Gaza Palestinian arrives in Egypt via the Rafah border, opened for the first time to the exit of critically wounded and ill since the start of the Israeli-Hamas conflict.

WHO’s Director General Dr Tedros Adhanom Ghebreyesus repeated calls for a “humanitarian pause” in the fierce fighting between Israel and Hamas-controlled Gaza to allow for the resupply of Palestinian hospitals in Gaza, and treatment of injured and ill, saying “we are running out of words to describe the horror.”

Speaking at a press briefing Thursday, Tedros welcomed Egypt’s agreement Tuesday to open two northern Sinai’s hospitals to critically ill or injured Palestinians, but noted that so far only 46 people have so far managed to cross over for treatment.  Three field hospitals to be set up in Gaza are also in the planning now to handle the humanitarian emergency. But implementation would depend on safe passage arrangements. And such facilities cannot replace regular services, Tedros stressed, noting that 14 out of 36 hospitals in the Gaza Strip are not functioning right now.  

Meanwhile, while the world’s attention is focused on Gaza and Israel, Sudan’s health system is also cracking under the strain of more than 7 million internally displaced people – one of the largest in the world, said WHO’s director general in his remarks.

“The already fragile health system is buckling under the load of injuries, outbreaks, malnutrition and untreated cases of diabetes, cancer and cardiovascular, kidney and respiratory disease,” Tedros said. “In addition to measles, rubella, malaria and dengue, outbreaks of cholera have been declared in three states.”   

Horror still unfolding

WHO Director General Dr Tedros Adhanom Ghebreyesus at 2 November press briefing.

“Since Hamas’s horrific attacks on Israel, on 7 October, more than 10,000 people have been killed. including more than 8500 in Gaza, and 1400 in Israel,” Tedros said. “In both Israel and Gaza,  Some 70% of those killed are women and children. More than 21,000 people are injured and more than 1.4 million people in Gaza have been displaced. 

Despite the rising calls for a “humanitarian pause” including from US President Joe Biden, the conflict showed no signs of letting up yet. Israeli ground troops appeared to be tightening their grip around Hamas strongholds in Gaza City, in the north of the enclave, backed by aerial bombardment.  Hamas missile attacks on Israeli cities continued for the 27th day, while in Lebanon, Hizbullah and Hamas stepped up pressure on Israel’s northern front, firing dozens of rockets into Israeli communities Thursday evening with a fiery direct hit in one city, Kiryat Shmona.  

“Everywhere…. death, destruction, loss. So far, WHO has verified 277 attacks on health care, including 218 in the occupied Palestinian territory, and 19 in Israel,” Tedros remarked. 

“The situation on the ground in Gaza is indescribable. Hospitals crammed with the injured lying in corridors…. Doctors performing surgery without anesthesia. Thousands of people seeking shelter from the bombardment. Families crammed into overcrowded rooms desperate for food and water.  Toilets overflowing and the risk of disease outbreak spreading and everywhere.

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.

“At the very least, we need a humanitarian pause in the fighting and ideally a ceasefire. We need unfettered access and safe passage agreed by both parties to ensure the security of access routes,”’” the WHO Director General warned. 

“Let me be clear, there can be no justification for Hamas’s horrific attacks on Israel,” he said referring to the 7 October surprise rampage by Hamas gunmen into 22 Israeli communities near Gaza that left over 1300 Israelis shot, burned or bludgeoned to death, while 242 men, women and children were taken hostage.

“I understand the grief, the anger and the fear of the Israeli people. I also understand the grief,  the anger and the fear of the Palestinian people,” Tedros said.

“WHO continues to call on Hamas to release the hostages, many of whom need urgent medical attention,” he added.  

“We continue to call on Israel to restore supplies of electricity, water and fuel. We continue to call on both sides to abide by their obligations under international humanitarian law. And we call on who[ever] can, to de-escalate this conflict rather than inflame it.”

WHO supplies delivered – but not reaching all parts of the enclave 

WHO health supplies delivered to Al Nasser Medical complex in the southern Gaza city of Khan Younis on 23 October, after a humanitarian corridor from Egypt opened up. Resupply to hospitals in northern Gaza has become virtually impossible since Israeli ground troops entered Gaza, WHO says.

So far, WHO has been able to deliver some 54 metric tons of medical supplies to Gaza since an emergency corridor opened from Egypt, at the Rafah crossing, said Tedros.  But he described this as a “drip feed” of aid in comparison to the scale required. 

“Before the seventh of October, an average of 500 tracks a day were crossing in together with essential supplies. Since the seventh of October, only 217 tracks have entered in total.  To sustain the humanitarian response on the scale needed, we need hundreds of trucks to enter Gaza every day.” 

