A healthcare provider screens people for African sleeping sickness.

The global health landscape is marked by paradoxes. The last several decades have been shaped by progress and setbacks – new medicines and emerging diseases, technological advancements and entrenched inequities. 

The Ebola outbreaks and COVID-19 pandemic exposed many of the already existing inequities in our global health ecosystem, from unequal access to vaccines to restrictive intellectual property laws that prevent low- and middle-income countries from developing their own medical products.

 As we witness both remarkable progress and glaring disparities in global health, it is abundantly clear that we have to redefine our approach as health funding, research and decision-making for African countries cannot be managed in the Global North. 

Advancing health equity and ownership in Africa is not merely a moral imperative; it is an essential pathway to harnessing the vast potential of the continent. In pursuit of this imperative, we must dismantle the barriers within global health institutions that have hindered Africa’s progress, and foster partnerships that empower African nations to lead the charge in shaping their own health destinies, being mindful of the new mantra: decolonising global health.

Disproportionate impact of infectious diseases

Africa has historically been disproportionately affected by infectious diseases such as HIV/AIDS, malaria, tuberculosis, and several other neglected tropical diseases with some conditions like yaws and guinea worm resurfacing in areas where they had previously been eradicated. 

At the height of the HIV/AIDS epidemic, access to life-saving antiretroviral therapy (ART) was severely limited in Africa as high drug prices, patent protections, and trade barriers made it challenging for African countries to procure and provide ART to their populations. 

In contrast, high-income countries in the Global North had widespread access to ART, which significantly improved the prognosis and quality of life for people living with HIV.

A woman prepares for an HIV test in Uganda.

Many African countries also have amongst the highest maternal and child mortality rates in the world, reflecting disparities in access to quality health care, including skilled birth attendants and emergency obstetric care. In some cases, very basic interventions such as clean water and clean hospitals can make a very significant difference in mortality. 

 Africa also faces significant health inequities in terms of access to sexual and reproductive health and rights (SRHR), such as limited or insufficient access to contraception and comprehensive sexual health education, which is sometimes hindered by religious practices in some African countries.

These barriers and inequities have hampered Africa’s health progress. Addressing and dismantling them demands a comprehensive approach.

Funding mechanisms must advance equity

 First, global health funding mechanisms must have a stronger focus on advancing health equity. This means directing more resources to countries and regions with the greatest health disparities and challenges, as well as prioritizing investments in health system strengthening, including infrastructure and workforce development. 

African governments should also explore innovative financing mechanisms that drive up domestic financing for health – such as social health insurance, community-based health financing, and public-private partnerships – to diversify funding sources for health.

 Simultaneously, all stakeholders must work to dismantle the systemic biases within global health, including empowering more women to hold leadership roles and prioritizing the health needs of vulnerable and marginalized communities. 

Moreover, while international partners and donors play a vital role in supporting health interventions across the continent, Africa’s health priorities, policies and research must be locally led. Empowering African leaders and experts is key to addressing these biases and ensuring that the unique challenges faced by African nations receive the attention and resources they deserve.

Collaboration is important for impact

 Collaboration across sectors and geographies is also indispensable in the pursuit of global health equity. International organizations, governments, academia, civil society, and the private sector all have a role to play in sharing best practices and directing resources where the need is greatest.

South-South cooperation, in particular, can facilitate knowledge-sharing and foster greater collaboration among countries facing similar resource constraints and health challenges.

The year 2030 is just around the corner and questions still remain about our ability to reach the sustainable development goals which, while not legally binding, require African governments, researchers and scientists to take responsibility.

African-led and supported research initiatives, conferences and platforms are crucial for understanding health disparities and designing effective interventions. 

The upcoming Third International Conference on Public Health in Africa (CPHIA 2023) will provide a platform for African leaders to reflect on lessons learnt in health and science, spotlight African research and innovation, and align on a way forward for creating more resilient health systems. 

Platforms like CPHIA exemplify the potential of home-grown initiatives to tackle health challenges through regional collaboration, with a focus on equity and inclusivity.

In our increasingly interconnected world, the urgency of advancing health equity in Africa cannot be overstated. 

The pursuit of health equity is an immediate and collective responsibility and requires a multifaceted approach that encompasses equitable and sustainable funding, empowered leadership, successful homegrown initiatives, and inclusive collaboration. 

By harnessing the collective will of all stakeholders, we can dismantle the barriers that have hindered Africa’s health progress and usher in a healthier, more equitable Africa.

Prof Margaret Gyapong is the Director of the Institute of Health Research, University of Health and Allied Sciences (UHAS) in Ghana, and co-chair of the upcoming Conference on Public Health in Africa (CPHIA).

Shingai Machingaidze is Acting Chief Science Officer at the Africa Centre for Disease Control and Prevention (Africa CDC) and the CPHIA secretariat lead.

Image Credits: Xavier Vahed/DNDi, 2011, Sokomoto Photography for International AIDS Vaccine Initiative (IAVI).

Dr Tlaleng Mofokeng (right), the United Nations Special Rapporteur on the Right to Health

Tackling inequities in food, nutrition and health outcomes needs a rights-based approach to food and nutrition, based on equality and centred on historically marginalised individuals and communities, according to Dr Tlaleng Mofokeng, the United Nations (UN) Special Rapporteur on the Right to Health.

“The intersection of the right to health and right to food is central to achieving substantive equality and realising sustainable development, human rights, lasting peace and security,” Mofokeng told a New York audience at the launch of her report on food, nutrition and the right to health.

“Ultra-processed products, with marketing strategies that disproportionately target children, racial and ethnic minorities, and people from socially disadvantaged backgrounds, have replicated colonial power structures and dynamics, with traditional diets and food cultures being replaced by diets largely shaped by corporations headquartered in historically powerful and wealthy countries,” said Mofokeng at the launch, which was hosted by Vital Strategies.

She called for mandatory front-of-package nutrition labelling, and fiscal and food policies consistent with the obligation of member states to protect the right to health and health-related rights.

“Within the context of food and nutrition, the obligation to respect human rights requires that states not engage in any conduct that is likely to result in preventable, diet-related morbidity or mortality, such as incentivizing the consumption of unhealthy foods and beverages,” according to the report.

Mofokeng also raised the issue of land expropriation, occupation and destruction, noting that this “eliminates the ability of Indigenous Peoples and other local communities to produce their own food for a healthy diet and turns food into a commodity controlled by those in power, thus violating their right to adequate food and health.’.

“Food is more than nutrition. Besides being one of the most common sources of pleasure, food is a social glue,” she said.

Palestinians shelter in Al Quds Hospital in Gaza, which Israel has ordered to be evacuated.

The WHO and the International Red Cross both issued weekend appeals to Israel to rescind its evacuation order on Al Quds Hospital, a major  healthcare facility in the northern Gaza Strip.  Israel has said that Al Quds, along with Al Shifa Hospital, are both being used as command and control centers by Hamas militants. But the UN and Red Cross say that thousands of displaced people are sheltering in and around the complex, along with patients too ill to be moved.

In a flurry of statements over the weekend, UN agencies also echoed Friday’s calls by the UN General Assembly for a humanitarian ceasefire. On Monday, however, Israeli ground forces appeared to be advancing even more deeply into northern Gaza, including a thrust westward from central Gaza to the sea, a move that could potentially divide the narrow enclave into two.  

