Neglected tropical diseases
A man with symptoms of the deadly NTD African trypanosomiasis (sleeping sickness), is examined by Dr Victor Kande in the Democratic Republic of Congo (DRC).

The number of people requiring treatment for Neglected Tropical Diseases (NTDs) decreased from 2.19 to 1.65 billion between 2010 and 2021 – an impressive 25 percent decline. However, interlinked challenges, including the COVID pandemic and, now, accelerating patterns of climate change are putting this progress at risk.  On World NTD Day, we need to recognise these  emerging challenges and look to more integrated approaches.

The impressive 25 percent decrease in the number of people requiring treatment for NTDs and the mounting number of countries that have eliminated at least one NTD are testimony to the progress being made to stamp out some of the world’s most deadly and debilitating diseases – which strike mostly at communities in developing countries and at people living in poverty. 

According to the World Health Organization (WHO), 47 countries have eliminated at least one NTD since 2010, and NTD programmes have performed better in the past year than in 2021.  

But while this progress is admirable, it is too slow for millions of people still living with, or at risk of infection from these 20 viral, parasitic and bacterial diseases considered NTDs which range from river blindness to leprosy, rabies and  more, and continue to defy national and global elimination plans in many parts of the world today. 

Storm clouds on the horizon

Moreover, new challenges like the COVID-19 pandemic and climate change are putting recent progress at risk, threatening to reverse the tremendous gains that have been made over the last few years.

During the pandemic, services for NTDs were the second most frequently disrupted set of health systems services. Looking ahead, changing temperature and rainfall patterns will exacerbate poverty and displace people, and climate change will influence the emergence and re-emergence of multiple NTDs in higher latitudes and altitudes and pose a major risk for communities.

This year’s World NTD Day is an opportunity to revitalise the way we tackle NTDs to not only maintain the progress we achieved so far, but to catalyse better, more efficient, bolder strategies for elimination in the future – harnessing the power of collective action.

The climate threat 

Water shortage in Ethiopia. Population exposure to heat is increasing due to climate change. Globally, extreme temperature events are observed to be increasing in their frequency, duration, and magnitude.

This is especially crucial in addressing the added challenges that climate change poses. 

NTDs are highly influenced by temperature, rainfall, humidity, and other climatic changes, and even small fluctuations can greatly increase transmission and spread, with potentially devastating effects. Climate change is thus threatening the re-emergence of NTDs in many parts of the world  and will likely result in negative health outcomes and disruptions to healthcare systems.

The threat to progress expands beyond NTDs to other infectious diseases. For malaria alone, studies show that climate change could lead to an additional 60,000 malaria deaths per year between 2030 and 2050.

Despite the risks, the world is paying little attention to the climate-health nexus and the impact it could have on the resurgence of NTDs and their transmission. 

Up until now, approaches to address health and climate emergencies have remained largely separate, perhaps partly due to the lack of knowledge and guidance surrounding the health impact of climate change.

The current literature on the intersection between climate and health also is insufficient to guide policy development. This is why countries, world leaders, and all stakeholders involved should prioritise research in this area. By exploring new and under-explored areas of the interface between climate and infectious disease, we can start to tackle the challenge and protect the gains and accelerate progress towards elimination. 

Removing NTDs from the disease control silo

Fulfilling the goal of elimination begins by taking NTDs prevention and control out of isolation and adopting a more integrated approach. At the Global Institute for Disease Elimination (GLIDE) we see the intrinsic value of promoting and adopting cross-disease, cross-border, multi-stakeholder and multi-sector, approaches to innovatively and effectively control, eliminate, and eradicate NTDs.

For this to work in global health, we must make way for more integrated healthcare systems that address preventable infectious diseases of poverty.

The COVID-19 pandemic has exposed the pre-existing cracks in our healthcare systems, spotlighting the dangerous link between NTDs, other communicable diseases, and health emergencies. It has also reinforced the need to address health issues in a more holistic manner. A stronger, more systems-wide approach to health will strengthen surveillance, early warning, and pandemic preparedness.

Mainstreaming NTDs within health systems and primary health care services, and promoting country ownership and accountability is an effective jumping off point, according to WHO’s NTD road map 2021-2023. In fact, this will contribute to sustainable and efficient NTD prevention and control, yielding better health outcomes and program management, and cost-effective solutions. But we must understand the economics of neglected diseases and elimination better in order to develop and refine investment cases in a more holistic way, using the health system and packages of essential health care as an important entry point to this mainstreaming.

Water, sanitation and hygiene as a starting point

Africa and Asia have the least access to basic sanitation facilities in the whole world

Another starting point is to consider cross-sector coordination such as with water, sanitation, and hygiene (WASH) for disease prevention. WHO’s roadmap lays out a plan for effective elimination efforts, citing WASH as one of the key interventions in tackling 18 of the 20 NTDs. Improved access to clean water and sanitation can reduce the transmission of many NTDs, such as schistosomiasis, trachoma and guinea worm which, according to the Centers for DIsease Control and Prevention (CDC), is caused by the parasite Dracunculus medinensis and contracted when people do not have access to safe water for drinking.

There is no vaccine or medicine available against guinea worm. However, eradication is being achieved by implementing WASH-related preventive measures. These include filtering drinking water to remove the water fleas that carry the parasite, providing improved water sources and preventing infected individuals from wading or swimming in drinking-water sources. The measures – supplemented by active surveillance and case containment, vector control and provision of improved water sources – have led to great progress toward eliminating guinea worm, with the number of human cases annually falling from 3.5 million in the mid-1980s to just 13 cases in 2022, poising it to become the second disease in human history that could be eradicated altogether, according to a report last week by the Carter Center. 

Breaking down silos

The elimination of NTDs is feasible, but we need new approaches. 