And with fierce fighting underway in northern Gaza between Israel and Hamas for the past several days, resupply of many health facilities has been impossible, said Mike Ryan, WHO’s Executive Director of Health Emergencies.  

“Getting trucks over the border is one thing, getting them to the places in which they’re needed is another and that has not been facilitated that has not been supported, in fact, if anything quite the opposite,” he said. 

Over the coming months,  WHO is developing a plan to set up three field hospitals in Gaza, including one in the northern part of the enclave and two in the south, said Dr Richard Peeperkorn, WHO’s Jerusalem-based representative for the Occupied Palestinian Territories.   

Dr Richard Peeperkorn, Jerusalem-based WHO representative to the Occupied Palestinian Territories.

The field hospitals would be part of a $50 million operational plan, also including recruitment of specialized emergency medical teams from abroad (EMTs). 

Even so, “the focus is first and foremost, on supporting existing health facilities, strengthening and maintaining services and instituting a trauma pathway,” Peeperkorn underlined. “We are now in an ultra-emergency phase. But in this humanitarian response, we have to focus on supporting, making sure that the existing health systems will be able to deliver. 

“It would be really a bit delusional if you think that when a few EMTs from outside, or setting up a few hospitals, that we can supply appropriate or even a minimum level of health services for 2.2 million Gazans.

“To have, of course, this plan – to make sure it’s operational, we need, ideally, a humanitarian ceasefire.  But we definitely need  humanitarian corridors and then a sustained access to the needed supplies.”

Presence of Hamas centers under hospitals – irrelevant to obligation to protect them 

Al Shifa Hospital – 15 October. Emergency Medical Teams (EMTs) deployed in a tent outside the hospital, the largest in Gaza, to handle the surge of patients.

As for Israel’s assertions that Hamas has sited key military command and control centers as well as supplies, underneath some of Gaza’s major hospitals, particularly Al Shifa and Al Quds in the northern part of the enclave, Ryan said that this didn’t absolve Israel from the responsibility to shield the facilities from attack.  Israel has told the hospitals that they need to evacuate patients and staff to the south, in order to stay clear of the conflict. 

“The reality on the ground at Al Shifa and other hospitals is that we have thousands of health workers, thousands of patients, and probably hundreds of thousands of civilians sheltering at these multiple facilities particularly, and all over but in the north now,” Ryan said. “The rules are clear on this. Health care must be protected. 

“We know what’s going on above the ground. We deal with the doctors, the nurses and the administrators of the hospitals, and they’re crammed full of patients, ongoing operations, intensive care, and much much else.

“We have no information on what may be happening elsewhere, or underneath these facilities. That’s not information we would have or could verify.”

Mike Ryan, WHO Health Emergencies ED: Use of hospitals for military purposes is illegal, but WHO has no independent verification of the reports.

While Ryan acknowledged that any “misuse of facilities for military purposes is equally outlawed under international law… we have no independent verification whatsoever of any of the information.

“And in this situation where such an eventuality occurs, again, it is the responsibility of the occupying power to, not only agree with the local health authorities on an evacuation, but then if that does happen, that has to be fully facilitated, fully supported logistically, and those patients those doctors need to have a place of safety where the patients can receive an adequate and similar amount of care. None of those, none of those criteria are met.” 

Mental health trauma on both sides 

Burnt-out remains of a home at Israel’s Kibbutz Kfar Aza, near the Gaza border where 52 of the community’s 400 members were killed by Hamas on 7 October, and another 20 are missing or held captive.

Israelis as well as Palestinians are suffering the snowballing mental health effects of the ongoing revelations around the Hamas massacre on 7 October and ensuing war, said Peeperkorn as well as WHO’s representative in Israel, Dr. Michel Thieren. 

In Gaza, there is the lack of day -to-day access to basic necessities, as well as the constant risk of death from aerial bombardments, Peeperkorn observed. 

While UN staff are often considered “a bit more privileged than the other Gazans…  in many of my staff, they are completely desperate, utterly, utterly desperate, and utterly depressed, and no vision about life anymore.  And this is a group that a lot of people would call privileged, so think about the rest of Gazans.    

On the Israeli side, still-unfolding evidence of the rape, mutilation, or burning of many civilian victims of the 7 October Hamas incursion, has become seared in the collective Isareli consciousness. Along with that, are the concerns about the fate of the 242 hostages reportedly held by Hamas, including about 50 infants, children and older people, as well as women and men. 