Internet services were blocked by Israel across most of Gaza on Sunday, leaving Palestinian civilians in confusion, and with signs of a breakdown in civil order while Israel’s air and ground raids continued. The services were gradually restored on Monday. Hamas kept up its missile fire on Israel, as well, including barrages targeting Tel Aviv, the Jerusalem region, and other major cities in the country’s center and south. 

Over 8,000 Gazans have now died in the fighting, said the Hamas-controlled Gaza Health Ministry, including over 3,000 children. Over 1 million Palestinians are displaced, including around 800,000 people who have fled south in line with an Israeli order for civilians to leave northern portions of the enclave. In Israel over 1,400 people have died, 200,000 are displaced and the number of hostages held by Hamas has been revised upwards to 244 people, including about 30 children, as well as women and elderly, Israel said.

On Monday, Hamas also released a video of three Israeli hostages calling for a prisoner swap and an end.

Reverse order against Al Quds Hospital

“Under International Humanitarian Law, healthcare must always be protected,” said WHO Director General Dr Tedros Adhanom Ghebreyesus in a tweet appealing to Israel to rescind its evacuation order against Al Quds hospital.  

The International Federation of the Red Cross said: “We are deeply alarmed to hear that the Palestine Red Crescent Society (PRCS) teams at the Al Quds hospital have again this morning been told to immediately evacuate the hospital. 

“Hospitals are places of help and refuge; they must be protected at all cost.”

The International Committee of the Red Cross, in another statement on Monday, “The human suffering is shocking…even wars have limits. Thousands killed. People have limited access to food and water. Hospitals are near collapse. Hospital corridors are full of wounded and displaced. Destroyed infrastructure and homes will take years to rebuild.

Israel says Hamas headquarters are under Gaza hospitals 

Israel, meanwhile, slammed the WHO and other UN agencies for failing to call Hamas to account both for the initial 7 October rampage, and more recently, alleged use by Hamas of hospitals as command and control centers. 

“We have shared information and we expect international organizations, including WHO, to condemn Hamas for using these protected facilities,” said Israel’s Ambassador to the UN in Geneva, Meirav Eilon Shahar, in a briefing to the international press on Monday. 

Israel has contended that key Hamas operations are taking place within underground tunnels below Al Shifa, Gaza’s largest hospital, as well as Al Quds, which has been explicitly ordered several times to evacuate. 

On Friday, Israel released details of its claims on Hamas operations at Al Shifa, including what it says are command and control centers nested in hospital diagnostic units, as well as extensive tunnel infrastructure under the hospital compound.

Israel’s rendition of alledged Hamas operations in and under Gaza’s Al Shifa Hospital, the largest facility in the Palestinian enclave of some 2.3 milliion people.

Hamas has denied the claims. 

But even if Hamas is operating from under the hospital grounds, international law still prohibits the hospitals’ attack, contended Kenneth Roth, former executive director of the Geneva-based Human Rights Watch. 

“We obviously had war crimes to start this all off – Hamas slaughtering Israeli civilians and abducting them and firing weapons indiscriminately to civilian populated areas,” said Roth in an interview with Al Jazeera on Monday. “But we know that under international humanitarian law, war crimes by one side do not justify war crimes by the other. Each side has an independent obligation to respect the laws.

Kenneth Roth, former Executive Director, Human Rights Watch, in February 2020.

“And we see Israel violating them. I think most recently, we look at what’s happening with Al Quds hospital. Even if there is some Hamas facility underneath, we don’t even know that, you know, Israel made a similar allegation regarding Al Shifa.  But when you have 14,000 people in the hospital. Many in critical situations where they can’t be moved, an evacuation order doesn’t suffice. 

“And it’s wrong to suggest that whatever military advantage comes from hitting the supposed Hamas facility underneath, would justify the wholly disproportionate harm to civilians.” 

Appeals to release hostages  

On Monday, Hamas also released a video statement by three of the Israeli hostages that it is holding. The video portrays three Israeli women calling for Israel to agree to a cease-fire as well as to an exchange of the hostages in exchange for some 6,000 Hamas captives and other Palestinian prisoners held in Israel’s jails. 

The women, Elena Trupanov, Danielle Aloni and Rimon Kirsht, who were kidnapped along from their homes 7 October along with children or other family members, slammed Israeli Prime Minister Benjamin Netanyahu, saying:

 “We’re paying the price for your political, military and diplomatic failure, for the failure of 7 October, because you didn’t have the army there, no one was there protecting us. And now we,  innocent citizens, are being held captive… Let their prisoners and citizens free. Let us free, let us return to our families now, now, now.” 

 

Israeli hostages call for cease-fire and prisoner exchange in video released Monday by Hamas.

A senior Israeli official was reported to have visited Qatar over the weekend to discuss the matter of a hostage exchange. Families of hostages are pressing the Israeli government to agree to an “everyone for everyone” deal –  although Israel’s prime minister has so far ruled that out.   

Meanwhile, Israel’s army announced that it had managed to rescue one female soldier, Ori Megidish, who was captured by Hamas on 7 October , in an overnight raid into Gaza.  Another kidnapped Israeli-German who had attended the outdoor festival near Gaza, which was attacked by Hamas on the same day, was found dead, Israel’s Foreign Ministry reported. 

“A paramount mission is to bring all of these hostages back, whatever their nationality, all of them will be returned. The demand should be towards Hamas to return these families unconditionally,” said IDF spokesman Jonathan Conricus, speaking from Tel Aviv to the Geneva briefing of UN press. 

“Responsibility for the safety and well-being of the hostages lies solely with Hamas,” Conricus said.  

‘Disappointed’ by failure to condemn Hamas rampage  

Israel’s Ambassador to the UN in Geneva, Meirav Eilon Shahar

At the Geneva briefing, Shahar screened gruesome video footage of the 7 October Hamas attacks on the 22 Israeli communities near Gaza, including victims tortured before they were killed; the decapitation of a young men with a shovel; and infants shot or burned to death in their cribs. 

“This is what the state of Israel is faced with, a terrorist organization that acts and operates like ISIS and we cannot have this on our border,” she asserted.  

Speaking about the UN General Assembly refusal to condemn Hamas for its attacks on Israeli civilians as part of a resolution adopted Friday calling for a humanitarian cease-fire, Shahar said: 

“We are very disappointed by …every government that hasn’t condemned Hamas…. That there is no reference to the massacre of October 7, it’s outrageous. 

She added that Israel had also been “let down” by the WHO and other UN Agencies, which had not condemned the Hamas attacks in their immediate aftermath. 

“The fact that you did not have heads of agencies that did not come out on the 7th, 8th, 9th, or the 10th [of October], and condemn Hamas for being a terrorist organization, for butchering civilians and women, what does it say?” she asked.  

Humanitarian aid flows 

In terms of aid flows, some 117 trucks had entered Gaza as of Monday since last week’s opening of the humanitarian corridor, UN officials confirmed.

“But that is not nearly enough,” Jens Laerke, of the UN’s Office for the Coordination of Humanitarian Aid (OCHA), told Al Jazeera. 

“There needs to  be more pressure so we get this up to speed,” he said. “We need this to happen very soon, and we need this to happen in tandem with a humanitarian pause so that aid can be delivered in a safe and secure manner.”

In the Geneva briefing, Shahar said that Israel had restored water supplies to Gaza from two Israeli pipelines that run into the central and southern portions of the enclave.  

