The first two girls ever vaccinated with the malaria vaccine RTS,S in Ghana. Now a second vaccine, R21/Matrix-M has been added to WHO’s recommended procurement lists.

The World Health Organization (WHO) has added the R21/Matrix-M malaria vaccine to its list of ‘prequalified’ vaccines, paving the way for bulk procurement and mass deployment of the new vaccine across malaria-endemic countries by UNICEF and other global health agencies.

The prequalification of the world’s second malaria vaccine, developed by Oxford University and manufactured by Serum Institute of India (SII), is expected to greatly expand access to malaria vaccination, particularly in malaria endemic regions of sub-Saharan Africa where supplies of the already available RTS,S vaccine cannot alone meet the high demand, said WHO in a statement on Thursday.

Some 100 million doses of the new vaccine are reportedly ready for rollout by SII, a major supplier of vaccines in Africa.

“Today marks a huge stride in global health as we welcome the prequalification of R21/Matrix-M, the second malaria vaccine recommended for children in malaria endemic areas,” said Dr Kate O’Brien, Director of the Department of Immunization, Vaccines and Biologicals. “This achievement underscores our relentless commitment to wiping out malaria which remains a formidable foe causing child suffering and death.”

Nearly half a million children in WHO’s African Region die from malaria each year – making it one of the continent’s biggest early childhood killers, despite declining death rates over the past two decades.  Globally, in 2022, there were an estimated 249 million malaria cases and 608,000 malaria deaths across 85 countries.

R21 malaria vaccine administration in clinical trials sponsored by Oxford University, which concluded with regulatory approval of the world’s second malaria vaccine.

Prequalification ensures safe manufacture of the vaccine

In October, WHO recommended use of the R21/Matrix-M vaccine,  developed by Oxford University and manufactured by Serum Institute of India, for the prevention of malaria in children following a review by the Strategic Advisory Group of Experts (SAGE) on Immunization and the Malaria Policy Advisory Group.

However, WHO “prequalification” remains a prerequisite for bulk vaccine procurement by UN agencies as well as for many other donor-supported programmes in countries. Effectively, the pre-qualification label confirms that the manufacture of the vaccine, in this case by SII, meets international standards.

“Achieving WHO vaccine prequalification ensures that vaccines used in global immunization programmes are safe and effective within their conditions of use in the targeted health systems,” said Dr Rogério Gaspar, Director of the Department of Regulation and Prequalification.

The first malaria vaccine to be approved by WHO, RTS,S/AS01 vaccine, obtained prequalification status in July 2022.  While the second vaccine R21/Matrix-M seemed to show even better results in some of clinical trials conducted prior to regulatory approval, WHO has said both are equally effective, noting that the two vaccines have not actually been tested head-to-head.

“Both vaccines are shown to be safe and effective in clinical trials, for preventing malaria in children,” said WHO in its statement. “When implemented broadly, along with other recommended malaria control interventions, they are expected to have a high public health impact.”

Image Credits: WHO/Fanjan Combrink, University of Oxford/Tom Wilkinson.

Nurses| Cameroon
Student nurses prepare for the morning rounds at the Ndop District Hospital in Cameroon.

The worldwide shortage of nurses should be considered a “global health emergency” – yet governments are failing to invest in measures to retain these essential workers, according to Howard Catton, CEO of the International Council of Nurses (ICN).

“The US has lost 100,000 nurses since 2020 and is predicted to lose up to 600,000 by 2027. The number of nurses leaving the UK register is also up since 2020. And in Switzerland, the dropout rates of new nursing students in their first year and second year is between 18 and 36%,”  Catton told a briefing hosted by ACANU, the Geneva UN press association.

Despite increasing evidence of nurses leaving or planning to leave the workforce, “governments are not in sufficiently prioritising investment in the nursing workforce”, he added.

“Improved working conditions and support and investment for the current nursing workforce need to be a priority to hold those nurses that we have.”

Governments are more focused on recruitment than retention of nurses, added Catton – and international recruitment by certain wealthy countries is decimating the healthcare in less affluent countries.

Recruitment from ‘red list’ countries

Howard Catton, CEO of the International Council of Nurses (ICN)

“A small number of high-income countries are driving 70% to 80% of recruitment activity,  overwhelmingly from countries in a weaker position than themselves. 

“Just in recent days, the UK announced that it had reached a target to recruit 50,000 more nurses earlier than planned. But it turns out 93% of those 50,000 were internationally recruited nurses, and we know that 6,000 of them came from the most vulnerable countries – the red list countries, that the World Health Organization (WHO) advises not to recruit from.”

Fiji has lost 25% of its nurses in the last year to Australia and New Zealand, he added.

In 2023, the WHO identified 55 countries – 37 from Africa – with “low workforce density” that might require “safeguards against active international recruitment” of their health workforce.

“The focus of government action, where we do see it, appears more on recruitment than retention,” said Catton.