“It’s a whole shadow of trauma that is spreading across the country, the survivors, the families of hostages, the witnesses of atrocities,” said Thieren, who has been quoted saying that in Israel’s Kfar Aza, near the Gaza border, he saw scenes “that I never saw in  Syria, Iraq, Sudan or anywhere else.”   

“The displaced populations, the hosting communities of those displaced people and survivors. I would even say, the decision makers, the whole country is plunged into a night of trauma, and the trauma spreads like a virus.” 

He noted that WHO’s European Regional Director Hans Kluge had just visited Israel to see the site of the 7 October mass killings first-hand, and discuss strengthened collaborations on mental health and rehabilitation.

Image Credits: WHO/EMRO, Health Policy Watch.

A climate early warning system in Zambia.

Wealthy nations are falling tens of billions of dollars short of their pledge to help climate-vulnerable regions adapt to a warming planet, widening an already vast gap in funding and leaving millions at risk, according to a new report from the UN Environment Programme (UNEP).

The report, released on Thursday, found that international financial flows for climate adaptation in developing countries fell to just $21 billion in 2021, down 15% from a peak of $25.2 billion between 2017 and 2020.

This is a fraction of the estimated cost of helping low-income countries adapt to the worst effects of climate change, which UNEP estimates to be 10 to 18 times greater than current levels.

The annual gap in adaptation financing alone is now estimated at $194 billion to $366 billion, an increase of 50% from the UNEP’s estimate from last year.

The $21 billion provided by advanced economies in 2021 is equal to just $3 for each of the 6.82 billion people living in the 152 countries classified as developing by the International Monetary Fund. 

Adaptation costs in climate-vulnerable countries will soar as the planet warms, UNEP warned, exacerbating the adaptation gap unless countries step up to provide funding.

“The world is sleeping on adaptation even when the wake-up call that nature has been sending us is becoming ever more shrill,” Inger Andersen, Executive Director of UNEP, said at a press conference on Thursday. “This year we saw temperature records again being broken. We saw more floods, more heat waves, more droughts, and more wildfires [inflict] misery upon very vulnerable communities.”

The UNEP report comes as the world heads into the final quarter of what is set to be the hottest year on record. The average global temperature on a third of days in 2023 has already exceeded 1.5C over pre-industrial levels. 

“The international community should be throwing billions of dollars at helping developing nations to adapt to these impacts – but it isn’t,” said Andersen.

The UNEP report also sets the stage for COP29, the critical UN climate summit to be held in Dubai later this month. World leaders at the two-week summit will attempt to reverse the current trajectory of global fossil fuel emissions, which is on track to warm the planet by 2.4C to 2.8C by 2100 under a business-as-usual scenario.

A study published in Nature on Monday found that the planet will be locked into a future over 1.5C in just under three years, in early 2029.

“Storms, fires, floods, drought and extreme temperatures are becoming more frequent and more ferocious, and they’re on course to get far worse,” UN Secretary-General Antonio Guterres said in a statement accompanying the UNEP report. 

“Yet as needs rise, action is stalling,” said Guterres. “The world must take action to close the adaptation gap and deliver climate justice.” 

Why is the adaptation gap widening? 

The adaptation gap – the difference between the amount of money needed to allow developing countries to adapt to climate change and the financing that governments have made available – is widening as the risks posed by climate change in developing countries escalate. 

Three main reasons explain the widening gap.

First, climate change is happening faster and with more severe impacts than previously thought. This means countries on the frontlines of the climate crisis need to do more to adapt, which requires more money. Fifty-five of the world’s most vulnerable economies have already lost over $500 billion to the climate crisis in the past two decades, according to a recent study.

“On the basis of the IPCC’s (Intergovernmental Panel on Climate Change) sixth assessment report, we anticipate higher impacts from climate change, even in the short term,” said Paul Watkiss, lead author of the finance section of the UNEP report. “Higher [climate] impacts means we have to do more adaptation.”

Second, international funding for adaptation is not keeping pace with the increasingly urgent needs of developing countries. International public adaptation finance fell by 15% in 2021, despite the proven economic benefits of investing in adaptation.

Every $1 billion invested in infrastructure to protect people from coastal flooding could save $14 billion in economic damages, UNEP found. And for every $16 billion invested in agriculture each year, 78 million people could be spared climate crisis-related starvation or chronic hunger.

The authors of the UNEP report attribute the drop in adaptation funding in 2021 to the financial pressures caused by the COVID-19 pandemic and the war in Ukraine. However, they also noted that the $3 billion lost is a drop in the ocean compared to the $194 billion to $366 billion that developing countries need.

