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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

What the countries have agreed to do

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

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

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

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

China makes progress, quality of care a concern for India

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

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

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

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

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

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

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

Additional inputs from Elaine Ruth Fletcher

Image Credits: WHO/Lindsay Mackenzie, Twitter.

A woman carries supplies through a flooded street in Haiti.

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

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

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

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

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

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

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

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

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

Image Credits: IFRC, Logan Abassi UN/MINUSTAH.

WHO member states applaud following late-night approval of WHA resolution on Climate Change and Health

WHO member states approved the first resolution on climate and health to come before the World Health Assembly in 16 years – even as 50°C temperatures in Delhi, flooding in southern Brazil and devastating Caribbean storms are driving home the message to more and more countries that climate change is real.

In several hours of late-night debate, states large and small, landlocked and ocean-bound, described in painful detail, their efforts to cope with growing trends of climate-triggered storms and drought, sea level rise, and food insecurity – all leading to more deaths and disability from noncommunicable diseases (NCDs), health emergencies, vector-borne diseases as well as mental health impacts. 

Developing countries along with rich nations also detailed new plans to promote greener health systems and climate-smart food production, ban single-use plastics, and better manage urban waste and other forms of environmental contamination – noting their deep inter-relationship with climate action. 

Shift from ‘adaptation’ to low-carbon health systems and intersectoral action

Traffic jam in Dhaka (Bangladesh) – Fossil fuel burning, including for transport, exacerbates climate change as well as air pollution that kills millions every year.

Whereas the last resolution adopted by the WHA in 2008 focused mostly on health sector “adaptation” to climate change, the new resolution carves out a much broader and more proactive roll for member states and their health sectors in efforts to shape future trends as well as respond to the inevitable.  Among the measures, it urges member states to commit to:

  • “Decarbonization” and “environmentally sustainable health systems, facilities and supply chains;” including consumption, procurement, transport, and disposal of water, energy, food and waste, as well as medical supplies, equipment, pharmaceuticals and chemicals, “with a view to lower greenhouse gas emissions,” without compromising health care provision and quality;
  • Multisectoral cooperation between national health ministries and other national authorities on environment, the economy, health, nutrition and sustainable development, “for a coherent and holistic approach to building resilience and addressing the root causes of climate change;”
  • Resource mobilization, including funding from multilateral development banks, climate funds, health funds and “innovative sources”;
  • Awareness among the public and health sector on the interdependence between climate change and health, “engagement in the development of climate and health policies, fostering recognition of health co-benefits and sustainable behaviour.”

“The very survival of our species will depend on this,” said Colombia’s delegate during a late evening debate over the draft resolution, to which over three dozen countries signed on as co-sponsors. He deplored the dearth of climate finance for developing nations which have contributed the least to the climate problem.

Colombia: ”The very survival of our species depends on this.”

“Sadly, climate ambition is still not supported with adequate and sufficient finance to respond to the huge needs of this crisis. Every year, finance gutters growing to the tune of billions of dollars, we’re not seeing a clear path to a tangible solution,” he said. 

Broad mandate – but still silent on core issues

The words “fossil fuels” or even “clean energy” don’t appear in the text – something civil society groups such as the World Heart Federation and some member states, including The Netherlands,  which co-sponsored the resolution along with Peru, lamented. 

Even so, the Dutch delegate expressed hope that WHO’s example of achieving net zero in its own operations – a feature of WHO’s new four-year strategy (2025-2028), would inspire member states to do the same, saying:  

“The Netherlands believes transitioning away from fossil fuels is a public health imperative and hopes the new WHO roadmap to net zero will inspire member states to follow suit.”

Extreme weather driving awareness

Mexico’s delegate describes how extreme weather has sensitized Mexicans to the “urgency” of climate action.

Despite such gaps in the text, nation after nation talked about how the reality of the devastating effects of extreme weather and sea level rise is driving more awareness of the need to act. 

That included small island states, such as Jamaica, and the Dominican Republic, and larger nations, from Pakistan to upper-income Mexico and high-income New Zealand. 

“Our delegation would like to approach this matter with a sense of urgency given the effects of the climate crisis that we’re living through,” Mexico said. “According to the World Meteorological Organization, Mexico had the weather event with the highest economic losses during 2023 – hurricane Otis,” she added, noting that in recent weeks, the country has now been facing a severe heatwave. 

“Climate change undermines the very foundations of our societies, threatening the security of our food systems and the safety of our homes and livelihoods. small island developing states including our sisters and brothers in the Pacific face threats to their very existence,” said New Zealand.

Clean and green healthcare 

Workers affix solar panels to roof of a new hospital in Alberton, South Africa. Opened in 2022, it features natural lighting, on-site grey water treatment and recycling.

