Cholera flourishes in dirty water.

As Malawi struggles with its biggest-ever cholera outbreak, its response is being hampered by the global shortage of vaccines, warned Dr Patrick Otim Ramadan, World Health Organization (WHO) Africa’s Incident Manager for Regional Cholera Response at a media briefing on Thursday.

By Wednesday, Malawi had recorded 40,284 cases and 1,316 deaths, with a case fatality rate of 3.3%, Dr Charles Mwansambo, Malawi’s Secretary for Health, told the WHO Africa media briefing.

Confirming that his country had run out of vaccines last month, Mwansambo said that while the vaccines were important in preventing transmission, cholera could only be stopped by addressing “water, sanitation and hygiene”.

“What is a bit unusual is that this cholera outbreak started during the dry season,” added Mwansambo. “Last year, we had tropical cyclones and floods that destroyed most of the water and sanitation facilities in the southern region, and this was the start of the current problem of cholera.

“We then had cases in the fishing community in the north, which is a very mobile population, and it has gone out of control. So there are a number of issues, starting with climate and the weather.”

Dr Charles Mwansambo, Malawi’s Secretary for Health,

Horn of Africa drought

Ten countries in the African region have reported cholera cases, with the DRC recording over 3,000 cases, mostly in the north of the country which has been destabilised by M23 insurgents. Many people displaced by the conflict between M23 and government forces are living in close quarters in camps with inadequate water and sanitation – a breeding ground for the rapidly spreading cholera bacteria that breed in dirty water, contaminated food and sewage.

DRC health official Dr Placide Welo Okitayemba said that most people in the camps got their water from water tankers, and many of the children in the camps are malnourished “and cholera progresses faster in children who are malnourished”.

“Some of the camps are in mountainous areas and it is hard to get water to them, so we may have to move some of the camps,” added Okitayemba, who directs the DRC’s cholera control programme.

The drought in the Horn of Africa is driving cholera cases in Kenya, Somalia and Ethiopia.

Case statistics for January alone accounted for 30% of the total cases in 2022, added Ramadan.

“We are concerned that, if this trend continues, we will far exceed the number of cases that we’ve seen in 2022 and it will put significant strain on the health systems in the countries that are affected, but also significant demand on the medical countermeasures that we need to respond to this,” he added.

Acute shortage of vaccines

With 18 countries globally reporting vaccines, there is an “acute shortage of oral cholera vaccines, routinely used to stop transmission in areas where access to safe water cannot be rapidly scaled up”, said Ramadan. 

To alleviate this shortage, the WHO recommended using a single dose of the two-dose vaccine last October, while at a global level, the WHO has been engaging with manufacturers.

As previously reported by Health Policy Watch, only two global suppliers make cholera vaccines available for mass vaccinations. Shanchol is produced by Shanta Biotechnics, a Sanofi subsidiary in India, and Euvichol-Plus, made by EuBiologics in South Korea.

Both companies supply the international cholera vaccine stockpile managed by the International Coordinating Group (ICG), a mechanism that coordinates the provision of emergency vaccines and antibiotics to countries during major outbreaks. 

All countries that need cholera vaccines apply to the ICG, and those that qualify for Gavi financing get free vaccines while the others need to reimburse the stockpile.

But Shanta Biotechnics announced a while back that it will stop making Shanchol this year, while production at EuBiologics is currently constrained as the company is expanding its facilities. The expansion will ultimately enable it to produce 50 million vaccines a year. 

Countries are also short of pre-packed cholera kits containing IV fluids and other measures to address infections, said Ramadan.

Dr Patrick Otim Ramadan, World Health Organization (WHO) Africa’s Incident Manager for Regional Cholera Response

Lessons from COVID-19

Dr Theirno Baldé, WHO Africa’s incident manager for COVID-19, said all countries were better prepared to address pandemics, including cholera, since the start of the COVID-19 pandemic.

“It’s very important to mention that a lot of effort has been done by countries supported by WHO and also the partners to scaling up response capacities in the region, both for detecting new pathogens but also for trying to respond to them,” said Baldé. ‘But we are not there yet. We need to triple our response mechanisms.”

Mwansambo concurred, saying that Malawi is using the same structures that were put in place for COVID-19 to respond to cholera, with the Presidential Task Force coordinating the response and also a budget for pandemic preparedness and response. 

However, Ramadan stressed that, in the context of cholera, all countries also needed to urgently improve their water, sanitation and hygiene (WASH) plans.

Image Credits: L Pezzoli/ WHO.

Pfizer’s Paxlovid, an oral antiviral approved by the US FDA in December, has shown 90% efficacy in preventing mortality among those who take it in the first few days of infection.

After three years of its “Zero COVID” policy, the Chinese government allowed a return to relative normalcy for its citizens in early December 2022. Due to the ongoing transmission of Omicron and its numerous COVID subvariants in China, the sudden policy shift was accompanied by rapid community transmission across the country and high numbers of severe COVID cases. 

The resulting surge contributed to severe shortages of COVID medicines across the country, particularly Pfizer’s WHO-recommended oral antiviral treatment nirmatrelvir/ritonavir – known by its brand name Paxlovid – for high-risk populations.

It is unlikely that Pfizer will voluntarily drop its price, making the Chinese government’s most viable option, should it decide to seize it, the issuance of compulsory licences for the domestic marketing of Paxlovid to companies with available manufacturing capacity.

Five Chinese companies are already positioned to manufacture Paxlovid for export to low- and middle-income countries (LMICs) through the existing voluntary licence agreement.

Scarcity of supply and a failed price negotiation

Paxlovid was added to China’s National Guidelines for Diagnosis and Treatment of COVID-19 in March 2022. Paxlovid was initially covered by a national healthcare reimbursement scheme at CNY 2,300 (US$340) per treatment. This price point was recently updated to CNY 1,890 (US$282).

In early January, Paxlovid was included in the annual price negotiation for medicines in the catalogue of China’s national healthcare reimbursement scheme. After long hours of negotiation between China’s National Health Security Administration (NHSA) and Pfizer, no price agreement was reached.

While the actual terms of the negotiations remain unknown, it was widely reported that the price Pfizer offered was rejected by NHSA. A response from NHSA stated they had negotiated in good faith with Pfizer, but a wide gap in positions on pricing remained. 

NHSA added that negotiations on the inclusion of any particular drug in the catalogue is done only once a year, meaning they will not engage with Pfizer on a separate negotiation on Paxlovid again this year. The current coverage of Paxlovid by the healthcare reimbursement scheme is set to expire at the end of March 2023.

