“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.

A woman in Sierra Leone gets her blood pressure checked in 2022 as part of a new collaboration between Medtronic LABS, the Christian Health Association, and Sanofi Global Health.

Better access to NCD medicines and treatments isn’t enough to ensure effective prevention and treatment of the conditions, responsible for 74% of premature deaths in the world. More attention needs to be focused on  training, retention and effective use of health care workers, said a panel of experts at the World Health Summit.

BERLIN – Following the recent UN declarations restating ambitious health goals for universal health coverage, ending TB and preventing pandemics, global health leaders are re-examining the tool box of strategies that can help push this ambitious triple agenda forward.  

Ensuring a global health workforce fit for purpose is one important thread running through all of these challenges – and far more focus needs to be placed on this in order to ensure attainment of critical health goals, particularly UHC.  

“The health workforce is the ‘lifeblood’ of a health system,” noted Katie Dain, head of the NCD Alliance. “We can be talking about access to medicines, digital technologies, but you need the health workforce in order to be delivering.” 

She was speaking last week at a World Health Summit event on Harnessing innovation to empower the health workforce for NCDs

Katie Dain, CEO of the NCD Alliance

“Some 4.5 billion people are not fully covered in terms of basic, essential health services.  And these services must now include diagnosis and treatment of chronic conditions – rather than infectious diseases alone,” Dain added.  

And the global workforce will need to double by the year 2030 in order to be able to meet the needs of a still-growing, but also aging global population – particularly for NCD care.  

 “Among the challenges picked up through UN General Assembly declarations were the sheer numbers in terms of the shortage of health workers,” Dain said, noting that “we’re going to need  80 million by 2030. And while this is a global challenge, it is particularly acute in the poorest nations.”

The problem is not just sheer numbers but more subtle workforce challenges, related to recruitment, training and retention. 

“We have to ensure that we are incentivizing them to stay within the, and we also have to be aware of the gender dimension – essentially 70% of the health workforce are women. So this is a gender equality agenda as much as it is a health agenda,” Dain said. 

Training and equipping health workers for new NCD challenges 

Bente Mikkelsen, director of the Department of Noncommunicable Disease, WHO

Along with the broad challenge of insufficient numbers, health ministries and global health leaders have to ensure that workers are better trained to deal with NCDs – particularly in low–income countries, where chronic disease prevention, treatment and care were not typically part of the basket of primary health care services – which was traditionally geared to maternal and child care, immunizations, and infectious disease prevention and treatment. 

“Seven out of ten deaths from NCDs is tremendous,” said Bente Mikkelsen, head of WHO’s Department of Non Communicable Diseases, who spoke at the panel along with Dr Osahon Enabulele, president of the World Medical Association (WMA) and Paula Head, lead of Roche’s  Policy, Value and Access team.   

Mikkelson noted that the COVID pandemic provided a sort of wake up call to countries worldwide about the importance of NCD care. “When we looked into the excess mortality during COVID, we have very strong reasons to believe that a major part of that was also because of NCDs. And unfortunately, these numbers are growing…. So there is an urgency and I think we have a golden opportunity to make a crisis into huge awareness building.”

Added Dain: “All countries, but particularly low and middle income countries, are seeing the biggest NCD burden, in terms of cardiovascular disease, cancer, diabetes, chronic respiratory, mental health, you name it. And when you ask the question, are our health workforce globally equipped, ready oriented towards dealing with chronic conditions? The very clear answer is no. 

“We all know in NCDs that we’ve been playing catch up in a way connected to some of the other big global health priorities like HIV AIDS, TB, malaria, women and children’s health. NCDs over the last decade have really gained a lot of traction, but it’s still playing catch up.” 

Globally, only 2% of development assistance for health is directed to NCDs, and “that’s still really pitiful,” she noted. 

“And we know that the health workforce is in a way, a mirror of the broader health system. And essentially health systems in many low income countries are still oriented to acute care. They’re not really oriented towards a chronic care model, which also includes health promotion and prevention, and early diagnosis – which is so important in NCDs and also really doable.”

Using technology to empower health workers 

Checking for high blood pressure is a basic procedure that can be undertaken by most health workers even in settings with limited resources.

Mikkelsen laid out a number of ways in which simple, but more effective uses of health technologies could improve the effectiveness and efficiencies of the health workforce. 

“It’s not only about new devices, new technologies but it’s really about co-creation and how we work together.  I  think many of the real solutions, will be in the co-creation of new service delivery models rather than gadgets and new examples. 

“We think it’s about the numbers of doctors, the numbers of nurses, and then we forget we have pharmacists, we have a lot of other workers that can help the health system to deliver.  So that’s also an innovation that needs to be addressed, and this leads to task shifting and how do we really integrate?”

She cited as examples, the training of HIV healthcare workers to screen for cervical and breast cancers for example. 

“For the first time, we have 21 approved proposals to the Global Fund to address HIV and the spike of cancers together.  What this means is that those who are in this space, mostly HIV -trained healthcare personnel, will get the training to be able to address the needs of, say, cervical cancer. So it’s not only about more health care workers, but it’s also about the integration of needs that can address that.”

Similarly, health workers trained in administering routine childhood vaccinations “should of course, be able to do the vaccination for HPV.  And those who offer diagnostics, should also take the time to measure the blood pressure, and the blood pressure causes. 

COVID triggered new innovation – let’s make that the norm

Health worker meets with NCD patient Jane at the NCD clinic in Tulagi, Solomon Islands.

During COVID, health care workers and systems found new ways to innovate, so as to treat COVID patients while delivering more routine care, she pointed out. “Now, we need not to go back to normal, but to create a new normal.  Use the innovation that happened in the crisis in more normal times, to find new ways to deliver health and health care services.

More self-care education, including use of rapid at-home diagnostics is another example of innovation that blossomed during COVID – and now needs to be mainstreamed, Mikkelsen noted. 

“We’ve set a goal of having 70 of women screen with formal testing and women identified to get treatment. So what do we do? 

“I think one recommendation that was issued earlier this year that can help is the recommendation of self care interventions. Self testing, something you can do at home. 

It requires, of course, a pack of innovative digital solutions. And this can be developed together with the women that are at risk for cervical cancer, And that is also coming together with the other thing we do, which is to try to launch the AI for diagnostic assessments in the same area – as well as target product profiles to explain what are the products that we are looking for.” 

Finally, she stressed that training health workers to give more attention to preventing NCDs can help to reduce the burden of chronic disease. 

“Because that is really the untapped opportunity. We still are not on par when it comes to tobacco use and alcohol. And we are still going in the wrong direction when it comes to the obesity and physical activity,” she said, noting the average amount of medical school training on NCDs prevention currently amounts to about 3 hours in six years of training.  

Attracting and retaining health workers 

Osahon Enabulele, president of the World Medical Association (WMA)

COVID also saw significant attrition of health workers, both due to deaths from the disease as dropouts due to burnout, mental health issues and even experiences of violence, noted Dr Osahon Enabulele, new president of the World Medical Association.

