According to an article recently published in the Lancet, some 10% to 25% of the USD $7 trillion spent on healthcare globally every year is lost because of corruption – an amount that exceeds the investments needed to achieve universal healthcare by 2030.

To understand how corruption affects healthcare worldwide, the Global Health Centre at the Geneva Graduate Institute organised a panel to discuss how the phenomenon manifests itself and what can be done to fight it. The event was introduced by Vinh-Kim Nguyen, Co-Director at the Centre, and moderated by Priti Patnaik, Founder of Geneva Health Files.

“Corruption is a disease of the health system, as it is well described in the Lancet,” said David Clarke, acting head of the Health Systems Governance Unit at WHO, Geneva. He explained that agencies focused on criminal activities have traditionally dealt with corruption. However, in recent years the WHO has felt the need to work on fighting it from a healthcare perspective.

“There’s a significant range of activities that could be regarded as corruption,” he noted, mentioning informal payments, absenteeism, data manipulation, lack of transparency, falsified medical products, embezzlement, and bribery. “All of them distort health systems and negatively affect how people receive health services.”

Clarke mentioned how in some countries, up to 80% of non-salary funds in healthcare never reach local facilities and an estimated 140,000 children per year lose their life because of corruption.

The goal of WHO is to fight corruption by creating more transparency and accountability, specifically in the health systems, he pointed out.

According to Dr. Mushtaq Khan, a professor of Economics at the SOAS University of London, fighting corruption is complicated because each of its manifestations might have multiple causes.

“Lack of resources is one of the factors driving corruption,” he pointed out. “If you are in an under-resourced hospital, then there is excess demand, and people have to pay to get seen.”

In addition, he highlighted how political clientelism and patronage represent another driver of corruption.

“The way patronage is used to create jobs is not directly related to resource scarcity,” Khan said, adding that a weak rule of law is critical in allowing corruption to thrive.

Corruption in the health sector
Corruption in the health sector

Case study: Moldova

During the panel, Dr. Ion Bahnarel, a former Deputy Minister of Health in the Republic of Moldova and the Head of the Department of Hygiene, University of Medicine and Farmacie “Nicolae Testemițanu,” presented the efforts that his country is making to fight corruption.

“Our government has initiated several reforms,” he explained. “They include creating anti-corruption structures in local and state institutions.”

Bahnarel said that all medical institutions now offer a system for employees and patients to report episodes of corruption anonymously. In addition, an Ethics Committee has determined new rules and procedures for health organisations for transparency and accountability.

According to Dr. Monica Kirya, a Senior Adviser at U4 Anti-Corruption Resources Centre in her native Uganda, “it is safe to say that you could die if you do not have money to pay a bribe to move up the queue to see a doctor.”

Kirya resides in Norway where U4 is based.

Kirya emphasized that health workers are victims as much as perpetrators of corruption.

“It’s well known that in many developing countries such as Uganda, health workers are extremely poorly paid,” she said. “This is one of the drivers of absenteeism, informal payments and other corruption that health workers engage in to make ends meet.”

Kirya explained that it is essential to pay attention to the structural factors of the system that enable corruption to thrive, such as bans on public service recruitment.

“These bans on public service recruitment started as structural adjustment programs in the 80s and 90s to reduce government expenditure, and they remain in force from time to time as a way to balance the public budget,” she pointed out.

According to the expert, these bans favour political patronage being used in the recruitment and appointment of health workers.

“Because health is a decentralised service in Uganda, and recruitment is often done at the local government level, district politicians and civil service administration use recruitment to extort money from medical graduates,” she said.

While all experts highlighted how fighting corruption effectively is complicated for various reasons, they also suggested how it should be done.

“It is essential to have evidence-based analysis,” said Khan. “This is what should inform reform, while often, the reform is driven by abstract models of what drives corruption, which might be somewhat relevant to the advanced countries’ experience but not to the developing countries’ experience.”

Everyone agreed that to offer better health services defeating corruption is crucial.

“If you had a problem that affected your financial well-being, that was a threat to your life and was a threat to the way that you live, wouldn’t you do something about it? This is what corruption is all about,” said Clarke. “Unless we address corruption, much of our work on strengthening our health system will be a waste of time.”

Image Credits: Screenshot, Screenshot, Geneva Graduate Institute.

SAGE chairperson Hanna Nohynek

Additional COVID-19 vaccine boosters are not recommended for people at low to medium risk of the disease who have been vaccinated and boosted once, according to the World Health Organization’s (WHO) Strategic Advisory Group of Experts on Immunization (SAGE).

SAGE recommends an additional booster six to 12 months after the last dose for “high priority” people, depending on factors such as age and immuno-compromising conditions.

It defines the high-priority group as older adults, adults with significant comorbidities (eg diabetes and heart disease); those with immunocompromising conditions, including children from six months and older (eg people living with HIV and transplant recipients); pregnant women and frontline health workers.

New SAGE chair, Finland’s Dr Hanna Nohynek, said that the recommendations were “updated to reflect that much of the population is either vaccinated or previously infected with COVID-19, or both”.

“Countries should consider their specific context in deciding whether to continue vaccinating low-risk groups, like healthy children and adolescents, while not compromising the routine vaccines that are so crucial for the health and well-being of this age group,” she added.

SAGE, which met last week, also stressed that its recommendation for additional boosters applied in the current context only, and was not a recommendation for annual COVID-19 vaccine boosters.

It also urged countries to base decisions to continue vaccinating the low-priority group, primarily healthy children, on disease burden and cost-effectiveness “considering the low burden of disease” in this group.

