Two-thirds of countries no longer criminalise consensual same-sex sex, a “remarkable reversal” since the start of the AIDS pandemic that has enabled global progress against the spread of HIV.

This is a key finding of Progress and the Peril, a report on HIV and decriminalisation released this week by Georgetown University’s Global HIV Policy Lab.

While 129 out of the world’s 194 countries, a further 24 countries don’t enforce their criminalising laws, said Professor Matthew Kavanagh, Director of the Center for Global Health Policy & Politics at the university’s O’Neill Institute.

“The reason why we’re talking about the decriminalisation of LGBTQ people around the world is because it has a clear link to HIV outcomes,” Kavanagh said at the launch of the report.

The trend towards decriminalisation has accelerated since 2017, with 13 countries representing 7% of the world, removing criminalising laws. The most progress was made in  2022 when Singapore, Barbados, St. Kitts and Nevis, and Antigua and Barbudan decriminalised consensual same-sex acts. In 2023, the Cook Islands and Mauritius joined them, with Venezuela removing its criminalising military law. 

“Knowledge of HIV status and viral suppression among the whole population is significantly higher where decriminalisation has happened,” added Kavanagh.

Professor Matthew Kavanagh, Director of the Center for Global Health Policy & Politics at the university’s O’Neill Institute.

Not a ‘Western agenda’

“This report shows how the world is increasingly rejecting the criminalisation of LGBTQ people,” said Winnie Byanyima, UNAIDS Executive Director. “Instead of sending a message of condemnation and fear, these governments are encouraging their people to come into the health system and get what they need for their well-being.”

Byanyima noted that progress had accelerated since the United Nations decision two and a half years ago to close the inequalities driving AIDS.

“That included creating enabling legal environments with a goal that, by 2025, less than 10% of countries in the world would have punitive laws standing in the way of ending the AIDS pandemic,” she added.

“There are some who say that this is a Western agenda. But no, look at this report – India, Botswana, Angola, Gabon, Barbados, Venezuela, and just a few weeks ago Mauritius. That is a South. The South is moving,” stressed Byanyima, who is Ugandan.

The Caribbean is the region that’s decriminalising at the fastest rate, she added.

UNAIDS Executive Director Winne Byanyima

Perils in some countries

But the report also warns of the perils, with recent prosecutions of LGBTQ people reported in 41 countries and “recent or pending legislation in several of these countries that make penalties more extreme”.

In May, Uganda passed an Anti-Homosexuality Act (AHA), which is one of the harshest anti-LGBTQ laws ever passed globally. Ghana passed a similar law in July.

“There is a concerted campaign [and] US organisations that are pushing the deepening of criminalisation,” warned Kavanagh, who described this as a well-financed, well-coordinated “neocolonial push”.

Florence Riako Anam, co-executive director of the Global Network of People Living with HIV (GNP+),  expressed deep concern that some countries are “continuing to deepen criminalisation and persecution against the LGBTQ communities”. 

“I’m speaking as a Kenyan and I can share how deeply worried I am about the coordinated efforts that are happening in East Africa to replicate the laws and condone violence and discrimination that we are seeing in Uganda,” said Anam. Kenya’s parliament is considering a Bill that is similar to Uganda’s AHA.

Florence Riako Anam, co-executive director of the Global Network of People Living with HIV (GNP+),

‘Step up and catch up’

Mandeep Dhaliwal, the United National Development Programme (UNDP) director for HIV and Health, said that homophobia and punitive laws cost the world more than $126 billion per year – largely calculated in lost productivity and increased health costs.

“People living with HIV in criminalising countries have 11% lower knowledge of their HIV status and 8% lower viral suppression rates,” said Dhaliwal.

Meanwhile, Byanyima called for the leaders of the one-third of countries that still criminalise to “step up and catch up”.  

“Those who are pushing in the opposite direction, sadly such as my own country, Uganda, towards direct criminalisation, are on the wrong side of public health, on the wrong side of economic growth, and on the wrong side of history,” she stressed.

“Politicians usually make this argument that [being LGBTQ] is unAfrican, really, with the purpose of disenfranchising LGBTQ people from society. Once they put them in the category of not citizens of Africa, then they are denied all their rights. I totally don’t respect it. I am a proud African and I support and promote and respect and cherish LGBTQ people.”

Mandeep Dhaliwal, the United National Development Programme (UNDP) director for HIV and Health,

Anam said that programmes and interventions for people living with HIV would not work “if some of us are not able to come into the room and share what their needs are,” she added, noting that this was a human rights issue that should not be confined to HIV.

“The struggle for our rights and dignity and quality of life has reached fervent urgency now more than ever,” said Anam. “Repressive laws institutionalising the criminalisation, prejudice, and violence against our communities – particularly those based on sexual orientation and gender identities – do not serve us. 

“They cause harm. They lead to the death of friends or getting harmed. All of us people living with HIV must access treatment, get undetectable and achieve quality of life.”

Vivek Divan, Head and Coordinator, Centre for Health Equity, Law & Policy

Vivek Divan, head of the Centre for Health Equity, Law & Policy, said that the effort to decriminalise in India had taken two decades.

“The litigation that led to the decriminalisation of queer people in India was filed in 2001 to an HIV NGO. It had many ups and downs being dismissed on the grounds of local standby in 2004, reinstated in 2005 by the Supreme Court and finally heard in 2008 with a positive decision being adjudicated in 2009 – all by the Delhi High Court,” said Divan.

Dhaliwal noted that progress against criminalisation “is not an accident”. 

“It is the result of the courageous leadership of LGBTQI communities, people living with HIV and other key populations working together with enlightened institutions and allies towards decriminalisation and anti-discrimination. We need much more of this kind of solidarity in a world that is suffering from a solidarity deficit,” said Dhaliwal

Image Credits: Stavrialena Gontzou/ Unsplash.

The 2022 edition of the Lancet Countdown report warned that “global health lies at the mercy of fossil fuels”. The 2023 report, published on Wednesday, finds “few, if any” signs that the world has taken heed of the impending health crisis.

A new report from the Lancet Countdown, an annual assessment of progress toward the climate targets of the 2015 Paris Agreement, paints a grim picture of the escalating health risks associated with a warming planet.

The report, compiled by an international consortium of 114 scientists, health experts, and researchers, warns that the world is on track for a “dangerous future” where climate-linked health crises from extreme weather events, including deadly heatwaves, drought-driven food insecurity, and the spread of infectious diseases, will become the daily reality for millions.

The report’s grim findings underscore the urgent need for immediate and decisive action to curb greenhouse gas emissions and avert the worst consequences of climate change on human health. If the world warms by 2°C above pre-industrial levels, human health faces an “intolerable future with rapidly growing hazards,” the report warns.

Extreme heat is already driving death and food insecurity around the world, with heat-related deaths of people over 65 increasing by 85% since 1990, the report found. The average person now experiences 86 days of “health-threatening high temperatures every year”, 60% of which are attributable to climate change. 

“Global mean temperatures are rising and we’re increasingly exposed to extreme heat,” said Dr Marina Romanello, executive director of the Lancet Countdown and lead author of the report. “Extreme heat is particularly dangerous for elderly populations, populations living with underlying health conditions such as heart disease, lung disease and kidney disease, and pregnant women, their unborn children, [as well as] very young children and those with neurological conditions.”

The higher frequency and intensity of heatwaves are also exacerbating food insecurity, with an estimated 127 million more people experiencing moderate or severe food insecurity compared to the 1981 to 2010 period, placing “millions of people at risk of malnutrition and potentially irreversible health effects”, according to the report.

A devastating drought in Somalia, part of a wider crisis across the Horn of Africa, has claimed the lives of 43,000 people, with half of those deaths being children under five, according to a March report by Somalia’s Ministry of Health. The drought has also pushed nearly half of the country’s children under five – 1.4 million children – into acute malnutrition, according to UNICEF.

The report further highlights the contributions of climate change to the proliferation of infectious vector-borne diseases such as Dengue and West Nile Virus, as climate change makes people more vulnerable to the diseases and the world more hospitable to the mosquitoes that carry them. Warmer temperatures are extending the geographical range where disease-borne mosquitoes can survive and thrive, as well as extending their mating season, allowing them to reproduce in greater numbers.

“The climate crisis is escalating the severity of extreme weather events, increasing food insecurity, exacerbating respiratory diseases, and fueling the spread of infectious diseases,” declared Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO). “The world is moving in the wrong direction, unable to curb its addiction to fossil fuels and leaving vulnerable communities behind in the much-needed energy transition.” 

The World Health Organization (WHO) has long advocated for a more prominent role for health considerations in international climate negotiations, emphasizing the substantial health benefits of decisive climate action. In the wake of the Paris Agreement’s ratification in 2015, the UN health agency hailed the treaty as ‘potentially the strongest public health agreement of the century.’

However, the 1.5°C temperature goal enshrined in the agreement is swiftly fading from reach. The health consequences of the already elevated global temperature, averaging 1.14°C above pre-industrial levels, are already impacting millions of lives worldwide.