“Our estimates of the costs of adaptation of increasing, and at the same time, the financing is at least plateauing, or even decreasing,” said Watkiss. “And so the gap widens.” 

Third, developing countries are reporting more accurate data on their adaptation needs, helping UNEP to better forecast problems it may not have had sufficient data to include in previous reports. 

As more data comes in, UNEP is able to quantify more needs, suggesting that the current UN estimate of the adaptation gap likely remains too low.

Unkept promises underline the scale of the adaptation funding gap

Action zone at the COP26 venue in Glasgow, Scotland where this rotating globe hanging from the ceiling reminds delegates of what they are trying to save.

Unfulfilled climate funding pledges from advanced economies expose the vast gap between rhetoric and reality in adaptation funding.

In 2009, advanced economies pledged $100 billion per year by 2020 to help developing countries mitigate and adapt to climate change. This pledge was reaffirmed in the Paris Agreement in 2015, but eight years later, it has yet to be fully met.

“The numbers are not that big: if you compare the $100 billion to the money that the United States spends on its military, and that was spent on COVID or to save its banks, this is peanuts,” Pieter Pauw, a co-author of the UNEP report told Reuters. “It is time for developed countries to step up and provide more.” 

At the COP26 climate summit in Glasgow in 2021, rich countries made another pledge: to double adaptation funding to $40 billion annually by 2025. But with the shortfall in adaptation funding already at $366 billion, this pledge is no longer sufficient.  

“Even if the promise that we made together in Glasgow in 2021 to double adaptation finance support to 40 billion per year by 2025 were to be met – and that doesn’t look likely – the finance gap would fall by only five to 10%,” said Andersen.

Timeline of the emergence of loss and damage in the climate negotiations, culminating in the historic agreement at COP27 last year. The agreement to establish a loss and damage fund is now under threat.

The historic loss and damage fund agreed upon at COP27 in Egypt last year is also in jeopardy due to financing disputes between rich and developing countries, Politico reported this week. 

The question of who should pay for the damages caused by climate change, which is disproportionately impacting developing countries, has returned to the forefront of international climate negotiations.

The United States and Europe, two of the world’s largest historical emitters of greenhouse gases, are facing renewed calls to be held liable for their disproportionate contributions to the problem.

The United States, which resisted calls for a loss and damage fund for decades, is reportedly ready to exit negotiations on the fund if language holding them liable for their disproportionate contributions to global greenhouse gas emissions is not dropped. 

The agreement on the establishment of a loss and damage fund at last year’s COP27 summit in Egypt provided hope that this contentious issue could finally be resolved. However, the recent impasse over the fund has raised concerns that it could be derailed, threatening a critical step towards climate justice.

“We’re at a breaking point,” Avinash Persaud, the lead negotiator for Barbados and aide to Barbados Prime Minister Mia Mottley, told Politico.

A breakdown in negotiations “will break COP,” Persaud added. “I feel that not enough people are sufficiently worried about that”.

Adaptation has limits

In Guinea, rural women form cooperatives where members learn how to plant a vitamin-rich tree called Moringa and how to clean, dry and sell its leaves. Used as medicine or a dietary supplement by societies around the world, Moringa also supports biodiversity and prevents soil erosion.

Adaptation measures such as early warning systems, sea walls, and mangrove restoration are essential for helping communities cope with the impacts of climate change.

Early warning systems help people evacuate ahead of extreme weather events, sea walls protect coastal communities from sea level rise and storm surges, and the restoration of natural ecosystems such as mangroves alleviates flooding and, in the case of Lagos, Nigeria, stops the city from going under water. 

But as the planet warms, warming seas and a rapidly changing climate are pushing these measures to their limits.

“The evidence is clear that climate impacts are rising and are increasingly translating into limits to adaptation,” said Henry Neufeldt, Chief Scientific Editor of the UNEP report. “Some of these may already have been reached.“

Hurricane Otis, which struck Acapulco, Mexico, in September 2023, is a prime example of these limits. The storm rapidly intensified from a tropical storm to a category 5 hurricane overnight, leaving residents off guard and meteorologists struggling to explain what happened.

Powerful hurricanes can normally be observed by meteorologists for weeks prior to landfall. But as the planet warms, sea levels are rising and storms are becoming more unpredictable, limiting the ability of early warning systems to reliably protect coastal communities from extreme weather.

In just 12 hours, Hurricane Otis’ strength more than doubled, reaching record wind speeds of 257 kilometres per hour at landfall. The residents of Acapulco had no time to evacuate, leaving 100 people dead or missing and wreaking vast destruction on the resort town.

