Davos Alzheimer’s Collaborative Founding Chairman George Vradenburg
Davos Alzheimer’s Collaborative Founding Chairman George Vradenburg

There will be close to 10 billion people in the world by 2050, and if the World Health Organization estimates are correct, as many as 22% of them – or 22 billion people – will be over 60.

A separate study by American doctors found that by that same year, the number of people living with dementia could be as high as 132 million – three times the current number.

The Organisation for Economic Co-operation and Development (OECD) estimates that impaired brain health drains as much as $8.5 trillion a year from the global economy in lost productivity. This number will increase as the population ages.

“We must better understand the brain and provide access to tools and information to help people nurture brain health as part of One Health in every community, country and health system,” according to the Davos Alzheimer’s Collaborative (DAC), a Swiss-based foundation and a US 501c3 initiated by The World Economic Forum (WEF) and The Global CEO Initiative on Alzheimer’s Disease (CEOi).

The DAC held a round-table discussion at Davos to discuss the need to prioritise brain health globally, especially given brain health’s impact on human and societal well-being, productivity, and resilience.

The discussion brought together leaders representing international organisations, scientists, experts from the healthcare industry, policymakers, and forward-thinking visionaries spanning both private and public sectors. Their collective aim was to delve into the significance of brain health as a crucial economic imperative, underscore the pressing requirement for ongoing global collaboration, and emphasise the essential role of fortifying health systems to ensure the well-being of populations with all levels of resources.

Moderated by George Vradenburg, founding chairman of the DAC, the discussion encompassed a range of critical topics, such as advancing the development of immunotherapies and vaccines, expediting interventions through the lens of patients’ groups, evaluating the effectiveness of public-private partnerships, intensifying efforts in risk reduction and prevention education, spotlighting the disproportionate impact on women, and emphasising the imperative for strengthened initiatives in data-sharing.

The event also kicked off a new network of global “Brain Health Ambassadors,” who will commit to promoting the inclusion of brain health at the primary care level and the international prevention of Alzheimer’s and related dementias. His Excellency Luis Gallegos, Chairman of the Board of UNITAR and former Minister of Foreign Affairs of Ecuador, became the first inaugural Brain Health Ambassador.

His Excellency Luis Gallegos, Chairman of the Board of UNITAR and former Minister of Foreign Affairs of Ecuador
His Excellency Luis Gallegos, Chairman of the Board of UNITAR and former Minister of Foreign Affairs of Ecuador

The Brain Health Imperative

“There is no question that we are all living longer, and that is good news,” Vradenburg said.

He emphasised that prolonged life spans contribute positively to society and the economy as individuals work for an extended period. Yet, he noted a potential oversight: “Rarely do you hear people talking about your brain span equaling your health span.”

Vradenburg expressed concern about the prevalence of individuals spending the last decade of their lives enduring some form of dementia.

“The prevalence of this disease is huge – nearly 50 million people around the world,” Vradenburg said. “But the disease starts 25 years or so before you get symptoms. So, this estimate of 50 million people diagnosed worldwide needs to be multiplied by a factor of eight to get the total number of people actually experiencing the disease.”

The silver lining is that today, doctors and scientists better understand what enables brain resilience and what can prevent Alzheimer’s, Vradenburg said. Moreover, as innovation accelerates and populations age, more countries and leaders see brain health as an economic, societal, and policy imperative.

“Governments, businesses, international organisations, and the scientific and advocacy communities everywhere are paying attention like never before. We have reached a critical inflexion point for action,” according to Vradenburg. He reminded that “2023 was a pretty good year” for people with Alzheimer’s, as the first disease-modifying drug was fully approved by the American Food and Drug Administration and covered by Medicare.

“For the patient community, this is excellent news,” he said. However, he admitted that the drug only has a moderate benefit – reducing the rate of decline by up to 27%, that it has side effects, and that it is expensive.

Prof Miia Kivipelto from the Karolinska Institute highlighted the current abundance of information regarding the factors influencing Alzheimer’s, particularly genetics, and the preventive measures available.

According to her, adopting a healthy lifestyle is pivotal, such as maintaining a balanced diet, participating in regular physical activity, practising relaxation techniques, effectively managing stress, and engaging in cognitive stimulation. She emphasized that the indicators for optimal cardiovascular health align with those crucial for maintaining brain health, including blood pressure regulation, cholesterol management, prevention of obesity, and controlling diabetes.

“What is good for the heart is good for the brain,” Kivipelto said.

Cognitive Reserve Strategies

Neuroplasticity is also crucial, noted Prof Murali Doraiswamy of Duke University.

“The important thing is that the brain is plastic throughout our lifetime,” he said.

Consider infants—they employ multiple senses, biting, smelling, and even testing the rebound of objects, Doraiswamy said. Participating in such multisensory activities is instrumental in shaping the networks within the brain. These networks, in turn, play a pivotal role in forming memories and experiences.

Prof Murali Doraiswamy of Duke University
Prof Murali Doraiswamy of Duke University

Doraiswamy highlighted the enduring presence of neuroplasticity even in the later stages of life and said researchers have explored various electrical and chemical stimuli in rodent models to augment neuroplasticity. While cautioning that these methods haven’t been applied to humans yet, he suggested the possibility of their future application.

Additionally, Doraiswamy introduced the concept of “cognitive reserve.”

“Cognitive reserve can simply be thought of as how many excess networks you have built up in your brain over a lifetime of experiences,” he said. “That reserve capacity is what protects you from decline if you suffer from a neurodegenerative disease. So, think of it as having access to cell phone towers and the more cell phone towers, you have a couple of get knocked out, you still have power.

“So it’s crucial for us to learn how to develop and monitor cognitive reserve.”

He said that physicians can evaluate an individual’s brain and cognitive reserve using state-of-the-art digital tools, including those accessible through smartphones.

“I think in addition to all of the pharmacotherapies that pioneers are developing, we need also to develop non-pharmacological ways,” Doraiswamy continued. “Now, with digital tools such as smartphone apps, it’s possible to create a closed-loop system where you can do cognitive self-testing at home in the comfort and convenience of your home. You can also send those reports to your doctor. And you can also decide to train what parts of your abilities are below normal for five minutes a day using these tools.”