Conricus said that Israel was monitoring and evaluating, together with WHO and other aid agencies, the flow of humanitarian assistance to Gaza. The aid is being delivered through Egypt’s Rafah, crossing, the only door open to Gaza now, even partly. But he stressed that fuel would not be among the supplies granted access, saying that Hamas continues to hold a large stockpile, which it is reserving for its military campaign. 

“There will not be fuel,” he said, “because fuel is what Hamas needs the most to continue fighting and we are not obliged to provide fuel to serve the combat objectives of our enemy.” 

Added Shahar, “We know for a fact that fuel is held by Hamas, we have been hearing from the international community that they were running out of fuel for the last ten days, and miracle of miracles it hasn’t.”  

Image Credits: @PalestineRCS, Israel Defense Forces , John Zarocostas, https://twitter.com/shehabagency/status/1718978565222334778?s=48&t=s8ZMGV7YU4KTrayXom00uQ.

GPMB co-chair Joy Phumaphi, Dr Tedros and co-chair Kolinda Grabar-Kitarovic at the launch of the board’s 2023 annual report.

 The world’s preparedness for the next pandemic is “perilously fragile”, with gaps that “leave us dangerously exposed to a future threat”, according to the Global Preparedness Monitoring Board (GPMB) in its 2023 annual report released on Monday.

“We lack the solid foundations needed to ensure current efforts for preparedness can be brought together to build an enduring bridge to a state of security. This is made more fragile by lack of trust both between and within countries,” said Kolinda Grabar-Kitarovic, co-chair of the GPMB.

“To counter a mistrust, we need to address its root causes, which is why this GPMB report places great emphasis on equity, accountability, leadership and coherence as underpinning factors for preparedness,” said Grabar-Kitarovic, former President of Croatia, at the launch of the report at the World Health Organization (WHO) headquarters in Geneva.

The GPMB is an independent body convened by the WHO and the World Bank in 2018 to ensure preparedness for global health crises.

Co-chair Kolinda Grabar-Kitarovic

Areas of decline from “already low levels of preparedness” include the global coordination of research and development (R&D); efforts to address misinformation; the participation of low and middle-income countries (LMIC) in the governance of pandemic preparedness; the lack of financing, and lack of independent monitoring. 

“Equity is not a ‘nice to have’ embellishment of global preparedness, it is its beating heart. Global security will be reached only when everyone regardless of geography is valued and assured equal access,” the report stresses.

‘Canary in the coal mine’

“We call these shortcomings ‘canary in the coal mine issues’ because these are the earliest signals of systematic problems. Without concrete commitments for financing and monitoring, preparedness capacities are likely to regress further over the coming years,” warned Grabar-Kitarovic.

However, the report identifies the negotiations to establish a WHO pandemic agreement, improved One Health surveillance capacity, community engagement and regional laboratory capacity as areas of progress. 

“The key takeaways are that our ability to deal with a potential new pandemic threat remains inadequate, and the world has insufficient capacities to guarantee our safety,” concluded Grabar-Kitarovic.

Joy Phumaphi, GPMB co-chair

Co-chair Joy Phumaphi said that the report, the fourth produced by the GPMB since its establishment shortly before the COVID-19 pandemic, is the first to use a new monitoring framework. The board assessed 30 indicators using a stop light grading system – yet not a single indicator scored “green” (full preparedness).

GPMB scoring 2023: green = excellent, yellow = good, orange = incomplete, red = poor. (Arrows = improving/ declining.)

Phumaphi, Botswana’s former health minister, characterised as “deeply troubling” the global failures to increase preparedness financing to meet the needs identified since COVID-19 and to integrate independent monitoring into reforms to health sector architecture.

Geopolitical tensions and competing demands for resources are also weakening countries’ resolve needed to close the pandemic response gaps, according to the board.

The report identifies four key priorities to repair the weaknesses in global preparedness, namely: strengthening monitoring and accountability; reforming the global financing system for pandemic prevention, preparedness and response (PPPR),  more comprehensive, equitable and robust R&D and supply chains; and stronger multi-sectoral, multi-stakeholder engagement.

Tedros agrees with independent monitoring 

“Our assessment reveals that current mechanisms for PPPR monitoring and accountability do not provide a complete picture,” said GPMB member Bente Angell-Hansen. 

“They tend to focus on systems and capacities and give less attention to important aspects of leadership, effectiveness and equity. They are mostly based on self-assessment with limited independent monitoring.”

Angell-Hansen added that a “critical weakness” in the current drafts of the pandemic agreement and the amendments to the International Health Regulations (IHR) was their lack of provisions for independent monitoring.

To address this shortcoming, the board proposes “independent monitoring to complement self-assessment and peer review, at all levels, nationally, regionally and globally” – as well as in the pandemic agreement and IHR amendments.

Speaking at the launch, WHO Director-General Dr Tedros Adhanom Ghebreyesus agreed with the board’s call for “independent monitoring and accountability mechanisms to be embedded in the ongoing reforms including the WHO pandemic agreement”. 

“In fact, it was the need for independent monitoring that impelled then-World Bank President Jim Kim and I to set up the GPMB in 2018. You cannot have accountability without monitoring, which provides accurate and timely information for turning commitments into effective action,” Tedros told the launch.

There has been furious lobbying for independent PPPR monitoring from a number of groups, including the Independent Panel for Pandemic Preparedness and Response. 

Financing needs ‘fundamental reform’

Board member Naoko Ishii outlined the world’s failure to raise adequate. sustainable financing as a key finding, with global research financing and global common goods financing being the worst resourced.

”Only 40% of countries have domestic contingency funds that could be used for health emergencies across the board,” said Ishii.

The report also highlights that global PPPR financing is “inefficient, uncoordinated, and insufficiently aligned to country needs and processes” and that the Pandemic Fund is far short of its aim of $10 billion.

“PPPR financing requires fundamental reform to free it from the limitations of development assistance and place it on a sustainable footing, based on burden-sharing,” recommends the report. “Strengthening PPPR requires ensuring sustainable financing for WHO and other international organisations working on PPPR.”

The report also proposes that the immediate funding gaps be addressed “to enable greater national investments and bolster international financing through new modalities and sources of financing”.

Governance: ‘Everything, everywhere all at once’

“Global health has become more crowded – much too crowded probably – and the governance of PPPR is deeply fragmented and lacks coherence. Some of us feel like in the Hollywood movie, ‘Everything Everywhere All at Once’,” said board member Ilona Kickbusch, chair of the Global Health Centre at Geneva’s Graduate Institute of International and Development Studies.

“None of the capacities we assess this year are adequate,” added Kickbusch. “And this after so many decades of work in this issue. There are multiple parallel efforts, some of which overlap but which still leave gaps, particularly in relation to equity, research and development and access to medical countermeasures.”

Ilona Kickbusch

Furthermore, “there is no strategic plan to coordinate the whole of UN, whole-of-society response to health emergencies and our governance structures struggle to provide the necessary leadership and unity to guide us through the pandemic”, she added.

While the pandemic agreement may address these gaps, the GPMB expressed concern about the slow pace of negotiations and “the challenges and divides that are holding back progress”. 

“Member states must redouble efforts to finalise the agreement before May 2024 when the World Health Assembly meets. Our collective preparedness against the next pandemic depends on it,” stressed Kickbusch.

Tedros agreed with her: “I think you know, I have made clear to our member states that there is no time to waste. Another pandemic or global health emergency could come at any time, just as it did in 2019.”

Describing the pandemic agreement as “a generational agreement that must be written by the generation with the lived experience of a pandemic”, he urged the board to “continue your advocacy with, and for, member states to work with a greater sense of urgency, with a particular focus on the most difficult issues”.