“Every day, every week, every month and every year from now on within our lifetimes, things are going to get worse and not a single country in the world is prepared,” said Andersen. “We are inadequately investing and planning on climate adaptation, and that leaves the world exposed.” 

Adaptation: Essential for billions facing climate impacts, despite limits

Climate adaptation measures have limits, but they are essential for the lives and safety of billions of people around the world who are already facing the effects of climate change.

Every decimal increase in the planet’s temperature affects millions. Nowhere is the need for adaptation more acute than in Africa, where at least 15,700 people have been killed and 34 million affected by extreme weather disasters in 2023 so far, according to an investigation by Carbon Brief.

Meanwhile, more than 29 million people continue to face unrelenting drought conditions in Ethiopia, Somalia, Kenya, Djibouti, Mauritania, and Niger, and more than 3,000 people were killed in flash floods in the Democratic Republic of the Congo and Rwanda in May.

Debt-laden countries, suffocating under debt repayments that exceed healthcare spending, face a spiral of rebuilding, sacrificing basic needs, and losing lives if climate adaptation funding is not secured.

“Developing countries, poor countries that are really having difficulties having a balanced budget, will have to divest from education, from infrastructure, health, to simply feed some of their people and respond to major disasters and major catastrophes,” said Ibrahim Thiaw, Executive Secretary of the United Nations Convention to Combat Desertification (UNCCD). “This is the reality of the world today.” 

Projected annual deaths attributable to climate change in 2030 and 2050, according to the Intergovernmental Panel on Climate Change.

Without financial support to help regions adapt to climate change, front-line communities will face conflict and mass migration, Thiaw warned.

“What is left to a young Somali, Haitian, or Sahelian when there is nothing left? When there is no ecosystem to provide food, capital, or natural capital, what is left for them to do but flee?” Thiaw asked.

“People do not fight each other simply because they hate each other,” Thiaw said, on how climate change fuels conflict. “They fight because they are competing for survival.”

Even if global greenhouse gas emissions are halted tomorrow, the planet will continue to warm for decades. The International Energy Agency projected earlier this month that fossil fuel demand will peak by 2030 but remain constant through 2050, nowhere near enough to stop the planet from warming.

“That adaptation finance in the world is actually shrinking at a time when we are calling for a doubling of adaptation is actually quite remarkable,” Thiaw said. “Climate change is hitting more and more, and international climate finance is declining – so where are we going? What impact will it have on the poorest and most vulnerable communities?”

Image Credits: UNDEP, Joe Saade/ UN Women.

GARDP executive director Manica Balasegaram, whose partnership has led the trial.

The world may soon have a new antibiotic to treat gonorrhoea after a successful phase 3 trial of an oral pill, zoliflodacin, that was led and sponsored by a non-profit organisation.

The results were announced late Wednesday by the Global Antibiotic Research and Development Partnership (GARDP), which conducted the trial in collaboration with Innoviva Specialty Therapeutics.

The gonorrhoea bacteria – Neisseria gonorrhoeae – has slowly grown resistant to many classes of antibiotics, leaving injectable ceftriaxone in combination with oral azithromycin, as the last available recommended treatment for gonorrhoea globally.

In a 2017 World Health Organization (WHO) survey of 77 countries, 97% reported cases of drug resistance to common gonorrhoea antibiotics, while two-thirds reported resistance or decreased susceptibility to the last option for treatment with a single drug. Recent reports of emerging ceftriaxone-resistant gonorrhoea infections have heightened the urgency for new antibiotics.

Zoliflodacin showed “statistical non-inferiority” when compared to the standard regimen – and it is much easier to administer as it’s one pill rather than an injection and a pill.

Meanwhile, previous studies have shown that zoliflodacin is active against multi-drug resistant strains of Neisseria gonorrhoeae, including those resistant to ceftriaxone and azithromycin, with no cross-resistance with other antibiotics. 

“The outcome of this study is a potential game changer for sexual health,” said Professor Edward W Hook III, the study’s protocol chair and Emeritus Professor of Medicine at the University of Alabama in Birmingham, US.

“In addition to the potential benefits for patients with infections with resistant strains of Neisseria gonorrhoeae, the potential lack of cross-resistance with other antibiotics and the oral route of administration will simplify gonorrhoea therapy for clinicians worldwide.”

Gonorrhoea bacteria cells.

Non-profit ‘fix’

Gonorrhoea is one of the top three most common sexually transmitted infections with over 82 million new annual infections – mostly in Africa. If left untreated, it can also cause infertility in women, life-threatening ectopic pregnancies, pelvic inflammatory disease and sterility in men.