“Recruitment, of course, is important in the medium to long term. But there’s a time lag. And the most simple, incontrovertible truth is that improved working conditions and support and investment for the current nursing workforce need to be priorities to hold in those nurses that we have.”

The rise in nurses’ strikes and disputes is an indication of the impact of the post-pandemic cost of living crisis, with a fall in real pay being reported even in Italy, Portugal, Finland and the UK. 

However, said Catton, “The approaches governments are adopting are unsustainable, and we’re concerned that there is a risk of more disputes and unrest over the year to come without the prioritisation of investment”. 

Pamela Cipriano, president of the International Council of Nurses (ICN)

ICN president Pamela Cipriano pointed out that slogans such as “health for all”, ‘leave no one behind’ and universal health coverage all depend on nurses – yet there is insufficient investment in nurses and nursing. 

“We need to move nurses from being invincible to being considered invaluable,” she added, cautioning those wanting to bring in workers who are less experienced and less expensive, “We urge great caution because someone with lesser education and training cannot replace the expertise of a nurse.”

Support for nurses in Palestine 

While the ICN did not involve itself in geopolitics, “there should be complete protection of health care facilities, health care workers and civilians in any area of conflict and war”, said Cipriano.

“We know that that’s been violated [in the occupied territories of Palestine], so we have spoken out against that. We, along with many other groups are calling for peace but also very specifically, protection of health care facilities and adherence to international law.”

The ICN had provided some financial support to Palestinian nurses, who are currently not being paid, “but not anywhere near the magnitude that they would need and hoping that we can help them to connect with other groups that can provide some financial support”, she added. 

Aside from financial support, Cipriano noted that nurses in the occupied territories needed education to deal with “new patient groups” as “the wounds of war are different from normal care”.

“Right now, we know they’re working in conditions where electricity, water supplies, medications, are at risk, so they are working in serious disaster conditions,” said Cipriano.

“Many times our other associations step up to help one another, either financially or it may be that regionally, there can be physical support.”

Tribute to Israeli nurse held hostage

Cipriano also paid tribute to Nili Margalit, an Israeli nurse kidnapped by Hamas on 7 October and held hostage for 55 days.

“She’s a 41-year-old nurse and… [she was able to] get medications to the people who were in the tunnel where she was being kept, to give them hope, to be the communicator, to be the organiser.,” said Cipriano 

“That is what nurses do. They rise in the face of crisis, as well as [during] the daily and life events that that people are facing. 

“In conflict and crisis, we can rely on nurses even though we know it also takes a tremendous mental toll on their well-being.”

Image Credits: © Dominic Chavez/The Global Financing Facility.

Al Shifa Hospital in northern Gaaza at time of WHO delivery of medical supplies on 16 December, 2023

From earthquakes in Afghanistan to floods in Libya and the conflicts in Gaza and Sudan, WHO’s Eastern Mediterranean region, is beset with one of the world’s largest concentrations of people trapped in humanitarian crises and in desperate need of emergency health services, food aid, as well as peace,  said Dr Ahmed Al-Mandhari, WHO Regional Director for the Eastern Mediterranean, Tuesday. 

“Our region is home to 38% of the global population in need of humanitarian aid, which means over 140 million persons,” said Al-Mandhari, speaking from the WHO Regional Office in Cairo at an end-year WHO briefing.  “This number represents the everyday tragedies experienced by the people of Syria, Afghanistan and Iraq after earthquakes. The lived horrors of the people of Libya after catastrophic flooding, drought in the Horn of Africa, the rapidly worsening conflict in Sudan, and of course, the humanitarian crisis that continues to unfold in Gaza with unprecedented brutality.”

The Palestinian death toll in Gaza from the conflict between Israel and Hamas is now approaching 20,000 people, with high levels of hunger, crippled health services and growing prospects of disease outbreak, Mandhari warned.  At the same time, the  brutal war raging in Sudan between the Sudanese Armed Forces and the paramilitary Rapid Support Forces (RSF), has led to the displacement of some 7 million people, leaving some 4.9 million people on the brink of famine, he said.

Dr Ahmed Al-Mandhari, WHO Director for the Eastern Mediterranean Region

Unlike Gaza, the Sudanese civil war has been happening pretty much “off the radar screen”, added Dr Richard Brennan, Regional Emergency Director, WHO Regional Office for the Eastern Mediterranean, at the briefing. 

“We’re not seeing much on the news media, in the international media,” observed Brennan.  However, there has been a marked escalation in hostilities over the past several days as RSF forces advance on the city of Wad Madani, south east of Khartoum, where hundreds of thousands of poeple from the capital had taken refuge and many are now forced to flee.

“Over 24 million people are in need of aid. It’s the largest displacement crisis in the world today,” said Brennan of the Sudan war. “There are high levels of fighting and violence, high levels of displacement, a major food and security crisis. People are going hungry.  There is a rapidly progressing cholera outbreak, as well as rapidly spreading outbreaks of malaria, dengue and measles.”