“Our data shows us that a thriving future still lies within our reach,” said Romanello. “The most concerning thing is that we’re accelerating in the wrong direction.”

Developing countries excluded from green transition as finance falters

As developing nations bear the brunt of climate change’s devastating impacts, financial support from wealthy countries for climate adaptation remains woefully inadequate, leaving them ill-equipped to cope with intensifying extreme weather events and rising health risks. The report highlights the persistent lack of “access to funding and technical capacity” in low- and middle-income countries, further exacerbating deep-seated health inequities within and between nations.

The Lancet’s findings echo the conclusions of the UN Environment Programme’s Adaptation Gap report, released last week, which found that adaptation finance flows to developing countries fell to just $21 billion in 2022, compared to the $367 billion required every year through 2030.

“The most vulnerable and minoritised communities are left the least protected, and the deep within-country and between-country health inequities are further exacerbated,” the report states. “This scarcity is aggravated by the rising economic losses from climate change impacts, and the persistent failure of wealthier countries reach the promised sum of $100 billion annually to support countries most affected by climate change.”

The consequences of this financial shortfall are stark: developing countries are being largely excluded from the accelerating shift to green energy technologies, despite their urgent need for these solutions. While clean renewable energy sources are gaining ground globally, their share in the world’s electricity generation still stands at a mere 9.5%. In low Human Development Index (HDI) countries, this figure plummets to just 2-3%, with 92% of domestic energy still derived from polluting fossil fuels.

“By and large, it is the very high human development index countries that are leading the way in the adoption of these green technologies in this new economic [era],” said Romanello. “Once again, we’re seeing that it is the most vulnerable countries that are being left behind in the zero-carbon transition and remain reliant on dirty fuels and exposed to health homes and energy poverty.”

Fossil fuel expansion threatens perilous future for human health

Change in fossil fuel lending in the years after the Paris Agreement, compared to the years preceding it. More than half of the 40 banks that lend most to the fossil fuel sector have increased lending since the Paris Agreement was signed.

The report’s predictive section, a new addition this year which projects the future impact of a warming climate on human health worldwide, underscores the alarming trajectory of global emissions which is “putting our collective future at risk”.

“Last year, the 2022 report said that our health was at the mercy of fossil fuels. Well, this report shows us is that it is even worse today,” said Romanello. “Looking at the 20 largest oil and gas companies around the world, we see that their plans today would lead to their share of emissions exceeding the targets of the Paris Agreement by 173% in 2040 – this is 61 percentage points more and last year when they were on track to exceed [1.5C levels] by 112%.”

This unabated fossil fuel expansion has placed the world on a perilous path towards a catastrophic 2.7 degrees Celsius of warming by the end of the century. The Lancet findings echo those of the UN Environment Programme, which said in its Production Gap report last week that government plans to expand fossil fuel production despite the climate crisis were “throwing humanity’s future into question”. 

The health implications of this scenario are profound and far-reaching. Even a 2-degree Celsius warming scenario would bring unbearable health consequences, with heat-related deaths projected to surge by 370%, heat-related labour loss by 50%, and an additional 524.9 million people facing moderate to severe food insecurity, according to the report. The potential for dengue transmission is also expected to rise by up to 37%.

The health threats posed by fossil fuel burning are further exacerbated by government subsidies, which effectively incentivize the industry. Moreover, agricultural emissions continue to rise, alongside a global food system that promotes unhealthy, carbon-intensive diets.

Health consequences of a 2C warming scenario in 2040.

The finance sector is playing a significant role in perpetuating this crisis. Average annual lending to the fossil fuel sector grew from $549 billion in 2010–16 to $572 billion in 2017–21. More than half of the 40 banks that lend most to the fossil fuel sector have increased lending since the Paris Agreement was signed.

This expansion of fossil fuel production has also been driven by high energy prices, which have yielded $4 trillion in profits for oil and gas companies in recent years. As a result, these companies are allocating more capital to fossil fuel projects than to renewables, on which they spend just 4% of their budgets.

Despite the mounting evidence of the climate crisis, the world remains woefully off track. A U.N. assessment of global climate commitments published on Tuesday found that even if all were met, which is a significant uncertainty, emissions may only be about 5% lower in 2030 than in 2019. The world is currently on track to reduce emissions by just 2% by 2030, according to the report. To limit global warming to 1.5 degrees Celsius above pre-industrial levels, emissions need to be 43% lower.

“The world remains massively off track,” U.N. chief Antonio Guterres said.

The Lancet Countdown report’s findings further align with those of a concurrent World Meteorological Organization (WMO) report, which revealed on Wednesday that greenhouse gas concentrations in the atmosphere reached a new record high in 2022.  

Another major climate report released concurrently, State of Climate Action 2023, concluded that “global efforts to limit warming to 1.5°C are failing across the board.” Across 42 indicators tracked in the report, published by Climate Action Tracker, only one – electric vehicle sales – is on track, while six – including deforestation, the carbon intensity of steel, and public financing for fossil fuels – are accelerating in the wrong direction.

“There is no end in sight to this trend,” warned WMO Secretary-General Petteri Taalas. “Despite decades of warnings from the scientific community, thousands of pages of reports and dozens of climate conferences, we are still heading in the wrong direction.”

“It takes thousands of years to remove carbon from the system once it’s emitted into the atmosphere,” said Taalas. “We must reduce the consumption of fossil fuels as a matter of urgency.”

Image Credits: Matt Howard/ Unslash.

Triage areas at Al-Shifa hospital courtyard, one of the largest hospitals in the Gaza Strip on October 10 before fighting around the health facility escalated.

Israel launched what it described as a “targeted operation” into Gaza’s besieged Shifa Hospital early Wednesday morning – which was immediately denounced by the World Health Organization as “unacceptable” and contrary to international law – regardless of whether Hamas made use of the facility for military purposes. 

Meanwhile, on Tuesday, an Israeli delegation visiting Geneva on behalf of the estimated 229 people held hostage by Hamas, met with WHO’s Director General Dr Tedros Adhanom Ghebreyesus as well as the president of the International Committee of the Red Cross, pleading with them to intervene more forcefully on the release of the captives, including 30 children, a pregnant woman, and 20 older people, with a range of injuries and chronic health conditions.  

‘Hospitals are not battlegrounds’ – WHO DG 

WHO Director General Dr Tedros Adhanom Ghebreyesus speaking at a WHO media briefing on Wednesday.

In statements early Wednesday morning, Israel’s military spokesman said that elite troops had entered the hospital, ostensibly to root out Hamas operatives, weapons and entrances to an extensive underground tunnel system – that may have been used to hide and transport some of the 240 Israeli hostages to other parts of Gaza.  

Speaking at a Wednesday afternoon press briefing, Tedros condemned the entry, saying:   

“Israel’s military incursion into Al Shifa hospital in Gaza City is totally unacceptable.. Hospitals are not battlegrounds.  We are extremely worried about the safety of staff and patients. 

“WHO has lost contact with health workers at Shifa Hospital. But one thing is clear – under international humanitarian law, health facilities, health workers, ambulances and patients must be safe-guarded and protected against all acts of war. 

“Not only that, but they must be actively protected during military planning.  

“Even if health facilities are used for military purposes, the principles of distinction, precaution and proportionality always apply,” added Tedros. “The safety of patients and staff, as well as the integrity of the health care systems in the wider community, are of paramount concern,” he added. 

Israel’s military said that the entry of troops was accompanied with Arabic-speaking medics, incubators and other supplies to address the plight of some 36 premature babies teetering between life and death. 

Aching relief needs everywhere in Gaza

Dr Richard Peeperkorn, WHO Representative to the West Bank and Gaza, at Wednesday’s WHO press briefing.

For the first time since the conflict began, fuel began to move into Gaza via the Egyptian Rafah crossing. A truck with 23,000 litres of fuel was permitted to cross to resupply the depleted reserves of the UN Refugee Agency, which is sheltering hundreds of thousands of Palestinians displaced by the fighting in tent camps and other temporary locations in the south of the tiny enclave – whose largest city in the north now lies in ruins. 

The Jerusalem-based Representative WHO’s Office for the West Bank and Gaza, Richard Peeperkorn, described the fuel entry, previously opposed by Israel, as a “promising step.”

But the supplies, which were approved for the re-supply of UNRWA installations only, are nowhere sufficient to meet the broader needs of Gazans, Peeperkorn and the WHO Director-General both said.  

“At least 120,000 litres a day are needed to operate hospital generators, ambulances, desalination plants, sewage treatment plans and telecommunications,” pointed out Tedros.  

“The problem can be easily fixed, the supply of electricity must be restored and sufficient fuel must be allowed to enter, to run vital infrastructure and distribute lifesaving aid,” he added.