This comes as vaccine manufacturers prepare to hike the cost of vaccines. Moderna and Pfizer are both planning an price increase of around 400% – from around $26 directly to the US government to $130 for the private market when government-sponsored vaccines are phased out.

Measles concern

Nohynek noted that every region of the world was reporting measles outbreaks, an indication that routine vaccinations for children had slipped during the COVID-19 pandemic.

SAGE will be reviewing the evidence “for vaccinating infants below six months and during pregnancy” which might lead to policy change, she added.In 2021, an estimated 25 million children missed their first dose of the measles vaccine, the worst level since 2008.

Impact of malaria vaccine

Dr Kate O’Brien

Dr Kate O’Brien, WHO’s Director of Immunization, Vaccines and Biologicals, said that the introduction of the RTS,S malaria vaccine in some of the worst affected malaria regions in Ghana, Kenya and Malawi, had resulted in a 10% reduction in all-cause mortality among children eligible to receive the vaccine.

“This is really a very remarkable impact of introducing this vaccine,” said O’Brien, stressing that it was only being introduced in areas with very high malaria rates.

However, there is high demand for the vaccine, with at least 28 countries expressing interest in introducing the vaccine, but supply remains highly constrained. For that reason, SAGE recommends flexibility in the immunization schedule in interval between the last two doses.

Four doses are currently indicated for children, from five months of age with doses administered monthly. 

The new R21/ Matrix-M malaria vaccine developed by Oxford University, “is in the late stages of clinical development, and we hope to review the final file in the coming months”, said Nohynek.

Identifying priority pathogens for new vaccines

WHO is in the process of defining regional priority targets for new vaccine development for non-epidemic pathogens. 

Early results indicate that tuberculosis, HIV, and antimicrobial-resistant pathogens such as Klebsiella pneumonia are important across all regions. Streptococcus pyogenes (Group A), Shigella, and respiratory syncytial virus (RSV) were identified as important by four or more regions, as was Plasmodium falciparum (malaria) by the African region.

There are “several candidate vaccines for TB in late-stage clinical trials” with the potential for multiple vaccines to receive regulatory authorization within three years, according to SAGE.

The candidate vaccine M72/ AS01E is showing the most promise 

Image Credits: Samy Rakotoniaina/MSH.

INB co-chair Precious Matsoso and Dr Tedros at the fourth INB meeting.

Negotiations on a global pandemic accord resume next Monday at the fifth meeting of the World Health Organization (WHO)’s Intergovernmental Negotiating Body (INB) amid calls for more attention to be paid to a One Health approach, and less to organised misinformation campaigns.

The meeting agenda is an extension of the INB meeting that ended on 3 March, as it will continue with the text-based negotiations, with member states rushing to meet the 14 April deadline for the submission of textual proposals.

In the three weeks since the fourth INB meeting ended, the INB Bureau has held three informal meetings to shed more light on a range of potentially tricky issues including the global supply chain, One Health, technology transfer and know-how and pathogen sharing.

Quadripartite Commitment to One Health

One of the key questions facing those crafting the pandemic accord is how to ensure that the One Health approach is central.

Monday saw the first annual meeting of the Quadripartite group – the WHO, Food and Agriculture Organization (FAO), United Nations Environment Programme (UNEP), and World Organisation for Animal Health (WOAH).

The leaders of the four bodies called for the One Health approach to “serve as a guiding principle in global mechanisms, including in the new pandemic instrument and the pandemic fund to strengthen pandemic prevention, preparedness and response”.

“Recent international health emergencies such as the COVID-19 pandemic, mpox, Ebola outbreaks, and continued threats of other zoonotic diseases, food safety, antimicrobial resistance (AMR) challenges, as well as ecosystem degradation and climate change clearly demonstrate the need for resilient health systems and accelerated global action,” according to the Quadripartite leaders.

The Quadripartite leaders urged all countries and key stakeholders to prioritize One Health in the international political agenda, strengthen their own national One Health policies, strategies and plans and accelerate their implementation.

They also called for strengthening and sustaining prevention of pandemics and health threats “at source” by targeting activities and places that increase the risk of zoonotic spillover between animals to humans.

More misinformation

However, alongside the negotiations, there has been an escalation of misinformation claiming that a pandemic accord will rob member states of their sovereignty, spread mostly by the same sources that pushed COVID-19 anti-vaccine messages.

“We continue to see misinformation on social media and in mainstream media about the pandemic accord that countries are now negotiating. As I said last week, the claim that the accord will cede power to WHO is quite simply false. It’s fake news,” said WHO Director-General Dr Tedros Adhanom during the body’s weekly press briefing last Friday

“Countries will decide what the pandemic accord says, and countries alone. And countries will implement the accord in line with their own national laws. No country will cede any sovereignty to WHO.”

The sources of this misinformation have tended to be the same as those that opposed COVID-19 vaccines.

According to a report in late 2021 by the US- and UK-based Center for Countering Digital Hate (CCDH), almost two-thirds of anti-vaccine messaging on Facebook and Twitter could be traced to just 12 prominent individuals.

These include Robert F. Kennedy Jnr,who campaigns against vaccines for children; Joseph Mercola, who sells dietary supplements and false cures as alternatives to vaccines, and ‘intuitive medicine’ proponent Christiane Northrup, who has also been linked to the conspiracy group, Q-Anon. This misinformation had reached 59.2 million English speakers by December 2020. 