Dr Richard Brennan, Regional Emergency Director, WHO Regional Office for the Eastern Mediterranean

Meanwhile, the western Sudanese region of Darfur, there has also been a fresh escalation of war-related violence against civilians, including “terrible stories of sexual violence against women and atrocities against the husbands and partners,” said Brennan. But despite the crisis there are large areas of the encircled region to which WHO and other humanitarian relief groups have no access at all. “We can only reach Darfour from cross border operations via Chad,” he said.

Sudan war: pink indicates areas controlled by Sudanese Armed Forces and allies as of 10 December 2023; green indicates control by Rapid Support Forces; yellow indicates control by Sudan People’s Liberation Movement-North.

WHO immediate aims for Gaza relief in ‘shrinking humanitarian space’

On Sunday, 11 December the WHO Executive Board approved a draft resolution to the World Health Assembly calling for the “immediate, sustained and unimpeded passage” of humanitarian relief to Gaza, including healthworkers, vehicles and supplies.

The most immediate needs include restoring the functionality of at least four hospitals in northern Gaza, with the support of emergency medical teams; expanding bed capacity and operations in southern Gaza hospitals, now in the line of fire as well; and a “better organized” medivac for wounded and ill Palestinians to Egypt or elsewhere abroad, said Dr Richard Peeperkorn, representative to WHO’s Jerusalem-based office in the Occupied Palestinian Territories (OPT).

Dr Richard Peeperkorn, WHO Representative, occupied Palestinian territory

But such aims faced huge challenges in light of the “shrinking humanitarian space.. and military activities making it very difficult for the One UN, including WHO, to move supplies, staff and patients.”

Coordination for safe passage of patients, health workers and supplies is “incredibly cumbersome,” he added, noting that a WHO mission to two northern Gaza hospitals had to be cancelled on Tuesday, due problems in coordinating safe passage.

On a visit to Al Ahli Hospital, in Gaza’s north last week, Peeperkorn said that he was “shocked” both by the scenes of urban devastation around the hospital and the needs inside, which were “unlike anything I had seen in my life.”

He described wounded people being brought in for emergency treatment on horse and donkey carts with over 200 patients “everywhere”, including the chapel of the hospital, operated by the Anglican Church.

Yesterday, Peeperkorn said he had received reports that “the fence surrounding the hospital had been demolished and there were tanks stationed outside.” A dozen people on the hospital grounds were reportedly arrested and remain in detention, including five staff.  That follows on a pattern of previous Israeli detentions and arrests of health workers at Al Ahli and elsewhere, he said.

“They’ve asked who to support with medical supplies, water and fuel. So we are planning a mission there tomorrow. But we hope on the current circumstances that this is possible,” Peeperkorn concluded.

More calls for Gaza cease-fire but prospects remain dim

WHO Executive Board meeting on the health and humanitarian situation in Gaza, Sunday. 10 December saw a fragile consensus reached.

“Stop this war, with no delay,” said Al Mandhari of the Gaza conflict.

In Sudan, “we absolutely need a ceasefire but unfortunately the military offensive is continuing, and more and more people are going to get caught up in the crisis because of the onward march of the military offensive,” added Brennan.

Yet another UN Security Council vote on the Gaza situation was scheduled for later Tuesday. Under US pressure, a fresh UN Security Council call for a “an urgent and lasting cessation in hostilities” had reportedly been watered down to call for an “urgent suspension of hostilities”.

Real prospects for a cease-fire in the near term seemed dim as Israel’s military advanced deeper into Gaza, including areas of the south where over 1.9 million displaced Palestinians are now living, after fleeing the north. Hamas has meanwhile said it will not negotiate over the release of more hostages under Israeli fire, demonstrating its resolve by lobbing missiles at Tel Aviv again on Tuesday, after releasing a new video Monday of three elderly Israeli hostages pleading for the Israeli government to prioritize their release along with the other 112 people still in captivity.

Israel initially launched air strikes on Gaza, followed by a ground invasion, in response to the 7 October Hamas incursion into Israeli communities near the Gaza enclave, in which gunmen killed over 1000 men, women and children in their homes along with young people at an outdoor festival.  Another 240 Israelis and foreign workers were carried back to Gaza, including about 30 children.

Some 114 hostages, mostly women and children, were released in a series of exchanges with Palestinian prisoners held by Israel during a week-long humanitarian pause in late November, before hostilities resumed. Israel has now seized large parts of northern Gaza, flattening most of the urban landscape, and carrying the battle to the tiny enclaves southern strongholds where most of Gaza’s population is now living in schools, around hospitals and makeshift shelters.

Israel, supported by the United States, Canada and other allies, has maintained that Hamas forces sytematically built tunnels, stored weapons and even hid hostages in and around health infrastructure, and any permanent cease-fire that leaves the organization’s military prowess intact would pave the way for more bloody attacks like that of  7 October, which Hamas leaders have already pledged to repeat.