“So the question is how do we create enabling working conditions? How do we create conditions that will make workers stay in their various practice centers?”

Health worker retention is a particularly big problem in Africa, which has 25% of the global disease burden, but just 3% of the health workforce, pointed out Enabulele, a Nigerian medical doctor by training. 

“We have a lot of pulling away of health care workers from Africa and Asia to Europe, America and other places that do not have enough health care workers. So it looks that the production of health care workers in Africa and Asia is for export to places like Europe, and that has implications for equity, for universal health coverage”. 

“SO we are looking at how we can, you know, better, you know, address these realities, but also how can we get governments to be more accountable to their promises?” to invest in UHC. 

National policy makers need to see health workforce as an investment – which will benefit economies and societies.  

“For us,  it is how to get that real political leadership. Not seeing health care investments as a cost, but as a fundamental intervention? 

“It’s very, very important for me, the question of advocacy, how do we advocate  to governments, to the leaders to see health as a necessary investment that must be made? 

“How do we get them to replace the negative working conditions for their practitioners? How do we get them to have very progressive mechanisms to retain them? And a lot of this has to be done even in the middle-income countries.” 

Role of industry 

Paula Head, lead of Roche’s  Policy, Value and Access

As head of a UK hospital during the pandemic, Paula Head saw plenty of exhausted health workers, mostly female, coming on duty while still exhausted from their last shift at the hospital.  

“But what I also saw during COVID was the most phenomenal ability to introduce innovation rapidly, effectively and safely, with the industry and the health services working closer together because we had a single focus – which was keeping the staff and their patients safe and well,” recounts Paula Head, formerly the head of a UK hospital during the pandemic, and now the Roche lead for Policy, Value and Access. 

“And so I wanted to continue that innovation journey but to do it from the private sector where I thought we could continue to make a difference. 

She sees self-testing as an example of one key area where industry can support innovation that eases the load for health workers and uses their skills more effectively to diagnose and treat a range of disease conditions. 

“We’re all familiar with self testing from COVID for doing and, of course, what that gives us is, first of all, the ability for patients to understand and manage their own health conditions. It also saves time from the phonetical physician having to take the test, send it to the lab, having to analyze the test, and so this really supports change in in the innovation and supports  the workforce. 

“Another example, done really effectively in Egypt, is end-to-end innovation in labs so that you can get a complete analysis from beginning to end, freeing up the lab workforce. 

“And then also another example I’d give is subcutaneous injection for cancer treatments.Most patients have to go through an infusion which takes many hours. The subcutaneous injection is injection under the skin; it takes much less time, which means that first of all, the patients aren’t having to stay in the hospital for long periods of time. It releases capacity, so enables those chairs to be available for people who absolutely do need an infusion. And it means that the products can be delivered in more remote areas because you don’t have to come to a specialist center for the treatment. 

“So those three are really good examples of how we’re moving technology and using innovation to support the health workforce.”

Using AI to improve health workforce performance 

Artificial intelligence innovations, when designed together with health workers, can empower them.

But these are innovations using the technology that are available now, she pointed out.

What’s need now is more collaboration between industry and health systems to anticipate and develop new solutions, she said. 

“Say we are looking at diagnosis. If we added in AI, and Roche is working on some of this now, we can move from diagnosis to prognosis and then from prognosis to stratification and targeting patients so that we use resources we’ve got for the patients where it can make the biggest difference. 

Still, she cautions that innovation best comes from the bottom up, rather than the other way  around. 

“We’ve got to work with governments to anticipate and understand what’s coming up and then find the right solution – rather than finding the solution that we think is right,” she asserted.

Added Mikkelsen, what’s also most needed is a refocusing of health care systems on the “multi-disciplinary teams” particularly in budget-strapped low-income countries. 

“Many of these countries has something similar to a primary health care service,” said Mikkelsen. “But it’s geared to HIV, TB and malaria because that is where the funding came from. And now we really need to see the whole person.”

Image Credits: Medtronics, E. Fletcher/HPW, E. Fletcher/ HPW, WHO / Blink Media, Neil Nuia, E. Fletcher/HPW , https://www.flickr.com/photos/mikemacmarketing/42271822770/.

Thousands of aid trucks are waiting to enter the Rafah crossing

A third convoy of 20 aid trucks with food, water and medical aid entered Gaza on Monday via Egypt’s Rafah crossing, in line with a  reported US-Israeli deal Sunday evening to keep desperately needed humanitarian aid flowing to the war-torn enclave. But no fuel has been allowed into the territory, and hospital generators are expected to run out by Wednesday, according to relief agencies.  

Israel is blocking fuel from entering Gaza as it claims Hamas will hijack fuel supplies to continue its missile attacks on Israeli cities, ongoing since the 7 October surprise incursion by Hamas gunmen into 22 Israeli communities, killing more than 1300 people, mostly civilians.  Israel has since cut off Gaza’s access to water and electricity from its grid, and bombarded the enclave at an unprecedented level of intensity.   

Now, the lives of Palestinian patients – including 130 premature babies dependent on hospital incubators – are at risk as fuel runs out, according to the UN Office for the Coordination of Humanitarian Affairs in the occupied Palestinian Territory.  Gaza’s desalinization plant is also dependent on fuel supplies to backup generators to produce clean water, since Israel cut off access to its electricity grid.  

Dr Tamer Al-Shaer, head of shelters in southern Gaza for the United Nations Relief Agency for Palestine (UNRWA), described the situation as “catastrophic” on Monday.

Nearly 420,000 people are sheltering in 93 UNRWA shelters in Middle, Khan Younis and Rafah areas, an increase of 14,000 (3.5%) in the past 24 hours, the UNRWA reported late Monday. 

This includes 3190 pregnant women and 18,000 with chronic conditions who need medical support, said al-Shaer.

Shelters are operating at 2.57 times their designated capacity, according to the relief agency.

Over 5,000 people have been killed in Gaza in the past two weeks, 40% of whom are children, according to Gaza’s Ministry of Health.

Meanwhile, UNRWA reported on Monday that 35 of its staff have been killed in Gaza since 7 October when Hamas first attacked Israel, unleashing an aerial bombardment of the territory by Israel in response.

The entry of the third convoy of trucks Monday means that 54 aid trucks have so far entered the territory from Egypt, in line with a deal on humanitarian aid reached with Israel during US President Joe Biden’s recent visit. But this is a drop in the ocean of need for an estimated 1.6 million Palestinians who are trapped and unable to leave the territory, UN officials say.

Before the 7 October conflict, 100 trucks delivered aid to the territory every day as almost a third of Gaza residents were food insecure even then.  

Five United Nations (UN) agencies, including the World Health Organization (WHO) and UNICEF, warned over the weekend that water production was at 5% of normal levels, food was running out and hospitals were overwhelmed with casualties.

“With so much civilian infrastructure in Gaza damaged or destroyed in nearly two weeks of constant bombings, including shelters, health facilities, water, sanitation, and electrical systems, time is running out before mortality rates could skyrocket due to disease outbreaks and lack of health-care capacity.