Last week, Twitter owner Elon Musk, who has 132.7 million followers, poured fuel on the fire by commenting that countries should not “cede authority” to the WHO.

This prompted Tedros to call him out directly on Twitter, along with another prominent anti-vaxxer who calls himself Kanekoa, who has also promoted the idea that the pandemic accord seeks to remove power from member states.

However, some right-wing politicians in the US, Australia and Europe are also claiming that the WHO is seeking to usurp countries’ sovereignty with the pandemic accord, while Russia and China have already shared their concerns about this issue in various WHO forums.

Tanzanian health workers being trained to tackle with the Marburg outbreak.

The World Health Organization (WHO) hopes to be able to fast-track the testing of various Marburg candidate vaccines following outbreaks of this rare and deadly viral haemorrhagic fever in Tanzania and Equatorial Guinea.

“WHO is leading an effort to evaluate candidate vaccines and therapeutics in the context of the outbreak,” WHO Director General Dr Tedros Adhanom Ghebreyesus told a media briefing on Thursday.

“The developers are on board the clinical trial protocols are ready. The experts and donors are ready. Once the national government and the researchers give the green light,” he added.

Four or five candidate vaccines already have doses ready for human trials, WHO’s Dr Ana Maria Restrepo told a media briefing.

Restrepo, who heads the WHO’s R&D Blueprint team, said that a Marburg consortium had been working together since the Equatorial Guinea outbreak had been confirmed in January.

“We are working through a platform that is cooperative that involves all the regulatory and ethics committees in Africa,” stressed Restrepo.

There are 28 potential candidate vaccines for Marburg, according to WHO R&D Blueprint. The virus is from the same family as Ebola and has an 88% fatality rate.

“Marburg belongs to the same family of viruses as Ebola, causes similar symptoms, transmits between humans the same way and like Ebola, has a very high fatality ratio,” warned Tedros.

“In the meantime, we’re not defenceless. Careful contact tracing isolation and supportive care are powerful tools to prevent transmission and save lives.”

Tanzania reports first-ever outbreak

Meanwhile, Tedros said that Tanzania had confirmed eight cases, including five deaths, by testing samples at a WHO-supported mobile laboratory set up last year “to prepare for viral haemorrhagic fever outbreaks, including Ebola and Marburg”.

National responders, WHO and the US Centers for Disease Control and Prevention (CDC)  “have been deployed to the affected region to carry out further investigations, monitor contacts and provide clinical care,” added Tedros.

A week ago, Tanzanian health authorities initiated a frantic search for the cause of the mysterious disease that had claimed several lives in the country. 

Five of the eight cases, including a health worker, have died and the remaining three are receiving treatment. A total of 161 contacts have been identified and are being monitored.

Tanzania Chief Medical Officer Tumaini Nagu said multiple isolation units to help monitor and isolate people displaying symptoms are now operational. 

“The government is closely monitoring the situation and taking appropriate measures to contain the disease,” Nagu told Health Policy Watch.

Tanzania Chief Medical Officer Tumaini Nagu

Lack of capacity

Equatorial Guinea has struggled to identify cases because of a lack of laboratory capacity but had confirmed nine cases with a further 20 probable cases. 

The first case from the eastern province of Kié-Ntem was confirmed in early February by the Institute Pasteur in Senegal. Two other people from Kié-Ntem province were diagnosed by a mobile laboratory at the Regional Hospital of Ebibeyin. 

A month later another case was identified in Litoral province in the western part of the country that was epidemiologically linked to a confirmed case in Kié-Ntem, while cases have also been confirmed in Centro Sur province.

The wide geographic distribution of cases and uncertain epidemiological links between cases “suggests the potential for undetected community spread of the virus”, according to WHO.

The provinces that share international borders with Cameroon and Gabon, and the WHO is working with those countries identify any potential cases, Tedros confirmed.

Dr Ahmed Ogwell Ouma, Acting Director of the Africa Centres for Disease Control.

At the Africa CDC press briefing on Thursday, acting director Dr Ahmed Ouma, said the center is providing Equatorial Guinea with needed technical support, infrastructural development and capacity building required to test for Marburg virus disease. 

“The government is responsible for the testing and to release those results to us,” he said, adding that the turnaround time for result is currently five days and this is being improved upon by the authorities and partners.

“The capacity is still being built,” he said. “The main lab is still not fully functional. We are finalizing calibration this week. And that main lab should be up and running in a few days as soon as the calibration and capacity building is done. And I think before the middle of next week when all that has been completed, they should be up and running. And that will make it easier to do more samples and [will be] a little bit faster.”

Meanwhile, health authorities are expecting genomic analysis results soon to see whether there is any connection between the outbreaks in Equatorial Guinea and Tanzania.

Dr Matshidiso Moeti, WHO Regional Director for Africa, said that gene sequencing analyses are being conducted in both countries to reveal any possible connections for both outbreaks. “We know that the world is interconnected in many ways, [but] the likelihood is not that high,” Moeti told journalists.

“The confirmation of these new cases is a critical signal to scale up response efforts to quickly stop the chain of transmission and avert a potential large-scale outbreak and loss of life,” said Moeti. “Marburg is highly virulent but can be effectively controlled and halted by promptly deploying a broad range of outbreak response measures.”

At the Africa CDC press briefing on Thursday, acting director Dr Ahmed Ouma, said the center is providing Equatorial Guinea with needed technical support, infrastructural development and capacity building needed to test for Marburg virus disease. 