Infectious diseases rising

Khan Younis refugee camp, Gaza. Hundreds of thousands of internally displaced people (IDPs) are sheltering in 90 UNRWA shelters in the Middle, Khan Younis and Rafah areas of the Gaza – where the onset of winter rainfall is exacerbating environmental health risks.

“What’s critically important is the water and sanitation,” said Peeperkorn, saying that some 4000 tons of rubbish per day was piling up in overcrowded camps in southern Gaza where solid waste removal services ceased functioning yesterday due to a lack of fuel. 

Sewage pumping stations, water wells, and Gaza’s two main water desalination plants in Rafah and the middle portion of Gaza also were not functioning due to a lack of fuel, Peeperkorn noted. 

In addition, said Tedros, heavy rains have flooded makeshift camps, “making conditions even worse” for those displaced. 

“We see a real problem in that disease surveillance is interrupted,” added Pepperkorn, noting that official reports on deaths and injuries had not been made for the past three days. 

But regardless of the limited reporting capacity, WHO is seeing sharp rises in acute respiratory infections, diarrhea, as well as skin diseases, scabies and Hepatitis A, he said. 

“And I want to really be clear that over the last three days, we have not received updates to date on injuries and deaths due to the intensifying hostilities and levels  of connectivity so it makes it much harder to evaluate,” he said.

The latest reports are of 11,078 Palestinian casualties since the original 7 October Hamas incursion into Israel, in which some 1200 Israelis and foreigners were killed, mostly civilians.   Since then, Israel has conducted one of the most intensive aerial bombing campaigns in modern history devasting large parts of Gaza City. Hamas has fired over 9,500 missiles into Israel, including a direct hit on the coastal city of Ashkelon Wednesday.  

Meanwhile, only about 10 hospitals are still operating on the strip out of the original 36, Tedros said, with about 1400 beds available out of an original 3500.  

And movement of critically ill patients to treatment across the border in Egypt remains challenging, Peeperkorn said. 

“We need to establish a mechanism that a medevac  becomes operational over the next three months,” Peeperkorn said, referring to the timely and efficient evacuation of critically ill patients. On Wednesday, some 30-50 critically-ill patients were evacuated to Egypt, he said. But thousands more will require medical transport over the next several months. 

WHO and ICRC meetings with Israeli delegation of hostage families

Ofri Bibas Levy, whose brother, wife and two young children were kidnapped to Gaza.

On Tuesday, four hostage families, accompanied by Israel’s Foreign Minister and Health Minister, were in Geneva to plead with WHO’s Tedros and Mirjana Spolijaric, president of the International Red Cross Committee, for more forceful international intervention on the fate of the captives. 

It was the first high-level meeting between Israeli ministers, the ICRC and WHO’s leadership on the matter since the conflict began. 

Spoljaric said in a statement that the ICRC was “doing everything in our power to gain access” to the hostages but “cannot force its way into where hostages are held” and “can only visit them when agreements, including safe access, are in place”.

Tedros, in his remarks on the meeting, stated, ” I heard and felt their pain and heartache. WHO continues to call for the hostages to be released unharmed, without any condition. We are deeply concerned for their health and well-being, just as we are concerned for the health and well-being of the people of Gaza, which is becoming more precarious every hour.”

At a briefing for Geneva’s UN press, the families appealed to the UN and international community to do more to obtain the release of their family members, beginning with  “even a sign of life”.  

Ilan Regev Gerby, the father of two children in their twenties kidnapped together from a weekend festival, fought back tears as he replayed a tape of his last phone conversion with his hysterical children, as Hamas forces entered the festival grounds on 7 October.  

Idit Ohel, mother of 22 year old Alon Ohel, described learning about her son’s fate from a Hamas video, uploaded to social media. The video, aired at the briefing, showed him and two other friends being hauled away by Hamas forces in a truck from the same outdoor festival, holding a tourniquet to the lower part of his arm, which was blown off by a grenade thrown into his hiding place, according to one eyewitness who survived.

“I ask the UN for security, for freedom and humanity,” said Ofri Bibas Levy, whose brother, sister-in law and their two children, ages four and 10 months, were kidnapped from their home  in a community near Gaza on 7 October. “Where is the humanity of two boys being held underground for 40 days?”

There have been reports of progress on a Qatari- brokered deal for the release of 50 hostages, mainly women and children held by Hamas, in exchange for the release of Palestinian female prisoners and a three-day truce – something that could unlock a humanitarian cease-fire allowing more health and humanitarian aid to flow into the besieged strip. 

A breakthrough has so far remained elusive insofar as Israel has been calling for the simultaneous release of all hostages, while Hamas is clearly interested in a staged release of the captives, in a bid to slow down and eventually halt  Israel’s military advances which aim at its overthrow. 

Even so, US President Joe Biden sounded an optimistic note Tuesday evening in a press briefing in Washington DC, where he send a message to hostage families saying, “hang in there we are coming.”

Image Credits: WHO/EMRO, WHO/EMRO, E. Fletcher/Health Policy Watch.

Director Generals Ngozi Okonjo Iweala (WTO), Dr Tedros Adhanom Ghebreyesus (WHO) and Daren Tang (WIPO) at their trilateral meeting on climate and health.

In anticipation of coming climate crises, developing countries should put in place “effective mechanisms in their domestic laws” that allow them to use the TRIPS flexibilities, asserted Dr Ngozi Okonjo Iweala, Director-General of the World Trade Organization (WTO) on Tuesday.

TRIPS flexibility refers to space allowed in the WTO’s Trade-related Aspects of Intellectual Property (TRIPS) Agreement for governments to relax patent rights to address public health needs, including issuing compulsory licenses to make medicines without the permission of a patent-holder.

“Let me emphasise that many developing country governments have not yet put in place the legal mechanisms or tools that allow the use of existing or future flexibilities. With the impact of climate change on health becoming more evident, this is the time to get ready,” Iweala told the trilateral climate change and health symposium convened by the WTO, World Health Organization (WHO) and World Intellectual Property Organization (WIPO).

 

The three bodies have agreed to step up their support for developing countries to “analyse their options to use TRIPS flexibilities” and update their laws to enable the use of these flexibilities alongside “enhanced procurement programmes”, she added.

“As you all know, at the WTO we have also been grappling with sensitive issues around intellectual property (IP) and technology transfer,” added Iweala.

“To solve problems in public health and the climate, breakthrough technologies must be incentivized, invented, developed and widely diffused. Innovation and access must go together. That is why the IP system was designed with ideas of balance and public interest at its core. Governments have legitimate scope to intervene when necessary to protect the public interest.”

Ngozi Okonjo Iweala, Director-General of the World Trade Organization (WTO)

Fossil fuel addiction ‘an act of self-harm’

WHO Director-General Dr Tedros Adhanom Ghebreyesus appealed for both “advanced technologies” and “trade arrangements” to protect lives in the event of climate crises.

“In the same way that we have been fighting for global equitable access to COVID-19 vaccines, we need to ensure that intellectual property and trade rules are not a barrier to accessing greener and healthier technologies,” said Tedros.

“The world’s addiction to fossil fuels is an act of self-harm,” he added. “This addiction not only drives the climate crisis but is a major contributor to air pollution, which kills almost seven million people every year – a death every five seconds. The health community has a critical role to play in protecting people from the escalating climate threats to health.”

However, countries had the responsibility to build health systems that can both withstand climate shocks and reduce their carbon footprint, added Tedros, referring to the WHO’s framework for building climate-resilient and low carbon health systems released last week. 

WIPO Director General Daren Tang

Warning that Africa would bear the brunt of climate-related deaths, projected to account for over half these deaths by 2050, WIPO Director-General Daren Tang said that “this cannot be our future”.

Tang added that, while some saw IP rights as an obstacle to achieving a better, fairer and more sustainable world, WIPO hopes that IP will “unleash the innovative and creative potential of our people around the world” to realise the sustainable development goals (SDGs).

Tang also referred to WIPO Green, a free online platform matching providers and seekers of green technologies around the world to address climate change.

“In the past 10 years, this platform has grown to cover 130,000 technologies from over 140 countries, becoming the biggest green tech exchange matching platform that the UN offers today,” said Tang. 

However, the challenge is to ensure that these technologies “create impact on the ground”, said Tang. 

“WIPO will continue to build innovation and tech transfer capabilities in member states so that tech transfer can lead to actual deployment on the ground, and homegrown innovation solutions can move from mind to market and be deployed and diffused across the world.”

Tobacco industry interference in governments’ tobacco control policies has increased in 43 out of 90 countries analysed over the past two years.

This is according to the Global Tobacco Industry Interference Index 2023 released on Tuesday by tobacco watchdog STOP, and the Global Center for Good Governance in Tobacco Control (GGTC).

“No country has been spared from the interference, and there is a worsening trend,” said Mary Assunta, CGTC’s head of research and advocacy. “More countries deteriorated in their scores compared to countries that improved” – with only 29 countries improving efforts to push back against industry.

Countries with the highest level of interference are the Dominican Republic, Switzerland, Japan, Indonesia and Georgia – and this is also reflected in “poor tobacco control measures in their countries”, according to the report.