“We call for a humanitarian ceasefire, along with immediate, unrestricted humanitarian access throughout Gaza to allow humanitarian actors to reach civilians in need, save lives and prevent further human suffering. Flows of humanitarian aid must be at scale and sustained, and allow all Gazans to preserve their dignity,” said the statement, which made no reference to the fate of over 200 Israeli hostages held by Hamas along with foreign students and workers.

Meanwhile two more Israeli hostages, Nurit Cooper, 79 and Yocheved Lifshitz, 85, were released late Monday night to the Red Cross making four hostages to be freed over the past four days. They were among the 222 people originally seized, including young children and older people, during the 7 October deadly rampage by Hamas gunmen in 22 Israeli communities near Gaza. 

There has meanwhile been an escalation in violence in the West Bank. Some 95 people have reportedly been killed, mainly in confrontations between armed Palestinians and Israeli troops, but also in clashes with Israeli settlers. On Sunday, an Israeli airstrike hit al-Ansar Mosque inside Jenin Refugee Camp, according to UNRWA. Israeli said it was targeting a Hamas and Islamic Jihad compound under the mosque being used to organize an imminent attack, a claim that could not be independently verified. 

-Updated 24.10 with news of the latest hostage releases

Image Credits: Eskinder Debebe/ UN.

Dr Gaya Gamhewage, WHO Director of the Prevention of and Response to Sexual Misconduct (PRS) team and Lisa McClennon, Director of the WHO Office of Internal Oversight Services.

The vast majority of sexual misconduct complaints have been made in the World Health Organization’s (WHO) Africa region, while the majority of abusive conduct complaints originate in the Eastern Mediterranean Region (EMRO), which comprises mainly of countries in North Africa and the Middle East.

This is according to the WHO’s dashboard on investigations into sexual misconduct.

Abusive conduct refers to all misconduct, excluding sexual exploitation, abuse and harassment (for example, discrimination and bullying).

Acknowledging that “culture change” is hard, Dr Gaya Gamhewage, WHO Director of the Prevention of and Response to Sexual Misconduct (PRS) team said that “more personnel are speaking up” and the number of allegations and disciplinary action was increasing.

Soon every duty station and every person who works with and for the WHO will understand how to prevent and respond to sexual misconduct, Gamhewage told a media briefing on Monday.

Describing the WHO’s accountability framework as “the most detailed” across UN agencies, Gamhewage said that “everyone who works with or for WHO, including senior leadership all the way up to the Director General, now has very distinct accountabilities for both preventing and responding to sexual misconduct”. 

“It’s intended to clarify for every member of the organisation, from me to the driver in Malawi, their individual accountabilities for both prevention and response,” she told a media briefing on Monday.

Every country office is also obliged to run a risk assessment for sexual misconduct and come up with a mitigation plan.

“That’s how we can be sure that we quantify and qualify the risks of sexual misconduct at every single duty station. So the mitigation plans are important and they have to be suited to each context. So far this year, nearly 40 countries have completed this and this allows us really to be targeted and contextualised in our work,” said Gamhewge.

Lisa McClennon, the newly appointed director of the WHO’s Office of Internal Oversight Services (IOS), reported that the investigative team has received 287 allegations of sexual misconduct, of which 120 have been investigated and 38 have been substantiated so far. 

“Since 2021, we have entered the names of 25 alleged perpetrators of sexual misconduct into the UN Clear Check database to prevent future employment within the UN system,” added McClennon.

Open-door sessions

To encourage openness, Gamhewge said she was hosting monthly “open-door virtual sessions” and monthly workforce surveys of the workforce. 

Almost 10,000 people have taken part in PRS webinars and open-door sessions this year, and more than 60,000 others have taken their courses and training. 

“I’ve personally met with nearly 200 of our 407 Country focal points. We openly talk about issues. We address concerns staff have and staff are proposing ideas for our culture to change so that, not only do we respond, but we prevent sexual misconduct from happening in the first place. “

The PRS will host a stakeholder review at the end of November to “further calibrate the actions we need to take, going into year two [of the WHO’s  three-year 

“The global event will focus on acknowledging and identifying best practices for addressing sexual misconduct across the system and looking at the joint challenges that we all continue to face,” she added.

Aid trucks stuck outside Gaza.

UPDATED ( 22:30 CEST 22.10.2023) The first convoy of 20 trucks carrying humanitarian aid to besieged Palestinians, including four trucks of WHO emergency medical supplies, entered southern Gaza via Egypt’s Rafah crossing Saturday. 

Another aid convoy of 14 trucks, including food water and medical supplies, entered Gaza on Sunday, UN officials  confirmed. They expressed hopes the humanitarian corridor could remain open, even as questions remained over its continuation amidst the Israeli threat of a ground invasion of Gaza along with an expanding arc of regional hostilities, including on the Israeli-Lebanese border.

At the same time, Friday evening’s release of two American-Israeli hostages, including a mother and her daughter, held by Hamas raised hopes that behind-the-scenes negotiations could aid in further humanitarian efforts.

United Nations (UN) Secretary-General Antonio Guterres said that the UN was “actively engaging with all the parties in order to clarify [the aid] restrictions so we can have these trucks moving towards where they’re needed”.

Addressing the media in front of Egypt’s Rafah border crossing to Gaza on Friday afternoon, Guterres called for the speedy movement of the aid trucks.

 “We are witnessing a paradox. Behind these walls, we have two million people that are suffering enormously: that have no water, no food, no medicine, no fuel,” said Guterres. 

“On this side [of the border] we have so many trucks loaded with water, with fuel, with medicines, with the food. 

“These trucks are not just trucks. They are a lifeline. They are the difference between life and death for so many people in Gaza and to see them stuck here makes me be very clear. What we need is to make the move; to make them move to the other side of this wall, to make the move as quickly as possible, and as many as possible.”

UN Secretary-General Antonio Guterres addresses the media outside the Rafah border crossing in Egypt.

Intense negotiations

On Friday, Tamara Alrifai, Director of External Relations for the UN Relief and Works Agency for Palestine Refugees (UNRWA) said that she did not know “what is stopping the trucks but what we know is… everyone is calling for an immediate humanitarian ceasefire and an unimpeded, continuous and safe humanitarian access for humanitarian convoys”.

She added that there were “intense negotiations” about the aid trucks. 

“What is needed is a continuous flow of aid. This is not about a one-off sending 20 trucks and then nothing. This is really a call for continuous and safe humanitarian access with security conditions that allow my colleagues in Gaza to do what they need to do, which is check in on the internally displaced people (IDPs), run the health centres and distribute water and food.”

Earlier in the day, construction teams were seen working feverishly to repair the Rafah border entrance. which had been bombed in Israeli airstrikes earlier in the week, to enable the trucks could enter Gaza.

During a World Health Organization (WHO) briefing on Thursday, Dr Mike Ryan, head of health emergencies, decried the Israeli decision to only allow 20 trucks into the territory – and not to allow fuel urgently needed to power hospital generators and water desalination plants.

