion measures when he assumes office in late January, both in the US and globally – and this is likely to impact on millions of women and girls, and organisations like Ipas and its partners.

Ipas focusses solely on expanding access to abortion and contraception services and works in 23  countries, mainly in sub-Saharan Africa, Asia and Latin America, as well in the US.

Last year, the organisation helped over 640,000 people to get abortions and over 1.5 million to get contraceptives.

 

Ipas staff member Adeodatus Shukuru, an internally displaced person and peer educator in the Democratic Republic of Congo, with women who have come for treatment at the Ipas mobile clinic.

US domestic impacts

Abortion access in the US has already been curtailed since the national right to abortion was abolished by the Supreme Court in 2022, thanks to conservative Trump appointees to the court.

Since then, 14 US states including Texas have almost totally banned abortion and four others have severely restricted access. Texas has focused its laws on health professionals who perform abortions, introducing lengthy jail terms for them.

This has instilled fear in health professionals to the detriment of patients. Recently, a Texan woman died in childbirth because doctors were too scared to give her a standard procedure after her miscarriage – presumably in case it was misconstrued as an abortion. 

Porsha Ngumezi bled to death because doctors did not give her get a dilation and curettage (D&C) that would have removed pregnancy tissue from her uterus and stopped her haemorrhaging, reports ProPublica. 

In July, a Texan woman was charged with murder for taking abortion pills to end her pregnancy.

“Right after the election, there was a huge increase in sales of medical abortion pills, which is an indicator in the US that women are expecting there to be a crackdown,” notes Kumar, who is based in North Carolina in the US. 

Restrictions on abortion pill mifeprisone

There are a number of different avenues that the future Trump administration can take to limit domestic access to abortion, through the executive, via administrative powers, Congress and the courts.

“One of the most significant paths will be restrictions on the use of mifepristone, one of two drugs that are that is used to provide medical abortions,” says Kumar, adding that 63% of all US abortions are medication abortions. 

Ipas anticipates that the Trump administration will restrict telehealth abortions, while the  Federal Drug Administration (FDA) may remove or restrict access to mifepristone or rescind the licencing of the drug altogether. 

“We could also see the Justice Department enforcing the Comstock Act that has been on the books since 1873, although it hasn’t been enforced in recent decades,” notes Kumar.

This prohibits the mailing and receiving of “obscene materials”, and abortion-related material, devices and pills could be categorised as obscene. 

“That kind of broad interpretation of the Comstock Act could criminalise people for administering surgical or medication abortion pills. And then, of course, there’s the judiciary, which could rule against access to medical abortion pills.”

Global scenarios

An Ipas-trained Natural Leader conducts a community session on safe abortion services in Achham, Nepal

But the US also exports its anti-abortion agenda, particularly to countries that receive US aid. Fifty one years ago, the US introduced the Helms Amendment, which prohibits the use of US foreign assistance money for abortion. This is adhered to by Republicans and Democrats.

In 1984, Republican President Ronald Reagan introduced what has become known as the Global Gag Rule, preventing NGOs that receive US funding from using their own funds to provide abortions or referrals, or lobby for abortion law reform. Every Republican administration has implemented this since it was introduced, while Democrats have rescinded it.

“The last time the Trump administration was in power, they expanded the Gag Rule to apply to all global health funding, which impacted about $12 billion,” said Kumar. “Now the threat is that it will be expanded even further, and it could impact programmes from HIV to water and sanitation to research.”

It could also be expanded to apply to US-based NGOs and foreign governments. 

“We don’t know if that will be the case, but if we do see such a drastic expansion, it will have a dramatic impact on not only Ipas’s work, but the work of all of our partners in this sector and beyond.”

Antiretrovials or abortion?

For example, in South Africa, abortion is legal and provided in the public health system. But  the country also receives US funding for HIV through the US President’s Emergency Plan for AIDS Relief (PEPFAR).

So would South Africa need to choose between providing abortion or antiretrovirals?