Governments that are party to the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) are obliged to protect their health policies from the commercial and other vested interests of the tobacco industry.

But the report exposes a range of interfering behaviour – including governments accepting tobacco corporate social responsibility (CSR) contributions, politicians accepting campaign contributions and officials weakening controls in the face of industry scare tactics.

The CSR handouts focused on post-COVID recovery programmes, environmental protection, such as cigarette butt cleanups and tree planting. 

“Non-health departments, especially finance, commerce and customs, continued to be targeted by the industry and were persuaded by exaggerated claims of industry’s contributions to the economy,” Assunta told the media briefing to launch the report.

“They believed the industry’s narrative that illicit trade will worsen if taxes are increased. Hence, in some countries – Colombia, Mongolia, Malaysia and Turkey – there was no [cigarette] tax increase, while in others there were delays in tax payments.”

Global Tobacco Industry Interference Index 2023

Politically compromised

“Policymakers in many countries became vulnerable to industry interference when they placed themselves in situations of conflict of interest. This happens either through accepting industry donations for political campaigns or investing in the tobacco business, a revolving door situation of retiring senior government officials joining tobacco companies, or industry executives taking up senior government positions,” said Assunta.

In Uruguay, although tobacco sponsorship including political donations is outlawed,  Montepaz, which controls 85% of the Uruguayan tobacco market, contributed to the financing of the president’s election campaign.

In Colombia, the former Director of Regulation at the Ministry of Commerce joined Philip Morris International (PMI) as its head of external affairs for Colombia and Perú.

In Bangladesh, a British American Tobacco (BAT) director is the senior secretary in the Prime Minister’s Office. In Gabon, the chair of the board of a tobacco body, CECA-GADIS, is currently a political advisor to the Head of State. In Switzerland, a member of the National Council (the larger house of the Swiss legislature) is also the salaried president of the Swiss Tobacco Trade Association. Switzerland has not ratified the FCTC, neither has the US.

Mary Assunta, CGTC’s head of research and advocacy.

The governments of Bangladesh, Jamaica, Korea and Zambia still invest their pension funds or national insurance funds in the tobacco business. The Bangladeshi government holds a total of 9.4% shares in BAT Bangladesh, the Korean government owns 7.7% shares in tobacco company KT&G,  and Zambia’s pension schemes have shares in BAT Zambia.

Meanwhile, in many African countries, tobacco companies gain prominence through charity.

“In countries like Zambia, Uganda, Tanzania, Nigeria, Madagascar, Gabon, Ghana, Cameroon and Nigeria, the tobacco industry engages in activities like granting scholarships, providing classrooms, training young people in agriculture or promoting young entrepreneurship,” said Leonce Sessou, executive secretary of the African Tobacco Control Alliance.

Sessou added that the industry supported a number of NGOs to promote itself, particularly in the youth sector.

Impact of industry influence

The growing influence of industry was experienced very directly in many countries.

Malaysia’s Wency Bui told the launch that her government had de-listed nicotine as a poison after lobbying by Japan Tobacco International (JIT). This enabled the company to market nicotine products such as e-cigarettes.

Tobacco companies also successfully lobbied for the end of bans on e-cigarettes, heated tobacco products (HTPs) and/or nicotine pouches in Egypt, Kenya and Uruguay. In Uruguay, the Ministry of Public Health even used information provided by Philip Morris International (PMI) instead of its own experts.

Five countries – Bolivia, Guatemala, Jamaica, Tanzania, and Zambia – reported that the tobacco industry sabotaged efforts to pass comprehensive tobacco control legislation. 

Applying pictorial health warnings on tobacco packs was delayed in Chad, Bangladesh, Laos and Nigeria, and the implementation of standardised tobacco packaging has been undermined by the tobacco industry in Georgia, Myanmar and Uruguay. 

Some progress

Global Tobacco Industry Interference Index 2023

However, Brunei, New Zealand, France, the Netherlands and Botswana are the top five countries that performed well in pushing back against the industry. Meanwhile, Ukraine improved the most in its push-back against industry despite fighting the Russian invasion.

The Netherlands has a protocol for civil servants interacting with the tobacco industry their  Code of Conduct on Integrity (Gedragscode Integriteit Rijk) contains guidelines on interacting with tobacco lobbyists.

Botswana is in the process of finalising regulations to implement its Tobacco Control Act in 2021, which prohibits any partnership, agreement or contributions from the industry to any public body. 

The report was launched at the start of the 10th Conference of the Parties (COP10) meeting on the Framework Convention on Tobacco Control (FCTC) in Panama City, which will assess countries’ progress on tobacco control.

Image Credits: PAHO.

Bombed out ruins of Tel Al Zaatar neighborhood in northern Gaza City, near the Indonesian Hospital.

Fierce gun battles between Israeli and Hamas forces raged in the vicinity of several strategically located hospitals in northern Gaza over the weekend and into Monday – leaving the fate of the remaining patients hanging in the balance. 

At Al Shifa hospital, hospital staff were reportedly trying to keep some 37 premature babies warm by wrapping them in foil in an operating room – after electricity in the nursery housing their incubators failed due to a lack of fuel.  Three babies had already died, the hospital director Mohammed Abu Salmiya told Al Jazeera in a phone interview early Monday, and others were at risk as oxygen supplies dwindled.

“Premature and new-born babies on life support are reportedly dying due to power, oxygen, and water cuts at Al-Shifa Hospital, while others are at risk. Staff across a number of hospitals are reporting lack of fuel, water and basic medical supplies, putting the lives of all patients at immediate risk,” the regional directors of WHO, UNICEF and the UNFPA reported in a joint statement Sunday

“We have no electricity except in the emergency section. The nursery section is out of service, maternity hospital is out of service,” Salmiya said, “The oxygen generator is not working. Water, we don’t have a single drop,” he said, describing the situation as “catastrophic.” 

“The world cannot stand silent while hospitals, which should be safe havens, are transformed into scenes of death, devastation and despair,” said WHO chief Tedros Adhanom Ghebreyesus, reiterating calls for an immediate stop to the fighting.

The appeals were echoed by US President Joe Biden who said Monday that Gaza’s hospitals “must be protected”

Partial evacuation of Al Shifa  

Al Shifa Hospital – 15 October. Emergency Medical Teams (EMTs) deployed in tents outside of the compound alongside displaced people sheltering in the area.

Thousands of people sheltering at the hospital left the compound over the weekend. But many still remain on the hospital grounds, aerial photos published Monday by the New York Times suggested.

“An unconfirmed number of IDPs, along with several staff and patients have reportedly fled the Shifa hospital over the past few days, amid the intensified attacks and Israeli calls to evacuate it,” OCHA reported in its  latest newsflash, noting that the Israeli military had opened a “corridor” for people to leave.

“However, reports cited by the WHO indicated that some of those fleeing have come under fire, resulting in casualties. Humanitarian agencies have received desperate calls from staff and patients’ relatives willing to leave but fearing reported snipers around the hospital. Others, particularly people with disabilities, are physically unable to leave by themselves,” OCHA added.

Israel has said that Hamas forces are trying to discourage people from fleeing Shifa and other hospitals in the area – where it says Hamas maintains key command and control centers underground. Hamas has denied the claims.

Israeli military spokesman Daniel Harari told a Sunday evening media briefing that it had offered help to the Shifa hospital director in the evacuation of the remaining patients, but Hamas was preventing them from leaving. Troops also brought some 300 litres of fuel to the hospital entrance Sunday night, but Hamas intercepted the delivery, he said. 

OCHA said in response,“Shifa’s director has stated to the media that the amount delivered would have been sufficient for 15-30 minutes only.” It added that “the hospital would have accepted if it was delivered through the International Committee of the Red Cross (ICRC).”  

Fighting interrupts Al Kuds Hospital evacuation – Israel says weapons found at Rantisi Hospital

View of Rantisi Hospital from the entry point to a nearby tunnel, as displayed by Israel’s military spokesman in a video tour of the now vacant hospital grounds.

There were also fire exchanges with Hamas at the entrance to Gaza City’s Al Kuds Hospital, according to Palestinian and Israeli reports;, the latter displayed aerial video footage of Hamas gunmen by the hospital walls facing off against an Israeli tank. 

The Palestinian Red Crescent later said that Al Kuds Hospital was no longer operational – but it could not reach the installation to evacuate it either due to the fighting in the area. 

At Al Rantisi Children’s Hospital, evacuated by patients and staff over the weekend following an earlier standoff between Hamas and Israel, a video of the now-emptied grounds, released by Israel’s military, revealed an array of weapons in a room decked with childrens posters in what appeared to be the hospital basement. Mounted on the wall was an electronic device bearing a World Health Organization logo.  In other videos and photo footage, a deep, steel-reinforced tunnel was displayed, some 200 meters from the hospital walls. 