“The government is responsible for the testing and to release those results to us,” he said, adding that the turnaround time for result is currently five days and this is being improved upon by the authorities and partners.

“The capacity is still being built,” he said. “The main lab is still not fully functional. We are finalizing calibration this week. And that main lab should be up and running in a few days as soon as the calibration and capacity building is done. And I think before the middle of next week when all that has been completed, they should be up and running. And that will make it easier to do more samples and [will be] a little bit faster.”

Image Credits: Muhidin Issa Michuzi.

Uganda’s Speaker of Parliament, Anita Among, during the passing of the Act.

The United Nations (UN) High Commissioner for Human Rights Volker Türk has called on Uganda’s President Yoweri Museveni not to promulgate the Anti-Homosexuality Act his country’s Parliament passed on Tuesday night.

Describing the Act as “probably among the worst of its kind in the world”, Türk said that, “if signed into law by the president, it will render lesbian, gay and bisexual people in Uganda criminals simply for existing, for being who they are”. 

Meanwhile, US Secretary of State Antony Blinken said that the Act would “undermine fundamental human rights of all Ugandans and could reverse gains in the fight against HIV/AIDS”, and urged the Ugandan government to “strongly reconsider the implementation of this legislation”.

The Act introduces “the offence of homosexuality”, with a potential life sentence for a same-sex “sexual act”. It also criminalises a person who “holds out as a lesbian, gay, transgender, a queer or any other sexual or gender identity that is contrary to the binary categories of male and female”.

It also proposes the death penalty for “aggravated homosexuality”, including sex acts with children, disabled people or those drugged against their will, or committed by people living with HIV. 

Landlords face prison sentences for renting premises to homosexuals, journalists face 20-year sentences for “promoting homosexuality” and even lawyers may face fines for representing gay clients.

The Act was proposed by Asuman Basalirwa from Bugiri and had the near-unanimous support of MPs.

Ugandan gay activist Frank Mugisha, told Reuters that if the Act becomes law, he will challenge it in court on grounds that it was unconstitutional and violated various international treaties to which Uganda is a signatory. 

However, Mugisha also said that he feared mob violence and the mass arrest of LGBTQ people, adding that his community would be too afraid to seek treatment at health centres and warned of the mental health damage, including an increased risk of suicide.

“The Bill confuses consensual and non-consensual relations – the former should never be criminalized, whereas the latter require evidence-based measures to end sexual violence in all its forms – including against children, no matter the gender or sexual orientation of the perpetrator. This bill will be a massive distraction from taking the necessary action to end sexual violence,” the UN High Commissioner said.

Rise in anti-LGBTQ activity

“Not only does it conflict with Uganda’s own constitutional provisions stipulating equality and non-discrimination for all – it also runs counter to the country’s international legal obligations on human rights and political commitments on sustainable development, and actively puts people­’s rights, health and safety at grave risk,” he added.

There has been a rise in homophobic sentiments, particularly among politicians and religious leaders in Uganda and neighbouring Kenya over the past few months

The OHCHR said that,  according to a report from a civil society group, in February alone more than 110 LGBTQI+ people “reported incidents, including arrests, sexual violence, evictions and public stripping”.

“Let us be clear: this is not about ‘values’. Promoting violence and discrimination against people for who they are and who they love is wrong and any disingenuous attempts to justify this on the basis of ‘values’ should be called out and condemned,” Türk said.

Meanwhile, UNAIDS has warned that, if the Act becomes law, it will curtail “the human rights of people living with HIV and some of the most vulnerable people of Uganda to access life-saving services”. 

“If enacted, this law will undermine Uganda’s efforts to end AIDS by 2030, by violating fundamental human rights including the right to health and the very right to life,” said UNAIDS East and Southern Africa Director Anne Githuku-Shongwe.  

“Research in sub-Saharan Africa shows that, in countries which criminalize homosexuality, HIV prevalence is five times higher among men who have sex with men than it is in countries without such laws,” said UNAIDS, calling on Museveni not to enact the Bill as it will  “cost lives and it will drive up new HIV infections”. 

“The harmful Act stands in marked contrast to a positive wave of decriminalization taking place in Africa and across the world, in which harmful punitive colonial legislation is being removed in country after country. Decriminalisation saves lives and benefits everyone.”

Describing the Act as “an extreme violation of human rights”, International AIDS Society (IAS) warned that it “threatens to reverse the country’s progress in the HIV response”. “Criminalizing LGBTQ+ people is wholly incompatible with an effective HIV response,” said the IAS.

In opposition to HIV response

“While Uganda has made considerable gains in reducing the impact of HIV, gay men and other men who have sex with men, trans people and sex workers continue to be less likely than the general population to access HIV treatment, prevention and care services and will be further threatened by this legislation.

“In 2021, key populations (gay men and other men who have sex with men, people who inject drugs, trans people, and sex workers) and their sexual partners accounted for 51% of new HIV acquisitions in central, eastern, southern and western Africa. This underscores the urgent need for governments in the region to work with, not against, communities most vulnerable to HIV.”

The IAS also noted that the Act is also “completely in opposition to President Museveni’s stated support for the HIV response. UNAIDS and others lauded the President when he launched The Presidential Fast-track Initiative on ending HIV & AIDS in Uganda by 2030, the first such initiative globally.”

Plastic
Most plastics that are produced end up in landfills in poorer countries.

Human health is in grave danger because of plastics across their entire lifecycle, a new study has found. The study, conducted by an international consortium of scientists, has pointed out that from production to disposal, plastics are bad news. 