Palestinians, supported by a large majority of other UN member states, have charged that the Palestinian civilian toll, including deaths of more than 7,000 children, has been disproportionately high, and the targeting of health facilities remains in contravention of international law regardless of claims about Hamas military deployment.

Regarding attacks on healthcare facilities, Mandhari issued an appeal to all sides, saying: “WHO and UN is always saying that attacks on healthcare is a breach of international humanitarian law, ..and any attack on these institutions or mobile teams on the ground is considered that way.  And we always call those conflicting parties to respect that law.  And if there is any breach, WHO encourages the relevant units, departments or organizations …to take it seriously and start doing whatever investigations are needed and then act against those who breach that sort of law.” 

Image Credits: @WHO, Eliajah Pepe/Wikipedia .

Vials of Pfizer´s COVID-19 vaccine.

Days after government officials took a break from frenetic pandemic accord negotiations, news broke that European countries had destroyed at least 215 million unwanted COVID-19 vaccine doses valued at over €4 billion.

The 19 countries surveyed dumped 0.7 doses per resident – with Estonia and Germany being the most wasteful, according to Politico, which broke the story this week.

In 2021, the European Union (EU) bought the equivalent of three doses per resident in secret deals with drug companies – hoarding these when African countries did not have access to any vaccines, not even for health workers.

Ending this cycle of waste and want is at the heart of the current pandemic agreement negotiations hosted by the World Health Organization (WHO). The talks are due to conclude in May 2024 with an agreement to govern countries’ conduct during pandemics – but parties seem to have entrenched disagreement about how best to ensure equitable access to vaccines and other medical products in future pandemics.


The People’s Vaccine Alliance’s Piotr Kolczyński said that the EU appears not to have learnt from its COVID mistakes, based on the positions it has taken during the pandemic agreement negotiations.

“The EU pumped unprecedented public funding into COVID-19 vaccines with no strings attached to ensure universal access. Yet, instead of learning from its mistakes, public funding conditionalities have been deleted from the draft Pandemic Agreement, and the EU is now trying to remove the remaining transparency and equity measures too,” said Kolczyński, who is the EU Health Policy Advisor at Alliance and Oxfam.

Several countries and non-state actors involved in the pandemic agreement negotiations advocate for governments that have invested public money in the development of pandemic products to retain a stake in these – via measures such as shares or joint intellectual property (IP) – so that private companies do not call the shots during pandemics.

However, the EU and the US have been lukewarm about this proposal.

COVAX lessons: Mitigating vaccine nationalism

Vaccine deliveries by the global COVAX facility.

Meanwhile, the four global co-convenors of the COVID-19 vaccine access platform, COVAX, urged in a joint statement on Tuesday that “future global pandemic preparedness and response architecture” be informed by COVAX learnings.

Noting that COVAX would close at the end of December, the Coalition for Epidemic Preparedness Innovations (CEPI), vaccine alliance Gavi, UNICEF and the WHO, highlighted three key learnings.

The first is the need to design, invest in and implement “an end-to-end solution to equitable access ahead of time” that “centres on the needs of the most vulnerable”.

While “vaccine nationalism will persist in future pandemics”, they urge “mechanisms to mitigate it – including by diversifying vaccine manufacturing so all regions have access to supply”.

The third lesson is “the need to take financial risks to avoid potentially deadly delays to the development, procurement and delivery of medical countermeasures”. 

Money left over from COVAX will be redirected to implement some of these lessons, including investing $1 billion in the establishment of an African Vaccine Manufacturing Accelerator (AVMA) to support African vaccine manufacturing, a measure announced recently by the Gavi board.

“In addition, a First Response Fund will be established to ensure financing for a vaccine response is immediately available in the event of a future pandemic,” they note.

New Africa-Caribbean solidarity

Meanwhile, Tuesday also saw the launch of a new South-South partnership, the Health Development Partnership for Africa and the Caribbean (HeDPAC) to strengthen health cooperation between Africa and the Caribbean.

“Promoting technology transfer for pharmaceutical manufacturing, building regulatory capacity, and enhancing universal health coverage will be core HeDPAC strategies,” according to a statement released via the WHO.

“COVID-19 left an indelible scar on our global solidarity and the right of all people to good health”, said Prime Minister Mia Mottley of Barbados. “It is our shared responsibility to ensure that the inequity of the global response to COVID-19 is not repeated. This is the kind of action that will allow us to help people where they need it most.”

HeDPAC will also focus on strengthening the health workforce in the two regions, and sharing innovative solutions in primary health care, with a special emphasis on climate resilience, and maternal and child health.

Pandemic negotiations 2024 deadline

The seventh meeting of the Intergovernmental Negotiating Body (INB) negotiating the pandemic agreement ended late on 7 December with a rapid and vapid report back – likely indicating that the negotiations remain difficult.

While informal inter-sessional meetings are set to continue in early January, the INB meets for the eighth time from 19 February to 1 March 2024. 

A ninth meeting is also planned before the World Health Assembly at the end of May at which the pandemic agreement is due to be presented.