“It’s hard to walk through what that would look like,” says Kumar. “It’s quite complex. Very likely, the announcement will be made about the Gag Rule on Day One of the Trump administration and we’ll see whether they’re expanding it and, if so, by how much.

“Then the contract language will come out several months later, and in that contract language, we will actually see how they’re intending on enforcing it.”

But the Gag Rule is also likely to also have a chilling effect on countries that may have been considering liberalising abortion access but decide it’s too high a price to pay given the centrality of the issue for the US, she adds.

Global aid is drying up

There aren’t many countries that can step into the breach left by the US withdrawal of funds for sexual and reproductive health (SRH). The Swedish and the Dutch – historically significant SRH funders, are also under more right-wing governments and are pulling back.

Canada remains supportive, but faces its own election in 2025 and conservatives are strengthening in that country too.

“Potentially other governments could step in, although I have to say I don’t have a long list in mind,” says Kumar.

“The world is in some ways, a much worse place than we were during the first Trump administration. We have at least two active wars going in Ukraine and the Middle East that Europe and the rest of the world are extremely worried about. That is taking not just human lives and resources.”

Alternative to Universal Declaration of Human Rights?

Trump ally Valerie Huber addressing the fourth anniversary of the anti-abortion pact, the Geneva Consensus Declaration, in Washington DC, in front of flags of signatories.

The prospect of the US defunding the UN Population Fund (UNFPA) is “almost a given”, says Kumar.

Its withdrawal from the World Health Organization (WHO) is “pretty likely” because of Republicans’ anger about how the WHO handled the COVID-19 pandemic and the pandemic agreement currently being negotiated.

“But the US withdrawal from these UN technical agencies is really about a broader issue,” says Kumar.

The Trump administration and its conservative allies are proposing the anti-abortion Geneva Consensus Declaration as “an alternative view of the Universal Declaration of Human Rights”, says Kumar. 

“This is a framework that undermines the Universal Declaration of Human Rights and imposes a different worldview, and that is actually what they’re after.”

Glimmers of hope?

“One major area of hope is that the sexual, reproductive health and rights movement has actually been extremely successful over the last 30 years,” says Kumar.

“Sixty countries have liberalised their abortion laws. Only four countries have gone backwards, and the United States is one of them.”

The election of a more liberal government in Poland that is making progress to relax its abortion ban “gave me a fair amount of hope that that the right wing fever may be breaking a little bit”, she added. 

The loss of support of Narendra Modi in the Indian election was also promising, says Kumar, as he has had to “form a coalition government and temper some of his anti-democratic tendencies.” 

Money talks and the US has long used it to force through its ambitions, but Kumar also hopes that countries will “make their values clear and resist some of the the bullying that typically takes place with the US government, especially when it comes to pooled funding mechanisms and working in partnership with the US government”. 

“A withdrawal of of some countries from US partnerships in development systems could send a very strong signal that countries don’t share the same values as the US government does,” she adds.

Image Credits: Ipas, Council on Foreign Relations.

Dr Faustine Ndugulile (centre) flanked by Dr Matshidiso Moeti, current WHO Africa director, and WHO Director General Dr Tedros Adhanom Ghebreyesus after his election in August.

Dr Faustine Ndugulile, the World Health Organization’s (WHO) regional director-elect for Africa, has died while receiving medical treatment in India, Tanzania’s parliament speaker announced on Wednesday.

Ndugulile, aged 55, was due to assume his position as the next leader of WHO Africa in February 

No reasons were given for his death, which has been met with shock and sadness by WHO Director-General Dr Tedros Adhanom Ghebreysus, WHO regions and the Africa CDC.

Ndugulile, a former deputy health minister and ICT minister in his country, has represented the Kigamboni constituency in Dar Es Salaam as a Member of Parliament since 2010 and chaired the country’s parliamentary health committee.

He served as deputy health minister under former President John Magufuli, who denied the existence of COVID-19. However, Ndugulile publicly urged Tanzanians to protect themselves against the disease and this may have cost him his position, according to Tanzanian news outlet The Chanzo Initiative.