Recent Palestinian casualties now unclear

Due to a collapse in communications, the Hamas-controlled Ministry of Health in Gaza did not update casualty figures over the weekend, OCHA also added. 

“The latest updated, provided on Friday, showed showed that 11,078 people had been killed in the Strip since 7 October. According to Israeli official sources, 47 soldiers have been killed since the start of [Gaza] ground operations,” OCHA said.  

Around 1300 Israelis have been killed since the original Hamas incursion into Israel on 7 October, including about 300 soldiers and police.  Over the weekend, Israel revised its estimate of Israeli casualties from the 7 October raids downward from 1400 to 1200, saying that extensive forensic investigations had been required to identify the precise number of victims, some of whom had been so badly burned that even DNA samples were difficult to extract.     

Humanitarian aid deliveries in south – inferno in north  

UN water truck at Khan Younis refugee camp, in southern Gaza where hundreds of thousands of displaced people are sheltering. UNRWA has said a fuel shortage will force it to cease operations in 48 hours.

While Israeli forces tightened its chokehold on northern Gaza, the pace of humanitarian aid deliveries increased slightly in the south, with some 140 trucks entering Gaza from Egypts Rafah crossing with fuel, medicines and water supplies. But that is still a fraction of the aid that arrived daily before the war began. 

UNRWA said that its humanitarian operations in Gaza would grind to a halt within 48 hours without fuel resupplies. 

Israel has imposed a total ban on fuel deliveries to Gaza, although there were unconfirmed reports that fuel had recently been delivered to the city’s desalination plant, which forms a vital part of the region’s fresh water supplies.  

Two other water pipelines from Israel to the southern Gaza strip were also restored last week, Israel has said. But supplies to the enclave, which suffers from water scarcity in the best of times, remained desperate, particularly in the northern part of the enclave where battles continue to rage.   

Jebalya refugee in the northern strip was the scene of an inferno Monday evening as an Israeli anti-bunker munitions collapsed buildings and triggered multiple fires.  

Not too far away, the once posh Rimal neighborhood, home to a number of Palestinian government insitutions, malls and a UN Beach club, along with Al Shifa Hospital, was also a scene of devastation, with fires burning in some bombed out buildings. 

Sexual violence on 7 October  – Israeli women publish evidence of assaults

Report on gender-based violence in connection with the 7 October Hamas attacks, presented in Tel Aviv, attended by WHO Representative to Israel Michel Tieran (center right).

Meanwhile, in twin events in Tel Aviv and Boston, reports by victims and their famlies of the 7 October incursions into Israelis communities around Gaza provided grisly testimonies of alleged gender-based violence faced at the hands of Hamas gunmen that entered villages and homes early that morning.   

“Women were violently tortured… murdered and raped. Mothers were separated from their young children who were kidnapped to Gaza, Others were abducted from their homes in front of their children,” said the Israeli civil society group “Bring them Home Now,” in a report of their findings, launched in the presence of Michel Tieran, WHO Representative to Israel.

“There is a wide variety of evidence of sexual violence and horrific gender-based crimes among them videos of survivors, eyewitness, first responders… and forensic evidence,” said Dr Cochav Elkayam-Levy, an expert in international human rights law, at another event sponsored by an association of Harvard University medical students. She said videos released by Hamas and eyewitness accounts by responders described how some women were stripped, bound, and bloodied by acts of sexual violence before being killed or taken captive. 

Later in the day, Hamas’ armed wing, the Al Qassam Brigades, published a statement and video footage claiming that one Israeli female hostage, 19-year-old soldier Noa Marciano, had been killed in an Israeli airstrike, while another captive soldier was wounded.    

There are still no clues as to the whereabouts or condition of the hostages still presumed to be alive.  But some of the women are elderly and require medicines for chronic diseases; others are under treatment for breast cancer, the families noted in the event in Tel Aviv. They called upon UN Women, the International Committee of the Red Cross, and other UN organizations to review the evidence of sexual violence against victims and to demand access to the hostages in captivity, including not only women but some 30 children.   

Image Credits: @GazaReport, WHO/EMRO, @idfonline.

Alcohol has had a fairly easy pass from public health authorities – although the World Health Organization (WHO) recently asserted that there is no safe level of drinking, upending many people’s cherished illusion that a glass of alcohol at the end of the day is harmless.

RESET Alcohol, a new public health initiative led by Vital Strategies, aims to tackle alcohol’s ubiquitous influence primarily by working with governments to increase taxes.

The $15 million initiative will focus initially on Brazil, Colombia, Mexico, Kenya, the Philippines and Sri Lanka.

“We were looking for governments that are committed to doing alcohol policy work and could demonstrate that they were willing to go forward and, particularly, raise taxes,” said RESET director Jacqui Drope of the choice of countries. 

Population size and alcohol abuse burden were also factors, she added in an interview with Health Policy Watch.

Most of these countries already have alcohol taxes. In the Philippines, for example, alcohol taxes already help to pay for universal health care, while in Kenya, civil society advocates are fighting to make sure alcohol tax rates keep pace with inflation.

Following the tobacco control example

“The primary focus has always been on increasing alcohol taxation as it’s one of the most effective things you can do,” added Drope, who has a long history in tobacco control.

Cigarette taxes have been shown to curb smoking, particularly in young people. For example, in New York state cigarette taxes are the highest in the US and the state has seen youth smoking rates drop by more than 90% since 2000 as a result. 

RESET Alcohol will work mainly by supporting governments, civil society and research groups to build their capacity to implement and strengthen alcohol policy. 

It will do so in part by mentoring people in policy and regulation development, taxation research, strategic communication and advocacy, and alcohol data and monitoring systems.

RESET Alcohol Director Jacqui Drope

Not prohibition

The initiative isn’t about prohibition, Drope stressed: “We’re coming at this from a harm-reduction standpoint. That is why it is about policy and what we can do at the population level. We aren’t working at the individual level and prescribing what individuals do.

“We know this is an unhealthy product, and there’s good evidence from the WHO to show that there is no safe level [of consumption]. What we’re trying to do is reduce the harms through policy, rather than saying that people should never drink again. This isn’t what we’re trying to accomplish.”

‘War of perception’

For adults aged between 25 and 49, alcohol is the leading cause of death and disability globally based on the Global Burden of Disease analysis. 

“Often the underlying connection of alcohol consumption between these deaths – from liver disease, heart disease, cancer, violence, vehicle crashes, falls, tuberculosis, HIV/ AIDS, and other conditions – is overlooked,” according to Vital Strategies.

People calling for more alcohol oversight is “cast as a buzzkill”, according to the global health organisation.

“It’s a war of perception that claims millions of lives each year. Alcohol use remains stubbornly rooted as a cultural norm in most of the world, and few recognise it as a public health threat.”

Drope acknowledged that alcohol is so deeply entrenched that even the health sector has been complicit in perpetuating the notion that moderate alcohol consumption is healthy: “We have a lot of work to do and think about to change norms, and change how we talk about alcohol.”

At risk ‘from the first drop’

Recent data that shows half of all alcohol-attributable cancers in the WHO European Region are caused by “light” and “moderate” alcohol consumption – less than 1.5 litres of wine or less than 3.5 litres of beer or less than 450 millilitres of spirits per week. 

“This drinking pattern is responsible for the majority of alcohol-attributable breast cancers in women, with the highest burden observed in countries of the European Union (EU),” according to the WHO European Region.

“We cannot talk about a so-called safe level of alcohol use. It doesn’t matter how much you drink – the risk to the drinker’s health starts from the first drop of any alcoholic beverage. The only thing that we can say for sure is that the more you drink, the more harmful it is,” explained Dr Carina Ferreira-Borges, WHO regional advisor for alcohol and illicit drugs. 

Alcohol consumption and related deaths in different regions of the world

Globally, the WHO European Region – which includes heavy-drinking countries such as Czechia, Latvia, Lithuania, Russia and Germany – has the highest alcohol consumption level and the highest proportion of drinkers in the population. Over 200 million people in the region are at risk of developing alcohol-attributable cancer.

“Although it is well established that alcohol can cause cancer, this fact is still not widely known to the public in most countries. We need cancer-related health information messages on labels of alcoholic beverages, following the example of tobacco products; we need empowered and trained health professionals who would feel comfortable informing their patients about alcohol and cancer risk; and we need overall wide awareness of this topic in countries and communities,” added Ferreira-Borges.

In early November, WHO Europe Regional Director Dr Hans Kluge and the Director of the International Agency for Research on Cancer (IARC), Dr Elisabete Weiderpass, issued a joint statement to the European Parliament calling for more awareness about the link between alcohol and cancer.

“The contribution of alcohol consumption to cancer incidence and mortality should be clearly recognized without the use of any qualifiers or misleading adjectives such as ‘harmful’ or ‘heavy’ consumption of alcohol or ‘responsible drinking’,” they noted.

“Measures should be taken to clearly inform the public of this risk, which is not well known among the general population,” they added, pointing out that two WHO health plans “recommend the use of health warning labels on alcoholic beverage containers to inform the public about the health consequences of alcohol use”.