An AFP journalist reported that six fuel trucks, apparently destined to power hospital generators, had indeed entered Gaza as part of Sunday’s medical aid convoy. That was denied by Israel, which has said it believes fuel designated for humanitarian use has been filtered off to continue fueling the war.

“We have very, very detailed lists of the medical equipment and supplies that we’re sending, and they’re extremely well documented,” added Ryan at Thursday’s briefing, adding that these included amputation kits, intubation kits, pneumothorax kits to treat punctured lungs, and “many wound dressings, infusions, disinfectants, anaesthetics and painkillers”. 

However, Ryan added that the routes of the aid trucks had to be “de-conflicting” to ensure that “the trucks are not attacked or disrupted in any way, and that the goods can be offloaded safely”.

“Bringing supplies through a border crossing and for humanitarian assistance requires security planning, logistics planning. It is best done with people on the ground and is best done with independent monitoring of the delivery, and we do that in countries all over the world and in very difficult humanitarian situations and in zones of actual conflict,” added Ryan.

Guaranteed ‘deconfliction’

Ryan stressed that the combatants carrying out the hostilities had to guarantee “deconfliction”.

The fact that Israel had only allowed 20 trucks was a “drop in the ocean of need right now in Gaza”, Ryan stressed.

He asked how the WHO was supposed to choose whether to prioritise water, food or essential medicines.

“You get to send 20 trucks into a situation where two and a half million people are thirsty, without food, without water, without medicine,” said Ryan. 

“It shouldn’t be 20 trucks, it should be 2000 trucks. And we shouldn’t have to be making these choices.”

Meanwhile, Israel has continued its airstrikes of Gaza and is currently massing troops on Gaza’s border in preparation for a ground offensive, while Hamas continued missile fire on southern and central Israel.

In a briefing to parliament on Friday, Israeli Defence Minister Yoav Gallant said that the final phase of the current miliary offensive would be the “removal of Israel’s responsibility for life” in the Gaza Strip.

On Friday, the Palestinian Red Crescent Society said Israel ordered the evacuation of Gaza’s Al Quds Hospital, which is treating some 400 patients and is providing sanctuary to an estimated 12,000 displaced people.  But Israel later denied that there had been an order to evacuate the hospital – although the army has called for all civilians and hospital activities in northern Gaza to move south.  AFP, which had reported on the evacuation call later withdrew its story.

Elaine Ruth Fletcher contributed to reporting on this story.

A man with diabetes checking his blood sugar level with a glucometer

World Health Organization (WHO) member states should include personal-use glucose monitoring devices in their vitro diagnostics (IVD) lists to help people with diabetes, according to the global body’s 2023 Essential Diagnostics List (EDL) released this week.

Diabetes caused 1.5 million deaths in 2019, and including personal glucose testing devices “could lead to better disease management and reduced negative outcomes”, said the WHO.

Another first for the list is the inclusion of three tests for hepatitis E virus (HEV), including a rapid test to aid in the diagnosis and surveillance of HEV infection, an under-reported disease which causes acute liver failure in a small number of people.

The list offers guidance rather than being prescriptive, with the aim of increasing patients’  access to diagnostics and better outcomes.

“The WHO Essential Diagnostics List is a critical tool that gives countries evidence-based recommendations to guide local decisions to ensure the most important and reliable diagnostics are available to health workers and patients,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. 

Other new tests added to the list include those for endocrine disorders, reproductive, maternal and new-born health and cardiovascular health:

The recent World Health Assembly  resolution on strengthening diagnostics capacity urges member states to consider the development of national essential diagnostics lists, adapting the WHO model list of essential in vitro diagnostics.  

Regulatory considerations for AI

The WHO also raised issues for consideration when regulating artificial intelligence (AI) for health this week.

With the increasing availability of health care data and the rapid progress in analytic techniques – whether machine learning, logic-based or statistical – AI tools could transform the health sector. 

WHO emphasizes the importance of establishing AI systems’ safety and effectiveness, rapidly making appropriate systems available to those who need them, and fostering dialogue among stakeholders, including developers, regulators, manufacturers, health workers, and patients.

“Artificial intelligence holds great promise for health, but also comes with serious challenges, including unethical data collection, cybersecurity threats and amplifying biases or misinformation,” said Dr Tedros.

“This new guidance will support countries to regulate AI effectively, to harness its potential, whether in treating cancer or detecting tuberculosis, while minimising the risks.” 

In response to growing country needs to responsibly manage the rapid rise of AI health technologies, the publication outlines six areas for regulation of AI for health:

  • transparency and documentation, such as through documenting the entire product lifecycle and tracking development processes.
  • risk management, including addressing issues including human interventions, training models and cybersecurity threats
  • externally validating data and being clear about the intended use of AI
  • commitment to data quality,
  • understanding the scope of jurisdiction and consent requirements, in service of privacy and data protection.
  • fostering collaboration between regulatory bodies, patients, healthcare professionals, industry representatives, and government partners.

 

Image Credits: Dischem.

WHO medical supplies shipped from Dubai and loaded onto trucks at Egypt’s Al Arish airport have been poised at Rafiah crossing awaiting a hoped-for Israel signal to enter Friday.

The World Health Organization (WHO) is poised to begin the transfers of medical supplies to the embattled Gaza Strip on Friday as part of a humanitarian convoy of 20 trucks, said WHO Director-General Dr Tedros Adhanom Ghebreyesus Thursday. 

But he and other senior WHO officials said the corridor needs to remain open permanently in order to respond to the gaping health and humanitarian needs that have emerged amongst Palestinians in Gaza where over 3,500 people – mostly women and children – have been killed and around 12,000 injured since  7 October.

Fighting broke out after Hamas broke through a border fence separating the enclave from pre-1967 Israel, killing over 1300 people in 22 rural communities.

Tensions were at fever-pitch Thursday evening in the region, as Hamas continued firing barrages of missiles into southern and central Israel, Lebanon aimed fire from the north, and Israeli officials hinted that a ground invasion of Gaza could be imminent, following 13 days of aerial bombings.   

“The situation is very dire and at a breaking point,” said Tedros. “We have been waiting with the supplies for a week. And with more attacks and less service, the levels of casualties will continue to rise. We hope there will be a crossing tomorrow.”

In line with a deal brokered by the United States, Israel on Wednesday agreed to allow an initial 20 trucks of medicines, food and water to enter Gaza through Egypt’s Rafiah border crossing.

“He [Israeli Prime Minister Binyamin Netanyahu] agreed that what he would do was to open the gate to let up to 20 trucks through, to begin with,” said US President Joe Biden, interviewed by reporters aboard Air Force One, following a one-day trip to Israel.  

Just a drop in the ocean of need  

Health workers in Gaza delivering emergency health care

But the 20 trucks Israel has agreed to let pass is only a “drop in the ocean” of what is needed right now in Gaza, WHO officials said. 

“It’s great to have a start. It’s fantastic that we’re beginning and I will pray this evening, and I don’t pray very often that that border will open tomorrow,” Ryan said.

“But we then need to take this beyond that beyond the gesture and then we need to make sure that a corridor is a corridor. Humanitarian assistance needs to move every day. 