The upcoming 28th Conference of the Parties (COP28) to the United Nations Framework Convention on Climate Change (UNFCCC), hosted by the United Arab Emirates (UAE) between 30 November and 12 December 2023, will be an opportunity for world leaders to both recognise and commit to addressing the health impacts of climate change.

The World Health Assembly’s NTD road map 2021-2030, meanwhile, emphasizes the importance of integrating NTD programs and establishing links with other sectors such as education, nutrition, WASH, animal, and environmental health. We also must increase spending on NTD control and elimination, strengthening the case for investment. 

There is an intimate connection between the health of individuals and the interlinked, cross-boundary events across the globe. 

Recognizing this, we need an approach that engages  all sectors and geographies  in ways that facilitate collaboration, stimulate innovation and continued investment and, finally, by staying committed to delivering a world free of NTDs. 

____________________________________

 

Simon Bland is the CEO of the Global Institute for Disease Elimination (GLIDE), based in the United Arab Emirates (UAE) and focused on accelerating the elimination of four preventable infectious diseases –  malaria, polio, lymphatic filariasis, and river blindness – by 2030 and beyond. Founded in 2019 as the result of a collaboration between UAE President, His Highness Sheikh Mohamed bin Zayed Al Nahyan, and the Bill & Melinda Gates Foundation, GLIDE works to elevate awareness and engagement, advance elimination strategies, and foster and scale innovation for disease elimination and eradication.

 

Image Credits: DNDi, Oxfam East Africa, Deep Knowledge Group.

Last year’s World Health Assembly mandated the secretariat to look into a replenishment fund.

An influential sub-committee of the World Health Organisation (WHO)’s Executive Board (EB) has greenlighted a proposal by the cash-strapped global body’s Secretariat to seek additional funds via a replenishment fund, that would be filled by voluntary donations from both member states and philanthropies recruited at high-profile events.

In its report published on Monday just as the WHO’s Executive Board’s began a week-long meeting, the Programme, Budget and Administration Committee (PBAC), accepted that a replenishment fund could provide an avenue for flexible funding that the WHO so desperately needs.

“The committee acknowledged WHO’s need for more flexible, predictable and sustainable financing and considered that a replenishment mechanism provided a possible solution, especially for chronically underfunded areas of the organization’s programme budget,” according to the report, which concluded the deliberations of the three-day meeting of the PBAC last week.

The Global Fund to fight AIDS, Tuberculosis and Malaria raised $15.7 billion in its ‘replenishment drive’ last year, while Gavi, The Vaccine Alliance as well as the World Bank and other UN-backed global organisations also run replenishment fundraising drives to attract additional funds from donors. 

Last year’s World Health Assembly mandated the WHO Secretariat to explore a replenishment fund based on six principles, including that it is driven by member states, allows flexibility in allocation, covers the base budget, and aligns with the WHO’s resolutions.  

Funding crisis

The Executive Board is now expected to consider the proposal further this week in a series of discussions on improving WHO’s financial sustainability.  A nod by the EB would pave the way for a full-fledged vote by the World Health Assembly in May.  

At the EB’s opening session on Monday, Director General Dr Tedros Adhanom Ghebreyesus confirmed that he expected that the proposal for a replenishment process would be submitted to member states for consideration.

“We recognize that with increased flexibility and sustainability come increased expectations for transparency, efficiency, compliance and accountability. All of this leading to results,” said Tedros.

Only around one-fifth of the WHO’s budget comes from members’ countries’ “assessed contributors” (calculated on their GDP), with the rest being made up from donations. But the donations are usually tied to particular programmes, inflexible and can be withdrawn at any time.

At last year’s World Health Assembly, member states agreed to increase their contributions to cover half of the WHO’s budget. This year, members’ annual contributions are slated to be increased by around 20%.

However, even when member states increase their contributions, there will still be a gaping shortfall, obviously undesirable given disease outbreaks and other demands.

Developing the replenishment option

Recommending that the executive board accepts the replenishment mechanism, the PBAC has advised the secretariat to develop the proposal further by examining “replenishment mechanisms established by other global health organizations and [analysing] the advantages and disadvantages of the various systems”.

It also recommended that the “funding envelope for a replenishment mechanism should be based on the base segment of the programme budget, minus approved assessed contributions”. 

Still up for discussion is whether the fund will be based on the budget over one (two-year) budget cycle or two (four-year).

More money for country offices

PBAC has also recommended that the WHO secretariat consider further increases to its country operations rather than head office and regional structures. However, while the secretariat confirmed its commitment to strengthen country offices, it said that this would only be possible “gradually over time”.

The WHO secretariat told PBAC that the main reason for the uneven financing of its programmes was “the extremely tight earmarking of the funds it received”. Director-General Dr Tedros Adhanom Ghebreyesus told the committee that member states’ agreement to an increase in assessed contributions would “make all the difference”.

In response, the committee proposed that the Secretariat should “improve the persistent uneven financing across programmes, major offices and levels of the organization, including by distributing undistributed funds”.

As far as the 2024/25 WHO budget is concerned, PBAC has recommended that  member states should have until 10 February “to study and provide feedback on the programme budget digital platform” to allow proper consideration of the proposed budget ahead of the World Health Assembly in May.

Pandemic
A healthcare worker wearing PPE disinfecting a street in the early days of the COVID-19 pandemic.

The World Health Organization’s Emergency Committee on the COVID-19 pandemic and Director General Dr Tedros Adhanom Ghebreyesus both agree: the event continues to constitute a public health emergency of international concern (PHEIC).

The UN health agency agreed on Monday that ending the state of international public health emergency over the coronavirus would be premature even after three long years since its appearance upended the world of normality as we knew it three years ago.