Global Brain Health Initiatives

Drew Holzapfel, executive director of CEOi, said some programs are already underway and working. For example, this year, his organisation is collaborating with eight flagship sites in five countries to improve how Alzheimer’s disease is diagnosed. His organisation funded 19 programs in 12 countries in 2023.

“We’re trying to speed up the time from detection to diagnosis so that we can get care to the people who need it as fast as possible,” Holzapfel said.

His organisation’s second focus is creating collaborations to scale Alzheimer’s and brain health longitudinal clinical trial research. In India, for example, a group of high-volume clinics is looking at AI’s role in brain health. In another example, they work with ophthalmologists there to help detect cognitive impairment early and get those people into the health system.

The group has also started to look at how brain health and climate change are interconnected with partners in Kenya, Slovenia, and Chile.

Finally, he said, they are working on finding ways to engage governments.

“There have been a lot of governments and international organisations that have made commitments to Alzheimer’s. And so we’re committed to working with these governments to ensure we bring those commitments forward,” Holzapfel said.

Dr Noémie Le Pertel, a senior fellow and founding chair for the Economics of Well-being and Global Human Flourishing Working Group at the Human Flourishing Network, housed at Harvard University’s Institute for Quantitative Social Science, said her team is currently undertaking the world’s most comprehensive study on mental health, physical well-being, and various childhood predictors, encompassing the entire lifespan.

Le Pertel said: “The call to action that I wanted to put forward was really for leaders in the room who are working in organisations, what can we do and how can we join forces to seize the opportunity to work in the workforce to upskill people to understand the role of their brain health, and how it impacts not only organisation, society, the economy, but the future of our society?”

Image Credits: Courtesy of the Davos Alzheimer’s Collaborative, Courtesy of the Davos Alzheimer's Collaborative, Courtesy of the Davos Alzheimer's Collaborative.

WHO has released a novel set of guidelines on the ethics and governance of artificial intelligence (AI) in large multi-modal models (LMMs), a type of generative AI frequently used in healthcare.

The guidelines include 40 recommendations for governments as well as other actors, such as technology companies and health care providers. Based on 2021 WHO guidelines for responsible AI usage, the new document takes into account the latest technological advances and the challenges they bring.

“We need transparent information and policies to manage the design, development, and use of LMMs to achieve better health outcomes and overcome persisting health inequities,” said Dr. Jeremy Farrar, WHO’s Chief Scientist.

LMMs – like Chat GPT, for instance – can produce various types of outputs, independent of the type of training data fed into the system. This type of algorithmic machine learning is unique insofar as it can mimic human communication and perform more innovative tasks beyond those explicitly programmed.

Advanced technologies offer new opportunities but also risk enhancing existing problems of discrimination and bias, inequalities in access, lack of privacy or automation bias: too much confidence in machines, said Farrar, at a WHO press conference launching the guidelines on Thursday.

AI is increasingly used in the health sector for many diverse purposes – from drug development to patient diagnosis as well as data management and administration. In its guidelines, WHO also outlined expanding applications, such as self-guided diagnosis and treatment as well as medical and nursing education.

WHO Bangladesh Office data analysts are in the control room, where dengue related data is monitored and stored.

Diagnosis is a field where LMM use holds a promise of substantial improvement. Models are used to detect various conditions, from tuberculosis, through reproductive and mental health to several types of cancer.

As any new technology, LMMs carry risks in case of inappropriate usage. Yet, stresses  Farrar, “we should not be scared of but rather responsible towards new technology.”

‘I wanted to ask LMM to write the opening remarks – but is that ethical?’

At a WHO-organised webinar Friday, leading WHO and external experts delved deeper into usage, threats and benefits to generative AI in healthcare.

With this rapidly developing technology, new possibilities can be both promising and unpredictable, panelists stressed.

“I wanted to ask an LMM to write those [opening] remarks for me but then I wondered if it’s ethical,” joked Alain Labrique of WHO’s Digital Health & Innovation division. With this rapidly developing technology, new possibilities can be both promising and unpredictable, panelists stressed.

Because of LMM’s complexity, the threats associated with other AI types are even more salient – including risk of data biases. 

“From the Global South perspective, diversity is crucial, especially to ensure data is adequately representative, ” remarked Keymanthri Moodley of Stellenbosch University, in South Africa.

Another concern is data privacy and cybersecurity threats to health systems relying more and more on LMMs. “We need to ensure adequate data collection, storage and sharing regulations. It is crucial to ensure the patients’ safety,” said Moodley.

Limits of accuracy and reliability 

The models’ outputs also still tend to have limited accuracy and reliability. As most resources in the field of AI are in the hands of for-profit enterprises, the models’ predictions can be skewed towards a solution beneficial for their designers. Despite those pitfalls, LMM usage also carries risk of overly trusting the machine’s recommendations.

Good, reliable AI can also turn out to be inaccessible to many healthcare systems, enhancing existing inequalities.

To mediate the existing risks, the guidelines propose policies and good practices to ensure responsible LMM use. The authors stress the importance of including all relevant actors from the design phase on, focusing on the product’s transparency, inclusion and enabling possibility for voicing concerns.

Key recommendations for governments and developers in the second phase of AI deployment

The new WHO guidelines encourage governments to audit and monitor LMM usage as well as ensuring that reliability and accuracy standards are met. The models must also be checked for respecting state and international law in cases that affect, for instance, a person’s dignity, autonomy or privacy.

“Governments from all countries must cooperatively lead efforts to effectively regulate the development and use of AI technologies, such as LMMs,” said Labrique.

Image Credits: WHO, WHO/Fabeha Monir, WHO.

A man melts lead metallic wastes, often used in the production of cooking pots, at a recycling warehouse in Koumassi, Abidjan, Ivory Coast.

The US government will commit $4 million to tackle lead poisoning, supporting developing countries to curtail lead in consumer goods like paints and toys in which the use of lead is still widespread, USAID administrator Samantha Power announced at the World Economic Forum in Davos.