“Two and a half million people need assistance,” Ryan added. “Twenty trucks is a drop in the ocean of need right now in Gaza…. We have the risk management processes in place. We have the means to monitor the delivery, but we need to be able to have access and we need to be able to have the deconfliction guarantees that will allow our staff to operate on the ground and do their jobs.”

Diesel fuel is for hospitals, desalination plant – and to bake bread

Palestinian families have taken refuge at a UNRWA schools in Gaza City to escape the ongoing Israeli airstrikes.

Fuel also is needed to power hospital generators and ambulances, Gaza’s desalination plant, and even to bake bread, the staple for survival in wartime, Tedros and Ryan stressed. 

“Fuel is also needed for hospital generators, ambulances, and desalination plants. And we urge Israel to add fuel to the life-saving supplies allowed into Gaza,” said Tedros at the presser. 

“The hospitals ran out of fuel days ago. What’s been happening is we’ve been finding fuel and others have been finding fuel within reserve stock. People on the ground in Gaza have been working together to try and re-prioritize whatever little fuel is left.

“The choice [right now] is between keeping a desalination plant going so you have some water or supplying the hospital, or supplying UNRWA, which are housing 600,000 internally displaced people,” Ryan added. 

But in the deal arranged Thursday, Israel refused to allow fuel to enter at all, contending that Hamas has been siphoning off supplies from UN agencies to fuel its weapons arsenal, being aimed at Israel.

No guarantees diversion of supplies can be avoided

Dr Mike Ryan, WHO head of Health Emergencies at Thursday’s press briefing.

Israel also has cautioned that it will only allow aid to flow so long as supplies are not diverted to Hamas fighters: “Israel will not prevent humanitarian assistance from Egypt as long as it is only food, water and medicine for the civilian population and not diverted to Hamas,” said Israel’s UN Mission in Geneva on Thursday.

Answered Ryan: “There are absolutely no guarantees in the humanitarian situation that you can completely avoid a diversion of resources. This is a fact that happens. 

“We do everything in our power to ensure that that doesn’t happen,” he said. “But what we need is a fully supported humanitarian operation, not a token. 

“Bringing supplies through a border crossing for humanitarian assistance requires security planning, logistics planning, it is best done with people on the ground. It is best done with independent monitoring of the delivery and we do that in countries all over the world and in very difficult humanitarian situations, and then zones of actual conflict. 

“But what we need are the guarantees and the joint planning on either side.  

Campaign of retaliation

Burned-out ruins of Kibbutz Beeri, Israel, where one in 10 residents died in the Hamas incursion on 7 October.

Since the mass killings of Israeli civilians on 7 October, Israel has launched an unprecedented campaign of retaliation – vowing to remove Hamas from power altogether in Gaza. It has dropped thousands of bombs in the tiny Gaza enclave, as well as demanding an evacuation of all civilians and hospitals in the northern part of the Gaza Strip, to the south.   

Hamas has meanwhile fired an estimated 5,500- 6,700 rockets at Israeli towns and cities in the country’s southern and central region. Hostilities have slowly been heating up along Israel’s northern border with Lebanon. And Thursday, the Iran-aligned Hizbullah launched a barrage of rockets at Israeli cities across the border after days of more sporadic clashes. 

The human damage on the Gazan side exceeds all previous Israeli-Gaza wars  – due to the unprecedented intensity of Israeli bombings over Gaza’s densely populated cities and refugee camps, where few civilians have access to bomb shelters.

Gaza Palestinian child looks over the destruction of a recent Israeli air raid.

Some 3,500 Palestinians have so far perished, more than half are women and children, said Richard Peeperkorn, WHO Representative at WHO’s Jerusalem-based office for the West Bank and Gaza at Thursday’s briefing. Another 12,000 have been injured.

Most Israeli casualties happened during the 7 October attacks, while fewer numbers have died in missile fire, against which Israel has built an extensive system of civilian shelters. Another 203 Israelis are being held by Hamas as hostages. 

There are over one million internally displaced Gazans, including people whose homes were reduced to rubble as well as Palestinians moving southwards in line with the Israeli evacuation order – which WHO and other UN agencies have repeatedly called Israel to rescind.

Some 100,000 Israelis have been forced to evacuate homes near the Lebanese border and in rural communities around the Gaza border, some of which are now little more than burnt fields of rubble. Thursday evening, Israel’s government approved a partial evacuation of the coastal city of Ashkelon, a city of 132,000 people just 13 kilometres from Gaza.  

“Like the rest of the world, all of us who have been shocked, appalled and saddened by the conflict in Israel and Gaza,” said Tedros.

“The attacks by Hamas and other armed groups on 7  October that targeted Israeli civilians were horrific and unjustifiable.  At the same time, WHO is gravely concerned about the health and well-being of civilians in Gaza, who are suffering from bombardment and siege.” 

Attacks on health workers and health facilities 

Dr Tedros Adhanom Ghebreyesus: WHO supports the UN Secretary General’s call fo an immediate ceasefire and safe return of hostages held in Gaza.

In Gaza, there have also been 59 attacks on health workers or health facilities, while in the occupied West Bank, there have been another 77 attacks on Palestinian ambulances and responders since 7 October.  

In Gaza, the worst attack came Tuesday night when some 470 people were killed in a huge explosion at Gaza’s Al Ahli hospital, where many displaced civilians had been seeking shelter, WHO said. 

Regardless of who was responsible, health workers and facilities need to be left out of the circle of hostilities, said Tedros. 

“I deplore the attacks on health care in both Gaza and Israel, which have led to deaths and injuries of health workers and patients on both sides. Under international humanitarian law, all armed actors are obliged to actively protect health care. The bomb that striked Al Ahli Hospital in Gaza City on Tuesday night, and the loss of life it caused, regardless of who was responsible cannot be tolerated.” 

Opportunity to prevent further escalation? 

Added Tedros, “There is still time and opportunity to prevent the situation from escalating further. 

“WHO supports the United Nations Secretary General’s call for an immediate humanitarian ceasefire. We call for the immediate and safe release of hostages seized and taken into Gaza by Hamas and other armed groups, among them children, older people and those who need urgent medical care. 

“We continue to appeal to Israel and Hamas to abide by their obligations under international law to protect civilians and healthcare. We appeal to Israel to restore supplies of electricity and water [to Gaza].”

Image Credits: WHO , WHO/Ministry of Health/Occupied Palestinian Territory , WHO/Eastern Mediterranean Region .

Pollution levels are rising in India’s capital, Delhi.

There have been some gains in the past decade, but peak pollution is still 30 times WHO’s safe limit. Top Delhi government advisor Reena Gupta speaks with Health Policy Watch about progress and obstacles.

Come October and millions of people in and around Delhi brace for a sharp rise in pollution in the last quarter of the year and on cue, the level of PM 2.5, a critical microscopic air pollutant that is usually the best measure of air quality, has already tripled from a month earlier. 

It’s been 10 years since the World Health Organization (WHO) deemed the city to be the most polluted in the world – even worse than Beijing whose air was notorious at the time. 