Paxlovid shortages have reportedly driven prices on the black market as high as US$7,200 per treatment. In the absence of any approval for generic versions of nirmatrelvir/ritonavir by China’s drug regulatory authority, people have turned to purchasing more affordable generics produced in India, where companies offer prices as low as US$36 per treatment to some low-income countries. 

Why is China – a middle-income developing country with a well-established pharmaceutical industry of more than 4,000 manufacturers, and a major exporter of active pharmaceutical ingredients (API) for the global market – so restricted in accessing affordable generic Paxlovid for people who need it now? 

To understand the root causes of this access crisis, a breakdown of Pfizer’s IP strategy is necessary.

Paxlovid’s patent status in China

Paxlovid is a co-packaged product containing two separate compounds – nirmatrelvir and ritonavir. Ritonavir has been off-patent since 2020, after AbbVie withdrew its remaining secondary patents on ritonavir worldwide (which were near expiration) following a compulsory license issued by the government of Israel on lopinavir-ritonavir (LPV/RTV) that had been considered as an antiviral treatment against COVID earlier.

Nirmatrelvir is a new compound for which Pfizer has been actively seeking patent protection globally. Pfizer has filed two patent applications on the nirmatrelvir compound in China, both of which remain pending.

In short, Pfizer currently holds no granted patent on nirmatrelvir nor Paxlovid as a whole in China. Yet it remains unclear if generic companies in China can freely produce and supply generic alternative versions of Paxlovid domestically. 

Paxlovid

Restrictive voluntary licensing terms hinder local production

Controlling who has access to Paxlovid even before Pfizer has secured patent protection on the product is central to the company’s IP strategy. In November 2021, Pfizer entered a voluntary license (VL) agreement with the Medicines Patent Pool (MPP) to facilitate generic supply of Paxlovid in 95 low- and middle-income countries (LMICs).

As of March 2022, 36 generic companies from 13 countries had signed the sublicense agreement, including five Chinese companies (Desano, Apeloa, Huahai, Fosun and Jiuzhou), for the production of API and/or finished product.

However, several issues with the terms of the Pfizer/ MPP VL continue to limit the options for access to generic supply in China. First, China is excluded from the territories specified in the terms of the VL agreement, meaning the five Chinese companies that signed the VL cannot supply the local market.

The exclusion of China and other major middle-income countries (MICs) like Brazil and other Latin American countries from the license territory is a long-standing practice of major pharmaceutical companies in VL negotiations with MPP. MSF has criticized this practice for its unethical consequence of blocking supply for local health needs.

Second, the terms of the VL say that exceptions can be made for local supply in excluded territories by licensed companies if their activities do not infringe on Pfizer’s “patents” as defined under the licence (Section 1.24). This includes cases of governments issuing compulsory licences according to their national law.

This means the definition of “patents” under the terms of the VL includes both granted patents and any pending patent applications. In the absence of a valid patent on Paxlovid in China, Pfizer can still prevent the five Chinese generic companies, of which several have completed the development of their generics and are ready to file for regulatory approval, from immediately supplying the Chinese domestic market to meet urgent health needs.

But if the Chinese government decided to issue a compulsory license allowing generic production and supply in the country, this could allow the five licensed companies as well as other generic supplies within China to immediately produce and supply the local market.

Finally, the VL terms require sublicensed companies to pass WHO prequalification (PQ) or stringent regulatory authority (SRA) approval before commercialization in ANY market (Section 3.5). This includes the local market where the generic companies are based.

There is no flexibility in the terms to reflect exceptional circumstances where urgent supply is mandated by national regulatory approval while WHO PQ or SRA approval is not yet complete. It is unclear how this requirement would be met if one of the Chinese generic companies included in the Pfizer/MPP VL licence were to launch a generic product locally under a compulsory licence issued by the Chinese government.

Notably, the other two VLs that MPP has signed on COVID therapeutics with Merck and Shinogi include flexibilities allowing national regulatory approval to be the basis for local supply in emergency situations.

Possible actions to overcome challenges

There are several possible solutions to the present challenges of access to affordable Paxlovid courses in China.  

As Pfizer failed to offer an acceptable price to the Chinese government to support better coverage of the drug under the national healthcare reimbursement scheme, it is not feasible to rely on a price reduction by the company. The unwillingness to negotiate comes in addition to the overall lack of transparency on different prices charged by Pfizer to countries and health agencies around the world.

Generic companies that signed the Pfizer/MPP VL may get the leverage to supply for local health needs if the territory of the licence is revised to include China in its scope. But based on past experience, such an amendment appears unlikely. 

The CEO of Pfizer has reportedly denounced the willingness of the company to facilitate generic supply in China, and would rather resort to its own contracted manufacturing company in China to supply the drug. This means Pfizer will remain in total control of overall production, supply and price. 

Generic companies that signed the Pfizer/MPP VL could supply to the domestic market if the Chinese government issues a compulsory licence for generic production and supply. This is both a fast and optimal solution, particularly in view of the fact that some of these generic companies have finished product development and are ready for regulatory approval.

Generic companies that did not sign the Pfizer/MPP VL may be less restricted and could catch up in seeking regulatory approval and launch their generic versions domestically. However, potential legal risks due to TRIPS-plus provisions, such as data exclusivity, may need to be lifted explicitly by the government. This could be done through a compulsory licence to provide certainty for independent generic suppliers.

China could also emulate the US approach, where the government directly authorized the use of patented health technologies in at least 166 government contracts without the consent of the rights holder to combat the COVID pandemic.

Grey areas under China’s TRIPS-plus provisions 

Beyond the issues outlined with Pfizer’s VL strategy, certain TRIPS-plus provisions create some grey areas for the rapid entry of generic Paxlovid production when Chinese patent law and drug regulatory rules are considered.

Chinese patent law contains several important public health safeguarding provisions. These include provisions on compulsory licensing, including for government use and public health needs, and an exception to facilitate research and development by generic companies in preparation for regulatory approval.

However, recent revisions of Chinese patent law and related regulations introduced stringent rules on data exclusivity, patent linkage and patent term extension that go beyond the obligations under the TRIPS agreement.

These revisions make it possible for a company holding only a pending patent application to threaten potential competitors with future lawsuits. Since Chinese law allows provisional protection based on pending applications, retrospective claims on infringement are valid under its patent laws.

These TRIPS-plus provisions increase the legal risks for rapid generic entry, alongside the restrictive VL terms outlined above.