Power also called for more resources and action towards the issue that kills nearly a million people, mostly children, every year, and affects the brain and neurological development of one in two children in low- and middle-income countries.

“For decades lead has poisoned kids in their classrooms, their bedrooms, their playgrounds, led lurks in the food that kids eat, the water they drink, the medicines they take, and of course the paint, brightening their bedroom walls and the toys that are helping them learn and grow,” she said at a press conference Thursday.

Currently, funding by donors toward lead mitigation efforts is approximately $15 million per year.

“Lead poisoning affects hundreds of millions of children worldwide, contributing to educational gaps and harming health and development. The US government’s commitment to make this a development priority is a welcome turning point,” said Susannah Hares, senior policy fellow and director of education at the think tank Center for Global Development.

USAID is the agency responsible for administering foreign aid and development assistance on behalf of the US government. At Davos, Power advocated for a global drive to support rolling out and enforcing binding regulations to curtail lead in consumer goods ranging from paints to spices, and cosmetics.

Control over consumer goods like paint, spices, and cosmetics contaminated with lead can save millions of lives.

Lead – a potent neurotoxin

Lead is a potent neurotoxin with no safe level of exposure, and lead poisoning can cause severe brain damage, according to the World Health Organization (WHO).

Globally, lead poisoning kills around a million people each year – more than mortality caused by HIV and malaria combined. A majority of these deaths are concentrated in poor countries.

WHO has identified lead as one of 10 chemicals of major public health concern needing action by member states to protect the health of workers, children, and women of reproductive age, as lead can be transferred from a pregnant mother to the fetus.

Lead can affect children’s brain development, resulting in reduced intelligence quotient (IQ), causing behavioural changes such as reduced attention span and increased antisocial behaviour, and reduced educational attainment. This affects a society fundamentally.

Pilots in India and South Africa

USAID administrator Samantha Power speaking at the World Economic Forum in Davos.

The $4 million will be used to lead mitigation efforts in India and South Africa. USAID will support local governments in developing strategies and addressing exposure risks, especially amongst children, who are particularly vulnerable to the effects of lead. The agency will also help with a nationwide survey of blood lead levels in children in Bangladesh, Power said in her remarks.

USAID will also join the Global Alliance to Eliminate Lead Paint, a partnership that has catalyzed legally binding controls on lead paint in almost 40 countries. The partnership is coordinated by the United Nations Environment Programme (UNEP).

USAID has missions in more than 80 countries. Around 51 of these countries are yet to introduce binding regulations on lead in paint, so the agency is well-positioned to advocate for and support lead mitigation efforts.

While lead in petrol has been phased out in all countries, lead in paint continues to be a cause of wide concern.

The challenge of enforcement

Lead poisoning is costing Africa $134 million each year, said Tanzania’s Labour Minister Mudrick Soragha at the Davos event. “And now I’m very happy to note that there’s a general consensus within the global community that we need to get rid of this harmful chemical substance. And for us it is critically important as a country to note that we are not alone in the fight.”

Soragha said that given the weaker health and regulatory systems in many low- and middle-income countries, effective response is a challenge.

“The issue is how to have the proper mechanism of enforcing those regulations, and making sure that our regulatory bodies have the capacity to be able to identify the products that have lead, and how to remove them,” Soragha added.

It is clear that the response will have to be global. “To eliminate lead poisoning, is an ambitious but achievable goal, as evidenced by the huge strides taken by countries like Bangladesh and Georgia. But if this is to happen, it’s crucial for other countries and donors to join the effort and invest in monitoring, proven solutions, and research,” Hares said.

Image Credits: EPA/L. Koula, Global Alliance on Health and Pollution.

Investing in women’s health can boost the world economy, says a new report.

The final hours of the World Economic Forum in Davos on Thursday saw the launch of a new  Global Alliance for Women’s Health which has the broad ambition of, “re-shaping the future of women’s health and the global economy.”

So far 42 organizations have expressed interest in joining the alliance, including government leaders and representatives from the private sector, entertainment industry, and philanthropic space. The alliance partners have already pledged $55 million.

The health alliance is a response to a WEF and McKinsey Health Institute report released this week that says improving women’s access to health services would allow more women to live healthier, higher-quality lives, and provide an unprecedented boost to the global economy.

Currently, health burdens for women are systematically underestimated, with datasets that exclude or undervalue important conditions, the report says. Women are also more likely to face barriers to care, and experience diagnostic delays and/or suboptimal treatment, according to the report.

The benefits of investing in women’s health have been estimated as high as $1 trillion annually by 2040 or an increase of 1.7% per capita GDP, according to the report. It would improve health outcomes for over 3.9 billion people globally, the report says, referring to the number of women in the global population.

The health alliance will pledge new commitments from governments, philanthropies, and pharmaceutical companies, among others, across three pillars: financing, science and innovation, and agenda-setting. So far partners have pledged $55 million to improve women’s health outcomes.

“Our analysis demonstrates that addressing the women’s health gap and investing in women’s health must be a priority for every country,” said Shyam Bishen, head of the Centre for Health and Healthcare at the World Economic Forum (WEF). “Beyond improving women’s quality of life, ensuring women have access to innovations in healthcare is one of the best investments that countries can make for their societies and their economies.”

Investing in Women’s Health Linked to Economic Growth

Despite living longer than men, on average, women spend 25% more of their lives in poor health, the report found. Improved investment in women’s health services including, but also going beyond the standard maternal and child health packages available in most countries could improve that.

The report said improving diagnostics, data on women-specific conditions like ovarian cancer, and directing more investments towards women’s health and research is needed.

“Investing in women’s health shows a positive return on investment: for every $1 invested, ~$3 is projected in economic growth,” the report says.

Surprisingly the report found that the economic return of such investments would be greatest in higher-income settings where the ratio is around $3.5 returned to $1 invested due to their higher economic participation. But even in low-income settings the benefit would exceed the costs and would be an estimated $2 in benefits for every $1 invested – or double.

In low-income settings, every dollar invested in women’s health will result in twice the economic benefits, according to the latest report by the World Economic Forum.