While the WHO designated gonorrhoea as a “priority pathogen”, no new treatments have been trialled in the past 40 years.

This is the first trial of a priority pathogen led by a non-profit organisation.

“Despite the extremely high public health value, there has been a lack of investment to develop new drugs for gonorrhoea,” said Dr Manica Balasegaram, GARDP’s executive director.

“The zoliflodacin programme demonstrates that it is possible to develop antibiotic treatments targeting multidrug-resistant bacteria that pose the greatest public health threat, and which may not otherwise get developed.”

Meanwhile, Professor Glenda Gray, GARDP board member and President of the South African Medical Research Council (SAMRC), said that “GARDP’s model can play a crucial role in helping to fix the public health failure at the heart of the global AMR crisis and is a significant step forward in the treatment of gonorrhoea”.

The trial involved 930 patients with uncomplicated gonorrhoea and included men, women, adolescents and people living with HIV. Around half the trial participants came from South Africa, with other trial sites in Belgium, the Netherlands, Thailand, and the US.

First-line treatment?

Sinead Delany-Moretlwe, principal investigator for the trial in South Africa

Prof Sinead Delany-Moretlwe, principal investigator for the trial in South Africa, said that the trial had been conducted under difficult circumstances during the height of the COVID-19 pandemic.

“The huge investment in HIV trial infrastructure has really given South African scientists the capacity to do trials in infectious diseases and to yield results that can be submitted to a range of regulatory authorities,” Delany-Moretlwe told Health Policy Watch.

While countries’ medicine regulators still need to grant approval for the drug, parties involved in the trial have discussed an implementation strategy – including whether zoliflodacin should be given as a first-line drug.

“Because it’s an easier drug to administer, if the cost is affordable, it makes sense to implement it [as a first-line treatment],” Delany-Moretlwe, research director of Wits RHI at the University of Witwatersrand in Johannesburg, South Africa.

“And ceftriaxone is not just used to treat gonorrhoea, so it is important to protect a class of drug that is used for more than gonorrhoea in terms of good antibiotic stewardship.”

Another factor in favour of using zoliflodacin for first-line treatment is that it has a unique mechanism that inhibits a crucial bacterial enzyme, which can also help to avoid the emergence of resistance.

Applying for approvals

“GARDP has the right to register and commercialise the product in more than three-quarters of the world’s countries, including all low-income countries, most middle-income countries, and several high-income countries,” according to a GARDP spokesperson. 

However, Innoviva affiliate Entasis Therapeutics has commercial rights for zoliflodacin in the lucrative markets of North America, Europe, Asia-Pacific and Latin America.

“Our aim is to provide sustainable access to an affordable product but we are unable to give further details at this time, as we move into negotiations with commercial partners,” a GARDP spokesperson told Health Policy Watch.

GARDP and Innoviva ST will apply for approval with the US Food and Drug Administration (FDA), and initiate registration activities in South Africa and Thailand shortly after FDA submission. 

“Once approval is obtained in these two countries, we will expand access to zoliflodacin through a process of collaborative approvals within a number of countries,” said GARDP, depending on “the public health need and on the epidemiological situation in each country”.  

Meanwhile, Innoviva CEO Pavel Raifeld said that treatment “could have a profound effect on how physicians approach gonorrhoea infections, as an oral alternative to an injection could improve patient access and compliance, as well as help reduce the increasing spread of antibiotic-resistant strains of the disease”.

The GARDP trial was funded with support from the governments of Germany, UK, Japan, the Netherlands, Switzerland and Luxembourg, as well as the Canton of Geneva, the South African MRC, and the Leo Model Foundation. It builds on a phase 2 clinical trial sponsored by the US National Institute of Allergy and Infectious Diseases (NIAID).

WHO-SEARO 76th Regional Committee Session in New Delhi
WHO-SEARO Regional Director Poonam Khetrapal Singh at the 76th Regional Committee Session in New Delhi, meeting this week in Delhi, where she announced that Bangladesh has become the world’s first country to eliminate visceral leishmaniasis or kala azar.

Bangladesh has become the first country globally to be validated by the World Health Organization for the elimination of visceral leishmaniasis or kala azar, as a public health problem.

VL, a life-threatening neglected tropical disease (NTD) caused by a parasite transmitted by sandflies,  affects some one million people worldwide every year, mostly in Southeast Asia and North Africa.

Bangladesh, India, and Nepal accounted for 70% of the global cases between 2004 and 2008. By 2016, Bangladesh and Nepal brought down the number of cases drastically while the burden in India remains relatively high. While death rates are relatively low, disfigurement of limbs, sexual organs, etc. create huge levels of disability among those untreated.