Member states from the United Kingdom to Indonesia also applauded the resolution’s strong stance on advancing clean and greener health care – including through the new WHO Alliance for Transformative Action on Climate and Health (ATACH). 

Launched at the UN Climate Conference (COP 26) in Glasgow in 2021, nearly 100 member states have joined the initiative, which promotes climate resilient health facilities – through knowledge exchange and voluntary country commitments to a stepwise set of low-carbon and, ultimately, net-zero targets.

“Indonesia is in the process of integrating a performance indicator on climate resilience and health facilities in the health sector master plan – meaning net zero emissions in health facilities by 2030,” said one delegate, describing the country’s plans and progress. She called upon WHO to support member states in accessing investments from the Green Climate Fund “and other financing mechanism dedicated to climate and health for promoting the implementation of green hospitals.” 

One Health, ecosystems and climate-smart agriculture

Ethiopia’s initiative has made tree planting a culture among Ethiopians, with more than 30 million people taking part every year during the summer rainy season,

Delegates’ statements also reflected an  increasingly nuanced understanding of the interlinkages between climate stability, biodiversity, sustainable food production and health. 

One Health – an issue that has become a volleyball in the pandemic agreement talks between rich and poor countries – even received a positive reference mention in the climate and health resolution – which a numbe of developing countries underlined as important.

“It’s important to bear in mind the importance of the One Health approach in the climate and health work,” said Colombia,”in particular, given the needs of protecting vital vital ecosystems like the Amazon, which is the most biodiverse ecosystem in the world –  and that plays a key role in climate in global health. “

Said Mexico, “climate justice for small scale farmers must also be coupled with the transformation of the food system”. She referred to the country’s ban on farm chemicals like glyphosate, as well as genetically modified corn. The Mexican moves have been hotly opposed by agribusness. But critics say both the GMO corn and glyphosate, a pesticide, have knock-on consequences for ecosystems, human health, livelhioods and sustainable food production.  

Ethiopia, meanwhile, is planting billions of trees to combat deforestation, soil erosion and flooding. The initiative has made tree planting a national past-time – although some critics have said it  needs better planning. In parallel, the country is promoting more “climate smart agriculture,” to improve nutrition and reduce biodiversity loss; improved urban waste management and electrification of transport. 

But finance remains key, Ethiopia’s delegate also underlined saying: “We urgently need increased international financing, technology transfer and capacity building support to protect our people from the climate.” 

Curbing plastic hazards 

Plastic
Most plastics that are produced end up in landfills, the oceans, and open waste dumps of developing countries.

Plastics pollution was also described as a dangerous blight to health, climate and environment by countries as diverse as Thailand and Tanzania.

The new climate resolution should help measures to “reduce plastic pollution in the health sector”, observed Thailand, adding that the country is also “working to reduce exposure to micro-plastics, which have been found in human food, water, and air – causing oxidative stress, neurotoxicity, and developmental toxicity,” said the country’s WHA delegate, noting a recent ban on single use plastic bags, as well as initiatives to better manage health sector waste, much of it from plastics.

While not specifically mentioned in the climate resolution, most plastics are produced by by products of fossil fuel extraction, as the International Council of Nurses noted in a statement – and therefore the issues are intertwined.

Over the past 30 years, plastics production increased fourfold, with growth rates still rising exponentially

And the fossil fuels industry has ambitious plans to increase plastics production over the next 25 years – compensating for possible slackening of demand in the transport and energy sectors.

UN member states’ are meanwhile also engaged in tough negotiations over a treaty to curb plastic waste – facing off against stiff industry interests. WHO has proposed that it join the global treaty talks, providing expert advice to negotiators, and to a UN Environment Science Policy Panel on chemicals, waste and pollution. The panel is set to convene in Geneva for it’s third meeting from 17-21 June.   

Russia protests WHO offer of health expertise to UN science panel on chemicals, waste and pollution 

Russia’s delegate objects to linking, plastics pollution, health and climate.

The WHO proposal to join the UN Environment Science Panel, as well as member state references to the linkages between health, climate and plastics brought a stiff response from the Russian Federation:

“We’d  like to draw your attention to how inadmissible it is to shift our focus from the issue of the impact on health of climate change – and pollution through plastic waste in order to focus on combating plastic itself,” the Russian delegate stated. “We must ensure an impartial, objective comprehensive comparison of plastic products with products made using alternative materials.”  

“Russia cannot support the idea of WHO providing Secretariat functions for the Science Policy Panel to contribute further to the sound management of chemicals and waste,” the delegate added. . 

He also called for WHO to keep the health care sector out of the center of deliberations over new UN treaty on plastics pollution – despite healthcare’s outsize consumption of single use plastics.