Broader national and global solutions for the future

China’s current Paxlovid access challenges show once again how relying solely on the voluntary actions and goodwill of pharmaceutical corporations is insufficient to ensure medicines reach people in need. It is also a telling example of how the exercise of IP rights by a dominant company can stand in the way of COVID therapeutics access, despite claims by the pharmaceutical industry that IP is not an issue.

These challenges were anticipated on a global level at the beginning of the COVID pandemic by a decision to allow countries to temporarily waive certain IP protections on COVID medical tools called for at the World Trade Organisation (WHO), known as the TRIPS Waiver.

Unfortunately, the final outcome decision at the 12th Ministerial Conference of WTO  was insufficient and narrow in its scope, applying only to COVID-19 vaccines.

In view of the present IP barriers erected against access to COVID treatments like Paxlovid, it is regrettable that the negotiations to include COVID therapeutics and diagnostics, not just vaccines, remain at a standstill at WTO. 

The frustrating proceedings at WTO are a reminder of the importance of prioritizing national and regional actions that can provide direct and long-lasting impacts on access to medicines for all. 

To address issues and limitations with voluntary licensing practices, governments should establish adequate mechanisms to allow public scrutiny and oversight over terms and conditions requested by the patent holders that restrict access options.

Requirements for full transparency on licensing terms, cost and pricing are crucial to ensure accountability for the private sector concerning the impact its IP protection practices have on public health. Terms restricting local production supply in developing countries and those restricting access to certain populations should be available for scrutiny.

All countries should review and improve national IP law and regulations to ensure implementation of the full range of public health safeguards, and refrain from introducing TRIPS-plus provisions that could have an unfavourable impact on access to medicines for those in need.

Authors

Zhenyan Zhu, is China Advisor of Médecins Sans Frontières (MSF) Access Campaign

Yuanqiong Hu, is Senior Legal and Policy Advisor, MSF Access Campaign

Guangjian Xue, MSF China Representative.

 

Image Credits: Bobbi-Jean MacKinnon, Pfizer .

Earthquake
“We know [casualty] numbers will climb,” WHO Director-General Dr Tedros Adhanom Ghebreyesus said on Wednesday. “We’re in a race against time to save lives.”
The earthquake that struck Turkey and Syria this week is now the deadliest the world has seen in over a decade. By Wednesday evening, 11,600 people had been confirmed dead. Tens of thousands more are injured.

As deaths continue to mount, search and rescue teams from across the world are in a race against the clock to locate survivors amidst the rubble of thousands of collapsed buildings. Experts warn the window of opportunity for rescue is closing rapidly.

“The first 72 hours are considered to be critical,” Steven Goldby, a natural hazards expert at Nottingham Trent University told the Associated Press. “The survival ratio on average within 24 hours is 74%, after 72 hours it is 22%, and by the fifth day it is 6%.”

Despite massive international efforts, the scale of the devastation means many people are still waiting for help to arrive.

Accessibility to war torn area limited

The intensity of the earthquake which affected Turkey and Syria is shown in darker colours, with the epicentre in orange.

“We continue to be very concerned about areas which are inaccessible,” said World Health Organization (WHO) representative in Syria Dr Iman Shankiti, noting that the damage caused to roads and transport infrastructure has rendered certain regions inaccessible to emergency services. “The health needs are tremendous.”

The affected area straddles the war-torn region of northern Syria where Kurdish forces, Syrian-backed militias, and remnants of Islamic State, all control enclaves of territory.

The quakes shattered roads surrounding Bab al-Hawa crossing, the only UN-designated transit point for aid from Turkey into Syria. As a result, emergency aid and response teams have yet to reach Idlib province. That has left some 4.5 million Syrians – around 60% of whom have already been displaced by the war – without assistance. The United Nations, which is already mounting a massive relief effort in Turkey with WHO and other UN agencies, said it hopes to send the first aid trucks to the Syrian side of the border on Thursday.

Refugees displaced by the Syrian conflict have been hit particularly hard. Turkey hosts more than 3.5 million Syrian refugees, and in the 10 Turkish provinces hit by the quake, more than 1.7 million of the 15 million inhabitants are Syrian refugees.

The UN estimates 10.9 million people inside Syria have been affected by the quakes. The World Food Programme said it has enough food to feed people in Syria for one week. A dozen years of war have critically weakened the country’s healthcare system, leaving just 50% of its hospitals operational.

At a press conference held at WHO headquarters, Executive Director Mick Ryan called on governments to reflect on the compounding effects of war and conflict on health systems, and the lives of ordinary people.

“What’s common in both the [Syrian and Ukraine] wars is the devastating impact of war and conflict on the health system, and the health and wellbeing of ordinary civilians,” he said. “The reality is, it doesn’t matter what takes a building down, 7.9 degrees on the Richter scale or a missile. It’s human bones that are crushed, it’s human children that are killed.

“The situation in Turkey and Syria in terms of the earthquake is largely unavoidable,” Ryan said. “The realities underlying the crisis in Syria and the crisis in Ukraine are entirely avoidable.”

Image Credits: US Geological Service .

Breastfeeding has been portrayed as outmoded and even ‘unfeminist’ in formula milk marketing.

Infant formula companies have “pathologised” normal baby behaviour to promote their products, and there should be “an international, legal treaty” to prevent their marketing,  according to health experts.

In addition, political lobbying by milk formula companies to influence public policy should be sharply curtailed. 

These are some of the suggestions contained in a three-part series published in The Lancet on Wednesday morning.

Fewer than half of all babies are breastfed as recommended by the World Health Organization (WHO), as formula milk companies “exploit parents’ emotions and manipulate scientific information to generate sales at the expense of the health and rights of families, women, and children,” argue the authors.

“The sale of commercial milk formula is a multi-billion-dollar industry which uses political lobbying alongside a sophisticated and highly effective marketing playbook to turn the care and concern of parents and caregivers into a business opportunity. It is time for this to end,” says series co-author, Professor Nigel Rollins from WHO’s Department of Maternal, Newborn, Child and Adolescent Health.

Exploiting mothers’ insecurities

The series exposes how the commercial milk formula (CMF) industry portrays normal baby behaviour –  including crying, fussiness, vomiting and poor night-time sleep – as “pathological” problems. They “exploit mothers’ insecurities about their milk and their ability to satisfy and calm their baby” – and offer CMF as a solution, adds the series.

The damning exposé comes over 40 years after the World Health Assembly adopted the voluntary International Code of Marketing of Breast-milk Substitutes in 1981 to reign in the infant formula industry – which has been powerless to stop marketing manipulation.

In fact, sales of milk formula grew 37-fold between 1978 and 2019 – from $1∙5 billion to $55∙6 billion annually.