The team of scientists, led by the Boston College Observatory on Planetary Health, Australia’s Minderoo Foundation and the Centre Scientifique de Monaco, called for a strong and comprehensive global plastics treaty to be adopted as soon as possible, to put the world on track to end plastic pollution by 2040. 

The study, published in the journal Annals of Global Public Health on Tuesday, stated that the current patterns of producing, using and disposing of plastics are leading to snowballing impacts on health from the womb to old age.  

“It is now clear that current patterns of plastic production, use, and disposal are not sustainable and are responsible for significant harms to human health, the environment, and the economy as well as for deep societal injustices”, stated an editorial accompanying the report. 

Along with pushing for the expedited adoption of a global plastics treaty, the study also recommends that a Permanent Science Policy Advisory Body be created to guide the implementation of the treaty. 

“The main priorities of this body would be to guide member states and other stakeholders in evaluating which solutions are most effective in reducing plastic consumption, enhancing plastic waste recovery and recycling, and curbing the generation of plastic waste,” the study’s authors added. 

Impacts on health from cradle to grave

That plastics cause harm to the planet is not news. However, this is the first study to look in detail into the dangers to human health from plastics at every stage of production, use and disposal. Among the key findings:  

  • Of the more than 10,000 materials used in plastics production, some 1,254 pose high health concerns. Those include toxic, mutagenic and carcinogenic monomers – of which PVC is perhaps best known, but there are many others.
  • At the use stage, some 63 of the more than 90 chemicals associated with plastics packaging rank in the highest category for human health. Many of the chemicals used in food packaging can leach out onto food, leading to human exposures.
  • Finally, at disposal stage, those same chemical components or additives can be released or leached out during recycling and recovery processes, the report found.  And most of the world’s plastics are not recovered at all – they are simply dumped into landfills, incincerated or shipped elsewhere – contaminating soils, fresh water aquifers, oceans and fisheries – with further ecosystem and health impacts.

“This is the first analysis to look at hazards to human health caused by plastics across their entire life cycle – cradle to grave – beginning with the extraction of the coal, oil and gas from which nearly all plastics are made, through production and use, and on to the point where plastic wastes are thrown into landfills, dumped into the ocean or shipped overseas,” Dr Philip Landrigan, director of the Program on Global Public Health and the Common Good at the Boston College Observatory on Planetary Health and the study’s lead author explained in a press release. 

Plastic
A range of chemicals are used, present and released throughout the life cycle of plastics.

Occupational health hazards, premature births and birth defects

Workers involved in plastics production suffer higher mortality from a range of causes from traumatic injury to lung cancer to interstitial lung disease. They are also highly likely to contract diseases like mesothelioma, angiosarcoma, breast cancer and decreased fertility. 

But plastics also cause a variety of health impacts across the population, from pregnancy and early childhood to older ages.  

“Because of the exquisite sensitivity of early development to hazardous chemicals and children’s unique patterns of exposure, plastic-associated exposures are linked to increased risks of prematurity, stillbirth, low birth weight, birth defects of the reproductive organs, neurodevelopmental impairment, impaired lung growth, and childhood cancer,” the study pointed out.  

“Early-life exposures to plastic-associated chemicals also increase the risk of multiple non-communicable diseases later in life.”

Massive adverse enviornmental, economic and social justice impacts

Elaborating on the production cycle of plastics, the scientists also summed up the massive adverse environmental, economic, human health and social justice impact that prolonged plastic use creates. 

Plastics are produced from coal, oil or gas, in an energy intensive process. The current modes of plastic disposal are highly inefficient. 

Plastic
A wall made of plastic waste in Singapore.

“Plastic disposal is highly inefficient, with recovery and recycling rates below 10% globally,” the study pointed out. “The result is that an estimated 22 megatonnes of plastic waste enters the environment each year, much of it single-use plastic and are added to the more than 6 gigatons of plastic waste that have accumulated since 1950.”

Apart from causing widespread pollution across terrestrial, aquatic and atmospheric environments globally, the reckless use of plastics causes significant economic costs. 

“We estimate that, in 2015, the health-related costs of plastic production exceeded $250 billion globally, and that in the USA alone the health costs of disease and disability caused by the plastic-associated chemicals PBDE, BPA and DEHP exceeded $920 billion”.

Around 90% of the plastics produced are not recycled or reused, and often end up in landfills in poorer countries. This adversely affects people who are already vulnerable and had nothing to do with creating the plastics crisis and lack the power and resources needed to address it. 

“Plastics’ harmful impacts across its life cycle are most keenly felt in the Global South, in small island states, and in disenfranchised areas in the Global North,” the study said. “Social and environmental justice principles require reversal of these inequitable burdens to ensure that no group bears a disproportionate share of plastics’ negative impacts and that those who benefit economically from plastic bear their fair share of its currently externalized costs”. 

Global Plastics Treaty

Plastic
The adoption of the resolution receives a standing ovation from the delegates present in Nairobi, Kenya, in 2022.

In 2022, Heads of State, Ministers of environment and other representatives from UN Member States at the fifth United Nations Environment Assembly in Nairobi, Kenya, approved a resolution to draft a Global Plastics Treaty by the end of 2024. This agreement on addressing the pollution caused by plastics would be internationally binding. 

“And as we embark on this journey, let us be clear that the agreement will only truly count if it has clear provisions that are legally binding, as the resolution states,” Inger Andersen, the executive director of the United Nations Environment Programme (UNEP) remarked after the resolution was passed. According to UNEP, plastics will account for 20% of oil and gas consumption by 2050. 