However, new diagnostics and tools have helped make big inroads in morbidity.

The country achieved the elimination target of less than one case per 10,000 population at the sub-district level in 2017. It has managed to sustain that progress despite the COVID-19 pandemic, leading to the WHO elimination milestone, said WHO Regional Director Poonam Khetrapal Singh speaking at the SEARO Regional Committee meeting ongoing in Delhi this week, where the achievement was announced. .

At the meeting the global health agency also noted that the DPR Korea has eliminated rubella and Maldives has interrupted transmission of leprosy – another NTD.

Maldives has not reported a leprosy case for more than five years now, WHO said, making it the first country in the world to officially verify interruption of transmission, through a concerted effort to reduce stigma and discrimination so that people infected could be diagnosed, treated and cured.

NTDs are a diverse group of 20 tropical infections that are common in low-income regions of Africa, Asia, and the Americas. They are also often under-researched and ignored by the research community and pharmaceutical companies. WHO’s NTD Roadmap aims to reduce by 90% the number of people requiring treatment for NTDs by 2030.

“Neglected tropical diseases like lymphatic filariasis, visceral leishmaniasis and leprosy, along with the threat to children and young people posed by rubella, require continued national leadership, commitment and collaborative action by countries and health partners worldwide,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus, in a WHO statement. “These achievements will positively impact the lives of the most vulnerable populations now and in the future,” he added.

Image Credits: WHO.

Climate change: A firefighter fighting against a veld-fire at  Jeffreys Bay, Eastern Cape Province, Republic of South Africa

A group of international health organisations representing 46 million healthcare workers, has published an open letter to the COP28 president Dr Ahmed Al Jaber demanding an “end to the fossil fuel era” at the upcoming UN Climate Conference in Dubai (29 November-12 December). Al Jaber, is the United Arab Emirates Minister of Industry and Advanced Technology as well as Special Envoy for Climate Change.

Meanwhile, an official declaration set to be signed by the world’s  Ministers of Health at the first-ever  UNC climate conference “Health Day” makes no reference to the fossil fuel phase out at all. On the plus, side, the final version, seen by Health Policy Watch, makes reference to a “just transition” in energy consumption as well as the important of reducing air pollution – much of which is emitted from climate-polluting sources.

The letter organized by two civil society organizations, Health Care Without Harm and the Global Climate and Health Alliance, uses stronger language than the official declaration:

“Fossil fuel interests have no place at climate negotiations,” states the letter, signed by some two dozen heads of global and regional associations and federations of health workers.

It demands that “countries commit to an accelerated, just and equitable phase-out of fossil fuels as the decisive path to health for all” at the annual UN climate conference.

“Ending our dangerous dependency on fossil fuels will improve the health prospects of future generations and will save lives. Keeping the global temperature increase within the 1.5°C target of the Paris Agreeement.”

“A full and rapid phase-out of fossil fuels is the most significant way to provide the clean air, water, and environment that are foundational to good health,” the open letter further states. “We cannot rely on unreliable and inadequate solutions, like Carbon Capture and Storage (CCS), that extend the use of fossil fuels but do not generate the real and immediate health improvements which a renewable energy transition provides. False solutions like CCS risk making harmful emissions worse, straining the health of overburdened communities and delaying our progress toward meaningful climate progress.”

Exclude fossil fuel industry representatives from COP

Can fossil fuels give way to solar power? COP28 UAE’s host is a petrostate – where fossil fuel pressures are keen to slow or stop the clean energy transition.

Another key demand of the appeal is that fossil fuel industry representatives be excluded from climate negotiations.

“Fossil fuel interests have no place at climate negotiations…. Just as the tobacco industry is not allowed to participate in the WHO Framework Convention on Tobacco Control, it is imperative to safeguard global collaboration on climate progress from the lobbying, disinformation, and delays in favour of industry interests,” states the letter.

Last year’s COP27 saw a record number of representatives for the oil and gas industry in attendance, and this year the number is expected to be higher.

The letter, supported by organisations that represent 46.3 million health professionals such as the World Medical Association, World Federation of Public Health Association and International Council of Nurses, outlines the critical need to protect  human health by reducing dependence on fossil fuels, rapidly investing in clean energy technology and reducing air pollution – all from the perspective that public health will benefit from this rapid transition. This letter is also endorsed by leading medical journals such as the British Medical Journal.