Although there has been progress, Delhi is still often labelled as the most polluted capital in the world. Back then, the annual average of PM 2.5 was 149 micrograms per cubic metre. Now it’s about 100, an improvement of a third. But between October and December 2022, the average was almost 160, which is over 30 times the WHO’s safe limit. This year could be worse, experts warn.

Reena Gupta, the national spokesperson of Delhi’s governing party, Aam Aadmi Party.

To understand why pollution is still so bad, Health Policy Watch spoke with Reena Gupta, the national spokesperson of Delhi’s governing party, Aam Aadmi Party (‘common person’s party’). She represented the state government at the United Nations (UN) Climate Week in mid-September in New York and has previously worked at the World Bank as a Natural Resource Management Specialist. As a top advisor to the government on environmental and air pollution matters, she recently held a meeting with experts and civil society representatives. 

Dirty industries shift out of Delhi’s jurisdiction

Delhi is doing its bit, according to Gupta – even at the cost of losing revenue to reduce pollution. She cites a recent study which shows only about a third of the pollution sources are within the megacity’s boundary. 

“In Delhi, we have converted all the industry to clean (sic) and natural gas. Why has that not happened in Gurgaon and Ghaziabad [which border Delhi]?

“Also what has happened is, because we are so strict in the industrial areas of Delhi, the industries actually move to Gurgaon and Ghaziabad. They move just outside Delhi because they want to be outside the control of Delhi Pollution Control Board and they set it up on the outskirts of Delhi and continue to pollute the air shed of Delhi. So we lost the revenue but our airshed didn’t get cleaned.”

The responsibility for cleaning the air in Delhi and its neighbouring areas rests with a statutory body called the Commission for Air Quality Management (CAQM). It is headed by a retired bureaucrat and has the authority to direct over a hundred officials, including police across this vast region with a population of over 70 million.

“It’s a bureaucratic body,” says Gupta, who describes it as “very ineffective”.

“You don’t have any politicians there. The people in CAQM will continue to draw their salaries whether the air pollution improves or doesn’t improve. However, if you had a body where you had ministers who were accountable to the people, then you would see more action.” 

Gupta advocates for an air quality centre that is parallel to India’s Goods and Services Tax (GST) Council, where the centre can play the leading political role. 

Led by India’s finance minister, the GST Council includes finance ministers from the states and meets frequently to jointly administer the landmark regime which helped unify India as a single market for most goods and services. 

The council’s work may have its critics but its continued existence is seen as an example of how India’s federal structure can work in an otherwise very divisive political landscape. 

“In the GST Council, at least you have all the finance ministers and everybody comes and gives their opinion because they know that they have to go back and be accountable to the people. CAQM is not accountable to anybody,” AAP’s national spokesperson says. The AAP and the Bharatiya Janata Party (BJP) , Prime Minister Modi’s party, are bitter political rivals. 

Another alternative for the centre, she says, is to do what China did – incentivise city authorities. 

“In China you had these regional bodies which set targets for cities and for so, for example, the Central government was to tell Delhi, Gurgaon, Noida, Ghaziabad, any cities that it thinks of, to reduce your PM2.5 by 10% in the next two to three years and an additional 1,000 crore rupees (10 billion rupees) can be given from an environment fund.”

‘Can’t shut schools, can’t cut Metro fares’

There are questions over the Delhi government’s own strategy to speedily reduce air pollution in its jurisdiction. 

Why, for instance, aren’t schools closed when air pollution turns hazardous? Children can be seen walking into school when PM 2.5 levels are well over 100-200 micrograms. This toxic pollutant is linked to inhibiting the development of young lungs and cognition apart from causing respiratory diseases. 

Why aren’t fares to the metro train service slashed specially during high pollution times? This could incentivise many to move away from private vehicles as vehicular pollution is significant – contributing around 41% of air pol;ution, according to one study.

But Gupta says her government doesn’t have the authority to cut fares even though they wanted to. 

“The Metro right now is very, very expensive for people, for 70% of the population of Delhi. So we wanted to decrease the metro fares. That was rejected by the Central government. Because of Delhi’s complicated structure, some of these reforms are very difficult for us to implement.” 

Delhi is a union territory not a state and, as such, the Central government, led by the rival BJP, has overriding powers over Delhi despite the city having its own elected legislature and government.

If cutting metro fares is out, so is closing schools. Gupta explains this doesn’t make sense because most of the kids – 70-80% she reckons – live in “one-room” houses. 

“Those parents want the kids to come to school because their argument is that it’s not as if at home they have air purifiers, it’s not as if at home they have any better air quality. So they would rather have their children in school. Whereas the rich of the city probably feel that their kids are more protected at home and sitting with air purifiers. And as a government we found that there is not that much of a difference in terms of the air quality at homes or in schools.”

Private vehicles priority over public transit?

There are, however, deeper questions about AAP’s focus on public transit. For decades better public transit has been linked to air quality. AAP has been continuously in power in Delhi since 2015 and boasts of constructing 27 new flyovers and widening roads. The city now has the most road space in its land use plan amongst Indian cities. 

Yet it has been slow in adding buses despite a Supreme Court order, made in 1998, for 10,000 more buses to purchased to improve air quality. Twenty-five years later,  the population has grown and some estimate over 20,000 buses are now needed. 

 Currently, although there’s a plan to rapidly add more electric buses, there are still fewer than 8,000 buses for the entire city of almost 33 million residents. 

Gupta, however, denies that her government’s priorities are misplaced. 

“I disagree. The focus is on public transport. The focus is on increasing the metro connectivity, the focus is on increasing the last mile connectivity because unless we improve that, we will not be able to get the rich people to leave their cars.” 

She blames the opposition for complaining about the procurement which delayed the process. 

Too many plans, too many cooks?

The capital’s air crisis invariably makes the headlines this time of year, and often draws the attention of India’s top court and recently even the Prime Minister’s Office. 

Delhi Chief Minister Arvind Kejriwal, announced a 15-point programme to reduce air pollution in the capital. Some involve direct action against pollution sources, such as monitoring over a dozen “hotspots” and deploying 600 teams to stop the burning of garbage. 

There is also an app where the public can post complaints and a “war room” set up by the government. However, experts point out, enough isn’t being done to actually stop sources of pollution. 

Some of the other measures raise questions of implementation and impact. The plan includes planting ten million saplings, although the ideal time do so was a few months ago mid-monsoon; a ban on fireworks, which has repeatedly failed in the past couple of years; hundreds of ‘smog guns’ and sprinklers to spray water in a bid to suppress pollutants, the efficacy of which has been questioned; almost 400 teams to check pollution-under-control certificates (PUCs) for vehicles, but this doesn’t check for PM 2.5 even though vehicles can contribute to about a third or more of Delhi’s PM 2.5 pollution. 

Apart from the state government, there is also central government’s Graded Response Action Plan (GRAP) overseen by the CAQM. Each time the Indian air quality index deteriorates and crosses certain benchmarks, the CAQM orders tighter controls. For example, ‘GRAP 1’ is implemented when the air quality index (AQI) crosses 201. 