“Investing in women’s health goes far beyond individual women. It is a direct investment in families, communities, societies, and economies,” said Anita Zaidi, President, the Gender Equality Division, at the Bill & Melinda Gates Foundation, in a press release. “Our collective future rests on closing the women’s health gap.”

Key commitments towards women’s health

The new health alliance will be guided by a governing board, comprised of world leaders representing the diversity of stakeholders that must be involved to advance investments in women’s health.

As a part of the alliance, Tower Capital Group, an economic development entity will commit over $25 million in 2024. In addition, Rotary International will launch the Rotary Healthy Communities Challenge, an initiative that will provide $30 million for disease prevention and treatment, focusing on maternal and child health in the Democratic Republic of Congo, Mozambique, Nigeria, and Zambia.

“Quality, affordable, and accessible healthcare, particularly in the context of women’s health, is a critical aspect of ensuring the well-being of women,” said Nisia Trindade Lima, Brazil’s Health Minister who will also serve as the co-chair of the alliance along with Zaidi. “This is a critical moment for a greater mobilization across sectors to invest in women’s health, keeping in mind the imperatives of equity and integral care.”

Image Credits: WEF Glosing the Women’s Health Gap 2024 report.

WHA76
The World Health Assembly in it’s May 2023 session. Now, member states have only four more months to reach the deadline for agreement on a pandemic accord.

As we approach the final months of member-state negotiations over a World Health Organization Pandemic Accord, due to come before the World Health Assembly in May, the efforts to forge a consensus have witnessed modest progress. However, the original divide between developed and developing countries on key issues such as finance, access and benefit sharing, transfer of health technologies, and ‘One Health’  approaches to pandemic prevention, continue to cast a long shadow over the process. Some critics worry that an accord, if and when one is achieved by the 2024 deadline, may be less meaningful in terms of substance and impact, because of the compromises required to reach an agreement.

This issue of the Governing Pandemics Snapshot, the latest in the Geneva Graduate Institute series, recaps highlights of the past six months of negotiations. It takes a closer look at three strategic issues:

  • The conundrum of parallel negotiations over a new ”Pandemic Accord’ alongside negotiations over revisions to existing WHO International Health Regulations governing health emergencies;
  • Proposals for turning the new Pandemic Accord into a WHO Pandemic “regulation” – sidestepping the thorny issue of country ratification;
  • Complex issues around the sharing of pathogen genetic sequence data (GSD), essential for the development of new medicines and vaccines – but also a resource that developing countries assert needs recompense from the pharma industry.

Key negotiation highlights: a recap of the past months

Following our last update in July 2023, several more sessions of the Intergovernmental Negotiating Body (INB), the WHO member state-led body negotiating the text, took place throughout 2023 and until the end of the year.

The sixth meeting of the WHO member state Intergovernmental Negotiating Body (INB), convened on July 17-21, 2023, had special significance as it centered around the draft compilation text of the proposed WHO Convention, Agreement or Other international Instrument (CA+). That draft, published in June, was developed by the six-member state body guiding negotiations, known as the “Bureau”. The “Bureau” text laid out multiple options for language on key, disputed issues related to issues such as access to medicines and vaccines, pathogen sharing, and One Health.

The July INB meeting was preceded by a series of informal inter-sessional meetings. These sessions, guided by volunteer co-facilitators, aimed to foster understanding and dialogue on key articles of the Bureau’s text. The sessions focused on a specific set of topics including Research & Development (R&D), Access and Benefit-Sharing, and Global Supply Chain and Logistics.

The practice of supplementing the formal INB sessions with informal meetings continued after INB 6, becoming a regular feature of the negotiation process. Following this approach, the INB Drafting Group, also open to all INB members, convened again from September 4-6, engaging in discussions on the three aforementioned topics. Additionally, they addressed articles related to  “One Health” approaches to preventing pandemics (e.g. through better management of pandemic risks related to AMR, livestock, wild animal trade and deforestation), as well as the co-development and transfer of technology and know-how.

Intersessional work persisted throughout September; this culminated in a one-day meeting of the INB Drafting Group on September 22. The group mandated the Bureau to prepare a new text of the pandemic accord in mid-October, intending to set the stage for the commencement of textual negotiations during INB 7 in early November and December 2023.

WHO Director-General Tedros Adhanom Ghebreyesus at Davos: to prepare for the next pandemic, countries have to focus on strengthening primary healthcare.

UN adopts political declaration on pandemics

In late September 2023, the spotlight shifted from Geneva to New York City, where a High-Level Meeting on Pandemic Preparedness and Response unfolded on the sidelines of the 78th United Nations General Assembly. The purpose was to convene Heads of State to highlight the issue and secure commitments from UN Member States to strengthen pandemic prevention, preparedness, and response (PPPR) at the global level. The result was a non-binding UNGA political declaration. Despite its symbolic political significance, the declaration was criticized for being rhetorical and lacking tangible commitments by member states to take concrete steps on policies and investments that could improve prevention, preparedness, and response.

Pandemic Accord “negotiating text” and a fresh round of criticism  

In October, the spotlight shifted back to Geneva where the Bureau unveiled the proposal for the Negotiating Text of the WHO Pandemic Agreement. Unlike the June version, this negotiating text selected just one option for language and approach to each of the contested articles, incorporating what the Bureau viewed as language with the greatest potential for agreement.

However, the text faced significant criticisms. To name a few, developing countries expressed concerns over the heavy burden imposed by proposed pandemic prevention and surveillance measures.

Those objections including even the very general reference in Paragraph 8 of the preamble to the support for the “One Health” approach to “multi-sectoral collaboration at national, regional and international levels to: safeguard human health; detect and prevent health threats at the animal and human interface, zoonotic spill-over and mutations; and sustainably balance and optimize the health of people, animals and ecosystems […]”.

Developing countries also objected to what they regarded as relatively weak provisions on equitable access to medicines, vaccines and other countermeasures.