Political lobbying

Nestlé (Switzerland), Danone (France), Reckitt (UK), Abbott (US), Friesland Campina (Netherlands), and Feihe (China) dominate today’s global market, and use tactics similar to those of the tobacco, alcohol, and ultra-processed food industries.

“The ability of CMF corporations to expand and sustain their marketing practices worldwide is only possible because of their large investments in corporate political activities aimed at fostering policy, regulatory, and knowledge environments conducive to such marketing,” argues the series.

Between 2007 and 2018, the big six manufacturers spent $184∙2 million on lobbying the US government, which went on to oppose marketing regulations in Hong Kong, Thailand, Malaysia, and Indonesia, and in the World Trade Organization, and through direct bilateral engagements with governments seeking to implement national breastfeeding protection laws.

Unsubstantiated claims

Specialised formula is being sold as “comfort milks” for hungry babies, for colic, allergies, and to enhance sleep –  claims that are scientifically unsubstantiated.

These “comfort milks” can contain prebiotics, hydrolysed proteins, xanthan gum, or low lactose, but there are no clinical trials to back claims that they can provide relief for infant discomfort.

”Hypoallergenic milks” are “increasingly playing a key role in the growth strategy of major manufacturers, fuelled by a rising awareness about allergies and food intolerance among parents”, according to the report.

The companies also make unsubstantiated inferences that milk formula can “enhance brain development and improve intelligence”, using terms such as “brain, neuro, and intelligence quotient” written in large font on their products.

Some marketing of commercial milk formula companies implies that the product can improve intelligence (brand names have been changed).

Undermining breastfeeding

There are huge health advantages to breastfeeding. Mothers transmit elements of their microbiota to their children through breastmilk, and these bacteria live in the babies’ gut and help fight disease, digest food, and regulate the child’s evolving immune system

Breastfeeding also releases oxytocin, prolactin, and other metabolites that “foster mother–child bonding and reduce physiological stress for both”,  while hormones in breastmilk stimulate babies’ appetite and sleep development.  

“Not breastfeeding increases the risk of infant and young child mortality, infections and malocclusion, and potentially obesity and diabetes,” notes the report.

For mothers, it reduces breast cancer and potentially ovarian cancer and type 2 diabetes.

Yet breastfeeding is portrayed in CMF marketing as generic, outmoded, and even “anti-feminist”, while formula milk marketing links it to “upward mobility, modernity, and later with women’s liberation”. 

“The idea that breastfeeding is anti-work and anti-feminist is repeated in popular blogs, media, and academic publications, especially in high-income countries,” argue researchers.

By undermining breastfeeding and fostering dependency on commercial supply chains, CMF marketing undermines infant and young child food security in the context of major disruptions to supply chains (such was seen in the US during COVID-19).

Pitches to health professionals

“Similar to pharmaceutical companies, the CMF industry sponsors professional organisations and their conferences, meetings, and training, and posts adverts and publishes sponsored articles in scientific journals,” the series notes.

Their influence is widespread. A review of paediatric association websites and Facebook accounts, found that 60% documented receiving financial support from CMF companies.

Pitches to health professionals are presented as the sharing of scientific information or professional training, creating an image of the formula milk company as an “objective and respectable adviser”. 

“For the company to provide support materials, sponsor attendance at scientific meetings, and fund conferences and other needs therefore seem natural and acceptable. These activities are presented as professional collaborations rather than inducements,” it notes.

The series also detailed the environmental harms associated with the industry, including “greenhouse gas emissions, water use and pollution, and packaging waste”.

Not enough maternity leave

Co-author Professor Rafael Pérez-Escamilla from Yale University’s School of Public Health points out that “breastfeeding promotes brain development, protects infants against malnutrition, infectious diseases, and death, while also reducing risks of obesity and chronic diseases in later life”. 

“Yet, globally, many women who wish to breastfeed face multiple barriers, including insufficient parental leave and lack of support in healthcare systems and at the workplace, in the context of exploitative marketing tactics of the commercial milk formula industry,” adds  Pérez-Escamilla.

A systematic review of studies spanning the Americas, Asia, Africa, Europe, Oceania, and southeast Asia, found that women with three months’ maternity leave, paid or unpaid, were at least 50% more likely to continue breastfeeding compared with women returning to work before this time, and those with six months or more were 30% more likely to maintain 6 months of breastfeeding. 

The US is the only high-income country that does not have legislated maternity leave.

“There is a pressing need to reverse unfair work burdens placed on women, to make visible the economic value of breastfeeding and other unpaid work within mainstream economics, and to recognise breastfeeding as a globally distributed form of food production within food surveillance systems,” the series notes.

“Data collection on breastfeeding is particularly poor in high-income countries, allowing governments to avoid their responsibilities for progressing the rights of women and infants and young children everywhere.”

Marketing of commercial milk formula using reassuring words such as “gentle” (brand names have been changed).

Ban marketing

Marketing of CMF products should not be permitted, argue the researchers.

“A framework convention, placing the rights of children and women at its heart, is needed to protect parents and communities from the commercial marketing of food products for and to children younger than three years old, including CMF marketing systems. The framework would restrict marketing but not the sale of these products.”

 Such a convention or treaty would obligate governments to fully legislate its provisions into national law. 

“The treaty must protect policymaking from industry influence, with obligations for senior public officials to divulge meetings with lobbyists and requirements for scientific organisations to disclose funding sources and members of expert advisory groups,” adds researcher Professor David McCoy from the United Nations University. 

“This would regulate the commercial milk formula industry while not restricting the sale of the products to those who need or want them. More generally, the global and public health community must also be much more critical about public-private partnerships that enable or tolerate conflicts of interest.”

The researchers also want requirements for research institutions, think tanks, professional organisations, and NGOs to disclose funding sources.

Image Credits: Ana Curcan/ Unsplash.

Antimicrobial resistance
Rivers, lakes and sediment can be transient sources of antimicrobial resistance.

A new UN Environment report calls for more attention to be focused on the environmental factors fostering the development of strains of drug-resistant bacteria immune to all known antibiotics, known as “superbugs”. By 2050, the UN estimates that up to 10 million deaths could be caused by superbugs and associated forms of antimicrobial resistance, matching the annual global death toll of cancer.

WHO has estimated that some 4.9 million deaths annually are associated with antimicrobial resistance (AMR), while a 2022 Lancet study found that in 2019, 1.27 million deaths – including 860,000 in Africa – were the direct result of drug-resistant bacterial infections. That same year, Africa saw 640,000 deaths from HIV. 