GRAP has been a dynamic programme although further studies are needed to show whether this is conclusively reducing pollution. 

For the last two years it’s been implemented since 1 October, perhaps to have protocols in place for quicker reaction as pollution spikes from mid-October. This is when multiple factors – including cooler temperatures and low wind speed which trap pollutants, crop stubble being burnt and festive firecrackers – make the air extremely hazardous to breathe. 

Several studies have linked even short term exposures to PM 2.5 pollutants to strokes, heart attacks and respiratory problems. Incidentally most of the stubble fires that affect Delhi are in Punjab, where Gupta’s party is in power. The state promised to halve the number of fires compared to last year but at the time of writing this the number had already exceeded last year’s count.

Significant changes

A significant change has been to base action on Air Quality Index (AQI) forecasts in Delhi rather than waiting for pollution to worsen and then take action. 

Other changes this year included a complete ban on diesel generators – only for this to be eased two days before imposition; a ban on burning coal and firewood in all restaurants, at the very first stage of GRAP unlike earlier; “strict restrictions” for the first time on certain types of vehicles operating on old fuel standards (which largely follow the Euro standards.) 

For all the political tension between the AAP and the BJP,  there is commonality in their pollution-control plans. Both back the ban on firecrackers, both press for planting more trees and drivers turning off vehicles at a stop light. Neither explicitly links the closure of schools to rising pollution but tacitly permits this when the pollution hits the “Severe” or “Severe +” benchmarks, levels that are extremely high even by Delhi’s poor record. 

Fireworks ban a mega-fail

The firecracker ban, specially during Diwali but also in other festive occasions, has failed repeatedly, despite having the official concurrence of the central and state governments, the Supreme Court and even the city police. 

“The regional issue comes into play, right? You have a firecracker ban in Delhi but you don’t have a ban in (next-door) Noida, how is it going to be effective?” asks Gupta.

“If the crackers are sold, people will buy and they will burst it. So I think in this also, we as citizens need to take ownership. How many policemen can you actually have on the ground that day to say that crackers should not be burnt?”

Banning firecrackers on Diwali also tends to be politically contentious. The BJP protested that this can hurt “religious sentiments” but their protest was overruled by the Supreme Court. 

No help for poor migrants burning biomass to cook

AAP’s Gupta points out another source of pollution: impoverished migrants coming to Delhi for better prospects, and burning biomass to cook food. 

“Some of the surveys that we did showed us that, because of poverty rates going up, a lot of migration is happening to Delhi right now,” said Gupta.

“So we looked into this whole idea that is it possible for the Delhi government at least to give subsidised (cooking gas) cylinders to some of our people who are living in the slums. We went very deep into it, but it would have been very difficult to implement because it would have been almost impossible to figure out who is a resident of Delhi and operationally it would have been very difficult. So we gave up that idea.”

 

Lifesaving WHO humanitarian aid to Gaza arrives in Egypt from Abu Dhabi. It is now poised at the Rafiah crossing into Gaza.

Israel on Wednesday confirmed that it would agree to allow humanitarian aid into Gaza via its Rafiah crossing from Egypt, where truckloads of  food, water and medicines have already been positioned in the hopes that a humanitarian corridor could soon be opened to reach some 2.3 million Gazans in a deepening humanitarian crisis.  

The Israeli agreement came after days of high stakes diplomacy involving Israel, Egypt and the United States, and was announced by US President Joe Biden during his whirlwind visit to the country – an unprecedented gesture by an American president in wartime. 

“In light of President Biden’s request, Israel will not prevent humanitarian assistance from Egypt as long as it is only food, water and medicine for the civilian population locating in the southern Gaza Strip, or which is evacuating to there, and as long as these supplies do not reach Hamas,” said the Israeli statement confirming the arrangements, and released shortly after Biden’s departure.

“Israel will not allow any humanitarian aid from its territory to the Gaza Strip as long as our hostages are not returned,” the statement  added. 

Over 70 cubic tons of medicines and health equipment have been waiting at Rafiah for over 72 hours, WHO said in a press conference on Tuesday, as the US and neighboring Arab states sought to broker a deal amidst heavy Israeli bombardment of Gaza and constant Hamas  missile fire into Israel.

Gaza man walks across a pile of rubble in a week that has seen the heaviest bombing attacks of the area ever by Israel.

Still held by Hamas forces 

Some 200 Israelis, as well as an uncounted number of foreign students and workers are meanwhile still being held by Hamas forces in Gaza – after they were taken captive in raids on 22 Israeli communities near the Gaza border on 7 October.  More than 1300 other Israelis were killed in the surprise Hamas attack, in which gunmen broke through a separation fence and went door to door, shooting and burning victims in their homes and on the streets in the early morning hours of a holiday weekend. 

While Israel has vowed to remove Hamas from power altogether now in the wake of the attacks, pressure has also been mounting on Israel’s government to advance moves that could gain the release of the hostages, which include mothers and young children, older people, many of whom are also dual nationals from some 22 countries, ranging from Nepal to Canada.  On Wednesday, Israel’s Prime Minister Binyamin Netanyahu said that he had asked Biden to intervene so as to arrange Red Cross visits to the captives.

Hamas militants arrive at Kibbutz Beeri. at 7 a.m. Saturday 7 October. A total of 100 people, one in 10 members of the kibbutz, were short or burned by the gunmen.

For 11 days now, Israel has been pounding Gaza constantly from the air, wreaking unprecedented damage on the enclave’s densely populated urban areas. The Palestinian Hamas authorities have reported some 2750 Palestinian casualties so far. 

Hamas has meanwhile continued firing thousands of missiles on wide swathes of southern and central Israel. Israel, which has anti-missile defenses and civilian shelters, has reported about another 100 casualties since the initial incursions by thousands of Hamas gunmen who broke through a fortified fence dividing Gaza from pre-1967 Israel on 7 October. 

A ground invasion on the horizon?

There were some flickering hopes Wednesday that the agreement over a humanitarian  corridor could create the foundation for a de-escalation of the crisis, advancing negotiations over the hostages and staving off an Israeli ground incursion into northern Gaza.  

Several days ago, Israel ordered the million or so Palestinians living in the northern part of the Gaza to relocate, as expectations rose of a Israeli military ground campaign to put an end to Hamas rule in Gaza – as Israel has now vowed.

The World Health Organization and other humanitarian organization have condemned the Israeli evacuation order, saying that forced relocation would be tantamount to a “dense sentence” for patients in 22 hospitals in the northern part of the enclave.  

“We have reiterated calls for Israel to reverse its evacuation orders for 1.1 million people in northern Gaza, including more than 2000 patients in 23,” said Dr Ahmed Al-Mandhari Director for WHO’s  Eastern Mediterranean Region, Tuesday morning. 

“We have highlighted both the impossibility of moving critical patients without risking their death and the already dire situation in southern Gaza’s hospitals, which are entirely unable to handle additional caseloads of patients.”

WHO Condemns Destruction of Al Ahli Hospital 

In a second late night press conference Tuesday, WHO officials condemned the attack on Al Ahli, which occurred just before 7 p.m. 