Conversely, several developed countries voiced firm opposition to a reference to countries to: “commit to agree upon, within the framework of relevant institutions, time-bound waivers of intellectual property rights to accelerate or scale up the manufacturing of pandemic-related products to the extent necessary to increase the availability and adequacy of affordable pandemic-related products [Article 11.3 (a)].

Civil society stakeholders have, meanwhile, lamented the perceived lack of ambition in provisions ensuring more equitable access to pandemic-related products, including the lack of reference to “access” provisions in relation to public R&D funding for medicines and vaccine development.

Others noted the absence of clear financing commitments for pandemic preparedness and response, and the intention to postpone many contentious issues post-adoption, risking a dilution of the accord’s substance and impact.

The INB 7 unfolded over the period of November 6-10, resuming on December 4-6. This time, civil society stakeholders were invited to be physically present at the WHO premises, although not in the room where the proceedings were held.

This phase primarily involved an initial reading of the negotiating text, during which Member States suggested edits or deletions and thus contributed to yet another revision of the draft text.

So, rather than allowing for the beginning of formal negotiations, the INB 7 process resulted in a lengthy and intricate “rolling text,” with each and every option incorporated once again – as had been the case in June. It appeared as if parties held firm in their stances, showing no inclination to yield ground on their original positions and increasing mistrust among negotiators.

This raises the question: are we moving backward instead of forging ahead?

Plenary panel of UN GA High-Level Meeting on Pandemic Prevention, Preparedness and Response in September 2023.

Tackling additional challenges as we near the finish line

With the May 2024 deadline looming forward, at least three additional challenges stand out.

Firstly, process. The current approach to negotiations is perceived as lacking effectiveness. The iterative textual method used so far involves the repeated issuance of new document versions by the Bureau, with member states subsequently incorporating edits without substantial engagement in real negotiations. The October text, which was originally  30 pages, had thus ballooned to around 100 pages by the end of the INB 7 sessions in December. This prompts legitimate questions about the ability of this process to bring parties closer to the finish line.

Secondly, time. The intricate and contentious nature of the issues at hand, combined with extensive small group work outside the official timetable, adds to the complexity. This year, there are only 19 official negotiation days scheduled for full INB group meetings on the calendar. So achieving any result poses a formidable challenge even to the most seasoned and well-intentioned diplomats.

Thirdly, momentum. Amidst a myriad of pressing global issues competing for political attention, focus, and financial resources, and with leading actors like the United States worldwide gearing up for nationwide elections in 2024, there is a shadow of uncertainty around the commitment of member states to embrace new global health rules and to prioritize pandemic prevention. Obtaining such commitments will likely be even more difficult if the current May 2024 deadline for the conclusion of negotiations and WHA review is pushed back – diminishing the sense of urgency and focus.

The next months will reveal if these challenges are surmountable.

Link to the other topics in this month’s issue of Governing Pandemics Snapshot here:

Session moderator Nancy Brown, CEO of the American Heart Association; Michel Demaré, board chair of AstraZeneca; Brazilian Health Minister Nisia Trindade Lima, Roy Jakobs, CEO of Royal Philips; Preetha Reddy, vice-chairperson of Apollo Hospitals and Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO).

Improving disease surveillance, strengthening primary healthcare, and being able to expand quickly during a crisis are some of the important lessons from the COVID-19 pandemic that can be applied to ‘Disease X’, according to health experts speaking on a panel at the World Economic Forum on Wednesday.

“Disease X is a placeholder for unknown diseases,” said World Health Organization (WHO) director-general Dr Tedros Adhanom Ghebreyesus. “You may even call COVID the first disease X, and it may happen again.”

“We lost many people [during COVID] because we couldn’t manage them. They could have been saved, but there was no space. There was not enough oxygen. So how can you have a system that can expand when the need comes?” Tedros added.

Need to strengthen primary healthcare

Many countries spend large amounts on their healthcare but this does not always translate into superior outcomes. In the United States, the richest country in the world where healthcare spending is in trillions of dollars, maternal deaths are on the rise.

“It’s not just about spending more, it’s also spending smarter. A shocking statistic, for instance in OECD countries, is that the average spend on prevention is 3% of the budget of health systems. And obviously, if you spend so little on prevention, you end up spending the majority of your budget on hospitalization or only treatments,” said Michel Demaré, board chair of the pharmaceutical company, AstraZeneca.

Tedros elaborated that the reason for poor outcomes was also that expenditure was focussed on tertiary healthcare which meant that some countries struggled with basics like contact tracing during the pandemic, as they ignored primary healthcare.

“To prepare countries, I think renewed commitment to strengthen primary healthcare is very important,” he said.

WHO Director-General Tedros Adhanom Ghebreyesus said to prepare for the next pandemic, countries will have to focus on strengthening their primary healthcare.

Collaboration Between stakeholders

A big takeaway from the pandemic was the benefit of collaboration, said Demaré, whose company distributed more than three billion doses of vaccine at no profit, mainly to low- and middle-income countries.

“Just as a reminder, we were not a vaccine company at the time. We just decided that this was a call for action and that we had to try to use our know-how and our networks to try to help. So we signed a license agreement with the University of Oxford. We then put together a network of more than 20 contract manufacturing organizations to which we transferred technology and skills to basically help build the vaccine,” Demaré said.

He added that quick action and quick decision-making were extremely important but the partnerships were the most important aspect. “We have partnered with academia, obviously with governments, with regulators, third-party commercial contractors, and with NGOs,” he said.

Michel Demaré, board chair of AstraZeneca, who said the large number of partnerships during COVID was a spontaneous and valuable response to the situation.

Risks to healthcare workers 

The healthcare sector is facing a huge shortage of staff which the medical journal The Lancet described as “dangerous” in May 2023, adding that the “situation is worsening.”

An estimated 115,000 healthcare workers died during COVID which has also brought into sharp focus the dangers facing those delivering care.

“Very quickly we saw that actually, it became more and more challenging for the healthcare systems to actually keep the staff up and running, to keep them motivated, but also actually to protect them from the disease and keep doing their job,” said Roy Jakobs, CEO of Royal Philips.

Jakobs said that while technology to help staff is available, making sure it gets to them and is scaled up rapidly, is a challenge.