Image Credits: Photo by Mat Napo on Unsplash, @CEPI .

Some of those petitioning against Uganda’s Anti-Homosexuality Act in court on Monday, including Pepe Onziema (left) and Frank Mugisha (centre).

The court challenge to Uganda’s Anti-Homosexuality Act, one of the harshest anti-LGBTQ laws in the world, began in Kampala on Monday before five Constitutional Court judges.

The Act, which was passed by an overwhelming majority of Members of Parliament in May, includes penalties such as a life sentence for same-sex acts between consenting adults, 10 years in prison for “attempted homosexuality;” the death penalty for “aggravated homosexuality” and 20 years in prison for  “promotion of homosexuality”.

However, there is unlikely to be much more live court action after Deputy Chief Justice Richard Buteera, chair of the hearing, agreed to entertain written submissions rather than live hearings.

This followed a request by the lawyers representing the eight petitioners, including MP Fox Odoi-Oywelowo, and LGBTQ leaders Frank Mugisha and Pepe Onziema,  that they wished to proceed by way of written submissions.

Respondents, the Attorney General, supported by evangelical Pastor Martin Ssempa and Watoto Church elder Stephen Langa, served the petitioners with their written submissions at the hearing, and the court directed the respondents to reply by 5pm on 20 December.

Thereafter, the court will deliver its judgment “on notice”, either in court or electronically.

Commenting on the decision, Nicholas Opiyo, the attorney for the petitioners, said that the intention was “to avoid the theatrical intention of some of the people admitted into the process whose only objective appeared to be using the court as a platform to raise money and profile”. 

“In the end, a decorous process to preserve the integrity of the court and the hearing was chosen over and above oral presentation,” added Opiyo on X inan apparent reference to Ssempa’s attempts to use the court challenge to fundraise for his anti-LGBTQ crusade.

Researchers threaten to withdraw after directive 

Meanwhile, Uganda’s National Council for Science and Technology faced international condemnation for directing all researchers to report anyone who violated, or was suspected to be violating, the Act in their research programmes to the police.

In an open letter sent to Dr Martin Ongol, acting secretary of the council, some 260 researchers worldwide call on him to immediately withdraw a directive he issued on 27 October.

 

The directive informed researchers that “the duty of confidentiality in research may be waived for the purposes of reporting to the relevant authorities the commission of an offence” in terms of the Anti-Homosexuality Act.

The Act itself obliges citizens to report anyone who has committed or intends to commit any offence under the Act or face “a criminal penalty or a fine”.

“This Directive means we cannot uphold our moral commitment to the rights of our study participants to life, health, dignity, integrity, self-determination, privacy, and confidentiality,” notes the letter.

“We are asking you to immediately withdraw this Directive, if not, we will be forced to reassess our current research in Uganda and our future research plans.”

Uganda has already paid heavily for its homophobia, with the county’s new World Bank loans currently on hold along with new grants from the US President’s Emergency Plan for AIDS Relief (PEPFAR), the country’s exclusion from the US African Growth and Opportunity Act (AGOA) that gives preferential trading terms to select African governments and US visa sanctions on key supporters of the Act, including all the MPs who voted for it.

Global spending on health increased during 2021 at the height of the COVID-19 pandemic, reaching a record $9.8 trillion or 10.3% of global gross domestic product (GDP) – mostly as a result of governments devoting more domestic resources to health,

Country spending was highest on hospitals, accounting for 40% of expenditure, followed by ambulatory care (outpatients) providers (19%–24%) and pharmacies (16%–23%). 

The fastest growth in spending was on preventive care providers, such as public health institutions and disease control agencies. 

This is according to the World Health Organization’s (WHO) Global Health Expenditure Report 2023, based on data from 50 countries.

However, the per capita spending was “unequal”, the report notes, with high-income countries spending an average of $4001 per person in comparison to a mere $45 in low-income countries. Upper-middle-income countries spent $531, which was substantially more than the $146 per person in lower-middle-income countries.

“The distribution of global spending on health remained highly skewed in 2021: 79% was in high-income countries, which are home to less than 16% of the world population,” according to the report. 

“Low-income countries accounted for only 0.24% of the global health expenditure, despite having an 8% share of the world’s population.”

Spending on COVID-19 rose in real terms in 39 of 48 countries with data, accounting for 11% of government and compulsory insurance health spending in 2021, up from 7% in 2020. 

There was “no evidence” that the additional COVID-19 spending meant countries spent less on other diseases, or that spending on COVID-19 vaccines meant less money for testing and treatment, the report finds, stating: 

“The analysis suggests that the increased spending for COVID-19 did not crowd out spending for other health needs, although it might have affected the rate of growth of spending for these other purposes.” 

In addition, out-of-pocket spending on health in low-income countries fell in 2020 and 2021 but rose to pre-pandemic levels in high, upper-middle and lower-middle-income countries in 2021 after a decline in 2020.