Tedros said in a statement that he concurs with the advice offered by committee in its report based on a closed videoconference on Friday. He acknowledged the committee’s views that the COVID-19 pandemic is “probably at a transition point” that must be navigated carefully while ensuring the world is able to mitigate the potential negative consequences.

“Achieving higher levels of population immunity globally, either through infection and/or vaccination, may limit the impact of SARS-CoV-2 on morbidity and mortality, but there is little doubt that this virus will remain a permanently established pathogen in humans and animals for the foreseeable future,” the committee reported.

“As such, long-term public health action is critically needed,” it said. “While eliminating this virus from human and animal reservoirs is highly unlikely, mitigation of its devastating impact on morbidity and mortality is achievable and should continue to be a prioritized goal.”

pandemic
Personal protective equipment was essential to protect healthcare workers during the pandemic

Seven pandemic recommendations

As a result of his decision, Tedros advised nations to:

  1. Maintain momentum for COVID-19 vaccination to achieve 100% coverage of high-priority groups.
  2. Improve reporting of SARS-CoV-2 surveillance data to WHO
  3. Increase uptake and ensure long-term availability of medical countermeasures.
  4. Maintain strong national response capacity and prepare for future events
  5. Continue working with communities and their leaders to address the infodemic
  6. Continue to adjust any remaining international travel-related measures and do not require proof of vaccination for international travel
  7. Continue to support research for improved vaccines that reduce transmission and have broad applicability

The committee said moving forward past the PHEIC will require a focused commitment by WHO and its 194 member nations, along with other international organizations, put in place “systematic, long-term prevention, surveillance, and control action plans.”

The committee members, whose statement comes on the three-year anniversary of the determination of the COVID-19 PHEIC in January 2020, said it agreed the world is in a better position than it was during the peak of the Omicron transmission a year ago, yet more than 170,000 COVID-19-related deaths have been reported globally in the past eight weeks.

It agreed surveillance and genetic sequencing declined globally, making it more harder to track known variants and detect new ones, while health systems are struggling with COVID-19 and caring for patients with influenza and respiratory syncytial virus (RSV), health workforce shortages, and fatigued health workers.

pandemic
Investment in strong health systems is key to pandemic=proofing the world.

WHO asked to study impact of ending pandemic

Vaccines, therapeutics, and diagnostics have been and remain critical in preventing severe disease, saving lives and taking the pressure off health systems and health workers globally, it said, but “the COVID-19 response remains hobbled in too many countries unable to provide these tools to the populations most in need, older people and health workers.”

Some 13.1 billion doses of COVID-19 vaccines have been administered, with 89% of health workers and 81% of adults older than 60 years completing the primary series, WHO said.

“COVID-19 remains a dangerous infectious disease with the capacity to cause substantial damage to health and health systems,” the committee said, adding that has asked the WHO Secretariat to provide an assessment of the regulatory implications for developing and authorizing vaccines, diagnostics, and therapeutics if the PHEIC were ended sometime “in the coming months.”

Image Credits: Photo by Maksym Kaharlytskyi on Unsplash, Tehran Heart Centre .

WHO Director General Dr Tedros Adhanom Gehebreyesus (left) and Didier Houssin, chair of the WHO Emergency Committee. on 30 January 2020, when the COVID International Health Emergency was first declared.

The World Health Organization’s Emergency Committee on the COVID-19 pandemic was meeting Friday evening – with mixed signals emerging about whether the expert advisory group would recommend that the global health agency end the state of international public health emergency over the virus whose emergence stunned the world a little more than three years ago.

At a press conference in December 2022, WHO’s Director General Dr Tedros Adhanom Ghebreyesus expressed hopes that the emergency that he first declared on 30 January, 2020, under WHO’s International Health Regulations, could finally be concluded sometime in 2023.

But in his remarks to the Emergency Committee’s 14th meeting, the WHO Director General hinted for a second time this week that the time may not yet be ripe – as cases of new infection increased again worldwide only recently and a new wave of the virus continues to rip through China shortly after strict lockdown policies were finally relaxed.

“As we enter the fourth year of the pandemic, we are certainly in a much better position now than we were a year ago, when the Omicron wave was at its peak, and more than 70,000 deaths were being reported to WHO each week,” said Tedros in his remarks at the closed meeting, reported by WHO in a press release.

“When you last met in October, the number of weekly reported deaths was near the lowest since the pandemic began – less than 10,000 a week,” he added.  “However, since the beginning of December, the number of weekly reported deaths globally has been rising.”

China trends create a second level of concerns

Following a massive wave of protests in autumn 2022, China lifted most of its COVID restrictions – which had been among the strictest in the world.

In addition, Tedros noted, the lifting of COVID restrictions in China has led to a spike in deaths in the world’s most populous nation, whose citizens were poorly protected by vaccinations as well as having low natural immunity thanks to months of social isolation.

“Last week, almost 40 thousand deaths were reported to WHO, more than half of them from China,” Tedros said. “In total, over the past eight weeks, more than 170,000 deaths have been reported. The actual number is certainly much higher.”

Earlier this week, Tedros also expressed his mixed feelings about declaring an end to the pandemic even more bluntly, saying: “While I will not preempt the advice of the emergency committee, I remain very concerned by the situation in many countries and the rising number of deaths,” he said, speaking at WHO’s weekly press briefing.

“While we’re clearly in better shape than three years ago when this pandemic first hit, the global collective response is once again under strain.”

In fact, after reaching a peak in mid-December, the wave of new cases in China and worldwide have been declining for the past month – both according to WHO data and other data monitoring platforms. However, in light of the reduced amount of COVID testing worldwide, the confirmed case count is an increasingly unreliable measure of true cases.

“Surveillance and genetic sequencing have declined dramatically around the world, making it more difficult to track known variants and detect new ones,” Tedros told the committee at the outset of Friday’s meeting.