“The lack of skilled manpower is a global shortage. We just do not have enough doctors and nurses to heal the world,” said Preetha Reddy, vice-chairperson of the private Indian healthcare provider, Apollo Hospitals.

But her group found digital tools helpful during the pandemic. “Within a span of two weeks we were able to train about all 150,000 workers on ventilator management,” she said.

Preetha Reddy, vice-chairperson of Apollo Hospitals.

Push for the pandemic agreement

Tedros made a push for the pandemic agreement currently being negotiated by member states with the May World Health Assembly as their deadline.

Much of the text of the agreement on technology transfer, pricing and transparency has already been watered down as Health Policy Watch reported earlier.

“The pandemic agreement can bring all the experience, all the challenges that we have faced, and all the solutions, into one, and that agreement can help us to prepare for the future in a better way because this is about a common enemy,” he said.

Brazilian Health Minister Nisia Trindade Lima reminded everyone that countries need social systems to support individuals during times of crisis.

“Health alone cannot resolve all of the matters. So, we have to include in this agenda, the social protection systems which are vital in times of crisis, like the ones that we lived through recently,” she said.

Ajay Banga, World Bank CEO

“What we have is an existential climate crisis,” World Bank CEO Ajay Banga told the World Economic Forum’s annual meeting (WEF) in Davos on Wednesday.

“We cannot think of eradicating poverty without caring about climate. We cannot think of eradicating poverty without thinking about health. We cannot think of eradicating poverty without caring about food insecurity and fragility.”

Banga’s remarks aptly summed up the mood of the past two days at the WEF, as the climate crisis casting a shadow over almost every session.

United Nations (UN) Secretary General Antonio Guterres spoke of a “global crisis in trust” caused by the “paradox” of “runaway climate chaos and the runaway development of artificial intelligence without guardrails”.

“As climate breakdown begins, countries remain hell-bent on raising emissions. Our planet is still heading for a scorching 3°C increase in global temperatures. Droughts, storms, fires and floods are pummelling countries and communities,” warned the UN head.

“The media has recently reported that the US fossil fuel industry has launched yet another multibillion dollar campaign to kneecap progress and keep the oil and gas flowing indefinitely. Let me be very clear again. The phase out of fossil fuels is essential and inevitable.”

UN Secretary General Antonio Guterres

Dr Tedros Adhanom Ghebreyesus, director-general of the World Health Organization (WHO), told a meeting with private sector leaders that “the health impacts of the climate crisis are not theoretical risks in the future. They are right here and right now”.

He called on the private sector to assist with enabling access to financial resources, and using their innovation to address the crisis.

Money to address the effects climate of climate change could be redirected from the fossil fuel sector.

Direct fossil fuel subsidies add up to $1.3 trillion, according to Kristalinea Georgieva, managing director of IMF News.“Put it into climate action,” she urged. “Let us take money from where it hurts to where it helps.”

The threat and promise of AI

Meanwhile, Guterres warned that AI was a double-edged sword that could both address and deepen inequity, and that the UN had already made preliminary recommendations on AI governance to” tap the benefits of this incredible new technology while mitigating its risks”.

“We need governments urgently to work with tech companies on risk management frameworks for current AI development and on monitoring and mitigating future harms,” he warned.

However, Gianrico Farrugia, CEO of Mayo Clinic, said that it was not possible to wait until every AI-related concern had been addressed: “Why? Because the need is so big and therefore in healthcare, we have to embrace AI, while at the same time we work together on regulations.”

Farrugia added that, “unless you embrace the fact that AI is truly an opportunity to transform healthcare, we’ll be missing out a lot”.

Gianrico Farrugia, CEO of Mayo Clinic

For example, AI analysis of a “simple and cheap electrocardiogram” has enabled healthcare providers to predict heart failure five years ahead of symptoms, and ahead of conventional testing. 

“Other algorithms based on the same data are now being able to predict silent atrial fibrillation – heart arrhythmias, valvular heart disease.. But then most interestingly, liver doctors found they could diagnose liver disease from the same electrocardiogram. Blood doctors found they could diagnose blood disorders.”

Mayo Clinic now runs “about 200 algorithms every day”, and AI has transformed ”our ability to create better outcomes; our ability to increase productivity, and our ability to scale in ways we couldn’t do before”, he stressed.

Christophe Webe, CEO of Takeda Pharmaceuticals, said AI would enable his company to achieve an “overall 30% efficiency gain in a few years”, and “discover new molecules that don’t exist today”. 

Stella Kyriakides, the European Commissioner for Health and Food Safety, said that it was possible to both harness “the potential that AI officers and have the guardrails in place” –  and the EU is the first place in the world to introduce an AI Regulation Act.

The European Union (EU) was using AI foremost to build a “European health data space” that would enable a patient’s records to be accessible at any healthcare facility in the EU, and also to track disease trends.

Paula Ingabire, Rwandan Minister of Information, Communication, Technology and Innovation, said that her country has been using drones to improve healthcare in hard-to-reach areas by, for example, collecting patient samples for testing.

Paula Ingabire, Rwandan Minister of Information, Communication, Technology and Innovation,

Meanwhile, Dr Jean Kaseya, head of Africa Centre for Disease Control, said that Africa was also planning to digitize data collection as part of its efforts to build pandemic preparedness, alongside improved early warning systems, better skilled health workers and multisectoral collaboration.

“We driven by the conviction that a healthier Africa is a healthier world for us all,” Kaseya told the WEF.

The ‘disastrously branded’ threat of antimicrobial resistance

Another lethal and growing threat is that posed by antimicrobial resistance (AMR) – and issue that has been hampered by “disastrous branding due to ambiguity”, according to the Global Fund’s Peter Sands.

“The terminology needs to be sharpened to get the public involved. The global community is bad at dealing with creeping problems. By the time it becomes a blazing fire, it’s going to be really dangerous,” urged Sands.

AMR is already the third leading cause of death globally, disproportionately affecting women and children.