On a positive note, Kickbusch said that during the course of the COVID-19 response, member states had come to recognise the central and vital role of the WHO in health emergencies. 

“They have demonstrated their renewed trust in WHO by increasing their assessed contributions to correct the incoherence that has plagued PPPR governance. This empowerment of WHO at the centre of global health is essential, complemented with efforts to strengthen the whole of UN multi-sectoral response to pandemics,” said Kickbusch.

More equitable R&D

The board’s Victor Dzau said that, while global R&D spending overall is “at a record high of almost $1.7 trillion per year, 80% of spending is concentrated in 10 countries – most of which are high income”. 

No “effective global mechanism to set priorities and coordinate pandemic R&D means that the world cannot prioritise countermeasures development” for the most harmful pathogens or deliver pandemic products according to need, said Dzau.

“Low and middle-income countries are inadequately represented in decision-making and coordination processes. This means that their needs are fully met in resource allocation,” he added.

To address this, the GPMB proposes “strengthening regional capacities for R&D, manufacturing and supply” which will help to address “the inequities in global access to medical countermeasures”.

Board member Chris Elias outlines the R&D proposals

Finally, the board calls on global, regional and national leaders to “fully institutionalise preparedness measures that work in the collective interests of all”, and to address the four key priorities it has identified to “repair the weaknesses in global preparedness”.

self-care
Self-care proved essential during the height of the COVID-19 pandemic, when millions of people around the world took testing and their health into their own hands to ease the strain on overwhelmed healthcare systems.

BERLIN, Germany — Last week, the World Health Summit in Berlin brought together experts, civil society, politicians, and international organizations from around the world to brainstorm solutions to the many threats facing healthcare systems today. 

Climate change, the looming health workforce crisis, and the increasingly distant goal of universal health coverage were all on the agenda. Panels and plenaries debated solutions like artificial intelligence, innovative financing mechanisms for global health, and the use of pharmaceutical innovation and digital technologies to further equity.

Yet the oldest solution in the book, self-care, received little attention. A panel organized by the Global Self-Care Federation (GSCF) and the World Health Organization (WHO), in a small conference room on the outskirts of the summit, was the only event to make it a focus.

That needs to change. Amid a widening health workforce crisis and a lack of universal health coverage for half the world, a broad alliance of public and private stakeholders are urging governments to recognize and develop self-care as a critical component of health systems. Their call is backed by a new joint statement on self-care launched at a World Health Summit, and signed by the WHO and three other UN agencies.

Formal care is only the tip of the iceberg

The global and economic value of self-care in data.

“When I think about the whole health continuum, I see an iceberg,” said Jurate Svarcaite, Director-General of the Association of the European Self-Care Industry, speaking on the panel. “The formal health system is what you see above the water, and self-care is what’s under. This invisible part of the iceberg is very difficult to visualize until you have the figures – and the numbers are really staggering.”

The self-care that people provide themselves and their families is essential to keeping even the most advanced healthcare systems afloat. Without it, the EU would need an additional 120,000 GPs, at a cost of $34 billion per year. Self-care allows physicians to focus on acute care by saving them nearly 1.8 billion hours per year globally, according to GSCF, a non-profit based in Geneva.

The impact of self-care in supporting health systems has grown significantly over the past 50 years and is set to accelerate further as over-the-counter pharmaceuticals become increasingly sophisticated, safe, and effective. 

Advances in over-the-counter medicines mean pharmacists can now empower patients by providing advice and treatment for a wide range of minor illnesses, such as coughs, colds, and skin conditions. This can help to reduce the burden on GPs and hospitals.

“Even in countries that have well-equipped and well-resourced health systems, I’ve never heard of a health system saying they have too many resources or too many healthcare professionals,” said Goncalo Sousa Pinto, Lead for Practice and Developmental Transformation at the International Pharmaceutical Federation.

“It is impossible to have sustainable health systems unless you revamp and you really invest in and strengthen primary health care – and self-care is really a way of responding to that challenge,” said Pinto. “It’s about prevention, it’s about early diagnosis, and it’s about reducing pressure on health systems so that patients that require more time in their health system can benefit from high-quality care.”

Self-care savings 

The COVID-19 pandemic demonstrated the essentiality of self-care in times of crisis. Healthcare systems would have collapsed, not just struggled, if millions of people around the world had not taken matters into their own hands.

“COVID really dropped the pin – all of us had to self-care,” said Svarcaite. “We were asked to stay home if we were sick, even if we caught COVID we just had to go to the pharmacy to get paracetamol for whatever symptoms we were feeling.” 

“We had to try not to go into the formal health system because it was caring for really, really sick people that needed the full attention of healthcare professionals,” Svarcaite added.

Self-care, enabled by enhanced health literacy, over-the-counter medicines, devices, and preventive care, can enable people to manage their health conditions and improve their productivity by up to 40.8 billion days globally, she said, referring to a 2022 report on self-care’s social and economic value. It is also often the only option for the nearly 4 billion people who do not have access to essential health services.

“There was not one country which had its health system saying ‘Hooray! We are ready, we can do the COVID, bring us more,’” said Svarcaite. “All health systems struggled, and it just shows that self-care is part of health system resilience.”

Self-care is not new, but it presents one of the highest impact ceilings and cost-benefit ratios to deal with some of the most intractable health problems of the future, such as climate change, conflict, displacement, and the health workforce crisis.

“We need to find new ways to deliver health and healthcare services,” Bente Mikkelsen, director of Noncommunicable Diseases at WHO, earlier told another World Health Summit panel focusing on the healthcare workforce. “For me, that can be the recommendation of self-care information.”

Self-care: A lifeline for sexual and reproductive health

Inequalities continue to be a fundamental challenge to global efforts to achieve universal health coverage, particularly for sexual and reproductive health and rights, according to the UN joint statement.

“Nowhere is the need for self-care more urgent than in sexual and reproductive health, where inequalities run deep,” said Dr Pascale Allotey, Director of WHO’s Department of Sexual and Reproductive Health and Research. 

Nearly 800 women die every day from preventable causes related to pregnancy and childbirth. 164 million women of reproductive age worldwide have an unmet need for contraception, one in three face sexual violence in their lifetimes, and over 1 million newly sexually transmitted infections are acquired every day. 

Self-care interventions, such as self-testing for pregnancy diagnosis, self-sampling for HPV and other infections, and self-management of medical abortion, can help to reduce these inequalities and empower women to make informed and independent choices.

“In so many places around the world, pregnancy self-tests are not available,” said Dr Manjuula Narasimhan, who leads WHO’s Sexual Health and Well-Being Unit. “If it’s not available at the pharmacy, it’s not available to that adolescent young girl asking ‘Am I pregnant? How do I find out?’”

WHO’s Sexual Health and Well-Being Unit Dr Manjuula Narasimhan speaks at the World Health Summit.

Pregnancy self-tests are a common and accessible means of contraception in high-income countries, but they are often unavailable or inaccessible to women in low-income countries. This can pose a significant barrier to women’s health and well-being, as early knowledge of pregnancy is essential for accessing timely and appropriate care.

In many low-income countries, pregnancy self-tests are not available in pharmacies or other retail outlets. They may only be available through health facilities, which can be difficult or impossible to reach for women who live in remote areas or who face stigma or discrimination.