While most attention to AMR has been focused on the use of anti-microbial drugs in the health care and animal husbandry sector, the report highlights growing evidence that the environment is a significant factor in AMR’s growth, transmission, and spread. 

Antimicrobials – which include antibiotics, antivirals, antiparasitics and antifungals – are critical to the health of humans and the livestock, aquaculture, and crops the global food chain relies on. Their discovery in 1928 led to a revolution in medicine that brought about a new era of food security and health now taken for granted.

But their overuse in the pharmaceutical, agricultural and healthcare sectors, and resulting spillover into the environment, is threatening to undermine their effectiveness altogether. As human-made antimicrobials spillover into rivers, soil, and other natural reservoirs, bacteria learn to ‘resist’ treatments to which they were previously vulnerable.

“We are confronted by a silent, slow-motion pandemic,” Mia Amor Mottley, President of Barbados, said at a press briefing marking the launch of the report, held on the sidelines of the Sixth Meeting of the Global Leaders Group on Antimicrobial Resistance in Bridgetown, Barbados. “Our greatest fear is that [AMR] may well become the leading cause of death in the world.”

Climate change and pollution are media for superbug spread

Projected global deaths by continent in 2050. Low-Income Countries (LICs) and Lower-Middle-Income Countries (LMICs) bear a significant burden of infectious disease and will be more adversely affected by AMR, according to the report.

The report calls attention to both global warming and the increased pollution of rivers, lakes and other waterways, which provide condusive environments for drug resistant pathogens to breed and spread. 

“The climate crisis and AMR are two of the most complex threats the world currently faces,” the report said. “Both have been worsened by, and can be mitigated by, human action.”

The UNEP report is the first to call for a “One Health” response to AMR, highlighting the relationship between extreme weather events, higher temperatures, and land-use changes and the spread of resistant bacteria. 

As temperatures increase around the globe, the evolution of resistant bacteria accelerates. In addition, extreme weather events, like floods, lead to the mixing of pathogens from diverse sources, exacerbating the spread of resistant bacteria in places where they did not exist previously, the report stated. 

Of special concern is the pollution of waterways by hospital wastewater, run-off from pharmaceutical production, and agricultural treatments, which contribute to the development and spread of resistant microorganisms in the environment. 

Wastewater and other effluents discharged by such industries are often highly contaminated with antibiotics and other chemicals used to protect or treat people, livestock and plants. When the contaminated waste is discharged, without adequate treatment, it creates an ideal medium for drug resistant bacteria and viruses to grow and flourish. 

This is a particularly large problem in burgeoning cities, which lack adequate wastewater management.  Low and middle income countries, particularly in Asia and South East Asia, are expanding their industrial agricultural production of plants and livestock – which often involves heavy drug and chemical applications  – without adequate effluent treatment.

“The same drivers that cause environmental degradation are worsening the antimicrobial resistance problem,” said Inger Andersen, Executive Director of the UN Environment Programme, at a launch of the report on Tuesday. “The impacts of antimicrobial resistance could destroy our health and food systems.”

Reduction of antimicrobial use is possible, but funding and planning are needed 

While a 2020 study estimated that the use of veterinary antimicrobials will increase by 11.5% by 2030, several countries have already undertaken successful national action plans to reduce the use of antimicrobials across the board. 

The Netherlands achieved a 68% decrease in antimicrobial use over a 10-year period after implementing a comprehensive action plan in 2008. The United Kingdom also reported a decrease in antimicrobial use in animals by 39.2% after publishing its “Five-Year Antimicrobial Resistance Strategy” in 2013. 

But as the global population expands, and financial resources to address AMR remain scarce, low- and middle-income countries will require support to ensure their agricultural industries do not follow the industrialized farming path charted by high-income countries now seeking to redress the negative impacts of antimicrobial use. 

“We need to be able to mobilize far more expansive resources globally if small countries are to play their part in ensuring that the planet that we live on remains safe,” Mottley said, adding that middle-income nations vulnerable to climate shocks should also be supported. 

Currently, 150 countries around the world have national action plans relating to AMR, but just 40 have been implemented. If the rest are not implemented, the risk of AMR getting out of control may become an inevitability. 

“It’s a big ask, but it’s a big problem,” said Dr. Haileyesus Getahun, Director Global AMR Coordination at WHO, who spoke at the publication’s launch. “Unless we step up to the plate, we’re going to have problems not just now, but for generations to come.”

AMR death toll may catch up to cancer by 2050

Predicted mortality from AMR compared with common causes of current deaths.

Antimicrobial resistance is listed by the WHO as one of the top 10 threats to global health, and its impacts are already taking a significant toll on the health of humans, animals, plants, and economies. 

If the development and spread of AMR continues at its current rate, modern medicine will struggle to treat even mild infections among humans, animals, and plants, with devastating consequences, scientists predict.

“We are here because antimicrobials are a super weapon,” UNEP’s Andersen said at a press conference accompanying the launch of the report on Tuesday. “But their effectiveness is under threat. Scattergun and careless use of this super weapon is increasing the emergence of antimicrobial resistant superbugs.” 

The report estimates knock-on effects from AMR could result in at least $3.4 trillion in annual economic damage by 2030, pushing 24 million more people into extreme poverty in the next decade.

“In a world profoundly skewed in favour of wealthy nations and communities, AMR will hit the most vulnerable the hardest. Poverty, lack of sanitation and poor hygiene make AMR worse,” Andersen said. “If we are serious about increasing equity and saving lives, we must act now on AMR.”

Image Credits: Balasaheb Pokharkar.

Syrian refugee camp: over 70% of Syrians face hunger and the earthquakes have worsened their plight.

The World Health Organization (WHO) triggered its “no regrets” policy at an emergency meeting on Tuesday in response to the earthquakes that devastated Turkey and Syria this week, while promising long-term aid to the affected regions after the period of emergency response ends.

The policy – which says that in unpredictable crises, WHO should err on the side of caution by over-resourcing disaster response efforts rather than risk under-funding them at a cost later paid in lives – immediately frees up all of the organization’s financial resources and personnel to attack the crisis.

Director General Dr Tedros Adhanom Ghebreyesus announced that WHO had mobilized its network of emergency medical teams – over 20,000 pre-qualified emergency responders, medics and nurses from its member states – to provide essential health care for the injured, with a focus on immediate trauma care.

In addition, three chartered flights carrying surgical trauma kits and other key medical supplies are on route to Turkey and Syria from WHO’s logistics hub in Dubai. The flights are estimated to arrive sometime between Tuesday evening and Wednesday morning.