“It will only count if it adopts a full life-cycle approach – stretching from design to production to circularity to reducing, managing and preventing waste.”

Switzerland and Ecuador reiterated the importance of a global plastics treaty in Davos in January 2023, in the world’s journey to end plastic pollution. 

While the treaty is currently under negotiations, it is expected that the powerful oil and gas producers will oppose the creation of a comprehensive treaty with teeth. 

The first session of the Intergovernmental Negotiating Committee (INC) took place from 28 November to 2 December, 2022 in Uruguay. The second session of the INC is scheduled to take place in Paris from 29 May, 2023 to 2 June, 2023. 

“Our report is intended to inform the Treaty negotiations. The Global Plastics Treaty is still two to three years away. But it will resonate with other treaties, including the agreement reached earlier this month known as the Oceans Treaty,” Landrigan said. 

The Permanent Science Policy Advisory Board, recommended by the study, will aim to inform the work of the treaty by arming the negotiators and participants with scientific evidence. 

“All big global agreements, or treaties, need scientific support. They need access to individuals with expertise to make sure the treaty reflects the most recent science. These treaties are never static, they must continually be updated to reflect the best current knowledge”. 

Image Credits: Photo by Hermes Rivera on Unsplash, The Minderoo-Monaco Commission on Plastics and Human Health, Photo by Nick Fewings on Unsplash, UNEP.

During the COVID-19 pandemic, people living with cancer, heart diseases, chronic respiratory diseases, diabetes and other non-communicable diseases (NCDs) experienced difficulties in accessing their routine medicines, according to a new report released by the World Health Organization on Wednesday.

While 21% of WHO member states reported stockouts of the five many medicines for people with NCDs, only 4% of high-income countries were affected whereas a third of low-and middle-income countries were affected.

“The COVID-19 pandemic has exacerbated the challenges that people living with NCDs face in accessing essential medicines,” said Dr Bente Mikkelsen, the WHO’s NCD Director.

“Many have had their treatment disrupted, which can lead to serious health consequences. It is therefore very important not only that treatment and care for people living with NCDs are included in national responses and preparedness plans, but that innovative ways are found to implement those plans.”

Numerous pharmaceutical supply chains were affected, according to the WHO, which called for improvement of “the transparency of the overall pharmaceutical information ecology as a foundation for pandemic planning and response”.

“If we are unable to identify weaknesses in the global NCD supply chain, we cannot hope to mend them,” the WHO noted in a statement on Wednesday.

“Without effective monitoring and transparent data, it is difficult to identify weaknesses in the global NCD supply chain. This requires countries to look at their supply chain, strengthen and expand medicine shortage notification systems, build in flexibility in their regulatory measures and minimize barriers to trade.”

Globally, more is spent on medicines for NCDs than any other therapeutic class. 

Although a few short-term interventions were adopted to respond to pandemic needs, the WHO wants “a longer-term strategy to strengthen access and delivery mechanisms during emergencies and mitigate future outbreaks”.

 “Let’s not forget: COVID-19 may be out of sight, but access to NCD medicines is still out of reach for many,” said Mikkelsen.

Co-chairs of the UN Water Conference, President Emomali Rahmon of Tajikistan and King Willem of Netherlands, at the opening ceremony.

“We are draining humanity’s lifeblood through vampiric overconsumption and unsustainable use and evaporating it through global heating,” United Nations Secretary-General António Guterres told the start of the UN 2023 Water Conference. which also coincided with World Water Day.

At the conference, national governments and stakeholders from all levels of society will collaborate to make voluntary commitments to accelerating progress on Social Development Goal Six, to promote access to safe water, sanitation and hygiene.

These voluntary commitments will form the Water Action Agenda, designed to deliver rapid, transformative change in the remainder of this decade.

“We’ve broken the water cycle, destroyed ecosystems and contaminated groundwater,” Gutteres added.

“Nearly three out of four natural disasters are linked to water. One in four people lives without safely managed water services or clean drinking water. And over 1.7 billion people lack basic sanitation. Half a billion practice open ablutions. And millions of women and girls spend hours every day fetching water.”

In addition, 1.4 million people die annually and 74 million will have their lives shortened by diseases related to poor water, sanitation and hygiene, according to the World Health Organization (WHO).

Global water demand is projected to increase by 55% by 2050. 

 

Is the raccoon dog the elusive “animal X” that passed SARS-CoV2 from bats to humans?

Raccoon dogs, lab leaks and Chinese secrecy have made for high drama as scientists who think they may have found the elusive “Animal X” that passed SARS-CoV2 were excluded from a data-sharing platform for “scooping” Chinese scientists.

Nineteen scientists, including world-renowned figures such as Dr Michael Worobey and Dr Angela Rasmussen – have published a report detailing how they had been scolded and falsely accused of rules violations by the data-sharing platform, GISAID, after reporting that they had found genetic material of wild animals intermingled with environmental samples collected by the Chinese Center for Disease Control in January and February of 2020 from the Huanan Seafood Wholesale Market in Wuhan – ground zero of the COVID-19 outbreak.

This co-mingling of SARS-CoV-2 virus and animal RNA/ DNA from five animal species “identifies these species, particularly the common raccoon dog, as the most likely conduits for the emergence of SARS-CoV-2 in late 2019”, the authors concluded in their study, published on the pre-print research server base Zenodo on Monday. 