“If the only way she can find out is to go to a clinic and do a blood test — likely in the local clinic where everybody knows her, and are wondering why she’s coming in — then that is a problem of equity,” said Narasimhan. “It is a problem of people having that ability, that agency, to be able to make informed decisions about their health.”

Health literacy: an essential pillar of self-care

The impact of self-care in supporting health systems has grown significantly over the past 50 years and is set to accelerate further as over-the-counter pharmaceuticals become increasingly sophisticated, safe, and effective.

Self-care can reduce the burden on healthcare providers. But self-care can only be effective when health literacy is well-integrated into health system strategies.

“Self-care is intrinsically patient-centric,” said Pinto. “But for these interventions by patients to be effective and to be the best options for patients, the pillar of health literacy and self-care literacy needs to be there. 

But health literacy is more than handing out pamphlets. It requires tailored awareness campaigns targeting the needs of local populations.

“Literacy is not just giving up a pamphlet and a brochure that they can read and many populations actually can’t read either,” said Dr Téa Collins, Platform Lead for Global NCDs at the WHO. “We need to be aware of the diversity of countries and the diversity of healthcare systems, knowing they are not all equipped to do things a certain way.

“There are also very different value systems because in different cultures there are different ways of managing health and disease,” Collins added. “We need to really consider and be culturally sensitive.”

A paradigm shift

Self-care panel underway at the World Health Summit in Berlin.

A shift towards self-care would require a paradigm shift in modern health systems, which are still largely based on top-down approaches to patient care.

“When we are talking about the medical model of care, particularly for those of us trained in this system, we are still gravitating towards this top-down approach,” said Collins.

A shift towards self-care would require a more collaborative approach to healthcare, with patients and healthcare providers working together to develop and implement care plans that are tailored to individual needs. It would also require a greater investment in health literacy and self-care literacy programs.

Self-care is not a magic bullet, but it is a critical part of the solution to the health workforce crisis and the broader challenges facing healthcare systems today.

A new joint UN statement recognizes the potential of self-care

The joint statement was issued at the World Health Summit by the World Health Organization and three other UN agencies.

As a next step, GSCF and its partners are calling on the World Health Assembly to adopt a resolution on self-care. The adoption of such a resolution would be a landmark moment for the advancement of self-care as a pillar of health systems.

“Self-care is an indispensable solution for realising Universal Health Coverage by 2030 and should be integrated into future health and economic policy, with a focus on affordability and access,” said Judy Stenmark, head of GSCF, which has been working in collaboration with WHO to advance self-care in policy agendas.

“A WHO Resolution on Self-Care would provide a comprehensive framework for governments, stakeholders, and the international community to strengthen self-care policies and interventions and would put us on a pathway to better health, well-being, and sustainable development,”  Stenmark noted.

The joint statement, released at the World Health Summit by WHO, the United Nations Development Programme (UNDP), the UN Population Fund (UNFPA) and the World Bank, outlines five priority areas for strategic investment and coordination, including:

  • Financing: We must implement innovative funding models that reduce costs, enhance efficiency, and build a more equitable system.
  • Expanding the health workforce: We need to expand the competencies of the health workforce to provide user-centred self-care options as part of high-quality primary care.
  • Fostering broad-based political will: We need to foster broad-based political will and accountability for integrating self-care across policies, programs, and sectors.
  • Strengthening regulatory systems: We need to strengthen regulatory systems to assure the safety and quality of self-care interventions.
  • Generating robust evidence: We need to generate robust evidence on the health economics and social impacts of self-care while respecting patient preferences.

“The statement represents a watershed moment,” said Allotey. “We really, really have a lot of work to do.”

Image Credits: Annie Spratt, CC.

The unequal distribution of vaccines between countries at the height of the pandemic manifested “as a global system privileging those former colonial powers to the detriment of formerly colonised states and descendants of enslaved groups,” according to the UN Committee on the Elimination of Racial Discrimination.

For centuries, colonialism has shaped global healthcare, leaving behind a legacy of disparities and injustices between the Global North and Global South that continues to exert a profound influence on the health and well-being of marginalised and indigenous populations across the globe.

Today, colonialism’s legacy is being challenged by a growing movement to decolonise the healthcare sector by shifting power to marginalised communities and empowering them to design and deliver their own care.

At a recent panel discussion hosted by the Global Health Centre of the Geneva Graduate Institute, in collaboration with Medicus Mundi, experts from across the health spectrum discussed practical steps to decolonise global health governance and give marginalised communities a greater voice and agency in their own healthcare systems.

“We are speaking about localisation, shifting powers and decolonising,” said Hafid Derbal, Co-Desk for Sexual and Reproductive Health and Rights (SRHR) and Co-Program Coordinator for Zimbabwe, South Africa and Mozambique, Terre des Hommes Schweiz. “Who is ultimately benefiting from our work and these changes? It must be the people we work with – the local organisations and civil society.”

One example of this approach is community-based healthcare initiatives, which tailor services to the specific needs and preferences of the local population. 

“Participative urbanism is a concept that we came up with to bring the voice of the marginalised as part of the mainstream public policy,” said Danny Gotto, founder and executive director of Innovations for Development (I4DEV), Uganda.

“We created a space for people in so-called slums to voice their concerns based on their context, based on their cultures, based on their interests, based on their aspirations,” Gotto said. “Then, we created a space for dialogue between policymakers and the common people to ensure that they decolonise urbanism because the context of urbanism, as borrowed from the West, is that the poor all live on the fringes.”

On a broader scale, collaborations are emerging to support countries with limited resources to manage specific health conditions. For example, the African Centers for Disease Control and Prevention (Africa CDC) is dedicated to building Africa’s capacity to confront healthcare challenges.

“Because many national health organizations lack the capacity and resources to represent what’s going on, the African Union’s creation of the Africa Center for Disease Control and Prevention has great potential,” said Ravi Ram of the Kampala Initiative and co-chair of the WHO Civil Society Commission.

Colonial legacies often resulted in the suppression of indigenous healing traditions and the imposition of Western medical paradigms. Ongoing efforts are underway to decolonize global health education by revising curricula to encompass diverse perspectives and local knowledge and experiences.

Dr Agnes Binagwaho.

“First, we educate students to amplify the voice of the marginalised and vulnerable people in the country, the region, the societies, the communities, and families,” Agnes Binagwaho, a former minister of health in Rwanda and the retired vice chancellor of the University of Global Health Equity, told the panel.

“We educate our students inside the communities the most in need in the country. Normally, medical schools are in cities and in the richest part of countries, not where the most needs are for health professionals. On top of that, we put our students in direct contact with local, national, and regional leaders,” Binagwaho said.

However, the idea that decolonisation is only about the Global North versus the Global South was challenged during the panel discussion. Power imbalances in global health extend beyond former colonial powers, reaching into emerging economies where this disconnect poses challenges for policymakers and healthcare organisations.

“India has also been following, in many ways, a colonial mentality toward its development programs,” said Kampala Initiative’s Ram. “We saw that in COVID, where protectionism overruled their public commitment toward sharing vaccines.”

“Brazil is doing the same work in Latin America, using its regional dominance, trade, and other economic factors to dominate smaller states, even within Brazil,” Ram added. “Much of the general and Afro-Brazilian populations have been excluded from the formal health system.”

WHO
Proposals to include intellectual property waivers for vaccines during the next pandemic in a potential Pandemic Treaty have run up against sharp resistance from the pharmaceutical industry and rich countries.

The inequities of the COVID-19 vaccine rollout exposed the deep inequities in global health, leading to calls for a decolonisation of the sector and negotiations on international legal instruments like the World Health Organization’s (WHO) Pandemic Treaty.