“We do not support the proposal that the main goal of the international treaty on plastic should be the issue of health care,” said the Russian delegate, disassociating the Federation from references to the WHO ATACH initiative on health sector resilience, as well. 

‘Gender equality’  

Prior to it’s approval, the draft climate and health resolution also was the focus of a back door struggle on its references to gender-related language, also led by Russia and other socially conservative  states.  

To reach consensus, references to “‘gender responsive/sensitive’ climate action and health systems” were removed from the final draft. That was in response to critics who said the words could imply recognition of  LGBTQI groups  – whose activities are banned and even criminalized in many countries around the world. 

The final draft saw just one single reference to “action on climate change and health that is more integrated, coherent and advances gender equality, in line with Sustainable Development Goals.”

Even so, the Russian Federation disassociated it from that reference, as well, after the draft was aprpoved, saying that terms like gender in/equalities “does not enjoy agreement.” 

Retorted Belgium, on behalf of the European Union: “We are rolling back on many years of substantial progress on human rights and gender, reducing our ability to mitigate climate change and of WHO to lead effective programs on the ground.” 

Image Credits: Flickr – joiseyshowaa, https://www.netcare.co.za/News-Hub/Articles/environmental-sustainability-at-the-heart-of-new-hospital-design, Tiksa Negeri / Dialogue Earth, Photo by Hermes Rivera on Unsplash, Plastics Atlas, 2019.

Rwandan Health Minister Sabin Nsanzimana, the Heart Foundation’s Trevor Shilton, NCD Alliance CEO Katie Dain and Karen Sealy of the Trinidad and Tobago NCD Alliance.

GENEVA – Just six countries in the world are on track to meet global targets to reduce non-communicable diseases (NCDs), particularly cardiovascular disease (CVD), cancer, chronic respiratory diseases and diabetes.  At the World Health Assembly (WHA) this week, every country – rich and poor – lamented their struggles to contain rising NCDs, which now cause three-quarters of global deaths.

Progress has been made since the last UN High-Level Meeting on NCDs seven years ago, sector leaders said at a sideline meeting organised by the NCD Alliance and the World Heart Federation on Thursday. But with current global NCD targets set to expire in 16 months when the next UN High-Level Meeting on NCDs will be held in New York, the world is “badly off track,” said Dr Bruce Aylward, World Health Organization (WHO) Assistant Director-General on Universal Health Coverage.

Bente Mikkelsen, WHO’s NCD Director, said it is “purely immoral” that only half the estimated 1.3 billion people who have hypertension were aware of their condition, although the diagnosis is simple. Undiagnosed hypertension is a major cause of strokes. While some 42 million people die from NCDs each year, many deaths could be averted with early detection and treatment.

“Four and a half billion people don’t have access to basic services, and two billion people are suffering financial hardship when they try to access life-saving services. This is a catastrophe,” said Aylward. “We can’t solve the NCD problem without financial protection. The poor in our societies need to be able to access medicines and services they need for free and that is a responsibility of governments.”

Expanded definition of NCDs 

In just seven years, the global NCD agenda has seen significant expansion, said Katie Dain, CEO of the NCD Alliance. The definition now firmly includes mental health and neurological conditions, and air pollution is recognized as a key risk factor. WHO’s Mikkelsen added that the links between climate change and NCDs are also now recognized.

Governments are starting to see addressing NCDs as an investment rather than purely an expenditure, with growing country-level leadership and involvement of people living with NCDs, Dain noted.

Rwandan Health Minister Sabin Nsanzimana said his country recently equipped 58,000 community health workers with blood pressure machines, a “very easy and cheap means of diagnostic screening.” Rwanda’s mortality rate began shifting from infectious diseases to NCDs around 2015, prompting the creation of an evidence-based, culturally sensitive NCD plan.

Nsanzimana noted that some lifestyle challenges are rooted in past community practices, making it difficult to encourage people to cut certain foods and drinks that are “strongly rooted in culture and society.”

“You tell people too much milk isn’t healthy, while mothers and grandmothers always said milk is everything,” he explained. Nsanzimana warned countries that not managing NCDs early leads to “complicated treatment” for issues like cardiac arrest and renal failure.

WHO’s Bente Mikkelsen addresses the meeting, alongside Loyce Pace, Ashley Bloomfield and Bruce Aylward.

Building community trust

New Zealand’s Ashley Bloomfield, co-chair of the Working Group on International Health Regulation amendments, also emphasized the importance of building community trust. “We’ve had tremendous success in tobacco control. Our adult daily smoking rate is now under 7%. In the early 2000s, over a third of our indigenous Maori girls aged 14 smoked daily. It’s now 3%,” he said.

Bloomfield added that effective communication to build public trust was a key lesson learned during the pandemic, citing New Zealand’s successful COVID response that minimized deaths and prevented health system overload by “keeping the virus out until we had high vaccination rates.”