Revolution in vaccines, treatments and diagnostics has not reached everyone

Related to that, the global response to COVID remains “hobbled” because “powerful, life-saving tools are still not getting to the population that need them most – especially older people and health workers, Tedros said.

“Many health systems around the world are struggling to cope with COVID-19, on top of caring for patients with other diseases including influenza and RSV, and with work shortages and fatigued health workers.

“And public trust in the safe and effective tools for controlling COVID-19 is being undermined by a continuous torrent of mis- and disinformation.”

It was unclear as to whether the committee’s deliberations would continue into the weekend, or when their conclusions will finally be announced.

However, there was speculation that their report might only be published on Monday, when the WHO Executive Board, WHO’s governing body, begins its first annual round of meetings for 2023.  Among the nearly 50 items on the week-long agenda are a raft of reports and recommendations on strengthening global preparedness and response to health emergencies.

The WHO Public Health Emergency of International Concern (PHEIC) was declared in the framework of the 2005 International Health Regulations, which constitute a legally binding agreement between WHO member states regarding emergency outbreak and response. In March 2020, Tedros also declared that the emergency also constituted a “pandemic” – although there is in fact no legal provision for a pandemic declaration in the IHR.

However, the weaknesses in the IHR system of outbreak alerts, notification and resonses, highlighted by the faltering and inconsistent reponse to the COVID pandemic, have paved the way for major reconsideration of global pandemic response frameworks, with debates over a new pandemic treaty, as well as IHR revisions, set to continue throughout 2023 and into 2024.  See related story here:

Governing Pandemics Snapshot

 

Image Credits: Twitter: @WHO.

nuclear
A Nuclear powerplant in Belgium.

The World Health Organization (WHO) on Friday  released an updated list of medicines that should be stockpiled in the event of a radiological and nuclear emergency, along with new policy advice in the event of such an incident.

“Preparedness for radiation emergencies is consistently reported as the weakest area of preparedness in many countries,” the 66-page report said.

This newest report updates the one released over 15 years ago, in 2007, and thus includes a host of new pharmaceutical developments. 

“In radiation emergencies, people may be exposed to radiation at doses ranging from negligible to life-threatening. Governments need to make treatments available for those in need – fast,” said Dr Maria Neira, WHO Acting Assistant Director-General of the Healthier Populations Division. 

“It is essential that governments are prepared to protect the health of populations and respond immediately to emergencies. This includes having ready supplies of lifesaving medicines that will reduce risks and treat injuries from radiation.”

Added Dr Mike Ryan, Executive Director of WHO’s Health Emergencies Programme: “This updated critical medicines list will be a vital preparedness and readiness tool for our partners to identify, procure, stockpile and deliver effective countermeasures in a timely fashion to those at risk or exposed in these events.”

Radiological or nuclear emergencies could occur at nuclear power plants, medical or research facilities or be the result of accidents during transport of radioactive materials, WHO explained. In addition, these emergencies could be the result of a malicious event, such as a nuclear bombing.

To date, there were two massive nuclear incidents: The 1945 atomic bombings of Hiroshima and Nagasaki by the United States, the consequences of which have been continually studied. There was also the 1986 accident at the Chernobyl nuclear plant in Ukraine – the largest uncontrolled radioactive release in history.

Former Russian President Dmitry Medvedev warned this month in yet another Telegram post that a defeat of Russia in Ukraine could trigger a nuclear war.

“The defeat of a nuclear power in a conventional war may trigger a nuclear war,” Medvedev wrote. 

Exposure to high doses of radiation can have severe consequences on a person’s long-term health or lead to immediate or early death. As such, aside from generic supplies and materials used for any type of emergencies, stockpiles should include medicines that either prevent or reduce exposure to radiation, WHO explained. 

Only a handful of recommended medicines 

There are only a handful of specific drugs that have been proven effective in the treatment of over-exposure to radiation and these are included in the report. They include: stable iodine; chelating sand (decorporating agents); cytokines used for mitigation of damage to the bone marrow; and medicines to treat vomiting, diarrhea and infections.

“One of the most serious outcomes of over-exposure to radiation is acute radiation syndrome (ARS), which manifests as a haematopoietic syndrome”. The latter, also called bone marrow syndrome, impacts blood cell production and in cases of acute poisoning, can lead to death through infection or hemorrhage.  

“Depending on the severity of the exposure may further progress as gastrointestinal, cardiovascular and neurological syndromes,” the report states. However, the WHO recommendations only include treatments of haematopoietic and gastrointestinal syndromes, “as cardiovascular and neurological syndromes are considered non-salvageable and require only palliative care.”

Blocking agents such as stable iodine, could be used to block the uptake of radionuclides in the body, the WHO report added. Other agents like Prussian blue are applied to remove radioactive ceasium from the body. Calcium or zinc diethylenetriaminepentaacetic acid can treat internal contamination with transuranium radionuclides.

“These and other elements of such stockpiles should be made rapidly available in case of radiation emergencies,” wrote WHO. 

Bone marrow syndrome – emerging treatments

In the case of haematopoietic, or bone marrow syndrome, radiation attacks all three blood lineages – white and red blood cells and platelets. 

Low white blood cell count weakens the immune system, making an individual vulnerable to infection. Red blood cells carry oxygen to the body and platelets are responsible for coagulation, which prevents bleeding, explained Yaky Yanay, CEO and president of Pluri – an Israeli-based biotech firm developing an injection of placenta cells for the treatment of ARS. 

The treatment has been approved by the United States Food and Drug Administration as an “Investigational New Drug” (IND) for use in the event of a nuclear incident – although it is not yet mature enough to be considered for the WHO list of recommended medicines. 

The WHO report notes, however, that researchers are making progress on developing novel treatments, although none of them have been approved by the global health agency for use in a nuclear emergency. 