Image Credits: Unsplash, WHO .

Lab technicians at work in Cape Town’s Afrigen Vaccines & Biologics, one of the core partners in the WHO co-sponsored mRNA vaccine technology transfer hub, founded by WHO in 2021.  Much more needs to be done to foster local manufacturing of vaccines and health products, said participants at the Second World Forum.

A new Health Technology Access Pool (H-TAP), which aims to broaden the scope of IP and patent-sharing with low- and middle-income countries and a new African Union co-sponsored ‘manufacturing support platform’ were among the initiatives announced this week at the Second World Local Production forum in The Hague.

The global forum, the second ever to be convened, brought together industry, governments, civil society and multilateral organizations, including WHO, in a quest to bolster the local production of medicines and vaccines in underserved regions, particularly Africa, which was last in line to get COVID treatments during the pandemic.

The new H-TAP aims to overcome the shortcomings of the COVID-19 Technology Access Pool, C-TAP, which failed to gain significant buy-in from the industry. It also will include medicines and vaccines beyond COVID products, said Dr Yukiko Nakatani, Assistant Director-General for Access to Medicines and Health Products, at the Forum.  However, whether the new mechanism can really overcome the shortfalls seen in C-TAP, which drew little industry support, remains to be seen.

“Six license agreements for 15 health products have been agreed upon with Covid-19 technology holders – including from one private sector manufacturer. A serological test license from the Spanish National Research Center (CSIC) led to a sub-license to Biotech Africa to develop their diagnostic technology,” said Nakatani at the Local Production Forum, in his review of the slim achievements of the C-TAP pool.

“A review of C-TAP has been undertaken and a new technology access pool operating model is being developed and will be launched end of 2023. Stakeholders consultations will be held to help in the refinement and implementation of the model,” Nakatani said.

H-TAP and the WHO Pandemic Accord – interface unclear

As for further details on the H-TAP initiative, WHO did not comment.  However Ellen ‘t Hoen, head of the non-profit Medicines Law and Policy,  said that she expected the ongoing WHO member state negotiations on a new pandemic accord would also have to “address the need for the expansion of such a mechanism to enable the sharing of IP, including know-how and trade secrets.”

Meanwhile, in an open letter published at the start of the three-day Forum, a coalition of 30 prominent medicines access organizations, including Oxfam, the People’s Vaccine Alliance, Unitaid, and Public Citizen, warned that efforts to strengthen local medicines production in LMICs without addressing IP to “building a bridge to nowhere”.

“Plans and seed resources for building a bridge to local manufacturing abound, but they all have one feature in common – they systematically refuse to address the intellectual property barriers,” the open letter states.

At the World Health Summit in Berlin last month, German Health Minister Karl Lauterbach stated that any agreement without strong IP protections would “not fly” for Germany and its fellow EU countries, comparing IP to part of the EU’s “DNA.”

That stance was further reinforced at the start of the seventh round of INB negotiations on Monday when European countries asserted that any changes to IP rights should be thrashed out at the World Trade Organization (WTO) – not the WHO.

Tedros acknowledges the shortcomings of C-TAP model

WHO Director-General Dr Tedros Adhanom Ghebreyesus and Dutch Minister of Health Ernst Kuipers at the second World Local Production Forum in The Hague, Netherlands.

It took a staggering three years for a vaccine license to be shared with C-TAP, long after its potential to save lives had diminished. Aside from one Taiwanese firm, noit’s some private pharmaceutical company shared vaccines or therapeutics with the platform.

In his opening remarks, WHO Director General Dr Tedros Adhanom Ghebreyesus acknowledged the shortcomings of the C-TAP, the WHO’s ambitious platform aimed at facilitating patent-sharing for COVID-19 vaccines, treatments and medical technologies during the pandemic.

“The COVID-19 pandemic demonstrated the incredible power of vaccines, tests, treatments, and other medical technologies to save lives, but it also exposed the vast inequalities in our world,” Dr. Tedros stated. “Of course, this is not the first time.

“When HIV emerged over 40 years ago, life-saving medicines were developed, but more than a decade passed before the world’s poor got access to them,” he lamented. “When the H1N1 influenza pandemic struck 14 years ago, vaccines were developed, but by the time the world’s poor got access, the pandemic was over.”

However, the wakeup call provided by the pandemic also marked a turning point, Tedros and other speakers noted. That led to the creation of WHO’s mRNA vaccine technology transfer hub, launched in 2021 in South Africa.  Another global training hub in biomanufacturing capacity was also launched by WHO in collaboration with The Republic of Korea.

Local manufacturing has become more prominent on agenda now

Mapping of existing and planned manufacturing initiatives in Africa, as of December 2022.

The issue of local manufacturing was ignored for decades when UN-backed initiatives like The Global Fund to Fight TB, HIV/AIDS and Malaria, and Gavi, The Vaccine Alliance, channeled most contracts to a handful of large, well-established manufacturers in China, India, Europe or North America – ostensibly to reduce costs.  The concentration of their procurement, however, also tended to disadvantage local startups in other low- and middle-income countries, which could not compete with pharma giants in economies of scale, or pricing.   

Technology transfer and local production of medicines was first included on the agenda of the World Health Assembly (WHA) in 2018. During the WHA that year, Medecins Sans Frontières representative Elena Villanueva-Olivo condemned the failure of global research and development efforts and unequal access to affordable health technologies as “crises of international concern.”

Belatedly the pandemic cast a sharp light on the dearth of local manufacturing, particularly in Africa. It highlighted the long-term damage of concentrating procurement amongst only a handful of manufacturers, and highlighted how over time, more local manufacturing of essential medicines and vaccines could offer greater affordability and improved access to life-saving treatments, as compared to reliance on imports.

Since then, a flurry of new initiatives have been announced by WHO, the African Union and pharma companies themselves, including giants like Pfizer.  Big questions remain, however, regarding the durability and sustainability of the new projects in planning or already underway. 

New platform launched to support African manufacturers

The new Health Products Manufacturing Support Platform, launched at the Forum by Unitaid, the African Union Development Agency, and WHO aims to address some of those sustainability issues.

The platform will provide technical assitance to African manufacturers along the entire “health products manufacturing value chain,” its promoters said.

The support could range from technical assistance in “business management, sales and operations”, to support for the acquisition and development of active pharmaceutical products, and preparation of drug dossiers to ensure compliance with regulatory standards, the project initiators said.

The initiative calls upon African manufacturers, R&D centers and centers of excellence, as well as “market actors” including industry associations to collaborate in the initiative.

Over 79% of African pharma products are imported, while Africa supplies only 3% of global production of medicines and vaccines, it’s developers note.

Sidestepping IP issues? 

Filling vials for vaccine R&D at South African’s vaccine manufacturer Afrigen.

While developed countries and the private sector have emphasized the need to create a broad “ecosystem” to foster local manufacturing of health products, including investments in training, knowledge transfer and procurement preferences of global agencies and countries, civil society have long contended that IP restrictions constitute the key barriers:

“All of these hopes for local and regional production hinge on whether low- and middle-income countries (LMICs) have access to IP-protected research tools, technology platforms, product and process inventions, trade secrets, regulatory data, biologic resources (such as cell lines), and other knowledge essential to product development,” said the CSO  signatories to Monday’s letter. 

“We cannot be complacent – or resigned – to the siren song of purely voluntary measures and continued private hegemony over tools and knowledge by which the right to health is realized,” the letter states.

“We learned the painful costs of knowledge privatisation during the COVID-19 pandemic when major vaccine producers, including leading participants in the World Local Production Forum, refused to license their IP and share their breakthrough technologies and manufacturing know-how with capable producers in LMIC regions,” the coalition of civil society groups wrote in their letter to the forum.

“Instead of building bridges to nowhere, international and multilateral institutions … must finally commit to supporting countries in their collaborative efforts to overcome IP barriers that will otherwise stifle local manufacturing,” the signatories added.

A draft set of recommendations from the Forum, seen by Health Policy Watch recommends “four interrelated elements to an ecosystem that need to be present,” to stimulate local manufacturing, including:

  • The essential components of supplies, infrastructure, skills and technologies for manufacturing capacity.
  • Financial investments for procurement, the scaling up of production and the equitable distribution of health products.
  • Skilled and trained policy makers and regulatory authorities for product quality, safety and predictability.
  • Information on, for example, actual production capacity and market demand.

It also recommends the “establishment of a network for synchronizing training resources and facilities for building private and public sector capacity in manufacturing, technology transfer, R&D, policy, regulation and implementation. For the moment, access to IP and other know-how needed for R&D and manufacturing is not on the map.

Stefan Anderson contributed reporting for this story. 

Image Credits: Rodger Bosch for MPP/WHO, Netherlands MoH, Clinton Health Access Intiative , Health Products Manufacturing Support PlatformMSP , Rodger Bosch/ MPP & WHO.