Magufuli fired Ndugulile as deputy health minister in May 2020 during the height of COVID-19. Magufuli died in March 2021 aged 61, amid rumours that he had been infected with COVID-19.

Ndugulile was also vice-chair of the global Inter-Parliamentary Union’s advisory group on health. 

Aside from a medical degree, 55-year-old Ndugulile had a Masters degree in public health and a law degree. 

Ndugulile secured 25 of the 46 votes for regional director at the WHO Africa regional conference in the Republic of Congo in August, defeating Dr Ibrahima Socé Fall (proposed by Senegal), Dr Richard Mihigo (proposed by Rwanda) and Dr Boureima Hama Sambo (proposed by Niger). 

In his CV, Ndugulile lists his notable achievements, including “championing the passage of the Universal Health Insurance Bill in 2023, advocating for the implementation of an integrated and coordinated community health worker program and successfully advocating for the ratification of the African Medicine Agency (AMA) convention”.

Describing himself as a “technocrat, politician and policy maker”, Ndugulile has promised to “prioritise strengthening of WHO country offices to ensure timely, relevant, optimal and effective support to the member states”.

He was due to succeed Botswana’s Dr. Matshidiso Moeti, who served as WHO Africa director for two terms. 

Inês Costa Louro, Aloyce Urassa, and Hamaiyal Sana
Inês Costa Louro, Aloyce Urassa, and Hamaiyal Sana

With half of the global population now under the age of 30, the question of how to involve younger adults in global health decision-making is becoming increasingly urgent. In the latest episode of the Global Health Matters podcast, Dr. Garry Aslanyan invites three young leaders to discuss the role of youth in shaping health-related policies and strategies for today and the future.

The three guests are Inês Costa Louro, Aloyce Urassa, and Hamaiyal Sana.

Louro is a first-year medical doctor from Portugal and serves as vice president for external affairs of the International Federation of Medical Students Associations.

Urassa is a public health scientist from Tanzania and the chairperson of the African Leaders Malaria Alliance Youth Advisory Council. Sana is a Pakistani medical doctor and vice chair of the World Health Organization’s Youth Council.

“I do believe we are the leaders of the future, and in a few years, we will be leading our countries,” Louro said. “We will be the voices in global health, not just the young voices.”

However, she noted that her generation is often seen as a group that can provide input on future challenges but is not always included in addressing current ones.

“I do believe that there needs to be a shift,” Louro emphasized. “I think a small shift could be to actually start participating and collaborating in capacity building and building resources together—not just showing us different resources that are not always adequate for the generation at hand. There are things that are already happening within some big organizations that I think are the key to youth engagement.

“Start valuing what we can bring to the table because a lot of us are actually researchers,” she continued, explaining that young people should be recognized not only for their voices but also as fellow experts.

Still, challenges to youth involvement persist, with funding being a major obstacle. According to Urassa, support is essential to ensure meaningful participation from diverse youth.

“You cannot just tell young people, ‘we are encouraging you to participate,’ while there is no clear mechanism on how they will participate,” Urassa said. He added, “There should be local promotion of these opportunities because most of them are promoted through high-level platforms or social media, where some of the youth who are most affected might not have access.”

Funding and visa issues are specific barriers that often prevent many young people from participating.

“If a big organization like WHO or a UN entity actually takes proactive steps on these issues, a lot of visas could be awarded to young people who would otherwise not be able to travel, attend conferences, or participate in other events,” Louro said. “That should be the first and foremost step toward equity, inclusion, and diversity.”

Young people’s digital expertise is another key factor in their potential contribution to global health. Louro highlighted this as one of the most relevant points.

“We live in a world where not only the future but also the present is digital. We live in a digital world,” she said. “Who better to navigate us in this digital world than us? Our generation. We are digital natives. We need to help navigate this digital transformation of health and the digital transformation of the world.

Listen to more Global Health Matters podcasts on Health Policy Watch >>

Image Credits: Global Health Matters/TDR.