Barely over a quarter of babies in North America are exclusively breastfed for the first six months of life – far lower than anywhere else in the world.

The US has yet to sign the International Code on Marketing Breast-Milk Substitutes, adopted by the World Health Organization (WHO) in 1981 to curb the aggressive marketing of formula milk, while its maternity leave benefits also lag behind many other countries.

The global rate for exclusive breastfeeding is now 48% – just 2% short of the 2025 target set by the World Health Assembly.

“South Asian countries have the highest exclusive breastfeeding rates at 61% followed by East and Southern Africa with the second highest birth rate at 55%,” UNICEF’s Fatmata Fatima Sesay told a media briefing on Thursday to mark Breastfeeding week.

“Almost one in three infants in the Middle East and North Africa are exclusively breastfed and only 26% in North America are exclusively breastfed, so we really need to close disparities and gaps,” added Sesay, who is the agency’s breastfeeding lead.

“We have seen that 21 countries have increased their exclusive breastfeeding by at least 10%. Countries as diverse as Cote d’Ivoire, Marshall Islands, the Philippines, Somalia and Vietnam have achieved large increases in breastfeeding rates, showing that progress is possible when breastfeeding is promoted, protected and supported.”

The WHO and UNICEF advocate for babies to be breastfed within an hour of birth, exclusive breastfeeding – nothing but breastmilk – for the first six months of their lives, with breastfeeding continuing until the age of two.

Restrictive working conditions

However, many women struggle to reach these targets because their working conditions do not allow this.

Dr Victor Aguayo, UNICEF’s global director of nutrition and child development, called on all stakeholders to provide three important measures to encourage breastfeeding, which is fa better for a baby’s health and development than formula milk. 

“The first one is to ensure a supportive breastfeeding environment for all working women. This includes access to lactation breaks and facilities that enable women to breastfeed their babies once they return to the workplace,” said Aguayo.

“The second one is to provide sufficient paid leave to all working parents to meet the feeding needs of their young children. This includes paid maternity leave for a minimum of 18 to 24 weeks or more after birth,” he added.

“And the third one is increased investments in breastfeeding support including national policies and programmes that regulate and promote public and private sector support to breastfeeding women in the workplace.”

The International Labour Organization’s (ILO) senior Gender Specialist, Emanuela Pozzan, noted that 649 million women lack adequate maternity protection.

“We see that paternity leave laws are on the rise,” she added. “We have 115 countries that provide paternity leave – 33 more countries compared to 2011. So the trend is positive, and yet 1.26 billion men live in countries that do not provide paternity leave.”

While 68 countries have parental leave, this was only paid in 46 countries.

‘The ILO’s Convention 183 on maternity protection says women workers should be provided with the right to one or more daily nursing breaks or a daily reduction of working hours, which should be counted as working time and remunerated accordingly,” she added. 

“In 138 countries there is the provision of statutory rights to time and income security for breastfeeding. Eighty  countries grant two daily nursing breaks, and 199 countries offer the right to daily nursing breaks for six months.”

Only one in 10 potential parents have access to free and affordable childcare services. And in fact, 21 out of 178 countries grant universal childcare services in the laws for children aged zero to two years.

Image Credits: WHO.

The presence of Hungary’s President, Katalin Novak (second from right) as a speaker at the Women Deliver conference, shocked many SRHR advocates.

The Women Deliver conference is one of the world’s largest gatherings on gender equity and sexual and reproductive health and rights (SRHR). This year, amidst a global backlash against the rights of women and people of diverse genders, the meeting was held for the first time in Africa in Rwanda from 17-20 July.  More than 6,300 women’s rights activists, feminists, and policymakers from 170 countries attended.

There were significant outcomes. Most notable was Canada’s commitment of more than $200 million in funding for new projects to support sexual health and reproductive areas, including family planning, comprehensive sexuality education, advocacy for SRHR, safe abortion and post-abortion care, and sexual and gender-based violence. There was also a timely boost for resourcing feminist movements and growing collective political influence from the local to multilateral spaces. 