WHO: Stockpile based on population size

WHO stressed that a country’s nuclear medicines stockpile should be based on reliable data for national risk profiles, the size of the population and available resources and capabilities of their health system. 

Finally, WHO called on national health authorities, health-care facilities, pharmaceutical suppliers and logistics, civil defense and emergency services to be leveraged in the event of an emergency. These teams should be coordinated in advance to be able to function effectively in the event of a nuclear incident. 

Image Credits: Photo by Frédéric Paulussen on Unsplash.

Outbreak
Africa is making progress against COVID-19, but Dr Matshidiso Moeti, WHO Regional Director for Africa, urged countries to remain on alert.

The first three weeks of 2023 were encouraging for the African continent’s fight against COVID-19. With cases down 97% year-on-year since the same period in 2022, hospitalizations for severe illness and deaths from the virus decreased significantly, the World Health Organization’s African Regional Office said.

“For the first time since COVID-19 shook our lives, January is not synonymous with a surge,” said Dr Matshidiso Moeti, WHO Regional Director for Africa, adding the continent hopes to transition out of “emergency response mode” as the fourth year of the pandemic kicks off.

But with an ever-growing crop of variants circulating, an uptick in cases in South Africa, Tunisia and Zambia, and the overall drop in reported COVID-19 cases partially attributable to low testing rates, Moeti urged African states to remain on guard against the virus.

“It is important that countries stay alert and have measures in place to effectively detect and tackle any upsurge in infection,” she said.

As the threat of COVID-19 comes under control, new dangers have emerged from a diphtheria outbreak in Nigeria and a cholera epidemic with Malawi as its epicenter. The outbreaks have already taken 38 lives in Nigeria, and 583 in Malawi.

Diphtheria and a mystery flu hit Nigeria

Africa CDC acting director Dr. Ahmed Ogwell Ouma said the cholera outbreak must be stopped.

At its weekly press briefing on Thursday, Africa CDC said the diphtheria outbreak had spread to four Nigerian states that do not share borders. Vaccines and treatments exist for the virus, but officials said the rapid spread of the disease constitutes a major public health concern for the African continent.

Diphtheria is a serious bacterial infection that primarily affects the nose and throat. Infection leads to a thick grey or white coating of the tonsils, throat, and nose, making it difficult for infected patients to breathe or swallow. Left untreated, diphtheria causes severe complications such as heart conditions, nerve damage, and death.

Out of 123 confirmed cases, the virus has killed 13% of the people it has infected.

Africa CDC also revealed it is working with its Chinese counterpart and health authorities in Nigeria to investigate the outbreak of an unknown flu-like disease that has infected at least ten Nigerians.

Officials also reported 59 confirmed cases and 23 deaths from Mpox in the first three weeks of 2023. New cases have been reported in the Democratic Republic of Congo, Ghana, Liberia, and Nigeria.

The 2022 cholera outbreak continues

Several African countries continue to suffer the fallout of a cholera outbreak that began on the continent in March 2022.

Africa CDC has pinpointed Malawi as the epicenter of the 2023 outbreak, which accounts for nearly 20,000 new cases and 583 deaths. Burundi, the Democratic Republic of Congo, Kenya and Mozambique have also reported new cases.

Cholera cases in Malawi have increased seven-fold since the same period in 2022. Africa CDC’s acting director Dr. Ahmed Ogwell Ouma said there are heightened concerns about the spread of the outbreak to Mozambique, a neighboring country that has only reported a few cases.

“The outbreak has affected most of the districts in Malawi, and this resurgence of cases in districts where cholera was being controlled is a very big concern for us and the government,” Ouma told journalists.

The mortality rate of Malawi’s outbreak is currently 3.4%.

Omicron remains the dominant variant in Africa

Experts say the presence of XBB1.5 in Africa has not led to increased hospitalisations or deaths.

Omicron remains the dominant variant driving Africa’s COVID-19 caseloads. While recent sequences from South Africa and Botswana revealed the presence of the XBB.1.5 variant on the continent, it represents just 23 of the 150,000 genomes sequenced in Africa.

“Despite the detection of new variants, the system for genomic surveillance is still working well and there is currently no concern for an increase in hospitalizations,” said Tulio de Olivera, professor at the Center for Epidemic Response & Innovation at South Africa’s Stellenbosch University.

XB.1.55 has only been detected in Southern Africa — four cases in Botswana and 19 in South Africa. The presence of the variant has not resulted in an increase in infections, hospitalizations or deaths especially in the last two weeks, Olivera said.

Instead, recent data from South Africa showed that transmission levels are decreasing, with an 18.1% drop in the number of cases detected in the third epidemiological week. This decrease, Oliveira said, is not related to lower testing, but rather a high level of population immunity.

Africa CDC reported that 44% of the target population on the continent have been vaccinated, with four countries having surpassed the 70% COVID-19 vaccination target. Of the nearly 1.1 billion doses of vaccines received by public health authorities, 83% – over 895 million doses – have been administered, including 45 million booster shots.

As the continent continues to make progress on immunization rates, Africa CDC encouraged its member states to continue targeted and public vaccination campaigns.

“We really are encouraging our member states to continue with targeted and public campaigns for vaccination, whether it is amongst youths, health workers or those with comorbidities, even the general public. If we do it in a targeted and sustained way, then we can get even more people vaccinated,” Ouma said.

Dr Samukeliso Dube, FP2030 executive director.

In the past year alone, women’s use of contraception in 82 low- and lower-middle-income countries has averted more than 141 million unintended pregnancies, 29 million unsafe abortions and almost 150,000 maternal deaths.

This is according to the global family planning partnership, FP2030, which released its 2022 Measurement Report on Wednesday.

Today, 371 million women of reproductive age are using modern contraception – an increase of 87 million over the past decade, according to the report.