The WHO’s “zero-draft” treaty proposes that 20% of pandemic-related products, such as vaccines, diagnostics, protective equipment, and therapeutics, be allocated to the organisation, which can then ensure equal distribution.

But the increasing monopolisation of entire economic sectors and various forms of profiteering are threatening to derail the Pandemic Treaty. Vaccine inequity was not solely shaped by perceived colonial division, but also the increasing monopolisation of the healthcare sector by private companies, the panelists said. 

“We’ve seen that member states and international organisations won’t necessarily be representing a national interest in the sense of the public. They’ll be representing a corporate interest,” said Ram. “I want to call attention to what’s happening here in Kenya, where a lot of health service delivery is being increasingly encroached upon by Indian corporates, where the Indian private sector is probably one of the most privatised in the Global South.”

Binagwaho echoed this concern, adding: “Money is controlled by the people who don’t want to change because they benefit from the system they have created over decades, and they’re resisting a lot.

“They have to give up a little, but to change that, we must change the world’s economic structure.”

Image Credits: CC, US Mission Geneva.

Trucks carrying humanitarian aid wait to cross into Gaza from Egypt through Rafah border point – some 74 have now passed but WHO says its not nearly enough.

The World Health Organization has issued its most forceful statement to date calling for the immediate release of some 200 Israelis and foreigners, including health workers and children, abducted by Hamas and other armed groups from Israel on 7 October during a deadly rampage of 22 Israeli communities that left about 1300 other people dead.   

Meanwhile, WHO’s Eastern Mediterranean Regional Office (EMRO) issued a fresh appeal for the entry of fuel supplies as well as more medicines  to Gazan overburdened hospitals, struggling to cope with a rising toll of casualties from unprecedented Israeli air raids. Since Saturday, Israel has the allowed entry of  74 trucks of food, water and medical aid. But it has barred fuel deliveries to the besieged enclave in an effort to stem the blitz of missiles being fired on Israeli cities by Hamas, and deplete its fuel reserves while staging the initial phases of a promised ground incursion into Gaza.  US President Joe Biden, a staunch supporter of Israel in the conflict, has admitted that the Gaza aid deliveries aren’t getting in “fast enough.”

WHO hostage statement

Outside of UN Headquarters in Geneva, demonstrators call for the release of some 222 Israeli and foreign hostages held by Hamas. In the past week, families have also met with the heads of WHO, the ICRC and the UN High Commissioner for Human Rights.

The WHO appeal on the hostages came late Wednesday evening following a meeting between WHO Director General Dr Tedros Adhanom Ghebreyesus and members of an Israeli civil society group representing families of those abducted. 

WHO is “gravely concerned by the humanitarian and health situation facing approximately 200 people, including health workers and up to 30 children, abducted from Israel by Hamas and other armed groups on 7 October 2023,” the statement said. It called for “the immediate release of all the hostages, along with urgent access to each of them and delivery of medical care.” 

Said Tedros, “We met today with families of people abducted from southern Israel on 7 October and heard firsthand the tragedy, trauma and suffering they are facing. There is an urgent need for the captors of the hostages to provide signs of life, proof of provision of health care and the immediate release, on humanitarian and health grounds, of all those abducted.”

Elderly, children and people with chronic health conditions

Two of the estimated 30 Israeli children taken hostage by Hamas at demonsration outside of the UN Headquarters in Geneva Sunday, calling for their release. Some families met with the heads of WHO, ICRC and the Office of the UN High Commisioner for Human Righs (OHCHR)

“Many of the hostages, including children, women and the elderly, have pre-existing health conditions requiring urgent and sustained care and treatment. The mental health trauma that the abducted, and the families, are facing is acute and psychosocial support is of great importance,” Tedros said.

The captives were taken after several thousand Hamas gunmen broke through an Israeli security fence separating Palestinian Gaza from pre-1967 Israel in the early morning of 7 December. Fanning out to some 22 Israeli villages and small towns nearby, the gunmen forced their way into hundreds of homes, and set others on fire. Survivors reported seeing neighbors and family members shot or bludgeoned to death, while a few were led away on foot,  motorcycles or in pickup trucks. 

So far, only four of an estimated 224 hostages have been released – including two elderly women, aged 85 and 79 on Monday, whose husbands remain in captivity.  Among the hostages are people of some 25 nationalities, including many Israelis with dual citizenship, but also Nepalese agriculture students and Thai caregivers who were working in the Israeli communities near Gaza.  A handful of the Israeli captives are Beduin Muslims, who live and work in the area.  

Since being taken captive, hostage families have launched a diplomatic campaign in Europe, North America and at UN institutions.  Last week some hostage family members also met in Geneva with the president of the International Committee of the Red Cross and Volker Turk, UN High Commissioner for Human Rights, on a tour that has also taken some families to Brussels and around European capitals as well as to the UN Security Council meeting in New York.   

WHO Eastern Mediterranean Office issues fresh appeal for Gaza fuel supplies 

Displacement of Palestinian families from northern Gaza to one of the UNRWA schools in Gaza City to escape the ongoing Israeli airstrikes on Gaza since October 7, 2023.

Meanwhile, WHO’s EMRO office warned again that more Gazan hospitals are facing collapse, due to the lack of fuel and the collapse of the electricity grid.

“In addition to the hospitals that have had to close due to damage and attacks, six hospitals across the Gaza Strip have already shut down due to lack of fuel, said the WHO/EMRO statement. 

“Unless vital fuel and additional health supplies are urgently delivered into Gaza, thousands of vulnerable patients risk death or medical complications as critical services shut down due to lack of power. These include 1000 patients dependent on dialysis, 130 premature babies who need a range of care, and patients in intensive care or requiring surgery who depend on a stable and uninterrupted supply of electricity to stay alive.” 

Since last Saturday, some 74 trucks carrying food, water and medicines have been allowed by Israel to pass into Gaza through Egypt’s Rafah, with 12 trucks crossing in the latest relay, on Thursday. 

However, UN Refugee Works Agency (UNRWA) officials say that is only about one-tenth of the aid that used to cross into the besieged Gaza strip, before the war broke out – and bereft of fuel.

WHO statements coincide with intense diplomatic activity on hostages and  de-escalation 

Palestinian man walks across a pile of rubble in Gaza, whish has seen the heaviest bombing attacks ever by Israel.

The WHO meeting and statements coincided with a UN Security Council debate Tuesday and Wednesday on the Israel-Gaza conflict, which ended in a veto by Russia and China of a proposed US resolution calling for a humanitarian “pause” in hostilities but also condemned Hamas and affirmed Israel’s right to defend itself. A competing Russian resolution that also called for a pause and condemned Hamas, but omitted language about Israel’s right to self-defense, failed to get the required 9 Security Council votes. 

While there have also been reports that Hamas is negotiating with mediators in Qatar, Egypt and elsewhere for the release of more Israeli captives, the hostage mission is vastly complicated by repeated Israeli threats to enter Gaza and remove Hamas altogether from power.  

The Hamas attacks on wide swathes of southern and central Israel, as well as from the northern Lebanese border, have led to the displacement of some 200,000 Israelis. Some of the Gaza-area Israeli villages that were the scenes of massacre on 7 October, are now mere burnt out ruins. 