“As representatives of the global medical community, … we are already seeing the impacts of the climate crisis on our health – heat stress, malnutrition, anxiety, vector-borne diseases, respiratory illnesses due to dirty air to name a few. Extreme weather events have another far reaching impact- hospitals and healthcare centres that are meant to provide cure and relief are often first in the line of fire, with access and infrastructure getting hit. Our dangerous addiction to fossil fuels will only aggravate this further. This is why we think that a rapid transition to clean and equitable forms of energy is a win-win on all fronts,” stated Dr. Lujain Alqodmani, President, World Medical Association.

“For the first time in the history of climate talks, there will be an entire day dedicated to health, providing an opportunity to address the direct health impacts of climate change on individual wellbeing and health care systems,” said Josh Karliner of Healthcare Without Harm.

“Health Day is a fantastic achievement to be celebrated. But unless the UAE COP Presidency and the world’s governments, including the health ministers attending health day, can address fossil fuels as the root cause of the climate crisis, it will call the credibility of health day and the COP process itself into question.”

When disaster strikes, healthcare at the forefront

Climate change: when disaster strikes, the health sector is at the forefront.

“When disaster strikes, hospitals and health care centres are often at the forefront,” added Dr. Pam Cipriano, President, International Council of Nurses. “They are also the epicenter of addressing the escalating and noxious effects of climate change that are robbing people of their health. We are seeing more people come into our health care centres, hospitals and clinics complaining of heat exhaustion, respiratory issues and allergies, second hand smoke exposure among other things.

“We firmly believe that COP28 is an opportunity to adopt unified solutions and take action to implement mitigation and adaptation policies that also protect our health. This means phasing out “dirty energy” like coal, oil and gas that have negative impacts on health and the environment and prioritising clean energy sources. We must invest in a healthy and climate-safe future–the time to act on this is now.”

“The Elders”, a group of senior leaders founded in 2007 by Nelson Mandela working for peace, justice and sustainability,  also added their support, “calling on the COP28 Presidency and all countries to commit to an accelerated, just and equitable phase-out of all fossil fuels.

“To safeguard the well-being of future generations, we must sever our dangerous reliance on fossil fuels and move quickly to support a transition into renewable energy so we can stay within the 1.5°C limit pledged in Paris. Without a resolute commitment to phasing out fossil fuels, we risk undoing our hard-won progress in safeguarding human health,” they stated.

Health Day Declaration makes no mention of fossil fuels

COP27
Global Young Greens protestors demanding the end of fossil fuels at last year’s UN Climate Conference in Sharm el Sheikh (COP27).

In terms of the absence of any reference to fossil fuels in the official Health Day declaration, the United States – not the UAE – pressured for more indirect language, sources told Health Policy Watch.

Since the main COP negotiations are anyway going to focus on the framing of the fossil fuel issue – US negotiators preferred not to draw that central controversy into the Health Day declaration, the sources said.

“We did manage to get in just transition and a reference to air pollution.  But no strong language on fossil fuels; countries did not want to pre-empt the wider discussions at COP,” said one diplomatic source.

The letter, organized by civil society groups, pulls no punches. It affirms that, “a rapid and full and rapid phase-out of fossil fuels is the most significant way to address health impacts of climate change.”

However it also does stress that unlocking more finance for low and middle income countries is the essential path to deliver an energy transition that is “just and equitable to all.”

Image Credits: Pixabay, Commons Wikimedia, Gellscom/CC BY-ND 2.0., Commons Wikimedia, Twitter/Global Young Greens.

Image Credits: AfricaNews.

A healthcare provider screens people for African sleeping sickness.

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

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

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

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

Disproportionate impact of infectious diseases

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

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

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

A woman prepares for an HIV test in Uganda.

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

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

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

Funding mechanisms must advance equity

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

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

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

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

Collaboration is important for impact

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Reverse order against Al Quds Hospital

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

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

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

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

Israel says Hamas headquarters are under Gaza hospitals 

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

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

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

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

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

Hamas has denied the claims. 

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

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

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

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

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

Appeals to release hostages  

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

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

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

 

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

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

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

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

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

‘Disappointed’ by failure to condemn Hamas rampage  

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

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

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

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

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

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

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

Humanitarian aid flows 

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

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

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

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

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

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

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

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

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

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

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

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

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

Co-chair Kolinda Grabar-Kitarovic

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

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

‘Canary in the coal mine’

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

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

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

Joy Phumaphi, GPMB co-chair

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

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

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

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

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

Tedros agrees with independent monitoring 

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

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

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

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

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

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

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

Financing needs ‘fundamental reform’

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

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

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

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

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

Governance: ‘Everything, everywhere all at once’

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

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

Ilona Kickbusch

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

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

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

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

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

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

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

More equitable R&D

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

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

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

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

Board member Chris Elias outlines the R&D proposals

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