The biggest increase in contraceptive use is in sub-Saharan Africa, where there has been an increase of over 6% in the past decade, to cover 23% of women and girls of reproductive age. 

“The past ten years have been full of obstacles for country health systems – wars, political upheavals, natural disasters, deadly disease outbreaks, and lately the COVID-19 pandemic – yet through it all, women everywhere have continued to seek out and use modern contraception in ever-growing numbers,” said Dr Samukeliso Dube, FP2030 executive director. 

“What our latest report shows is just how unstoppable the demand for modern contraception is,” she added. “Women want to control whether and when to have children, and how many children to have.”

in sub-Saharan Africa, young married women aged 15-24 relied on methods such as injections and pills obtained from government facilities, while most unmarried sexually active women in the same age group relied on condoms from private health sources. 

Globally, there has been “a steady shift towards long-acting and reversible contraception”, according to  FP2030’s Jason Bremner.

Today, implants are the most common method in 10 sub-Saharan African countries and the second most common method in another 14. 

Between 2012 and 2018, the use of implants in Benin, Guinea, and Mali more than doubled among unmarried sexually active women aged 15-24, and today more than one in five unmarried sexually active contraceptive users in these countries are using implants. 

Funding flatlining

However, the report shows that donor funding for family planning is not keeping up with the growing demand for modern contraception. In 2021, donor government funding totalled approximately US$1.4 billion, which was substantially lower US$1.52 billion received in 2019. 

The US remains by far the biggest funder of family planning, making up over 41% of the $1.39 billion in bilateral disbursements in 2021. The UK has reduced its contribution the most, and now contributions little over 11%. The Netehrlands is now the second biggest donor, contributing 13,7%.

“Failing to adequately fund family planning efforts would be a missed opportunity for millions of women,” said Dr Dube. “We need not only to hold the line but also to secure new funding to accommodate the surge in demand for family planning. The hard-won gains of the last 10 years could slip away if we don’t act now.”

“There are still 50 million women who report using a traditional method, such as rhythm and withdrawal,” according to Bremner, adding that they should be offered the opportunity to use a more modern and reliable form of contraception.

A resident of Ifakara tucked into a mosquito net.

IFAKARA, Tanzania – When you think of malaria, a swarm of mosquitoes flying against an orange sunset is a dangerous sight.

As part of their mating ritual, the dreaded bloodsuckers brazenly hover for 30 minutes, males adroitly flapping their slender wings to produce a sound that lures female partners to join them.

The mosquito proliferation that results from this harmonic mating song ensures a grim reality for farmers in Tanzania’s Mchombe Village, who struggle with bouts of malaria.

Locals in this impoverished village use all the ammunition at their disposal to fight the deadly insects, whose population keep rising. At dusk, they routinely shut down windows, burn piles of fresh eucalyptus leaves to produce scented smoke to chase away the mosquitoes and, most importantly, get under their bed nets to sleep.

“Malaria is a big problem here. The mosquitoes reproduce themselves in large numbers,” said Amina Jaka, a paddy farmer at Mchombe Village.

The 28-year-old mother of four children, says mosquitoes are ubiquitous due to the presence of stagnant ponds of water, and her children struggle to sleep through the night because of them.

Clever insects

Jaka, who has witnessed two malaria deaths in the village in the past few weeks, is increasingly worried about her children and makes sure they are tucked under mosquito nets even they sleep in the afternoon.

“Mosquitoes are very clever insects. You simply don’t know when they will bite you,” she said.

Msombwa villagers, who had considered themselves exempt from malaria after a mammoth government-led anti-malaria campaign in the village two years ago, are baffled by the rising number of mosquitoes in recent months.

Nestled on the lower echelons of the Kilombero River, the village is a hotspot for the Anopheles mosquito, which transmits the plasmodium parasite that causes malaria.

Although malaria infections have declined in most parts of Tanzania since 2000 thanks to multiple vector control interventions, including insecticide-treated bed nets, residual spraying and improved diagnostics, the struggle is far from over.

Constant innovation

Scientists in Tanzania are constantly devising new ways to control the mosquito population. At a research institute run by the Ifakara Health Institute dubbed ‘Mosquito City’ as it’s home to the world’s largest captive colony of mosquitoes, researchers are studying the mating behaviour of mosquitos.

Fedros Okumu, a senior entomologist and director of science at the centre, said his team uses cutting-edge approaches to trap, repel and kill mosquitoes when mating.

“One of the most interesting experiments we have done is to study the mating behaviour of malaria mosquitoes,” he told Health Policy Watch.

“Male mosquitoes usually fly to their favourite mating places to begin a ritualistic flight dance [at sunset], drawing in females,” Okumu said, adding that a male would then identify and pursue a flying female by detecting her flight sound.

 “If the male can’t properly hear the female then the chase fails and they don’t mate,” he said.

Although mosquitoes’ romances sound like a trivial matter, researchers say it is a rare opportunity to kill the malaria-causing insects.

A doctor at Ifakara district hospital treating a malaria patient

In 2021 there were approximately 247 million cases of malaria worldwide with about 619,000 deaths, according to World Health Organisation (WHO).

The  WHO Africa region carries the heaviest global malaria burden. In 2021 the continent was home to 95% of malaria cases and 96% of deaths, with children under five accounting for about 80% of the deaths.

At Mosquito City, scientists are studying the Anopheles funestus mosquito, which is responsible for 90% of malaria cases in the region.   

“This is a least understood species of mosquitoes because it is extremely difficult to raise in a laboratory environment,” Okumu said.

There are 3500 known species of mosquitoes of which 400 belong to Anopheles family, and only 50 to 70 of them can transmit malaria to humans, he said. In Africa, malaria parasites are transmitted by the Anopheles gambiae, funestus, arabiensis and colluzzi species.