As aftershocks continued into their third day, the official death toll rose to 5,102, with another 22,000 injured across Turkey and Syria. Over 5,700 buildings were destroyed in Turkey alone, including 15 hospitals. Exact numbers for the destruction of infrastructure in Syria are not known. 

Officials said casualties will continue to rise as rescuers frantically search the rubble for survivors in sub-zero temperatures. The last earthquake of a similar magnitude in Turkey, which shook the north west of the country in 1999, killed over 18,000 people. 

“It’s now a race against time,” Tedros said. “Every minute, every hour that passes the chances of finding survivors alive diminishes.”

Daraa, Syria

A story split by the border

By Tuesday morning, Turkish officials said around 1,000 ambulances, 4,500 health personnel and 240 national emergency medical teams had been deployed to the disaster zones. The arrival of national and international personnel would reinforce this response. Crisis units have also been set up in all affected provinces under the coordination of the national disaster response agency.

In Syria, meanwhile, just 28 ambulances and seven mobile clinics had been dispatched by the government to affected areas in Aleppo and Latakia, just two of the five cities hit by the quakes. 

The stark difference in response illustrates the contrasting realities for survivors on either side of the Turko-Syrian border.

Turkey, despite its recent economic troubles, remains the world’s 19th largest economy, with a vast network of allies across the globe. It has a functional state that is aware the country sits on a dangerous fault-line and is at tremendous earthquake risk, with national plans and designated government agencies to respond to emergencies.

But across the border, a deadly mixture of war, displacement, climate shocks, inflation, economic decay, crumbling infrastructure and a recent cholera outbreak has trapped Syrians in what the WHO calls a “super crisis”. 

Impacts from the earthquake are expected to further compound these crises, making the vulnerable even more vulnerable.

Rebels, poor roads and makeshift houses

The last rebel enclave in northwestern Syria – a place close to three million people who fled the fighting in Syria call home – was the hardest hit by the earthquakes. Rebels govern the region with very few resources, and many people live in temporary housing, tents, or unfinished, poorly built apartment blocks.

Areas of the country under government control do not fare any better. Prior to the quakes, the UN estimated 90% of Syria’s population of 18 million live in poverty, while 70% are in need of humanitarian assistance, the largest number since the conflict began 12 years ago. 

Barely a week before the earthquakes hit, the World Food Programme warned that food insecurity in Syria had reached a 12-year high, with an estimated 2.9 million people at risk of sliding into hunger and a further 12 million do not know where their next meal will come from. This means 70% of the Syrian population may soon be unable to provide food for their families, the UN agency said.  

“If we don’t address this humanitarian crisis in Syria, things are going to get worse than we can possibly imagine,” WFP Director David Beasley said from Damascus on January 27. 

‘Every minute, we lose a life’

As the Syrian conflict reaches its 12th anniversary next month, humanitarian aid has dwindled. In 2022, the United Nations (UN) received less than half of its $4.4 billion target to meet the needs of the people caught in the crossfire of a never-ending stream of crises beyond their control. 

With so many people in need of humanitarian assistance in Syria, the destruction of roads used to deliver aid is another major concern, UN and WHO officials said. 

“The movement of aid through the border into northwest Syria is likely to be or is already disrupted due to the damage caused by the earthquake,” said WHO Senior Emergency Officer Adelheid Marschang. “This, in itself, would be a huge crisis.”

Statements from Médecins Sans Frontiéres (MSF) and the Syrian Civil Defense – an organization better known as the White Helmets – backup Marschang’s concerns in grim detail. 

“Health facilities are impacted and overwhelmed. Medical personnel in northern Syria are working around the clock to respond to the huge numbers of wounded arriving at facilities,” said Sebastien Gay, MSF’s Head of Mission in Syria. 

In a message sent out over WhatsApp, the White Helmets said harsh weather was impeding their rescue efforts, and leaving thousands stranded in the cold. With medical supplies and manpower already stretched thin before the earthquake, the group pleaded for help from the international community. 

“Tens of thousands of civilians are homeless,” the statement said. “The medical situation is abysmal. Tens of thousands of buildings are now cracked. There’s a snowstorm. There’s predictions of flooding in the area. The humanitarian situation is disastrous, with every meaning of the word.

“Every minute, we lose a life. We are now racing with time.” 

 

Image Credits: Engin Akyurt/ Unsplash, Mercy Corps, Mahmoud Sulaiman/ Unsplash.

As the world discusses how language model chatbot ChatGPT is changing the way information is created, the new episode of the “Global Health Matters” podcast addresses the question of how artificial intelligence and other technological tools can improve healthcare.

“Investigators have already been testing the applicability of artificial intelligence to healthcare,” says host Garry Aslanyan. “A recent study in PLoS Digital Health has shown these kinds of AI algorithms to have huge potential in the early diagnostics of dementia.”

Highlighting the potential of new technologies but also their limits, during the episode Aslanyan entertains a conversation with Florence, a freely accessible AI health worker developed by the World Health Organization in partnership with the Ministry of Health of Qatar.

“Florence was engaging, but I must admit I didn’t get the responses that I needed to hear,” remarks Aslanyan.

According to Yara Aboelwaffa, an independent Digital Health Consultant and co-founder of Health 2.0 Egypt, eventually Florence will become a game-changer.

“The future versions of Florence, or generally AI powered chatbots, have many possible uses like debunking medicine myths or responding to simple medical questions,” she tells Aslanyan. “There are a lot of possibilities for the future of Florence. Mostly that it can become the first line of primary care that would initially relieve some of the pressure on the medical professionals.”

Can chatbots become culturally acceptable?

For Tim Mackey, an associate professor at the University of San Diego and the co-founder of healthcare big data startup S-3 Research, the key question is whether chatbots will become culturally acceptable for people.

“I think the thing that’s important for public health people to understand is that we can’t just depend on technology to solve all our problems,” he says. “We have to give it time to develop and we have to invest more in it.”

Funding research and implementation of new technologies is one of the key challenges of the field, both experts point out.

“Most of the digital health projects are focused on market needs that are highly profitable and scalable,” Aboelwaffa highlights. “That’s because innovations that do not have a proven financial return on investment are still extremely limited because they don’t get funded.”

Mackey and Aboelwaffa also emphasise the significant positive impact that new technologies are already having in many fields of healthcare, a trend that has been accelerated by the COVID-19 pandemic.

“There’s a lot of innovation coming forward in the future and also being developed right now, and a lot of it is focused on a suite of digital health tools that can be used to enhance public health,” remarks Mackey.