Lack of data on spending patterns

The WHO said that action is still needed at the domestic and international levels to improve data collection on spending patterns. 

“While most countries regularly report aggregated health spending data, few consistently report the critical details that underpin these high-level results. Accordingly, only a partial view of the spending dynamics during the COVID-19 pandemic – by provider, function, and disease and condition – is possible in this report.”

The report also notes the lack of information on health capital investment “which limits the insights into this critical area of health policy”. 

“More effort is needed, therefore, to improve data collection and increase the number of countries developing and reporting disaggregated health account data. Key to this is institutionalising health account practices at the country level.”

Hard to sustain higher spending levels

External aid was “crucial” in supporting government spending in 2021 in low and lower-middle-income countries. However, sustaining government health spending and external aid at 2021 levels may be challenging given “the deterioration in global economic conditions and the rise in debt-servicing obligations”.

“Amid this more difficult financing environment, a key challenge for countries will be to resist the urge to de-prioritize government spending on health. Doing so risks rolling back progress towards universal health coverage,” according to the report.

Image Credits: WHO African Region , WHO PAHO.

Dr Anshu Banerjee, WHO director for maternal, newborn, child, adolescent health and ageing, described the new guidelines as “a tool to support a holistic approach to chronic low back pain care”.

The World Health Organization (WHO) has released its first guidelines for addressing low back pain, a condition affecting an estimated 619 million people, or one in 13 worldwide.

The new guidelines are designed to enhance care quality for millions suffering from the condition, offering healthcare professionals a range of non-surgical treatments applicable in primary and community care settings. The guidelines also list treatments to avoid, including lumbar braces, traction-based physical therapies, and opioid painkillers.

The prevalence of low back pain is expected to surge as the global population ages, with estimates predicting a rise to 843 million affected individuals by 2050. Low back pain currently accounts for 8.1% of years lived with disability globally, according to the WHO.

“To achieve universal health coverage, the issue of low back pain cannot be ignored, as it is the leading cause of disability globally,” said Dr Bruce Aylward, WHO assistant director-general for universal health coverage and life course, in a press release accompanying the guideline launch.

Nine out of ten cases of low back pain are chronic, deeply affecting patients’ ability to work and stay active in family and social life, often leading to broader economic and mental health consequences. The guidelines emphasise mental health care as crucial in treating these conditions.

Chronic low back pain also has significant economic repercussions at the national level, pushing individuals out of the workforce and straining health systems.

The annual global costs associated with low back pain exceed $50 billion and potentially reach up to $100 billion at the upper end of estimates, according to the British Medical Journal. This financial impact is especially pronounced in low- and middle-income countries (LMICs), where 80-90% of employment involves heavy labour, significantly increasing the prevalence of LBP compared to high-income nations.

The WHO guidelines provide a multifaceted approach to treatment, emphasising patient education in self-care techniques, structured exercise programs, spinal manipulative therapy, and massage, while cautioning against certain treatments like traction and therapeutic ultrasound.

WHO officials emphasised that while the guidelines provide a general framework, adapting them to local clinical practices is essential for effective implementation.

“Addressing chronic low back pain requires an integrated, person-centred approach,” said Banerjee. “This means considering each person’s unique situation and the factors that might influence their pain experience.”

Recognising low back pain as a national health priority is crucial for optimising healthcare management in this area, WHO stressed – a step many countries have yet to take.

Image Credits: Adam McGuffie.

Vidya Kishnan and Garry Aslanyan on "Dialogues," a new series from the Global Health Matters podcast.
Vidya Kishnan and Garry Aslanyan on “Dialogues,” a new series from the Global Health Matters podcast.

The elimination of tuberculosis cannot be achieved if medicines are locked in a “patent panoply,” according to Indian author and journalist Vidya Kishnan.

Speaking to Garry Aslanyan on the most recent episode of Dialogues, a new series from the Global Health Matters podcast, the author of “Phantom Plague: How Tuberculosis Shaped History” said that “everything that happened in COVID has been happening for decades with TB.

“In India, the entire TB program got ‘Covidized,’ down to the helpline of the Ministry [of Health], and infections and respiratory diseases don’t simply go away,” Kishnan said. “So, the first thing we need to do is look at how technology is transferred because vaccines and drugs first and foremost, it’s technology. It’s somebody’s intellectual property. And I feel like TB elimination cannot, will not be achieved if the medicines, the latest most humane therapy, is locked in a patent panoply.”

The most exasperating aspect, according to Kishnan, is that the advancements in tuberculosis therapies resulted from a sincere collaboration within the public domain. Universities, student funds, and philanthropic contributions collectively supported these efforts. Notably, several late-stage clinical trials for bedaquiline took place in India and South Africa, with patients actively contributing to the process.

“It’s really unfair that you use patients for research, but then when … all of these drugs came out of industrial scale subsidies to pharmaceutical companies, and others in patent panoplies.”