But WHO’s Director of Health Emergencies, Mike Ryan, refrained from assigning blame for the explosion, which killed some 500 people, saying only that attacks on a hospital are illegal in international law and “this violence on all sides has to stop.”  

The explosion, which Gaza’s Health Ministry blamed on an Israeli aerial bombing,, touched off spontaneous, angry protests in Beirut, Amman, and elsewhere in the Arab world, which continued Wednesday for a second night. 

Israeli officials  flatly denied that it had bombed the hospital, and shared TV footage filmed live at the time of the incident from both Al Jazeera and Israel’s Channel 12 station, suggesting that a missile shot from Gaza had misfired, with shrapnel falling on the hospital, triggering an explosion. 

The time-stamped  Al Jazeera footage captures the launch of a missile from arching in the darkened sky and then flaring as it suddenly descends – followed by a dome-like orange explosion seen on the ground at 18:59.  

Israel’s N12 TV channel also shared live footage of the same moments, showing a similar missle trajectory and explosion at 18:59, which it captured from a border watch post.   

The fact that no large crater was evident at the hospital site also tends to indicate that the explosion was not the result of a bombing, one international official involved in the Gaza relief effort told Health Policy Watch, on condition of confidentiality. 

On his visit to Israel, Biden said that US intelligence corroborated the Israeli reports that the blast had been caused by “the other team.”  

Image Credits: Care International , @uasupport999.jpg.

A lab technician in South Africa’s mRNA vaccine hub, Afrigen.

BERLIN – German mRNA vaccine maker BioNTech’s partnerships with vaccine manufacturing facilities in Rwanda, Senegal and South Africa will support the African Union’s ambition to produce 60% of the continent’s vaccine needs by 2040, the company told the World Health Summit.

But Ayaode Alakija, former Chief Humanitarian Coordinator for Nigeria and World Health Summit Ambassador, cautioned that Africa needs “end-to-end manufacturing” not a “cut-and-paste model”.

“It’s really about partnerships. Nobody can do this alone,” stressed BioNTech’s Sierk Potting. “What we are trying to establish right now, with the partners at the table and in Rwanda in Africa, is a first step into real manufacturing in Africa.”

Despite pandemic lockdown constraints, BioNTech took little over a year from conceptualizing a modular facility for the production of mRNA vaccines in Rwanda in March 2020 to breaking ground in that country in June 2021, Potting told a session hosted by the Partnership for African Vaccine Manufacturing (PAVM).

Ayaode Alakija

PAVM was launched in April 2021 and is a key component of the AU’s ambition to expand local production of vaccines. Currently, less than 1% of vaccines administered in the continent are locally manufactured, which contributed to the continent being last in line to receive COVID-19 vaccines during the pandemic.

“We have to start building this because otherwise we will be in the next pandemic and during the next pandemic, nothing would be happening,” said Potting, adding that local manufacturing in Africa is both necessary and feasible through partnerships with organizations like the AU and the African Centre for Disease Control and Prevention (Africa CDC). 

Emile Bienvenu, Director-General of Rwanda’s Food and Drug Administration, highlighted his country’s strategic approach towards achieving this goal as part of PAVM. 

“Building a vaccine industry in Africa relies on developing a conducive environment and the two main targets for Rwanda were attracting investors and becoming a regional hub for vaccine production,” he said. 

Bienvenu said that Rwanda’s collaboration with BioNTech has been successful thanks to five key factors: research and development, regulatory framework, supply chain, manufacturing, and human capital. 

He also emphasized the significance of the African Medicines Agency, which is in the process of being set up in Rwanda, in boosting pharmaceutical manufacturing across the continent.

Not tech transfer

But Alakija, who also served as the World Health Organization’s (WHO) Special Envoy for the Access to COVID-19 Tools Accelerator (ACT-Accelerator) during the pandemic, cautioned against tokenism.

“What we need in Africa is end-to-end manufacturing,” she said. “We don’t need a cut-and-paste model to give a sort of appeasement to keep Africa acquiescent,” referring to BioNTech’s self-contained modular approach, which it has shipped to the African countries to launch a production facility, and promoted as an efficient way to jump-start manufacturing in the region. 

“This is not how tech-transfer works,” Alakija told Health Policy Watch, in an interview after the panel. “Let us not sugarcoat: the discussion should not be infantalizing Africa, rather about decolonizing it.”

Historically the continent had been manufacturing vaccines, but inefficiency, corruption and under-investment had made the continent dependent on the global north for disease surveillance and response tools, critiqued Alakija during the panel.

“We in Africa have had governance problems and we need to first discuss these within home before publicizing bold plans as were shared in the panel today,” she told the session.

Stop gaslighting Africa 

Alakija also challenged the illusion of a seamless path to vaccine equity in Africa, pointing to the glaring realities of vaccine procurement challenges seen during the COVID pandemic, which have not yet been systematically addressed.

“Africa had pooled procurement, but BioNTech and Pfizer wouldn’t sell to us,” she pointed out, recalling the failed African Vaccine Acquisition Trust efforts to buy COVID vaccines in bulk shortly after they were put on the market in developed countries. 

“I’m sitting here (in this panel) mildly frustrated because some of what I’m hearing almost feels like gaslighting.”

“Money is power and would the global north, with vaccine hoarding history during COVID, really be ready to lose their contentious stronghold in the $5 billion vaccine market?” Alakija asked. 

“This is why I say we must all learn geopolitics, because until we have the right governance, poor governance in Africa will benefit high-income countries of the world.”

Alakija also challenged the emphasis on manufacturing vaccines, suggesting that focusing on health infrastructure may be a more important priority: “It is a money sink when we should be investing in our health systems.”

BioNTech CMO Özlem Türeci and CEO Ugur Sahin with African heads of state, Nana Akufo-Addo (Ghana); Macky Sall (Senegal) and Paul Kagame (Rwanda) and WHO’s Director-General Tedros Adhanom Ghebreyesus; and kNUP’s Holm Keller at BioNtech briefing on new BioNTainer plug-and-play facility.

Long-term commitment 

Reflecting on PAVM and Rwanda’s example, Marie-Ange Saraka-Yao of the global vaccine platform, Gavi, stressed the importance of a sustained, long-term effort to bolster vaccine manufacturing in Africa. 

Saraka-Yao also underlined the necessity of matching supply with actual needs, pointing to the slump in demand for COVID vaccines. 

“We need to find an equilibrium in both product quality and pricing,” she added, referring to the recent controversy in South Africa when the government opted to procure its pneumococcal vaccine from the Indian manufacturer Serum Institute of India, rather than locally, because tendering to India was more affordable. 

She also introduced the new financial instrument that Gavi is in the process of designing – the African Vaccine Manufacturing Accelerator (AVMA), which aims to provide support for sustainable procurement and long-term vaccine manufacturing on the continent, in recognition of the larger initial costs faced by new African vaccine manufacturers.

“It’s really about supporting manufacturers to come into this market, to be able to produce at least 700 million doses a year over time,” she said. 

Image Credits: Kerry Cullinan.