“The thing I’m most excited about is data,” says the consultant, sharing what she is witnessing in the Middle East. “Data is the bedrock for providing evidence for informed interventions within the health system. Many different health systems within the region have been implementing national-level systems to collect, aggregate and report on data.”

Asked about how she sees the healthcare of the future, Aboelwaffa says that she thinks it is going to be “participatory, preventative, personalised, democratised and destigmatised.”

“It basically means that health systems will empower people to take charge of their own health, shift to more preventative approaches to keep the population in this magic circle of wellness, and provide tailored health services that address specific needs of the individual regardless of their age, sex, gender, and income,” she concludes.

Image Credits: TDR.

Daraa, Syria, is devastated by war.

As a second earthquake hit Turkey and Syria on Monday morning, the World Health Organization’s (WHO) member states offered their solidarity during an Executive Board (EB) session that presciently focused on refugees and migrants.

The two earthquakes struck within 12 hours, and by Monday evening over 2,600 deaths had been reported, while thousands of people had been displaced as their homes were destroyed.

Syria’s representative appealed to the EB for support from member states, saying that many people were still under ruins.

“The emergency services are working flat out at all levels. They’re doing their utmost, but it’s a terrible disaster,” she said. “We’re facing a lot of problems today, and that’s also because of the blockade on our country. We call on the conscience of the world to wake up and support us. We hope that WHO and all of its member states will help us as we seek to grapple with this disaster.”

WHO Director-General Dr Tedros Adhanom Ghebreyesus told the EB that the WHO’s network of emergency medical teams had been activated “to provide essential health care for the injured and most vulnerable affected by the earthquake that hit Turkey and Syria”. 

Extension of WHO action plan on refugees and migrants

Meanwhile, the EB resolved to extend the WHO’s action plan on refugee and migrant health through to 2030. 

It is estimated that there are more than one billion people on the move globally, about one in eight of the global population, according to a report prepared by Tedros for the EB.

“In 2020, there were 281 million international migrants and by June 2022, the number of forcibly displaced people had reached more than 100 million,” the report added. 

“Migration and displacement are key determinants of health and well-being. Refugees and migrants remain among the most vulnerable members of society faced often with: xenophobia; discrimination; poor living and working conditions; and inadequate access to health services, despite frequently occurring physical and mental health problems.”

The WHO action plan was focused on five priorities, including “promoting the health of refugees and migrants through a mix of short-term and long-term public health interventions” and ensuring the “continuity and quality of essential health care, while developing, reinforcing and implementing occupational health and safety measures”, according to the Secretariat report.

“The need is now to shift the operational paradigm from immediate issues to a longer-term vision for refugee and migrant health,” it added.

Poland’s lessons from Ukraine

Poland told the EB that the war in Ukraine had forced it to update its approach to refugees, and it was ready to “share our experience in order to contribute to global response to the health needs of refugees”

“Last year, we encountered a new, unexpected situation which has caused the biggest wave of migration in Europe since World War Two,” said Poland. “Since 24 February last year, almost 10 million of our neighbours from Ukraine have crossed the Polish border.”

Poland had enabled Ukrainians to get free access to universal health services, set up hotlines to facilitate understanding of how to access services and an innovative digital application that “enables smooth communication between a doctor and patient not speaking the same language”. 

“We ensured the continuation of long-term TB and HIV/AIDS treatment according to the Ukrainian scheme and with the same medicines they were taking at home”, while Ukrainian children were included in the Polish system of vaccinations. 

Ukrainian refugees

Morocco told the EB that “60% of refugees throughout the world are in our region [the Eastern Mediterranean].” 

“Yemen is one country that is particularly severely affected by war. There’s been a war raging there for seven years and this has triggered a very serious crisis, one of the worst in the world, and 70% of people living there need humanitarian assistance just to survive,” said Morocco.

In June, Morocco will be hosting a third round of global consultations on the health of refugees and migrants to provide guidance for decision-makers to strengthen healthcare for refugees and migrants throughout the world.

US Assistant Secretary of State for Global Public Affairs Loyce Pace said that her country was a co-sponsor of the resolution, stating that “we must strengthen our commitment to address the needs of health needs of refugees and migrants in all their diversity, especially as countries chart their path towards achieving universal health coverage”. 

“Reaching women and girls in conflict-affected fragile settings is essential to promoting gender equality, and empowering all women as well as achieving key targets,” said Pace.

“We expect WHO to lead by example and show member states that refugees and migrants should play a central role in the implementation phase.”

This sentiment was echoed by the International Committee of the Red Cross, which called for refugees to be included in the development and implementation of any health plans aimed at them.

Meanwhile, Rwanda, speaking for the 47 African member states, appealed for the integration of migrant and refugee health into regional and international initiatives “in a way that lessens the burden on host countries, enhancing coordination and partnership, capacity strengthening and support, strategic health information and multi-sectoral approaches to health”. 

Traditional medicine policy 

The EB also adopted a draft decision calling for a global policy on traditional medicine that was tabled by Bangladesh, China, Eswatini, India, Indonesia, Japan, Malaysia, Nicaragua, Republic of Korea, Singapore, South Africa, Thailand and Turkey.

The WHO and India are establishing a Global Centre for Traditional Medicine in Jamnagar in Gujarat in India, and 170 of the 194 member states report that their citizens use traditional medicine.

Thailand, on behalf of the WHO Southeast Asia region, expressed its support for the global centre, noting that it would “harness the potential of traditional medicine from across the world through knowledge sharing, evidence generation and incorporating modern science and technology to improve the health of people and the planet”.

Meanwhile, the US’s Pace stressed the importance of “scientific rigour in studying the safety and efficacy of traditional medicines” and “evaluating traditional medicine”.

“Member states must also adhere to their obligations under the Convention on International Trade in Endangered Species of Wild Fauna and Flora and take meaningful action to protect endangered species from exploitation,” she added.

Image Credits: Mahmoud Sulaiman/ Unsplash, Maria Teneva/ Unsplash, Kevin Buckert/ Unsplash.

US representative Loyce Pace (left) and Denmark’s Erik Brøgger Rasmussen

A major overhaul of the World Health Organization’s (WHO) finances is chugging ahead after member states at Monday’s Executive Board meeting agreed that the reform proposals – including the mooted replenishment fund to bolster the global body’s core finances – will be taken to the World Health Assembly in May.

However, some member states expressed concern about the body’s financial priorities, accountability and reporting.

Madagascar, on behalf of the 47 African member states, once again called for a greater budget allocation for regions and country offices, while Russia called on the WHO to pay more attention to corruption and fraud as these were “more common than sexual misconduct”.