But that is nowhere near the level of destruction now being seen in densely populated Gaza – where average people lack access to the network of shelters that Israel has built for its civilian population against missile attack – not to mention its “Iron Dome” air defense system. Around one half of Gaza’s 2.3 million Palestinian inhabitants have reportedly been displaced.  

Gaza reports soaring casualties 

A Palestinian boy with his cat salvaged from an apartment bombed by Israel.

Gaza’s Hamas-run Health Ministry released Thursday a detailed report on 7,028 Palestinian casualties, including 2,913 minors as a result of the conflict. Although US President Biden has expressed scepticism as to whether the numbers indeed are that high, WHO and UN sources, say that the Hamas figures have usually been reliable, bearing up to post-war scrutiny.  The Hamas toll, however, does include some 471 people reported to have been killed in the explosion at Al Ahli Hospital, which French and US intelligence agree was an errant missile fired from Gaza. It also does not separate military from civilian deaths. 

Regardless, Palestinian casualties appear to now outpace the combined Gaza toll of all of its major conflicts with Israel since in 2008. And there is no doubt that Palestinian deaths far outpace the losses seen by Israel, which has lost 1,400 people, including 380 soldiers.   

And irregardless, Israel’s air raids on Gaza, some of the heaviest ever seen on an urban area anywhere in the world, have thrust average Palestinians deep into crisis – overcrowding hospitals, as well as schools and refugee centers. Israel also has called for the evacuation of most of northern Gaza, while it takes aim at the huge labyrinth of underground tunnels created by Hamas as refuge for its fighters and high-ranking officials. 

The fuel war 

Some Gaza facilities, like Nasser Hospital in Khan Yunis, now have solar power capacity – but PV cannot fill the energy gap left by fuel shortages.

Already two weeks ago, Gazan health officials warned that hospital fuel supplies would run out in days. Fuel is also  critical for powering Gaza’s desalinization plant to produce clean water, UN and relief workers stress, in light of the heavy salt-water encroachment and pollution of Gaza’s wells and underground aquifers. And it is essential to bakeries, producing bread, a critical staple food. 

As of this week, fuel reserves hadn’t yet entirely been exhausted. On Monday, WHO reported its delivery of  34,000 liters of fuel to ambulance services and four major hospitals in southern Gaza.  But “this is only enough to keep ambulances and critical hospital functions running for a little over 24 hours,” WHO warned. 

Meanwhile, Hamas has continued to strike out against southern and central Israel, hitting homes in the city of Rishon Le Zion Wednesday night, and at Tel Aviv on Thursday, even if the pace of attacks was slackening noticeably from as hundreds of rockets a day, fired at the beginning of the incursion. to around 100 a day.  Precisely because of that, Israel remains adamant about allowing fuel convoys  into Gaza – which they say could be filched by Hamas.  

In the past few years, more Gazan hospitals have also been fitted with large PV rooftop solar installations, as part of a major initiative by UNDP, as well as WHO and bilateral donors – to cope with chronic interruptions in electricity grid supply that were a problem even before the war. But PV solar capacity is still under development, and clearly cannot meet the needs of flooded hospitals now. Moreover, one of the hospitals with one of the biggest and newest PV installations, the Palestinian Red Crescent’s Al Quds Hospital, is located in the northern Gaza strip, which Israel has called to evacuate. 

–Updated Friday 27.10.2023 with further details of the death toll in Gaza, as reported by the Hamas-controlled government.

Image Credits: E. Fletcher , © UN Photo/Eskinder Debebe, E. Fletcher/HPW, WHO/Eastern Mediterranean Region , Care International , UNRWA, WHO, 2019.

A new report by the United Nations University warns that climate change is a major factor in pushing the world towards multiple tipping points, which will cause rapid and fundamental change to the planet.

Human activity is pushing the world towards multiple tipping points that will cause rapid and fundamental change to the planet, according to a new report by the United Nations University Institute for Environment and Human Security (UNU-EHS).

The Interconnected Disaster Risks report, released on Wednesday, identifies six key tipping points: accelerating extinctions, groundwater depletion, mountain glacier melting, space debris, unbearable heat, and an uninsurable future.

These tipping points are defined in the report as the moment at which a given system is no longer able to buffer risks and provide its expected functions. 

Once a tipping point is reached, it is irreversible and can lead to cascading failures of other systems. For example, the loss of mountain glaciers could lead to water shortages and mass migration, while unbearable heat could make some areas uninhabitable.

The report also highlights the interconnectedness of the tipping points, warning that they could trigger each other in a vicious cycle. For example, the loss of biodiversity could make ecosystems more vulnerable to climate change, which could lead to more extreme weather events and further biodiversity loss.

Running out of time

The report’s authors say that humanity is running out of time to avert disaster. They call for urgent action to reduce greenhouse gas emissions and protect ecosystems.

“These tipping points have either passed or are about to happen,” said Dr Jack O’Connor, lead author of the report and a senior export at UNU-EHS. 

“Depending on where you are in the world, you might have a little bit more time,” said O’Connor. “But you should be looking at what is happening in other places of the world because we are all interconnected, and the impacts of tipping points passing in other places will eventually affect you.” 

The report comes a month before representatives from all countries will meet at the annual UN Climate Conference, COP28, in Dubai.

Chain reactions are already underway 

Extinctions are already happening at an alarming rate. Animals are running out of places to feed and reproduce as humans take over more and more land, while climate change is making it harder for threatened species to survive. This loss of biodiversity is increasing the risk of a chain reaction of extinctions, which could have devastating consequences for ecosystems and human societies alike.

“Recent research has shown that the way that ecological networks have formed means that as we lose biodiversity, we increase the risk of this chain reaction of extinctions in an ecosystem,” said O’Connor. “Extinctions could accelerate at a much faster rate in the future.”

Depleting groundwater is another major tipping point that is already having real-world impacts, threatening food security in many parts of the world. Groundwater is essential for agriculture, providing a reliable source of water during droughts and other periods of water scarcity. 

Yet, in many parts of the world, groundwater is being extracted faster than it can be replenished. This is due to a combination of factors, including population growth, climate change, and unsustainable agricultural practices. 

Farmers who are already facing the vagaries of fluctuating rainfall can no longer rely on groundwater to make up the shortfall. Some countries, such as Saudi Arabia, have already surpassed the groundwater risk tipping point, while others, like India, are not far behind.

Impacts of today in the future

Rising space debris is becoming a major issue as more and more satellites are launched into low Earth orbit (LEO), the region of space closest to Earth that is already crowded with satellites. By 2030, as many as 100,000 satellites could be in orbit, posing a significant risk to other spacecraft and missions. 

“Communities and individuals can influence the other tipping points on the list … [but] I think this is the one where individuals probably have the least agency,” said Dr Zita Sebesvari, another lead author of the report and deputy director of UNU-EHS.

New research from the University of British Columbia’s Outer Space Institute echoes Sebesvari’s concerns, estimating that as many as one million satellites may be headed into orbit.

“By treating orbital space as an unlimited resource, humanity is creating serious safety and long-term sustainability challenges to the use of low Earth orbit (LEO), including science conducted from space and the ground,” the study said.

“If even a portion of these million satellites are actually launched, national and international rules will be needed to address the associated sustainability challenges, like collision risks, light pollution, and reentry risks,” Andrew Falle, lead author of the study, told Space.com.

Transformative change needed

The report provides two categories of solutions for each of the problems: avoid solutions and adapt solutions. Avoid solutions target the root drivers of the tipping points, while adapt solutions help prepare for or better address the negative impacts.