“Effective malaria control can be achieved when we identify, understand and target just one or two anopheles species instead of trying to kill all mosquitoes,” he said.

Recent gains in the fight against malaria have been attributed particularly to the use of insecticide-treated bed nets . Since 2000, over two billion insecticide-treated nets have been delivered to malaria-endemic countries including Tanzania. This rapid scale-up has been by far the largest contributor to the impressive drops seen in malaria incidence since the turn of the century, according to WHO.

But in the last two decades, analysts say their effectiveness is increasingly being compromised by the emergence and spread of insecticide resistance and increasing outside exposure to mosquito bites.

Genetically modified mosquitos

Scientists globally are now working to better understand the overall ecology of mosquitoes as the malaria vector and how the changing landscape will affect the mosquito population in the future.

One such innovation is to create genetically modified mosquitoes under lab conditions, which, upon mating with wild mosquitoes, produce offspring that are incapable of further reproduction or transmitting malaria to humans.

However, malaria researcher Zul Premji said past efforts to ensure the genetic control of mosquitoes using the sterile-insect technique have been less successful than expected due to low competitiveness between sterile and wild males.

“Many mosquito species can be cultured in large numbers under controlled conditions, but due to genetic selection and loss of natural traits, such insects may behave differently from their wild siblings,” Premji told Health Policy Watch.

However, the seasoned researcher is confident that laboratory cultures and subsequent genetic transformation of target mosquito species may result in insects with widely different mating behaviours compared to their wild siblings.

But Jaka and fellow villagers are sceptical about whether a genetically modified species will make any difference.

To them, what matters to prevent malaria is the provision of free insecticide bed nets, and repellents, quality diagnostics at local hospitals and the availability of antimalarial drugs.

Image Credits: Peter Mgongo.

The new Brazilian government under President Lula da Silva intends to propose that the World Health Organization (WHO) addresses the health of indigenous people systematically, including by training indigenous health workers.

Santiago Alcazar, the former head of WHO in Brazil, told a discussion convened by the Geneva Global Health Hub (G2H2) on Monday that Brazil would propose that the WHO establish a project on indigenous people’s health at the body’s executive board meeting, which starts this weekend.

Alcazar was addressing a G2H2 discussion on authoritarianism in a pandemic, which focused on the judgement of the Permanent People’s Tribunal (PPT) that former Brazilian president Jair Bolsonaro was “liable for crimes against humanity” during the COVID-19 pandemic.

Indigenous peoples, Black people, and quilombola (descendants of escaped slaves)  were worst affected by the Bolsanaro administration’s “rejection of isolation, social distancing, [COVID] prevention, and vaccination”, according to the PPT, which was set in 1979 up to expose human rights violations of ordinary people worldwide.

“Contrary to the unanimous position of scientists around the world and WHO recommendations, Bolsonaro not only ensured that the Brazilian population did not adopt the planned measures to limit the infection but repeatedly created various obstacles to them, frustrating his own government’s attempts to protect the population from the virus,” according to the PPT judgement.

Bolsonaro is infamous for declaring during the pandemic: “Everyone has to die one day. We have to stop being a country of sissies.”

During the height of the pandemic, there were reports of people being buried in mass graves in the Mannaus in the Amazon as graveyards struggled to cope with the death toll. In June 2020, as the death toll soared, Bolsonaro’s government simply stopped publishing statistics on COVID-19 infections and deaths.

Infographic: Brazil Stops Publishing COVID-19 Figures As Deaths Soar | Statista You will find more infographics at Statista

‘Genocidal weaponisation of COVID’

G2H2 co-chair Nicoletta Dentico, who was part of the PPT jury that heard evidence against Bolsonaro, said that the tribunal had drawn global attention to Bolsonaro’s “genocidal weaponization of COVID”.

Dentico indicated that having public hearings was one of the few tools that civil society could use against authoritarian governments during a pandemic.

PPT secretary Gianni Tognoni told the meeting that the Commission for the Defense of Human Rights Dom Paulo Evaristo Arns, the Articulation of Indigenous Peoples of Brazil (Apib), the Black Coalition for Rights, and Public Services International (PSI) has requested the hearing.

They argued that Bolsonaro and his government “intentionally spread COVID-19”, causing an estimated 480,000 unnecessary deaths that “mainly affected the indigenous population, people of colour, and health workers”.

Brazilian human rights lawyer Eloisa Machado said that the Bolsonaro government had a “deliberate project to disseminate COVID-19”, yet the country’s general prosecutor, aligned with the former president, had not been interested in investigating any criminal activity.

“There was an explicit recommendation to follow recommendations that were not medically endorsed, there was a resistance to adopting measures to reduce the circulation of people and there was also an explicit ruling against using masks,” said Machado.

Outrageous claims

“States and municipalities also did not have the financial resources to fight against COVID-19,  there was negligence in the purchase of vaccines and there was a lack of vaccination campaign,” said Machado.

While a  parliamentary commission found that Bolsonaro was propagating the pandemic by failing to implement preventive measures, the conditions in the country were not conducive to openly challenging the “democratically elected dictator”, added Machado.

There was court action against some of Bolsonaro’s more outrageous claims – such as that a person could get AIDS from the COVID-19 vaccine – but nothing to expose the systemic way in which he pursued a deliberate policy of mass COVID-19 infection instead of trying to protect people.

As a result, civil society organisations opted to approach the PPT for a hearing to show that there had been a systemic policy that had particularly affected the country’s most vulnerable people.

“We’re confident that the judicial interpretation of the PPT ruling will be able to be used to bring justice, aside from this occurring in a symbolic realm,” said Machado, stressing that civil society is adamant that there should be no amnesty for the crimes against indigenous populations committed during the pandemic. 