“Fundamental to that was building public trust, so people understood the why,” said Bloomfield. “Effective communication to build trust in the population … helped to minimise deaths and prevented our health system from being overwhelmed.” 

Karen Sealey, executive director of the Trinidad and Tobago NCD Alliance, said her group of 13 organizations successfully lobbied for years to establish a health ministry NCD unit. The alliance is now so well trusted that it assisted with the ministry’s pandemic vaccination drive.

Community involvement in health

“Next year’s NCD High-Level Meeting needs to represent a massive step change, with a significant focus on ground-level action and implementation, where the biggest gap is,” Dain said.

Community health system involvement is a timely topic, as the WHA adopted a “social participation” resolution this week.

The resolution urges member states to “implement, strengthen and sustain regular and meaningful social participation in health-related decisions across the system as appropriate, taking into consideration national context and priorities,” and suggests “facilitating capacity strengthening for civil society to enable diverse, equitable, transparent and inclusive social participation.”

Conservative countries targeted this resolution for its use of “gender-responsive,” as reported by Health Policy Watch. In the final resolution, this term was replaced by “gender equality”.

The ongoing 77th World Health Assembly in Geneva, Switzerland

The World Health Organization (WHO) has urged stakeholders in the health sector to collaborate in reorienting health systems towards a primary healthcare approach, a key priority in helping more people access universal health coverage (UHC). The organization has also called on countries to increase domestic spending on health and for banks to fund climate and health projects.

Speaking at a roundtable discussion during the ongoing World Health Assembly in Geneva on Wednesday, WHO Director-General Dr Tedros Adhanom Ghebreyesus emphasized that investments in health and UHC should be seen as an investment in healthy, productive, and resilient societies.

“Fundamentally, UHC is a political choice,” Tedros said. “But it’s a choice that must be translated into budgetary action.”

Currently, more than half the world’s population lacks coverage for essential health services, and nearly one in four people have suffered financial hardship or incurred catastrophic expenditures to access health services. Progress in reducing maternal and child mortality has also stalled in recent years.

“For this agenda to succeed, it must be embedded in national leadership,” said Dr. Githinji Gitahi, Group Chief Executive Officer of Amref Health Africa. “Unless the national ministers of health, ministers of planning, ministers of finance lead the way for accountability, transparency and national plans, it is going to be difficult to implement.”

Dr Githinji Gitahi, Group Chief Executive Officer of international health and development organisation Amref Health Africa

As extreme weather events rise due to climate change, attaining UHC has become even more important. Kazakhstan’s Minister of Healthcare, Dr Akmaral Alnazarova, shared their experience in handling recent floods that affected nearly 80% of the country, emphasizing the role of primary healthcare in providing 90% of basic medical services and ensuring continuous access during emergencies.

During the roundtable, Japan announced plans to establish a hub for UHC in Tokyo in collaboration with WHO and the World Bank, inviting countries and stakeholders to collaborate and share learnings from its own experience in delivering UHC.

The Finance Conundrum

Finance remains a crucial challenge to scaling up UHC, especially for low- and middle-income countries with limited capacity. The WHO is pushing for more domestic public financing as the most sustainable solution and urges countries to prioritize spending on healthcare through a multi-sectoral approach.

“There isn’t a financing gap. There is just money that is not moving towards the right things. There’s plenty of money out there,” said Mariana Mazzucato, Chair of WHO’s Council on the Economics of Health for All.

Despite Mazzucato’s assertion that there is no financing gap, the WHO itself faces a significant funding shortfall. The organization has secured only $4 billion of the $11 billion needed to fund its four-year work plan, GPW-14, which was approved by the World Health Assembly on Monday.

Mariana Mazzucato, Chair of WHO’s Council on the Economics of Health for All

Low- and middle-income countries, as well as Small Island Developing States, are grappling with the highest debt repayment rates in 25 years and the escalating costs of being on the front lines of the climate crisis. These nations have openly expressed their difficulties in raising funds to finance the ambitious goal of UHC.

More than half of the world’s poorest countries, home to 2.4 billion people, are being forced to cut public spending by a combined $229 billion over the next five years, according to Oxfam.

In 2021, low- and middle-income countries allocated 27.5 percent of their budgets to debt service, which was twice their education spending, four times their health spending, and nearly 12 times their social protection spending. Sixty-two countries worldwide currently spend more on refinancing foreign debt than on health care.

Multilateral development banks, meanwhile, are slowly beginning to prioritize climate and health projects. The European Investment Bank, which serves all 27 European Union member countries, no longer funds fossil fuels and is expanding its investments in health systems. The World Bank currently has $35 billion invested in health system financing across 100 countries and plans to expand into new geographical areas.