European Health Commissioner Kyriakides said that one in three European citizens were prescribed an antibiotic every day – with overuse being a key driver of resistance. In addition, some 40% of Europeans thought that antibiotics were effective against viruses, which they are not.

“The European Union (EU) has adopted guidelines to prevent the abuse and  misuse of antimicrobials, with targets and measurable goals,” said Kyriakides.

Cheryl Moore, (Wellcome Trust); Vanessa Kerry, (CEO of Seed Global Health), Bayer AG CEO Bill Anderson; Nisia Trindade Lima, Brazil’s health minister, and Victor Dzau, president of the National Academy of Medicine.

Progress made towards Sustainable Development Goals (SDGs) is being reversed by climate change and, despite the promises made at the recent COP28, there are gaps in funding to address the crisis, Vanessa Kerry, the World Health Organization’s (WHO) Special Envoy for Climate Change and Health told a panel at the World Economic Forum in Davos.

The global temperature increase is already 1.4°C above pre-industrial era and the world is currently on path to a 2.4°C increase, added Kerry, who is also CEO of Seed Global Health.

“A lot of funding was put on the table for climate and health. $1 billion was pledged,” said Kerry. “But of that $800 million was pre-committed, pre-earmarked, so this isn’t new money. And this isn’t available money. We are sitting here in Davos, this is some of the biggest wealth in the world. So when we talk about what we have to do in this moment, we have to think about how we can step into that gap more now.”

Kerry was speaking at the event called, “When climate change impacts your health”. 

The year 2023 shattered global temperature records and at 1.4°C above the pre-industrial era, the planet is just shy of the 1.5°C target set by the Paris Agreement in 2015.

In countries like Zambia, cholera outbreaks linked to a rise in rainfall are leading to school closures, and malaria is spreading in countries where it had been previously eradicated. All of this, she said, were progresses made after significant investments and that are now at risk of reversal. Experts across fields said there is recognition that climate change is having an enormous impact on health, but the response has been limited and slow. 

Climate resilient health systems 

Nisia Trindade Lima, Brazil’s health minister

Brazilian Health Minister Nisia Trindade Lima spoke of the wide range of climate-related impacts on health in her country from rising food insecurity as droughts become more frequent, to epidemics of infectious diseases like dengue as rising temperatures lengthen the transmission season of the virus. 

“In order to build resilient health systems, we need to conceive systems that focus on equality and that are going to be developed and implemented hand-in-hand with other sectors of the government, civil society, and the private sector so that we can have plans that reduce carbon emissions, that implement sustainable measures in the health system itself,” said Lima. 

Brazil will unveil proposals to build resilient health systems at the G20 meeting in Rio in November, said Lima. Brazil took over the G20 Presidency from India this year and also hosts the 2025 climate talks, COP30.  

Promoting climate-resilient agriculture

Bill Anderson, CEO of Bayer AG, one of the world’s largest pharmaceutical and biotechnology companies, said that with crops failing regularly now due to climate extremes, many countries are struggling with food insecurity. 

Bill Anderson, CEO of Bayer AG

Anderson said his company has worked on short-stature corn that will only grow to be six feet instead of 10 feet so the stalks would not bend and collapse as easily during extreme weather events, as well as making pesticide applications easier.

Bayer is also working on reducing methane production from rice, a staple crop in many countries. Although methane stays in the atmosphere only for a few decades it is a greenhouse gas that is 28 times as potent as carbon dioxide. 

“We have an opportunity to replace that (rice) with so-called direct-seeded rice that requires about 40% less water, and [causes] 90% less methane production. So these are examples that are good for farmers, they’re good for eaters, and they’re good for the environment,” Anderson said.

Need to bring down health-sector emissions

Victor Dzau, President of the US National Academy of Medicine said that in recent years the health sector has woken up to the impact of climate. It has also reckoned with its own contribution to global carbon emissions which is estimated to be around 5% of the global carbon emissions, equivalent to the carbon footprints of some countries.

At the same time Dzau said that to reduce the health impacts of climate change, one has to go beyond the health sector.

“At the end of the day, if you look at where the carbon emissions coming are from, three-quarters are from energy use, and 20% from agriculture, land-use. So those have direct impacts on climate, which have impact on health,” he said.

Image Credits: The Future of Food .

Filmmaker Leopoldine Huyghues Despointes, a global advocate on disability rights, and ATscale CEO Pascal Bijleveld address the launch in Davos.

“It’s not just about people with disabilities, this is about all of us,” stresses Pascal Bijleveld, the CEO of ATscale Global Partnership, an organization established in 2018 to advocate for assistive technologies (AT) access, especially in low- and middle-income countries.

The first-ever global campaign to expand access, ‘Unlock the Everyday’, was launched on Tuesday at the World Economic Forum (WEF) in Davos, led by ATscale together with UNICEF, the World Health Organization (WHO), the International Disability Alliance and other partners.

The term assistive technology (AT) describes a broad range of products and their related systems and services – from the most basic, like eyeglasses to access ramps for people with motor impairments and smartphone text- to- speech functions, explained Bijleveld.

An estimated 2.5 billion people worldwide need at least one form of assistive technology, with the most common devices being eye glasses, hearing aids, prostheses and wheelchairs. By 2050, the number is likely to increase to 3.5 billion, says WHO.

But access to AT is more than uneven: in low- and middle-income countries (LMICs) only 10% of those in need can obtain appropriate devices in contrast to 90% in high-income countries.

‘My wheelchair is my independence’

“Assistive technology is a bridge that connects individuals with disabilities, ageing populations, and those suffering from non-communicable diseases to a world of opportunities – opportunities for education, employment, and above all, inclusion in society,” said the First Lady of Pakistan, Begum Samina Arif Alvi, who is encouraging global leaders to support the campaign.

During the launch, speakers representing ATscale  and other campaign partners discussed the importance of AT and the role different stakeholders can play in bringing about change.:

“My wheelchair is my legs. My wheelchair is my independence. [Without it] I wouldn’t have studied, or be able to go around and spread the word and travel,”  said Leopoldine Huyghues Despointes, a filmmaker and global advocate for disability rights

The campaign is largely directed at governments, and calls for greater investment in AT and related services through appropriate, inclusive policies.