Throughout her writing career, Kishnan has dedicated considerable effort to investigating and documenting the profound impact of tuberculosis on individuals from various backgrounds in India. In her book, she delves into critical questions concerning the intersection of race and caste within policies that shape the dynamics of tuberculosis spread and control in the contemporary context of her home country.

Kishnan tells Aslanyan that in India, people live in congested cities and are still segregated by race, caste, and class. Pathogens do not respect these boundaries. However, the rich generally access medicines, whereas the poor are left behind.

In India, tuberculosis has reemerged as the foremost infectious disease killer. She said the lessons from previous pandemics underscore a fundamental truth: No one can be considered safe until everyone is protected from the threat.

“I feel like a stuck record saying this over and over again everywhere I speak. But it was quite surreal to see the science denialism and the racism and casteism in my country, all of the things I had read about, the xenophobia, all of it just came to life in the past three years,” Kishnan said. “If we are greedy and if we think in these myopic ways, I don’t see any way we will prevail over these pathogens despite all the fruits of modern medicine.”

Aslanyan concluded: “This conversation reminds us, as global health professionals, of many challenges on the long road ahead toward the ultimate goal of tuberculosis elimination and the importance of community engagement.”

Listen to previous episodes of Dialogues on Health Policy Watch.

Image Credits: Global Health Matters (TDR), Global Health Matters Podcast (TDR).

Dr Tedros Adhanom Ghebreyesus at end 2023 press briefing

In the wake of COP28, WHO will press ahead with calls for fossil fuel phase out, stepped up commitments for health sector decarbonization, and a new resolution on Climate and Health, set to go before the World Health Assembly in May 2024.

Those were key takeaways from an end-year WHO global press briefing by WHO Director General Dr Tedros Adhanom and other senior officials in an end-year press briefing Friday before the Geneva press corps.

Health and humanitarian crises associated with raging conflicts in Gaza, Sudan, Myanmar, Haiti, DR Congo and other conflict hotspots were also top on the agenda of WHO, as well as other UN agencies in as second press briefing Friday morning, looking back on 2023.

In addition, WHO warned that a more dangerous clade of mpox, the virus that swept the world in 2022 and 2023, is now being transmitted by sexual contact in the central and western Africa, including female sex workers as well as men who have sex with men – and its spread also represents a potential global threat. Even so, “not a single dollar” of donor funds has been raised to support the scale up of diagnosis, treatment, vaccination or monitoring and surveillance in DR Congo and other African states where the virus is most active and spreading, said Maria Van Kerkhove, a WHO Health Emergencies specialist.

Fossil fuels the main driver of climate change

Drought in Burkina Faso, yet another sign of climate change impacting human health and livelihoods.

“We single out fossil fuels because it’s not just one of the contributors, it is the major contributor to climate change,” said Dr Tedros, at the Friday afternoon press briefing. “Fossil fuels are three components – oil, coal and natural gas.  And these three combined contribute more than 75% of carbon emissions.  So if you don’t focus on the fossil fuels that contribute more than 75% to the carbon emissions, then where do you focus?

“When you focus on the major contributor, you can make progress and that is why the global community is asking for more consensus on phasing out fossil fuels.”

A landmark agreement Wednesday, at the close of the UN Climate Conference in Dubai, COP28, took the first tentative steps towards that goal. The final agreement calls, endorsed by 198 nations, for a “just, orderly, and equitable” transition away from fossil fuels in energy systems to achieve “net zero by 2050 in keeping with the science”.    A call for a complete phase out of fossil fuels, supported by 127 nations at COP28, was removed from the text after intense lobbying by oil-producing nations, led by Saudi Arabia. The reference to “energy systems” also creates a giant loophole in the calls for transition, effectively overlooking fossil fuel use in heavy industries like cement and steel industries, as inputs to fertilizers and plastics, and possibly transport.

Following a first-ever “health day” at COP28, a WHA resolution on climate and health is now being negotiated by member states, said Dr Maria Neira, head of WHO’s Department of Climate, Environment and Health.

There are also initial efforts underway to explore how health indicators could be better integrated into global measures of progress on climate change – to better underline the health connection and inspire progress, she said.

“Why not put up a health-related indicator as the ultimate demonstration of success,” she told Health Policy Watch, adding that air pollution exposures could be one relevant measure, insofar as most air pollution is created by the same sources of fossil fuel or biomass burning that contribute to climate change.  “Or how about the number of countries implementing air quality guidelines for instance, or having health incorporated into national determined contributions (NDCs)?”

Unprecedented number of health and humanitarian crises

Emergency shelters at the Awar camp site in Mahagi, Ituri province in the eastern Democratic Republic of the Congo.

As the climate crisis continues to exact an increasingly severe human toll, 2023 has seen an almost unprecedented number of health and humanitarian crises raging across the world, Tedros and other WHO officials at the briefing noted.