Palestinian civil defence responders search the rubble of a building  for survivors in the aftermath of an Israeli air strike in the Gaza Strip.

There has been a massive rise in diarrhoea, respiratory infections and skin conditions and in Gaza since Israel’s siege and bombing of the territory began in early October, disrupting supplies of clean water, sanitation, food, fuel and leaving thousands homeless.

Since mid-October, over 33,551 cases of diarrhoea have been reported in the area, over half affecting children under age five, according to the World Health Organization’s (WHO) Eastern Mediterranean Region (EMRO). During 2021-2022, the average number of diarrhoea cases in children under five was around 2,000 a month.

Almost 55,000 people have been diagnosed with upper respiratory tract infections, over 12,600 with rashes, almost 9,000 with scabies and over 1000 with chicken pox.

United Nations (UN) aid agencies have also warned of cholera, typhoid and measles outbreaks as many people lack access to clean water, food and shelter.

No water in Gaza

In northern Gaza, the two main sources of drinking water, a desalination plant and a water connection from Israel, have been shut down for “several weeks”, while on 4 and 5 November, seven water facilities across the Gaza Strip were directly hit and sustained major damage, including three sewage pipelines in Gaza city, two water reservoirs (in Rafah and Jabalia refugee camp) and two water wells in Rafah, according to the UN’s Office for the Coordination of Human Affairs (OCHA).

OCHA said that by Thursday, all of the Gaza Strip’s 120 municipal water wells were expected to shut down as fuel to pump water is depleted. Israel said last week that it had restored supplies from two pipes into southern and central Gaza, one of which was damaged in the fighting. It is unlikely those supplies can reach the embattled north. 

Israel has blamed Hamas’s monopolization of scarce resources such as food, fuel and water for its own military purposes for the escalating humanitarian crisis in Gaza. But the daily volume of drinking water Israel has allowed to cross the Gazan border with Egypt is enough to serve just 4% of Gaza’s population, OCHA said in its daily update on Wednesday.

WHO EMRO reports that “lack of fuel has led to the shutting down of desalination plants, significantly increasing the risk of bacterial infections like diarrhoea spreading as people consume contaminated water” and has “also disrupted all solid waste collection, creating an environment conducive to the rapid and widespread proliferation of insects and rodents that can carry and transmit diseases”.

It added that “damaged water and sanitation systems, and dwindling cleaning supplies” have made it almost impossible for health facilities to maintain basic infection prevention and control measures. 

“These developments substantially increase the risk of infections arising from trauma, surgery, wound care and childbirth,” it added. An estimated 50,000 women are pregnant in Gaza.

Emergency Medical Teams (EMTs) have been deployed to support Shifa, Aqsa, and Abu Yousuf Al Najjar hospitals in expanding their emergency departments’ capacity.

‘Disastrous conditions’ at biggest hospital

Meanwhile, the medical conditions at Al-Shifa, the largest hospital in the Gaza Strip and one of the oldest Palestinian health institutions, are “disastrous”, according to a joint statement by the United Nations Relief and Works Agency for Palestine Refugees (UNRWA) and WHO. 

Fierce fighting between Israel and Hamas has reportedly been raging for the past several days in the vicinity of the hospital, an area Israel has described as a major Hamas command and control centre.

“There are currently almost two patients for every bed available. The emergency department and wards are overflowing, requiring doctors and medical workers to treat wounded and sick patients in the corridors, on the floor, and outdoors.”

“The number of wounded increases by the hour while patients are undergoing immense and unnecessary pain as medicines and anaesthetics are running out,” they added.

Dr Marwan Abusada, the hospital’s head of surgery, told The Guardian that they have “zero capacity”. 

“We have 153 patients at the ER. All the beds are occupied. We have no space for patients to go after they undergo surgery. We have a type of worms [in] the wounds after the surgery. Most injuries and surgeries have no follow-ups as the medical teams cannot cope with the influx of injuries every hour,” said Abusada.

On Wednesday, the UNRWA facilitated the delivery of WHO’s emergency medical supplies and medicines to Al-Shifa Hospital in Gaza City,” only the second delivery of lifesaving supplies to the hospital since the escalation of hostilities and the total siege of Gaza began”.

Out of almost 1.5 million displaced people, nearly 725,000 are in 149 UNRWA facilities, while 122,000 are sheltering in hospitals, churches, and other public buildings, and about 131,134 in 94 non-UNRWA schools, while others are living on the streets near hospitals.

Shelters run by UNRWA are so overcrowded that an average of 160 people are sharing a toilet and there is one shower for every 700 people, according to the agency.

France hosts Gaza conference

Delegations from over 80 countries and organisations met on Thursday at the International Humanitarian Conference for the Civilian Population in Gaza hosted by France on the eve of its annual Paris Peace Conference.

United Nations (UN) Under-Secretary-General for Humanitarian Affairs Martin Griffiths told the conference that the UN “cannot be part of a unilateral proposal to push hundreds of thousands of desperate civilians in Gaza into so-called safe zones”  if there is no agreement between all the parties on the establishment of these zones.

Calling for an immediate humanitarian ceasefire, he also expressed concern that “satisfactory conditions do not exist anywhere in Gaza to ensure adequate shelter, food, water, sanitation and health”.

Meanwhile, International Rescue Committee President David Miliband told CNN on Wednesday that a humanitarian ceasefire in Gaza needed to last for an “absolute minimum” of five days to allow aid agencies to do their work. Israel gave people in northern Gaza four hours to leave the territory on Wednesday before it intensified its attacks again.

“There needs to be a massive scale-up of the aid flows – that’s medicines, that’s non-food items, that is food, that is water, the basics of life and the fuel to get those goods around the Gaza Strip,” said Miliband.

“Second, you can’t deliver aid without aid workers,” he added, but it was unsafe for them to operate. 

“Thirdly — essential — we’ve got to be able to have safety for civilians who come to receive aid when they bring their kids when they bring their wounded, they’ve got to be able to be safe in a health centre,” added Miliband, warning of the threat of cholera, measles and typhoid.

On Thursday, the US White House announced that Israel had agreed to daily four-hour military pauses in northern Gaza, which would be announced three hours beforehand. They are intended to encourage people to flee to the south via two humanitarian corridors that have also been agreed upon.

No end in sight as war enters second month 

A Palestinian Civil Defense vehicle was struck by an Israeli air strike on 21 October. The strike killed between 6 and 10 civilians, according to Airwars.

As the brutal war between Israel and Hamas presses on into its second month, over 10,569 people – one in every 190 Palestinians living in Gaza – are dead, according to the Gaza Health Ministry. The Ministry does not distinguish between combatants and civilians.

Nearly 1,400 Israelis and foreign nationals have been killed in Israel, the vast majority on 7 October, according to Israeli authorities. Some 240 men, women and children kidnapped by Hamas and other militias on the day of the attack continue to be held hostage. Their locations within Gaza and the number still alive are unknown.

UN Secretary-General Antonio Guterres strongly condemned both Hamas’s brutal and deadly assault on thousands of Israeli civilians on 7 October, as well as its war tactics of embedding military facilities into critical civilian infrastructure and using civilians as “human shields,” in an interview with Reuters on Wednesday.

Hamas has fired over 9,500 missiles into Israeli cities since its 7 October incursion into 22 Israeli communities where civilians  were shot and burnt to death in their homes. Hamas-aligned militias in southern Lebanon have also stepped up their missile attacks into northern Israeli cities, reaching as far as the outskirts of Haifa.

Guterres also emphasised the deadly toll the massive Israeli airstrike campaign is inflicting on civilians in Gaza: “When one looks at the number of civilians that were killed with the military operations, there is something that is clearly wrong.”

The first 19 days of the war saw Israel conduct over 7,000 airstrikes on Gaza, killing an estimated 6,500 people. The 7,000 bombs dropped on Gaza – a territory half the size of New York City – in under three weeks outpaced even the most intense month of the bombing campaign by the US-led coalition against the Islamic State in Iraq and Syria (ISIS), according to Airwars.

The rate at which Israeli airstrikes are hitting Gaza ranks as one of the most intense campaigns of the 21st century. The deadly toll on humanitarian, medical and media workers has been unprecedented.

The war in Gaza is already the deadliest conflict for journalists since the Committee to Protect Journalists (CPJ) began gathering data in 1992. As of 9 November, 39 journalists – 34 Palestinian, four Israeli and one Lebanese – were confirmed dead, according to the CPJ. This accounts for 70% of journalists who have lost their lives reporting since the start of 2023.

The situation for humanitarian workers is even more dire. UNRWA announced on Wednesday that two members of its staff had been killed in the preceding 24 hours. Seven more UNRWA staffers were confirmed dead by the time the agency’s Commissioner General, Philippe Lazzarini, spoke at the international conference on Gaza in Paris on Thursday.

The 99 UNRWA staffers killed since the onset of the war is “the highest number of United Nations aid workers killed in a conflict in the history of the United Nations,” the agency said.