However, despite public commitments, many private banks continue to invest billions in coal projects, while green projects in developing countries struggle to secure funding due to perceived high risks and low profitability. The cost of borrowing money in developing countries is often prohibitively high, with interest rates two to three times higher than those in wealthy nations.

“Since 2,000, 30% of member states have made progress in expanding both service coverage and financial protection towards UHC,” Tedros said. “It is vital that all international funding is better aligned with national plans, priorities and systems.”

Image Credits: Twitter.

As the World Health Organization moves to put climate and health at the centre of its work, experts say research gaps could threaten its ability to act effectively.

GENEVA – The World Health Organization has made climate change its top priority in its four-year work plan adopted at the World Health Assembly this week, but significant gaps in climate health research could hinder the UN health body’s efforts, experts warned at the Geneva Health Forum on Tuesday.

Current research on the effects of climate change on health is heavily skewed towards the global north and China, while countries most vulnerable to climate change, such as Small Island Developing States, remain understudied. Additionally, most studies focus on the direct health effects of climate phenomena, overlooking the impact on non-communicable diseases (NCDs), which are the primary drivers of the global disease burden.

“Most of the research has been focused on temperature-related health risks and hazards followed by infectious diseases,” said Dr Ming Yang, Senior Editor at Nature Medicine at a session on “Safeguarding Health from Climate Change.” Organized by the Vanke School of Public Health in Shanghai, China and the University of Geneva, the session came on the closing day of the three-day Forum, which brought together leading scientists with field practitioners on the margins of the 2024 World Health Assembly.

“There’s been very little research when it comes to other health outcomes like NCDs, maternal and child health, mental health, the impact of climate change on healthcare systems, extreme weather events and on diets and food security.”

Dr. Ming Yang, Senior Editor at Nature Medicine.

The health implications of climate change on NCDs range from mental health stresses caused by extreme weather to increased cardiovascular diseases from wildfire smoke, malnutrition from droughts, and increased risk of vector-borne diseases. The WHO recently acknowledged an insufficient understanding of the impacts of climate change on malaria and other neglected tropical diseases.

Climate change can affect many of the leading risk factors for premature deaths, such as malnutrition, air pollution, high blood pressure, tobacco use, unhealthy diets, high blood sugar, obesity, high cholesterol, kidney dysfunction, and occupational hazards, according to The Lancet. As the global health burden of NCDs continues its rise, experts at the Forum highlighted the crucial importance of expanding climate research to explore its impact on these illnesses. 

“No one is talking about obesity, heart disease – the real disease burdens,” said Dr Anders Nordström, Former Ambassador for Global Health at the Swedish Ministry for Foreign Affairs. “We are not getting it right with the epidemiology.”

Recent decades have seen a sharp rise in the number of nations facing severe threats from climate change and its health repercussions.

Ahead of the World Health Assembly, the WHO noted that published research on climate and health has too often focused on “low-disease burden countries with high access to quality healthcare”, while the world’s poorest nations, most at risk for climate disasters according to the IPCC, have seen little research quantifying the health effects of climate change.

“Climate change is not just about heat waves,” Yang emphasized. “It’s about extreme weather events like wildfires, floods, and tropical cyclones. It’s also about the increasing damages of air pollution. We are only beginning to understand the chronic health impacts of climate change on cardiovascular and respiratory disease, renal and neurological outcomes, and especially mental health.”

The disparity in climate health research becomes even more pronounced when examining climate adaptation versus mitigation. A recent WHO review found that a mere 34% of malaria and NTD studies addressed mitigation strategies, while only 5% explored adaptation methods.

This adaptation deficit mirrors the broader global climate action landscape, as affluent nations fail to fulfill their commitments to assist climate-vulnerable regions in adapting to a warming world.

Developing countries received just $21 billion in international financial flows for climate adaptation in 2021, according to the UN Environment Programme (UNEP). However, UNEP estimates that these nations need between $194 billion and $366 billion per year for adaptation alone. With the climate crisis escalating, the funding gap is expected to increase even more.

The WHO’s GPW-14 plan, which sets climate and health as its centrepiece while funding the UN health body’s global activities from emergency response to a full range of health issues, brings the financial scope of the climate challenge into perspective. With a target budget of $11.1 billion, the WHO has secured only $4 billion and plans to raise the rest at a late 2024 fundraiser.

“Clearly climate change is the most important crisis,” said Maria Neira Director of the Public Health, Environment and Social Determinants of Health Department at the WHO, “Now, what’s next?”

Image Credits: Project LM/Flickr, Matt Howard/ Unslash.

Verde's Minister of Health, Filomena Mendes Gonçalves.
Cabo Verde’s Minister of Health, Filomena Mendes Gonçalves.