This is the first time that scientists have proposed that the elusive “animal X” responsible for virus spillover from animals to humans might have been found.

Later on Tuesday, it appeared that GISAID had removed all the authors’ access to its platform. The platform is a public-private partnership that is hosted by the German government that allows scientists to share data about infectious diseases.

Report co-author and French evolutionary biologist Florence Débarre accidentally found the Chinese Center for Disease Control and Prevention (CCDC) environmental samples on the GISAID infectious diseases database on 4 March 2023.

The samples had apparently been posted to support a CCDC preprint article published on 25 February by a group of Chinese scientists affiliated with CCDC and other governmental resaerch institutions.

In the preprint article, the Chinese authors asserted that of the 1,380 samples collected from the environment and the animals in the market in early 2020, “No virus was detected in the animal swabs covering 18 species of animals in the market” – exactly the opposite of what Worobey and his colleagues said they have found.

Of the environmental samples taken from the marketplace in the early days of the pandemic, only 73 tested positive for SARS-CoV-2 and three live viruses were successfully isolated – which 99.9% related to the genetic forms of virus strains circulating among humans in those early days, according to the Chinese authors.  

Genetic footprints of ‘multiple animal species’ co-mingling in SARS-CoV2 environmental samples 

In contrast, the Worobey-led research group, in their analysis of the same GSAID data, said they found genetic evidence of “multiple animal species” co-mingling among the SARS-CoV-2 positive environmental samples collected at the marketplace.

In particular, they identified mitochondrial genomes for the common raccoon dog; Malayan porcupine; Amur hedgehog; masked palm civet; and hoary bamboo rat “from wildlife stalls positive for SARS-CoV-2”. 

This is important, they assert, because although live mammals had been observed in the market in late 2019, an area where many COVID-19 patients with the earliest-known onset of symptoms worked, the animals’ presence and “exact locations were not conclusively known” at the time when SARS-CoV2 first surfaced in the marketplace.

The most recent data posted on GSAID, therefore, raises the likelihood that wild animals kept caged in the market could have been a conduit for passing the coronavirus, which originates amongst bats, to humans, the authors state. 

In another explosive finding, some of the animals they identified – such as the fox-like raccoon dogs – are known to be susceptible to  SARS-CoV-2 but “were not included in the list of live or dead animals tested at the Huanan market, as reported in the 2021 WHO-China joint report on the origin of the COVID-19 pandemic”, the authors state. 

The fox-like raccoon dog is susceptible to SARS-CoV-2.

Even more crucially, in some cases, there was more animal genetic material than human material “consistent with the presence of SARS-CoV-2 in these samples being due to animal infections”, say the authors.

In 2021, an international team assembled by the World Health Organization (WHO) to investigate the origins of SARS-CoV-2 identified animal transmission – through an elusive ‘Animal X’ – as the most likely route of infection in their report. But the theory stalled due to a lack of actual evidence in the WHO report about the exposure of wild animals in the marketplace at the time to the virus. 

Chinese secrecy – data withdrawn

The controversy around the data, and its implications, has been heightened by the fact that it has now been withdrawn from the GSAID site.

This happened shortly after the scientists said that they had contacted one of the Chinese preprint authors, on 9 March, and were told they could conduct an independent analysis of the CCDC data.

But on 11 March,  a day after the Worobey group told the Chinese colleague that they had found animal genetic material in the samples, the data was pulled from the site “at the request of the submitter”. 

Not only that, but the GISAID Secretariat sent emails to the scientists “admonishing us to comply with the GISAID terms of use, or in some cases falsely accusing us of having breached the GISAID terms of use”, wrote the Worobey group. 

“We are well aware of these terms of use, have not breached them, and have no intention of breaching them,” they wrote.

While the GISAID website makes no mention of a secretariat, its business affairs are run by the executive board of the Friends of GISAID, the members of which are not named, and advised by an 11-person scientific advisory council that includes US, Chinese, European, Japanese and Singaporean representatives.

However, GISAID released a statement on Tuesday accusing the Worobey group of “scooping” the Chinese group by using its data and publishing it before the Chinese scientists had done so.

“Unfortunately, GISAID learned that select users published an analysis report in direct contravention of the terms they agreed to as a condition to accessing the data, and despite having knowledge that the data generators are undergoing peer review assessment of their own publication,” according to the statement.

GISAID said it had asked the Chinese researchers whether “best efforts to collaborate have been made in this case”, and were told the Worobey group had communicated “only their intent to publish their analysis of the generators’ data. As such, the best efforts requirement has not been met”.

“GISAID’s goal is to incentivize timely and transparent data sharing by providing a trusted place for data contributors to see their rights respected.  It should be apparent to everyone that the data generators [Chinese researchers] are the ones most familiar with the details surrounding their submitted data and the context in which it was collected,” added the platform, stressing that the Chinese research should have been published first.

WHO involvement

However, it is unclear whether the international scientific community will agree, as China has long been accused of withholding data and access to Wuhan sites.

The WHO confirmed late last week that it had been informed both about the findings and the CCDC’s actions on 12 March, and it reached out to its Scientific Advisory Group for the Origins on Novel Pathogens (SAGO) and the CCDC.

After calls between SAGO and the CCDC, the CCDC confirmed that “DNA from wild raccoon dogs, Malaysian porcupine, and bamboo rats among others” had been found “in SARS-CoV-2 positive environmental samples”, according to a SAGO statement released last Friday.

“These results provide potential leads to identifying intermediate hosts of SARS-CoV-2 and potential sources of human infections in the market,” according to SAGO.