Those range from the approximately 1.9 million Palestinians displaced in Gaza amidst the ongoing Israel-Hamas war; to the war in the Sudan which has displaced over 7 million people, also causing acute, widespread hunger; a new civil war in Ethiopia, this time with rebels in the country’s Amhara region; gang violence in Haiti, and rebel violence in eastern DR Congo that has displaced a record 6.9 million people. And that list doesn’t even include Russia’s war in Ukraine, as well as protracted conflicts in Myanmar, northwestern Syria and elsewhere.

“All of these crises come at a heavy price, in term of lives lost and communities destroyed, but also in terms of the cost of delivering humanitarian aid,” said Tedros.  He called again for an immediate cease-fire and unfettered access by health workers transporting patients and bringing supplies to hospitals in all parts of the beseiged enclave, and particularly to three still-functioning hospitals in northern Gaza, an epicenter of combat.

While a recent Israeli announcement that it would open up a new crossing into Gaza from its Kerem Shalom crossing point is “very good news”, Dr Richard Peeperkorn, WHO representative to the Occupied Palestinian Territories, stressed that “we are not only talking about getting supplies into Gaza, ware talking about getting supplies to people all over Gaza.”

Sexual transmission of Clade 1 mpox raises renewed concerns

Mpox lesions

Meanwhile, WHO officials expressed growing concerns over the increasing signs of sexual transmisson of the deadly Clade 1 of mpox in DR Congo, Nigeria and neighboring countries.  While last year’s global outbreak of Clade 2 of the virus was primarily seen among men who have sex with men, Clade 1 is now being transmitted sexually to women, including sex workers in major Nigerian and Congolese cities, such as Goma, said WHO’s Rosamund Lewis, speaking at a Friday morning press briefing convened by the UN press office in Geneva.

Whereas the Clade 2 virus that trigggered a WHO declaration of a global public health emergency in 2022, has a case fatality rate of about .18%, death rates of Clade 1 are 5-8% in the DRC, which has recorded its highest-ever levels of confirmed and suspected cases this year, Lewis said.

“This is a much more serious disease,” said Mike Ryan, at the WHO Friday evening briefing. “The virus is growing in geographic dimensions, and in numbers. Anytime you see a virus breaking those geographic barriers, breaking the susceptible group barriers. You have to be very careful. 

“From a global level, we have not been able to raise any funding to deal with an ancient threat that is killing right now, spreading right now, evolving, right now,” Ryan stressed, also noting the genetic links between mpox, an orthopoxvirus, and smallpox, which was finally eradicated in the 1970s.  

“We talk about all of the casualties of war, but smallpox probably killed more people than all of the wars in  history,” Ryan added. 

Image Credits: E. Fletcher , Yoda Adaman/ Unsplash, IOM 2023, Tessa Davis/Twitter .

Dr Olivi Ondchintia Putilala Silalahi, WHO Indonesia national professional officer for routine immunization, inspects a COVID-19 vaccination site in Indonesia.

A spike in COVID-19 cases in Southeast Asia has prompted Indonesia, Singapore and Malaysia to reintroduce screening for travellers at airports.

In the past week, Indonesia has installed thermal body scanners at Jakarta International Airport and the main ferry line.

The Bali Port Health Office has also implemented thermal checks at three border entry points: Benoa Port, Celuk Bawang, and I Gusti Ngurah Rai International Airport, and appealed to travellers to wear masks – particularly if they are feeling unwell.

Should a tourist or foreign national test positive for COVID-19 upon arrival, they will be immediately quarantined in a designated health facility or referral hospital in Bali, according to a circular issued this week by the Ministry of Health.

The Indonesian health authorities have also urged citizens to wear masks, ensure they are fully vaccinated and postpone travel to areas that are reporting a spike in COVID-19 cases.

https://twitter.com/BloombergAU/status/1735242493136920598

Jump in cases in Singapore

In Singapore, COVID cases increased by 10,000 in a single week, jumping from 22,000 to 32,035 in the week ended 2 December, according to the health ministry.

“The increase in cases could be due to a number of factors, including waning population immunity and increased travel and community interactions during the year-end travel and festive season,” said the Ministry of Health. 

“We urge the public to exercise precaution, personal and social responsibility,” said the Singaporean Health Ministry.

“When travelling overseas, stay vigilant and adopt relevant travel precautions, such as wearing a mask at the airport, purchasing travel insurance, and avoiding crowded areas with poor ventilation.”

“Everyone is advised to keep up to date with their COVID-19 vaccinations. This includes an additional dose around one year after their last vaccine dose for those aged 60 years and above, medically vulnerable persons, and residents of aged care facilities,” it added.

Malaysia COVID cases: 14 December 2023

Meanwhile, cases in Malaysia doubled in a week, jumping from 6,796 cases at the end of November to nearly 13,000 by 9 December, according to the New Strait Times.

Malaysian Health Minister Dzulkefly Ahmad recommended on Thursday that people wear masks and get a COVID-19 booster if they were elderly or had co-morbidities, according to the Strait Times.

Image Credits: WHO Indonesia.