In the case of unbearable heat, the report suggests halting greenhouse gas emissions and driving society towards low-carbon ways of living as an avoid solution. An adapt solution would be to help install more air conditioners in places that need them the most.

The report emphasizes that current solutions are only working to delay the onset of the tipping points, not to avoid them altogether. While some work is being done on transformative solutions, these need to be scaled up significantly, the authors say.

“Real transformative change involves everyone,” Sebesvari said. “The report serves as a timely reminder before the UN Climate Conference that we must all be part of the solution.”

Two girls sit together after receiving their HPV vaccinations at their primary school in Masaka, Rwanda. Young girls who receive HPV vaccines can hope for a future free of cervical cancer. / Credit: UNICEF

Nigeria, Africa’s most populous country has introduced the human papillomavirus (HPV) vaccine into its routine immunization system, aiming to reach 7.7 million girls – in the continent’s largest-ever vaccination drive against the virus that causes nearly all cases of cervical cancer. 

Girls aged 9–14 years will receive a single dose of the vaccine, which is highly effective in preventing infection with HPV types 16 and 18 that cause at least 70% of cervical cancers,  WHO and Nigerian health ministry officials announced on Tuesday. 

Africa is one of the regions with the largest burden of cervical cancer deaths, due to a dearth of prevention, screening and treatment services.

In 2020 – the latest year for which data is available – Nigeria recorded 12,000 new cervical cancer cases and 8,000 deaths, making it the third most common cancer and the second most frequent cause of cancer deaths among women aged between 15 and 44 years.

“The loss of about 8,000 Nigerian women yearly from a disease that is preventable is completely unacceptable,” said Muhammad Ali Pate, the Coordinating Minister of Health and Social Welfare. 

“Cervical cancer is mostly caused by HPV, and parents can avoid physical and financial pain by protecting their children with a single dose of the vaccine. 

In November 2020, the WHO launched the “90/70/90” global initiative to eliminate cervical cancer as a public health problem. The strategy aims to vaccinate at least 90% of girls against HPV by the age of 15 years; screen 70% of women by age 35; and treat at least 90% of identified precancerous lesions and invasive cancers. 

Still, nearly half of LMICs have been unable to introduce HPV vaccinations, as many countries cannot still afford the vaccine at the $4,50 per dose procurement price negotiated by global health agencies, according to a 2023 article in BMC Public Health. 

Rwanda was the first sub-Saharan African country to introduce HPV vaccination in 2011. Uptake since has been slow with only a few other African countries integrating the vaccine into their routine basket of services, peaking in 2019 with six new countries: The Gambia, Liberia, Côte d’Ivoire, Kenya, Malawi and Zambia.  

UNICEF has recently launched a major initiative to bolster HPV immunization. In 2023, the agency is supplying some 36 million vaccine doses to 52 low- and middle-income countries worldwide. Some two dozen African countries have received some form of support for HPV vaccinations, whether or not they are yet integrated into the routine basket of immunizations. 

Image Credits: UNICEF.

“The transition to clean energy is happening worldwide and it’s unstoppable,” said IEA Executive Director Fatih Birol.

The International Energy Agency (IEA) has projected that global demand for oil, coal, and gas will peak by 2030, but that demand for fossil fuels is set to remain “far too high” to keep the Paris Agreement Target of 1.5C within reach.

The IEA now says that the transition to clean energy is happening worldwide and is “unstoppable”, according to its annual World Energy Outlook report, released on Tuesday. It credits the record growth of key clean energy technologies, such as solar PV and electric cars, for this shift.

“It’s not a question of ‘if’, it’s just a matter of ‘how soon’ – and the sooner the better for all of us,” said IEA Executive Director Fatih Birol. “Taking into account the ongoing strains and volatility in traditional energy markets today claims that oil and gas represent safe or secure choices for the world’s energy and climate future look weaker than ever.”

The IEA predicts a surge in renewable technologies will underpin this green transformation of the global economy. By 2030, renewable energies such as solar, wind, and hydropower could provide nearly 50% of the global electricity mix, up from around 30% today. The number of electric cars on roads worldwide is projected to increase 10-fold.

“Peak” does not mean “decline”

The IEA projects that oil and gas demand will remain constant until at least 2050, as consumption increases in developing economies and decreases in advanced economies

For the first time in over 150 years, the global economy is poised to reach peak demand for fossil fuels – but charts in the IEA report show that “peak” does not mean “decline”.

While demand for coal – the dirtiest fossil fuel of which 55% is already sold at below market rates globally – will drop off sharply after 2030, demand for natural gas and oil will remain around 2030 “peak” levels until at least 2050. The IEA projects oil and gas demand will be buoyed by increases in consumption in developing economies which will offset expected decreases in advanced economies. 

The IEA also warns that governments are not doing enough to support the transition to clean energy. It recognized investments in fossil fuels will remain “essential” to keep the global energy mix balanced, but said that investments in fossil fuels are currently too high. Global fossil fuel subsidies surged to a record $7 trillion in 2022. 

“As things stand, demand for fossil fuels is set to remain far too high to keep within reach the Paris Agreement goal of limiting the rise in average global temperatures to 1.5C,” the report said. “This risks not only worsening climate impacts after a year of record-breaking heat, but also undermining the security of the energy system, which was built for a cooler world with less extreme weather events.”

Projections at the mercy of political shifts on green energy

Three times as much investment will go into new offshore wind projects than into new coal- and gas-fired power plants by 2030, the IEA projects.

The IEA’s assessment is based on current policies already implemented by governments and could change – for better or for worse – depending on whether governments backtrack or double down on major climate pledges. 

Former US President Donald Trump has already signalled he will try to repeal the Inflation Reduction Act, the largest package of green investment in US history, if re-elected in 2024. UK Prime Minister Rishi Sunak has also made a habit of backtracking on his country’s net-zero pledges, pushing ahead with plans to “max out” the UK’s fossil fuel reserves.

China, the world’s largest consumer of fossil fuels, is also a key factor. The country accounts for half the world’s coal use and has driven two-thirds of the growth in global oil demand over the past decade. China’s commitment to harnessing its green energy dominance to reshape its dependence on fossil fuels is essential to the IEA’s projections.

The fossil fuel industry has different ideas

Oil cartel OPEC supplies over half of the world’s oil and controls over 80$ of proven oil reserves.

The IEA assessment is in stark contrast to the views of the fossil fuel industry, which has long insisted that oil and gas will continue to play a major role in the global energy mix. The Organization of the Petroleum Exporting Countries (OPEC), the global oil cartel that supplies 51% of the world’s oil and controls 81% of proven oil reserves, said in its annual report earlier this month that it expects oil demand to increase by 17% by 2045.

The OPEC report called for expectations of what green energy can deliver to be more “pragmatic and realistic”, reflecting language used by the United Arab Emirates presidency ahead of the upcoming Un Climate Conference in Dubai, which will kick off in late November.

OPEC Secretary General and Kuwaiti oil executive Haitham Al Ghais wrote in the foreword of the report: “Calls to stop investments in new oil projects are misguided and could lead to energy and economic chaos.”

The bullish projections of OPEC are shared by American fossil fuel giants ExxonMobil and Chevron, who both announced plans to buy smaller shale producers in the United States a combined total of over $100 billion.

The International Energy Agency (IEA) has a mixed track record in forecasting fossil fuel demand. In 2016, the agency incorrectly predicted that China’s coal demand had peaked, while it had previously underestimated the rapid growth of renewable energy sources such as solar power.