This is despite the CCDC’s assertions to the contrary, which mention 18 animals, none of which are raccoon dogs.

But, said SAGO, “the presence of high levels of raccoon dog mitochondrial DNA in the metagenomics data from environmental samples identified in the new analysis, suggest that raccoon dog and other animals may have been present before the market was cleaned as part of the public health intervention”.

Late on Friday afternoon, WHO Director-General Dr Tedros Adhanom Ghebreysus did not mince his words at a media briefing when he appealed to China for transparency, adding that these samples could have been shared three years ago.

China has consistently refused to accept that COVID-19 might have originated on its shores, and has asserted that the virus could have been spread from imported frozen fish sold at the market – the frozen food chain hypothesis.

However, the independent origins group report stated that “there is no conclusive evidence for foodborne transmission of SARS-CoV-2 and the probability of cold-chain contamination with the virus from a reservoir is very low”. 

Lab leak revival

Dr Robert Redfield, ex-CDC head, testifies at the hearing in favour of the lab leak theory.

In early March, the Republican-dominated US House Subcommittee on the Coronavirus Pandemic convened its first hearing to examine COVID-19’s origins, focusing almost entirely on the theory that COVID-19 originated from a laboratory “leak” at the Wuhan facility studying coronaviruses. 

Dr Robert Redfield, former head of the US CDC, told the hearing that he found it implausible that a virus could jump from animals in the Wuhan wet market to humans.

The lab leak theory was initially pushed by then-US president Donald Trump and his allies in 2020.

The impetus for the lab leak theory has grown this year, particularly as the US ramps up its anti-China rhetoric – and China’s secrecy and refusal to share data has fueled it.

“The FBI has for quite some time now assessed that the origins of the pandemic are most likely a potential lab incident in Wuhan,” Christopher Wray, the head of the US Federal Bureau of Investigation (FBI) told Fox News in late February.

The Trump-appointed Wray added that “we’re talking about a potential leak from a Chinese- government-controlled lab that killed millions of Americans”.

However, the origins report described this hypothesis as “extremely unlikely”, saying that “the deliberate bioengineering of SARS-CoV-2 for release has been ruled out by other scientists following analyses of the genome”. In addition, the SARS-CoV-2 from bats and pangolin that were being studied at the Wuhan lab “are evolutionarily distant from SARS-CoV-2 in humans”. 

Meanwhile, recent polls show that roughly two-thirds of Americans believe that Covid probably started in a lab, according to the New York Times.

Image Credits: Bernd Schwabe/ Wikipedia, Ryzhkov-Sergey/ Wikipedia, CSPAN.

As the impact of drought worsens, there is a growing risk of famine in Somalia. Some 4.5 million Somalis are directly affected by the drought, and about 700,000 people have been displaced.

The worsening drought in Somalia is likely to have caused 43,000 excess deaths in 2022, of which around 21,500 are children under the age of five, according to a new report released on Monday.

“We are racing against time to prevent deaths and save lives that are avoidable. We have seen, deaths and diseases thrive when hunger and food crises prolong. We will see more people dying from disease than from hunger and malnutrition combined if we do not act now,” Dr Mamunur Rahman Malik, the World Health Organization (WHO) representative for Eastern Mediterranean region (EMRO) said. 

“The cost of our inaction will mean that children, women and other vulnerable people will pay with their lives while we hopelessly, helplessly, witness the tragedy unfold”.

The Horn of Africa, particularly southeast Ethiopia, northern Kenya and Somalia, has been experiencing one its worst hunger crisis in 70 years. Along with the

failure of six consecutive monsoon seasons, Somalia is also struggling with the effects of climate change-induced weather events, political instability, ethnic tensions, food insecurity and rising prices. The COVID-19 pandemic only exacerbated an already grim situation.  

The study was commissioned by UNICEF and the WHO and was carried out by the London School of Hygiene and Tropical Medicine and the Imperial College, London. The study involved a statistical mode, which retrospectively estimated that the crude death rate across Somalia increased from 0.33 to 0.38 deaths per 10,000 person-days between January 2022 and December 2022. 

The death rate in children younger than five years was almost double these levels. The researchers used data from 238 mortality surveys carried out by the Food Security and Nutrition Analysis Unit for Somalia to arrive at these estimates. 

“Our findings suggest that tens of thousands of Somalis lost their life in 2022 due to drought conditions, with this toll set to increase in 2023. This is in spite of Somalis’ own resilience, support by Somali civil society within and outside the country and a large-scale international response,” said Dr Francesco Checchi, co-author and professor of epidemiology and international health at the London School of Hygiene and Tropical Medicine. “Far from being scaled back, humanitarian support to Somalia must if anything be increased as the year progresses, and sustained until Somalia exits this latest crisis.”

For the year 2023, the crude death rate is forecasted to increase to 0.42 deaths per 10,000 person-days by June 2023. 

The highest death rates were estimated in south-central Somalia, around the areas of Bay, Bakool and Banadir regions, the center of the current drought. 

“We continue to be concerned about the level and scale of the public health impact of this deepening and protracted food crisis in Somalia,” said Somalia’s Health Minister, Dr Ali Hadji Adam Abubakar.

“At the same time, we are optimistic that if we can sustain our ongoing and scaled-up health and nutrition actions and humanitarian response to save lives and protect the health of our vulnerable, we can push back the risk of famine forever, else those vulnerable and marginalized will pay the price of this crisis with their lives.”

Image Credits: UN-Water/Twitter .