Cabo Verde, a group of 10 islands in the Central Atlantic Ocean, was declared malaria-free in January. This milestone makes it one of the 43 countries and territories globally recognised with this certification by the World Health Organization (WHO).

Cabo Verde is only the third country in the WHO African region to be certified malaria-free in the past 50 years, following Mauritius in 1973 and Algeria in 2019.

The African continent bears the heaviest malaria burden, with around 95% of global malaria cases and 96% of malaria-related deaths occurring there in 2021, according to WHO. The most affected are impoverished rural communities, where children under five and pregnant women suffer the most, according to the Global Fund.

The latest World Malaria Report revealed that there were approximately 608,000 malaria deaths worldwide in 2022. Additionally, the number of malaria cases saw a significant increase in Pakistan, Ethiopia, Nigeria, Uganda, and Papua New Guinea compared to the previous year.

Cabo Verde’s certification means that the transmission of malaria by local Anopheles mosquitoes has been stopped across the country for at least three years. Additionally, the government has shown it can effectively prevent malaria from returning.

So, how did Cabo Verde achieve success?

On Wednesday, Cabo Verde’s Minister of Health, Filomena Mendes Gonçalves, shared five steps for malaria eradication that worked for her country: strong political engagement; surveillance and rapid response; a multi-sectoral approach, where the government worked closely with the community; international partnerships with organisations such as WHO and the Global Fund; and diligence – once the disease appears eradicated, a plan to prevent re-establishment is required.

Cabo Verde eliminated malaria after implementing a strategic plan from 2009 to 2013, focusing on expanded diagnosis, effective treatment, and increased surveillance, According to WHO. To prevent imported cases, free diagnosis and treatment were offered to international travellers and migrants.

In 2017, the country improved its response to an outbreak, achieving zero Indigenous cases for three consecutive years. During the COVID-19 pandemic, Cabo Verde maintained progress by enhancing vector control, malaria diagnosis, and surveillance, particularly at entry points and high-risk areas.

Impact of climate change

Cabo Verde’s story took centre stage at an opening discussion on the third day of the Geneva Health Forum. The event, run in collaboration with the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) and on the margins of the 77th World Health Assembly, focused on vector-borne diseases, including neglected tropical diseases, exacerbated by climate change and other environmental factors.

The Geneva Health Forum, organized by the University of Geneva, brings together key global health scientists and policymakers with medical practitioners and other field actors.

Last week, WHO and Reaching the Last Mile published a major review in the Transactions of the Royal Society of Tropical Medicine and Hygiene, analysing 42,693 articles on climate change and vector-borne diseases. The study found that rising temperatures and changing weather patterns alter the spread of these diseases, posing significant health risks and straining healthcare systems. As mosquitoes and other disease vectors expand their range, the report showed, the risk of these diseases reaching new, unprepared areas increases.

Samal, a father from Nepal, contracted visceral leishmaniasis (black fever) in 2022. He became so ill that he lost 15 kilograms and was unable to work for three months. Samal lost nearly 100,000 Nepalese Rupees as a farmer and woodcutter, equivalent to three months’ wages.

Thoko Elphick-Pooley, executive director of Uniting to Combat NTDs and Co-Chair of the G7 Taskforce on Global Health
Thoko Elphick-Pooley, executive director of Uniting to Combat NTDs and Co-Chair of the G7 Taskforce on Global Health

His nephew and brother also caught the disease. Fortunately, Samal received treatment and survived. However, as Thoko Elphick-Pooley, executive director of Uniting to Combat NTDs and Co-Chair of the G7 Taskforce on Global Health, explained, “Many are not so lucky.”

Nepal, a village in the foothills of the Himalayan Mountains, sits about 1,300 meters above sea level. Historically, temperatures seldom rose above 30 degrees Celsius. Today, they regularly soar past that mark, bringing with the heat many new diseases like black fever, which thrive in dark and humid environments.

“Nepal is now breeding grounds for sandflies,” which causes black fever, Elphick-Pooley said. “If untreated, it is fatal in over 95% of cases. Samal’s story shows the catastrophic impact of climate change on individuals, families, communities, and entire countries.”

Climate change has dealt a blow to Nepal’s fight against black fever, said Elphick-Pooley. The country, which had seen cases plummet from 2,200 to under 300 in ten years and was on track to eliminate the disease, must now postpone its goal of eradication.

Countless other countries are experiencing a similar phenomenon, facing a rise in diseases from dengue to malaria. Pakistan reported a staggering 900% increase in dengue cases following severe flooding, as revealed at the United Nations Climate Change Conference last year.

Authorities, even in affluent European nations, are now on high alert for dengue outbreaks, with health agencies warning that threats will soon emerge in the southern United States and previously unaffected regions of Africa.