“Without government support, we’ll never reach sufficient AT access – the market forces alone are not enough,” highlighted Bijleveld, in an interview with Health Policy Watch ahead of the event.

Nonetheless, the campaign is also appealing to other stakeholders who have their part to play: including private sector and bilateral development partners, which often neglect AT needs in programmes and initiatives to foster more inclusive health services.

Nine-to-one investment return

Ensuring lifetime access to the AT they need for people in LMIC would cost approximately $70 billion over 55 years, the campaign estimates.

But there is a nine-to-one return on investment from providing AT through improved educational outcomes, better paid employment and lower longer-term healthcare costs, a recent ATscale study shows. Yet those benefits are often overlooked by policy makers.

Bijleveld, admits that health financing choices are often difficult, especially on a tight budget: “For some countries it might be a matter of, say, picking between AT and malaria vaccine subsidies. In such cases there is a tendency to favor the option that is more visibly live-saving.”

Eyeglasses or smartphones? Hard to choose

Asked to identify the most important AT, Bijleveld says it is difficult to rank.

Some might go for eyeglasses, he observed, because of the huge number of people – estimated to be about two billion – who need corrective glasses.

But a smartphone is an equally useful AT because of its versatility, he pointed out. It can provide a text-to-speech function or speech recognition, magnify text, and provide other, less standard visual aids. It also helps those who have trouble hearing: from captioning to sign language translating applications. It can help people to navigate through a city and also to communicate without having to go to a physical destination.

By raising the profile of the issue and promoting collaboration between organizations and sectors, Unlock the Everyday hopes to reach more inclusion through AT.

“We truly believe that by uniting partners, policymakers, global decision-makers, the private sector, communities and of course, assistive technology users themselves, we can create a global movement that will motivate those in a position of power to take decisive action,” he concluded.

As  the proportion of older people grows worldwide,  AT will become all the more necessary on a global level. But AT accessibility for older people can also help achieve more inclusion for people living with disabilities

“Captioning is a good example,” Bijleveld observed. “If you’ll get it right for somebody needing AT, you’ll get it right for everyone.”

Image Credits: Devex.

A dense toxic smog in New Delhi blocks out the sun. (8 November 8, 2017).

The Clean Air Fund (CAF) urged philanthropic funders to significantly increase their support for programs and services to enhance air quality with a new report published in time for the World Economic Forum Annual Meeting 2024 in Davos.

“It is vital to ramp up the scale and impact of air-quality funding from this sector,” the fund wrote in the report.

The report showed that philanthropic foundation funding for air quality surged to $330 million from 2015 to 2022, with annual financing experiencing a more than fourfold increase during that period. Nonetheless, the data indicates only a marginal uptick in 2022, with estimated funding for air quality from foundations at $71.3 million—a slight rise from the previous year—hinting at a deceleration in year-on-year growth.

From 2019 to 2021, annual increases averaged $14.7 million, whereas during the subsequent period from 2021 to 2022, the increase dwindled to just $3.8 million.

Moreover, outdoor air-quality funding accounts for less than 0.1% of all foundation funding.

“Funding for air quality from foundations has increased but remains a minuscule proportion of total philanthropic funding,” said CAF CEO Jane Burston. “Air pollution is one of the most pressing challenges of our time, with 99% of the world still breathing toxic air.

“I urge funders to recognize that air quality isn’t a niche issue and work together to tackle the problem,” she continued. “By doing so, we can act on climate change, improve our health, strengthen economic outputs, and address social inequality all at the same time.”

Air Pollution’s Deadly Toll

Pedestrians in Bangladesh cover their faces to keep from breathing in dust and smog. Air pollution takes 22 months off the average life expectancy in Bangladesh, according to recent reports. (Photo: Rashed Shumon)

Air pollution causes 8.3 million deaths a year, including 5.1 million from fossil fuel pollution, according to an article published last year in the BMJ. In addition, air pollution can have long- and short-term health effects. The report cited a connection between air pollution and cancer, heart attacks, diabetes and strokes, as well as exacerbated asthma and even miscarriage.

The situation is more acute in low- and middle-income countries, which bear the burden of nine out of 10 deaths attributable to outdoor air pollution.

Philanthropic Gaps in Air Quality Funding

CAF’s report focuses exclusively on funding for air quality from philanthropic foundations. The data was gathered through direct engagement with foundations actively providing grants related to air pollution and from online and public sources. These foundations encompass various forms, including individual, family, and business entities or those funded through public donations.

CAF is a global philanthropic organisation that funds programs that promote air quality data, build public demand for clean air and drive policy change.

In its report, CAF also noted that foundation funding is meager in countries that need it most. For example, Africa, home to 50% of countries with the highest air pollution based on population-weighted PM2.5 exposure, received only around 1% of total outdoor air quality funding.

It also showed that more than a quarter (26%) of funding was aimed at communications and raising awareness projects; only around 10% went toward implementation (12.3%) and data (11.5%) projects.

Strategic Shifts for Air Quality Action: CAF Recommendations

Severe air pollution in Anyang, China in January 2022. Africa and the Middle East are among the world’s pollution hot spots according to the largest-ever collection of WHO data.

CAF called on foundations to shift their priorities and examine opportunities for partnerships to increase scale and address air pollution alongside other causes. It also stressed investing in air-quality data, which, it said, is necessary to build policy and strategy.

“A major barrier to progress on air pollution in many contexts is the lack of solid local data and analysis of air-pollution levels, including the sources of emissions and the localized health impacts of dirty air,” the report said.

Finally, it noted that “health funders should support efforts to understand the health costs of air pollution and health benefits of action and to better understand health-equity impacts on marginalized groups.

“They can also play a role in synthesizing evidence on the interplay between air pollution, climate and health security, including vulnerability to epidemics, the resilience of health systems, and negative feedback loops between climate change and air quality – such as wildfires, desertification and heatwaves – which exacerbate health risks,” the report concluded.

Image Credits: Rashed Shumon, Wikipedia, V.T. Polywoda.