Civilian lives buried beneath a war of numbers 

The deaths in Gaza include at least 2,550 women and 4,237 children, with another 25,956 people injured, Gaza’s Health Ministry has said. A further 2,260 people are reported missing, many presumed to be buried beneath the rubble left behind by Israeli air strikes, including 1,270 children. The Gaza Health Ministry is controlled by Hamas. 

More than 1.5 million Palestinians – three-quarters of the population of Gaza – have been displaced since the start of Israel’s military operations in the enclave. The flow of aid on which Gazans depend has slowed to a trickle. In peacetime, around 500 trucks transporting humanitarian aid and commercial goods entered Gaza every day. But a month after the Hamas attack on Israel, just 650 trucks had been allowed to enter the enclave. 

One out of every 19 people in Gaza are either injured, missing, or dead, according to Gaza Health Ministry figures. Hamas is estimated to have a fighting force of between 20,000 and 30,000 combatants – 1.5% of the population of Gaza. Children, meanwhile, make up around 47% of Gaza’s population, according to UNICEF. 

“We need to distinguish – Hamas is one thing, the Palestinian people (are) another,” said Guterres. “If we don’t make that distinction, I think it’s humanity itself that will lose its meaning.”

Gilad Erdan, Israel’s Ambassador to the United Nations, shot back at the UN chief, stating that Israel is working to limit civilian casualties and has opened an evacuation corridor to South Gaza, while Hamas targets Israeli civilians. 

“Would the Secretary-General dare say that since the number of German civilian casualties during World War II was higher than American or British civilian casualties, it meant that something was ‘wrong’ with the US and UK military operations when fighting a genocidal regime?” Erdan told Reuters, adding that the death toll provided by the Gaza Health Ministry should not be trusted. 

Israeli officials have repeatedly disputed the casualty figures provided by the Gaza Health Ministry, citing its lack of distinction between civilian and military casualties and influence exerted by Hamas over death tolls. US President Joe Biden has voiced similar scepticism, stating on October 27 that he had “no confidence in the number that the Palestinians are using”. 

However, the Gaza Health Ministry’s death tolls from previous wars with Israel have proven reliable. The numbers provided by the Ministry during clashes with Israel in 2008, 2014 and 2021 all matched – with small discrepancies – the post-war tallies reached by UN, independent, and even Israeli investigations. 

“The numbers may not be perfectly accurate on a minute-to-minute basis,” Michael Ryan, head of the WHO’s Health Emergencies Program said of the Gaza Health Ministry figures. “But they largely reflect the level of death and injury.”

Children dying at an unprecedented rate 

The estimated 4,237 children killed in Gaza account for 40% of all deaths since the war began, a staggering rate with few precedents. 

Three weeks into the war, Save the Children revealed the number of children killed in Gaza was greater than the total number of children who lost their lives in all global conflicts since 2019. A further 980 children in Gaza have been confirmed dead since that report. 

“An average of about 160 children are killed every day based on the figures of the [Gaza] Ministry of Health,” WHO spokesperson Christian Lindmeier said at a media briefing on Tuesday.

Seven years into the ongoing Yemeni civil war, a conflict in which both sides have employed child soldiers and notorious for its high rate of child casualties, 3,773 children – fewer than in just one month of the war in Gaza – have died, according to the UN. The deadliest conflict for children in recent decades is the Syrian civil war, in which 27,126 children were killed in over 10 years of fighting. 

If child deaths continue to proceed at the current rate, the number of children killed in Gaza would match that of more than 10 years of Syria’s civil war in around seven months.

The historic rate at which children are losing their lives in Gaza is transforming the enclave into “a graveyard for children”, Guterres said on Monday. 

“Every year, the highest number of killings of children by any of the actors in all the conflicts that we witness is the maximum in the hundreds,” said Guterres in an interview with Reuters on Wednesday. 

“We have in a few days in Gaza thousands and thousands of children killed, which means there is also something clearly wrong in the way military operations are being done,” he stated.

Hamas’s bloody calculation

Flames and smoke billow during Israeli strikes in Gaza, which have caused an unprecedented level of destruction since the 7 October Hamas incursion into Israel.

To Hamas leadership, the deaths and displacement of Palestinian civilians are not a surprising or unwanted outcome, but a pivotal part of a bloody calculation, according to new reporting based on interviews with its senior leadership in Doha, Qatar. 

“We succeeded in putting the Palestinian issue back on the table, and no one in the region is experiencing calm,” Khalil al-Hayya, a high-ranking member of Hamas’s leadership, told the New York Times of the largest massacre of Jews since the Holocaust.

“What could change the equation was a great act, and without a doubt, it was known that the reaction to this great act would be big,” al-Hayya added when asked about the scale of civilian deaths in Gaza.

The terror group’s leaders have repeatedly declined to express any remorse for the brutal actions of its fighters in the raid on Israel and its citizens that left 1,400 dead and more than 200 taken hostage.

“We had to tell people that the Palestinian cause would not die,” al-Hayya concluded, regarding the thousands of Palestinian and Israeli lives lost since the Hamas attack on 7 October.  

On Thursday, Palestinian terror group Islamic Jihad released a video of two hostages, offering their release. The captives include a 77-year-old woman and a 13-year-old boy, abducted with his brother, father and partner, from Kibbutz Nir Oz.

Negotiations are reportedly underway in Doha between Israel, the United States and Qatari mediators over the possibility of the release of 10 to 15 hostages in exchange for a one-two-day humanitarian pause, Reuters reported.  

“Israel is a country that has no place on our land,” declared Hamas official Gazi Hamad in a Lebanese TV interview last week. “The existence of Israel is illogical….7 October, 10 October, 1 million October, it is justified.”

Elaine Ruth Fletcher contributed to this report. 

Image Credits: Airwars, WHO EMRO.

Pandemic agreement negotiations are underway again this week

An effective pandemic agreement will need to include “accountability mechanisms” to ensure that countries implement the terms – and these will need to be independently monitored, according to new research published in BMJ.

“Accountability mechanisms are used through a variety of methods across global treaties and governance mechanisms to varying degrees of effectiveness,” argue the researchers, based on their evaluation of other global treaties and interviews with experts. 

“The pandemic agreement should have accountability mechanisms built into it from the start to increase the likelihood of countries complying with the obligations they sign up for.”

 

‘Soft incentives’ for compliance

While finding consensus is the current imperative for the INB, there is a risk that countries will simply fail to implement the terms of a pandemic agreement.  During the COVID-19 pandemic, for example, many countries did not comply with the  International Health Regulations (IHR), despite the fact that they are legally binding.

To enhance compliance with a pandemic agreement, the researchers – mostly from Spark Street Advisors – argue for the provision of “soft incentives” such as “technical and material resources” to help countries.

“Reputational incentives” could also assist with compliance, they add, arguing against “the harms of sanctions and benefits-based incentives”.

But compliance with the terms of the agreement should not simply rely on countries’ self-reporting, as is the case with many international agreements.

“The pandemic agreement should establish, as part of its institutional arrangements, an independent monitoring committee, tasked with producing regular assessments of state parties’ compliance with the pandemic agreement and the timeliness, completeness and accuracy of self-reporting,” they argue.

This monitoring committee “should be politically, financially, technically and operationally independent of the WHO and donors”, and able to” triangulate” information from a diverse range of sources including civil society about countries’ compliance.

It would report to a high-level political body to promote compliance with the pandemic agreement.

‘Find common ground between public health and profit’

Meanwhile, Dr Tedros Adhanom Ghebreyessus, the Director-General of the World Health Organization (WHO), appealed to member states negotiating a pandemic agreement to find “common ground”  between equitable access and innovation; protecting public health and making a fair profit; global health security and national or regional interests. 

Addressing a closed session of the seventh meeting of the intergovernmental negotiating body (INB) in Geneva on Wednesday, Tedros warned that “a pandemic agreement that fails to ensure collective security and equity in all its forms, fails”. 

Referring to “numerous meetings” in the almost two years since a special session of the World Health Assembly decided to establish the INB, Tedros said “I believe strongly that this [negotiating] text may help you come closer together on the path towards consensus.

“No one is pretending your work is easy. I know it is not. It is not surprising that, with 194 member states, reaching consensus is not straightforward. But that does not mean it is unachievable,” said Tedros, whose INB speech was released by WHO.

Sovereignty ‘nonsense’

Tedros also appealed to member states to counter the “torrent of fake news, lies, conspiracy theories and mis- and disinformation”. 

“There are those who say – whether they believe it themselves or not – that the accord will cede sovereignty to WHO; that it will give the WHO Secretariat power to impose lockdowns or vaccine mandates on countries, and other nonsense. 

“You know and we know that the agreement will give WHO no such powers.  We need your support to put this nonsense to rest.  We need your support to counter these lies, by speaking up at home and telling your citizens that this agreement will not, and cannot, cede sovereignty to WHO. Period.”

The seventh INB meeting started on Monday, will break on Friday, and then resume on 4-6 December.