The WHO and Reaching the Last Mile report indicated that better evidence was needed to understand the link between climate change and these diseases. It also noted a lack of evidence tied to mitigation and adaptation.

But Elphick-Pooley said that “while generating more and better evidence is critical, we cannot let gaps in evidence stop us from moving. We cannot stand still while waiting for better evidence; we must act based on what we know now. We are already seeing the impacts of climate change. This is urgent.”

She called on health leaders to develop new treatments, disease management, and prevention strategies to advance a disease-elimination agenda.

“We already know how to treat or prevent many of the 21 NTDs. let’s do it,” Elphick-Pooley said.

Malaria in the United States

The link between climate change and vector-borne diseases has even alerted the U.S. Department of Health and Human Services.

Loyce Pace, assistant secretary for global affairs in the department, said the country has been having the conversion “about our friends in Brazil who are facing a crisis.” She said Brazil’s floods are not only producing hundreds of thousands of climate refugees but precipitating additional waterborne diseases “in a way that is absolutely putting these constraints not only on the public health system” but on the people.

Moreover, the Centers for Disease Control and Prevention (CDC) identified a handful of locally acquired mosquito-transmitted malaria in Texas and Florida last year. Locally acquired mosquito-borne malaria has not occurred in the United States since 2003.

“These mosquitoes are getting smarter,” Pace said. “They’re getting better at what they do. They’re showing up in places they’re not supposed to, like Maryland, down the street from Washington, D.C.. This is happening in real time. This is not a tomorrow problem. This is a problem today.”

She said the U.S. is prepared to take a one-health approach and called on other countries to do the same.

“It’s not hopeless, right? We have this problem in front of us, but we absolutely do have the solutions we need to deploy,” Pace said. “I trust that we can get it done together.”

Image Credits: Geneva Health Forum.

Israel scored a tactical victory Wednesday evening when World Health Organization (WHO) member states agreed in a vote of 50-44 to amend a draft decision denouncing the health situation in the Occupied Palestinian Territories, with a reference calling for the release of some 125 Israeli hostages still held by Hamas. Another 83 member states were absent or abstained from the politically-charged vote.

The original draft WHA decision was led by Algeria and supported by some 35 member states, including Russia, Egypt, Colombia, Cuba, Venezuela, and Iran.

The decision denounces  “acts of violence,” the “use of starvation of civilians” and the “wanton destruction of health facilities”  –  and calls upon the “occupying power” to fulfill its obligations under international law,” including replenishment of medical supplies, safe passage of fuel and health supplies and additional humanitarian assistance.  

WHA debate on issue adjourns while member states debate next moves

South Africa’s delegate speaks on behalf of the original resolution condemning the health situation in Gaza, and other Israeli-occupied territories.

As of publication, it was unclear if the draft decision, with the amendment referring to Israeli hostages, would indeed be brought to a vote.  Immediately following the vote on the amendment, Egypt, on behalf of the co-sponsors, requested that it be withdrawn altogether.

However, WHO rules would require Israel’s agreement to withdraw the Algerian-led resolution, now that Israel’s amendment has been approved.  Ultimately, the WHA debate on the draft decision was adjourned until later Friday. That leaves both Israeli delegates and the resolution’s supporters, including sworn enemies such as Iran, unsure of what to do next. Neither side will want to cede more diplomatic points to the other.

At the debate preceeding the vote on the amendment, dozens of member states, from Africa, Latin America, Asia and Europe, as well as Palestine that holds observer status, deplored the humanitarian situation that has been created by Israel’s war on Hamas in Gaza, including the interruptions in humanitarian aid, destruction of health facilities, and the recent deaths of displaced Palestinian civilians sheltering in a supposedly safe zone near Rafah from a nearby Israeli aerial bombing.

“The international community should exert all efforts through the various instruments at our disposal to improve the ongoing humanitarian catastrophe in the occupied Palestinian territory, including Gaza,” said South Africa’s delegate to the Assembly, referring to South Africa’s case against Israel for alleged genocide before the International Court of Justice.

Israeli Ambassador to Israel, Meirav Eilon Shahar calls for a vote over an amendment on Israeli hostages held by Hamas.

Speaking to the assembly, Israeli Ambassador Meirav Eilon Shahar said  “a decision that does not also condemn the militarization of health facilities by terrorists in Gaza has no intention of improving the health conditions on the ground… A decision on health that does not demand the immediate and unconditional release of all hostages – who are held by a terrorist organization, raped and tortured – is an unforgivable moral failure.”

Wednesday’s debate was only the first of two scheduled by the assembly on the war in Gaza and its humanitarian fallout, which has led to the displacement of over 1 million Palestinians, and over 34,000 deaths, along with severe hunger and malnutrition in parts of Gaza.  Some 1,200 Israelis died and more than 250 were taken hostage during the October 7 Hamas incursion into Israeli communities that triggered Israel’s invasion of Gaza.  While an estimated 125 hostages, including over a dozen sick and elderly people, young women, and several young children are still being held in Gaza, it’s unclear how many are still alive.