State of emergency in Yanomami

Alcazar, who now works for the Fiocruz Foundation, said that indigenous communities had been abandoned during COVID-19. Last week, the government declared a state of emergency in Yanomami territory, Brazil’s largest indigenous territory, in reaction to severe malnutrition.

During Bolsanaro’s reign, illegal gold miners have been operating freely in the area, often clashing violently with local people, and the health system has been neglected.

“Brazil has 2.7% of the world’s population but it has 11% of deaths due to COVID,” said Alcazar, adding that this was not just a result of incompetence but “evil intent”.

Image Credits: Aljazeera.

Trans Fats
Policies to eliminate industrially produced trans fats are relatively simple to implement, and can save lives and economies.

Five billion people around the world have no protection against industrially produced trans fats (ITFAs), putting them at risk of heart disease and death, the World Health Organization said.

ITFAs are responsible for over 500,000 premature deaths from coronary heart disease every year. Commonly found in baked goods, cooking oils, and packaged foods, ITFAs are created in an industrial process that adds hydrogen to liquid vegetable oils to make them more solid.

“Take any liquid oil and bubble hydrogen through it, and that makes it more solid,” Dr Tom Frieden, CEO of Resolve to Save Lives said at a WHO press conference announcing the launch of the report. “That’s pretty good for baking. Unfortunately, it’s also solid in your coronary arteries.”

The WHO first called for the worldwide elimination of ITFAs in 2018. Best-practice policies have gained significant traction since, protecting 2.8 billion people globally – a six-fold increase – but the WHO target for the total elimination of trans fats by 2023 is “unattainable,” the report said.

Momentum for banning ITFAs has grown, but the world still has “a long way to go,” WHO Director-General Dr Tedros Adhanom Ghebreyesus said.

Most legislation policing ITFAs has been implemented by high-income nations, with the Americas and Europe taking the lead. The European Union successfully banned all ITFAs from its food supply in 2021, and nearly 80% of people living in high-income countries are protected by what the WHO considers best-practice policies.

Four countries – Bangladesh, India, the Philippines and Ukraine – account for all 51% of people covered by best-practice policies in lower-middle income countries, with India representing 41% of that total. While 62 countries have implemented laws to ban ITFAs, covering 46% of the global population, no one living in low-income countries enjoys any legislative protections.

“Trans fat has no known benefit, and huge health risks that incur huge costs for health systems,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “Put simply, trans fat is a toxic chemical that kills, and should have no place in food. It’s time to get rid of it once and for all.”

The tobacco of the food industry

No one living in low-income countries is protected from trans fats, putting them at risk of its devastating health effects.

Unlike sugar, sodium, or saturated fats, ITFAs are not naturally occurring in any food group. While sugar and sodium can pose serious health risks, their omnipresence in foods people around the world rely on every day makes a ban both impossible and impractical. A ban on nutrients like sugar and sodium is also unnecessary, as their adverse health effects can be managed through light-touch regulation paired with dietary guidelines and recommendations.

But ITFAs are produced industrially and injected into the food supply, and can be easily replaced by healthier alternatives like vegetable oils. Experts say this makes their total elimination an easy decision for governments.

“It’s very rare for us in the nutrition space to be able to say it’s just so bad,” said Dr Rain Yamamoto, a scientist at the WHO’s department of nutrition and food safety. “There are no health benefits whatsoever.”

While significant progress has been made in the fight against ITFAs in recent years, nine of the 16 countries facing the highest estimated burden of trans fat-induced coronary heart disease deaths do not have best-practice policies in place. These include Australia, Egypt, Pakistan, Iran, and South Korea.

WHO also emphasized the cost of falling behind the regulatory wave for countries not currently facing a high burden from ITFAs. As more economies become off-limits to industrial producers of trans fats, countries unprotected by legislation policing ITFAs face the prospect of companies dumping products into their food supplies. This is particularly concerning given the lack of any legislation in low-income nations regulating ITFAs.

“If it’s not present, then there’s no harm in banning it and preventing other countries from dumping products into your country,” Frieden said. “Think of artificial trans fats as the tobacco of nutrition. It has no valid use.”

Today, 62 countries have implemented bans on ITFAs.

Denmark leads the way

Studies suggesting that trans fats could be a cause of the large increase in coronary artery disease were penned as early as 1956, but it would take until the early 1990s for renewed scientific scrutiny to confirm their negative health impacts.

The findings spurred Denmark to begin enacting policies to cut ITFAs out of the country’s food supply in 1991. What began as mandatory labelling and nutritional education policies evolved into a political and social pressure on companies to phase out ITFAs from their products in the decades that followed.

By the time Denmark became the first country in the world to pass a total ban on ITFAs in 2007, consumption had already been cut by some 90% since 1991.

A 2022 study found the policies substantially reduced coronary heart disease mortality, preventing an estimated 1,200 deaths by 2007. The 11% reduction in mortality observed over that period is similar to the contribution from decreases in smoking rates.

National legislative bans on ITFAs following Denmark’s lead by Iceland, Austria, and Switzerland, have also proven to be extremely effective.

“There’s really no alternative to governmental action,” Frieden said, adding that proper enforcement mechanisms are critical to ensuring industry takes action to eliminate trans fats.

Globally, legislation to remove ITFAs from foods is seen as one of the most potent public health measures for reducing non-communicable disease burdens emphasized by WHO in the Sustainable Development Goals to reduce premature deaths from NCDs by 30% by 2030.

In the absence of legislation, WHO Director-General Dr Tedros Adhanom Ghebreyesus called on companies to pull their weight.

“I call on the food industry to help us make up for lost time by replacing industrially produced trans-fatty acids with healthier oils,” Tedros said. “If they so choose, these companies could have an almost unparalleled impact on global health.”