Meanwhile, Denmark’s Erik Brøgger Rasmussen, speaking on behalf of his country, Estonia, Finland, Iceland, Norway and Sweden, supported the decision to increase assessed contributions to the WHO.

The proposals to improve governance strike “the right balance between the respective roles and responsibilities of member states and the secretariat”, added Rasmussen, but added that the countries looked forward to “improvements in transparency, efficiency and accountability”. 

He added that while the replenishment mechanism “has potential”, this should be “further explored” including through in-depth consultations between the Secretariat and member states in the run-up to the World Health Assembly.

The UK and US supported the idea of a replenishment fund but stressed this should be voluntary, while China stressed that it should ensure that the WHO had access to flexible funding.

Germany commended the Secretariat for its “substantial progress” in resolutions, adding that the current programme budget “shows the weaknesses of how WHO was financed”. 

It added that “the replenishment mechanism, as an additional voluntary pillar of WHO funding, will lead to a more sustainable, transparent and above all, predictable financing”.

WHO Director-General Dr Tedros Adhanom Ghebreyesus and Raul Thomas, WHO Assistant Director-General for Business Operations.

Increase in members’ fees

“The gradual increase in assessed contributions will be an important step to further strengthen WHO.”
Australia expressed commitment to “working with fellow member states and the Secretariat to implement reforms that are tangible, cost-effective and have measurable impact to achieve more efficient use of resources”, and also supported “sustainably financing the organisation, particularly through increased assessed contributions”.

Japan, however, cautioned that all economies had been affected by the COVID-19 pandemic, and that it would need to be able to justify any increases in assessed contributions to its citizens.

In response to member states’ concerns, the WHO’s Secretariat reported that more budgetary information would be loaded onto the member states’ password-protected portal once certain security issues had been resolved.

Raul Thomas, Assistant Director-General for Business Operations, said that there would also be reportbacks to the Programme, Budget and Administration Committee (PBAC), the EB and the World Health Assembly – but that with 59 proposed reforms on the table, “the major challenge is going to be resources”.

In response to Africa’s ask, Thomas said that country allocation had increased from 39% in the 2018/19 biennium to 50% in the proposed 2024/ 25 biennium – with a 4% increase since  the last biennium. 

“We are making strides in this respect. What we really need to also focus on is the financing of the budget,” stressed Thomas. “Increasing a ceiling alone will not address our problems.”

Shortly before the EB, the influential PBAC proposed that the WHO Secretariat should explore details about a replenishment mechanism for continued consideration by Member States, consulting members about the timeframe, and base segment of the programme budget to be used in a replenishment mechanism.

Dr Bruce Aylward, the Director-General’s special advisor, said that the Secretariat had “heard loud and clear” member states’ suggestions on the replenishment mechanism.

“We’re delighted to do this in consultation with the member states. It’s a big new direction for the organisation, and we are committed to having intercessional sessions with you to work out some of the detail,” he added.

“We’ve heard the importance of ensuring those [funds] are unearmarked contributions, that they are directed in the right manner, etc and we look forward to further discussing those with you.”

Russia
The World Health Organization’s Executive Board meeting

The Russian delegation to the World Health Organization (WHO) Executive Board (EB) called the report on the work of the UN health agency’s response to the Ukraine war “politicised,” prompting a spirited defense from the agency chief.

Russia pressured the UN health agency to revise a report related to its emergency response in Ukraine, prompting a tense exchange with WHO Director-General Dr Tedros Adhanom Ghebreyesus on Saturday while also clashing with the United States and its European allies over descriptions of the humanitarian crisis sparked by Russia’s war on the country. 

Russia’s delegation to the EB accused the WHO Secretariat of preparing a one-sided report on its emergency response in the embattled country, which it said politicised references to Ukraine, describing the Russian military action as an “invasion”.  Russia said that the single-word description was evidence that WHO’s leaders were under political pressure.

The report on WHO’s response to the Ukraine emergency was filed as a follow-up to a May World Health Assembly resolution condemning Russia’s war on Ukraine, which was approved in May. The report was considered in Saturday’s session along with a broader WHO report, which referred to Ukraine as one of eight acute global health emergencies among the 50 emergencies to which WHO was responding.

Unusual move at EB meetings

Despite the EB chair’s attempts at mediation, the decision was made to merely “note” the report – in contrast to the norm at EB meetings to reach decisions by consensus.

The EB’s Chair Dr Kerstin Vesna Petrič of Slovenia asked EB delegations, which include both Russia and the US, to agree that the Secretariat will continue to work on the report “with a view to presenting, comprehensive, balanced validated data. It’s understanding that all relevant aspects will be included.”

US Ambassador Bathsheba Nell Crocker also urged the Secretariat to include language in the report stating that Russia’s latest attacks that have caused “unspeakable harm to civilians and critical infrastructure in Ukraine.”

Russia
Ukraine operating theatre destroyed

A testy vote in showdown with Russia

Despite Petrič’s attempt to compromise, Russia insisted upon a roll-call over the EB report – documents that are typically approved by consensus. Petrič then led delegations in a vote to “note” its report on WHO’s humanitarian and emergency health response to the war in Ukraine.

Among the 34 EB delegations with the right to vote, only 22 delegates were in the room at the time of the vote and participated; the motion passed by a vote of 18-4 with six abstentions.

The US and Denmark delegations, among others, accused Russia of undermining the work of the Secretariat.

Russia

WHO Director-General Dr Tedros Adhanom Ghebreyesus responds to Russia’s charges of politicisation.

The last word

Defending himself and his office against charges of politicisation, Tedros fired back that “it would not be right that we conclude this without me saying something.”

He assured the assembly that “this report was written truthfully and in good faith,” and urged any member nation to come to the Secretariat with any concerns if they feel there are specific issues or facts that are wrong.

Tedros vehemently defended his use of the word “invasion” in the humanitarian and emergency health response report to describe what happened in Ukraine.

“I used the same word in a speech last year,” he noted. “I couldn’t find any other word that would represent it because it’s the truth. What could I say?”

“The report is truthful and was written in good faith, and it’s my report and I take full responsibility,” he said, adding the report was written a while ago and would be updated. “We didn’t try to politicize anything. … There was no pressure.”

Last year’s, WHA resolution condemning Russia’s invasion of Ukraine passed by 88 votes to 12 – but the 53 abstentions reflected the discomfort of many members, particularly in low- and middle-income countries, with the debate that they perceived as polarising the global health body.

Image Credits: WHO.