Second Gaza resolution has wider support

A second draft resolution  on Gaza, to be considered tomorrow, has much wider WHA suport and is likely to be adopted by consensus.  It makes a call on “all parties to fully comply with their obligations” under the 1949 Geneva conventions, and ensure “unimpeded, safe, and unobstructed” passage for medical personnel.” 

That resolution, which was the focus of a special session of WHO’s Executive Board on 10 December, was approved by consensus, including with support from the United States, Israel’s closest ally, in what was then a first such vote in the UN system. 

That draft resolution to be considered Friday, makes no direct mention of either the Israeli  hostages or Palestinian prisoners held by Israel. 

But Article 2  “reaffirms that all parties to armed conflict must comply fully with the obligations applicable to them under international humanitarian law related to the protection of civilians in armed conflict and medical personnel.”

US Secretary of Health and Human Services Xavier Becerra

GENEVA – The United States believes a “good deal” is within reach on the pandemic agreement, with parties “close to consensus,” Secretary of Health and Human Services (HHS) Xavier Becerra told reporters at the US Mission in Geneva on Wednesday.

“There is a clear consensus that we can’t let the status quo be upon us if another pandemic comes,” Becerra said, adding that the US believes it has given the talks their “best shot”. “We’re so optimistic because everyone gets it. It’s not just our health. It’s our economies. It’s our security that’s at stake.”

Despite some disagreements, “the contours of the agreement are in place,” Becerra said, expressing optimism that countries would leave this week’s World Health Assembly (WHA) with “something” to show that the World Health Organization (WHO) is ready for the next pandemic.

Spain’s Dr Fernando Simón (centre), flanked by Thiru Balasubramaniam of Knowledge Ecology International (left) and Dr YuanQiong Hu (right) of Médecins Sans Frontières.

Key Spanish negotiator Dr Fernando Simón echoed the sentiment, stating that differences between countries are not significant.

“Faster is the best. There is no perfect treaty, but if we don’t get this pandemic agreement, we risk getting a trade agreement, not a public health agreement,” Simón said at a meeting at the Médecins Sans Frontières headquarters.

One or two-year delay?

However, US Ambassador Pamela Hamamoto cautioned WHA delegates on Tuesday that the pandemic agreement might take one or two years to conclude, citing “fundamental differences” on “complex technical issues that require extensive deliberation and carefully crafted workable solutions.”

US Ambassador Pamela Hamamoto at WHA77

The 47 African member states of the WHO are pushing for the pandemic agreement to be concluded and presented to a special WHA by year’s end.

The upcoming US presidential election on November 5 could impact the negotiations, particularly given the high level of disinformation surrounding the pandemic agreement in the US.

Should Donald Trump win the US election, his administration is likely to scupper the pandemic agreement – and possibly pull out of the WHO altogether.

‘We shouldn’t leave Geneva with nothing’

But Becerra and Loyce Pace, HHS Assistant Secretary for Global Affairs, were both upbeat, intimating that it was now up to other parties to pick up the pen and sign the deal. 

“If we can get this across the finish line, I think what we show – with the pandemic accord and improved International Health Regulations – that we’re ready to take on these challenges so that never again will we suffer a pandemic [like COVID-19],” said Becerra.

Loyce Pace, US HHS Assistant Secretary for Global Affairs

“Frankly, we shouldn’t be leaving Geneva and going home with nothing, not after all that’s been done,” Pace said. “The world needs us to update our global health security architecture. The world needs world leaders and public health leaders to truly commit to what’s required.”

The US is also pushing hard for the amendments to the International Health Regulations (IHR) to be adopted this week. The IHR governs countries’ conduct during “public health emergencies of international concern”.

“We don’t know how long it’s going to be before we get another type of COVID-kind of tragedy. We don’t want to wait,” Becerra said. “We made it unambiguous and clear what we could offer and also what we could accept.

“The elements of a big deal are already on the table. And that’s why, again, we feel optimistic, because those are pretty good deals. It’s just a matter of now finally making sure everybody says: ‘We’re ready to sign on the dotted line’,” he added.

A new WHA drafting committee met most of Wednesday to work out a process for adopting both measures and may report back to the WHA as early as Thursday.

Some African countries have linked their support for the IHR amendments this week to their timetable for the pandemic agreement. But this position is not monolithic. Botswana, for example, supports the IHR’s adoption this week.

Russia indicated on Tuesday that it opposed the adoption of the IHR this week, so the issue might go to a vote.

Additional reporting by Elaine Fletcher.