Closing the gender nutrition gap

A monumental campaign, Closing the Gender Nutrition Gap: an Action Agenda for Women and Girls, was launched by over 40 organizations to close the gender nutrition gap. Women and girls worldwide are twice as likely to suffer from malnutrition as men and boys. 

This campaign is an excellent opportunity for feminist movements to highlight the stark – and growing – inequalities in nutrition. Cultural norms, social roles, economic disparities, and discriminatory practices create and sustain this overlooked crisis. 

‘Closing the Gender Nutrition Gap’ identifies four action areas.

The United Nations Population Fund (UNFPA) announced the Kigali Call to Action: United for Women and Girls’ Bodily Autonomy to accelerate investments and actions, with women-led organizations and the feminist movement at the center. UNFPA called for coordinated and collective action to achieve bodily autonomy, reproductive rights and gender equality for women and girls everywhere.

Increased attacks

The meeting came a year after the US Supreme Court struck down Roe v Wade, a key abortion rights law, which is still sending vibrations and bringing a lot of uncertainty about women’s reproductive rights beyond the US.  

In Africa, for the last few years, conservative leaders have been restricting space and policy around women’s bodily autonomy, donors have restricted funding, and there’s fear among civil society organizations advocating for reproductive justice, including abortion. 

There are intensified, well-organized attacks on the human rights of women and the LGBTQI+ community, especially in Africa. Women and LGBTQI+ people are becoming increasingly unprotected in many African countries as they are subjected to waves of well-funded efforts by anti-rights actors that endanger lives.

Family Watch International head Sharon Slater, a leading international opponent of sexual and reproductive health rights, on a visit to Uganda shortly before that country adopted its Anti-Homosexuality Act.

Well-organized anti-gender movements have been working to undermine women and LGBTQI+ communities rights for decades. This growing conservative, anti-gender narrative includes key influential policymakers, fundamentalist religious bodies, and even some “progressive” governments funding anti-LGBTQI+ backlash through bilateral relationships with religious civil society organizations, such as the Inter-Religious Council of Uganda. 

These groups have popularized support for discriminatory and retrogressive legislation in developing countries, such as the 2023 Anti-Homosexuality Act in Uganda, which made ‘aggravated homosexuality’ punishable by death. As a result, many Ugandans who identify as members of the LGBTQ+ community are now living in fear for their lives.

With the support of conservative civil society organizations that have access to major decision-making bodies, negotiations and forums, anti-rights entities from Africa and across the globe are co-opting human rights language and weakening or removing references to sexual and reproductive rights. 

Beyond financial backing, anti-rights and anti-gender actors have trained and helped representatives take over influential positions in governments, courts, and other institutions in many places to institutionalize anti-rights norms and practices in offices of influence.

Contradictions at Women Deliver

Many feminist activists had hoped this year’s meeting to be a crucial rallying point, but that high hope was very quickly shot down by the presence of key advocates against the very rights this conference is intended to promote. Specifically, the participation of Hungary’s rightwing president, Katalin Novak, who addressed the opening ceremony, shocked many feminists and advocates. 

As former Family Minister in the populist government of Viktor Orban, Novak has been a party to anti-LGBTQ laws and the tightening of abortion regulations in her country. Novak has also told women not to expect the same pay as men, while her government has outlawed adoption by unmarried couples and excluded LGBTQ couples from adopting children. Hungary has also refused to ratify the Istanbul Convention, designed to protect women from violence. 

Thousands protest against anti-LGBTQ laws in Budapest, Hungary, in 2021.

Much more to my discomfort was the number of people that applauded her speech in Kigali; whether it was about being in the presence of a  president or sharing the values communicated, they cared little for the symbolism that their applause meant for women and LGBTQI rights in Africa.

Her speech was dismissive of teenage pregnancies in many global south countries, which is an insult to a region grappling with rates as high as 25%, twice the global average at 92 births per 1000 women.  Her presence, and the opportunity given to her to speak, were not representative of the supposedly progressive audience gathered in support of all women in all their diversity and all their choices.

Novak also perpetuated harmful gender norms around women and their supposed reproductive responsibility to “choose motherhood”, while her appreciation for African women’s high birthing rates was concerning, especially with burdens associated with this, from high maternal deaths, high teenage pregnancy rates, high unmet need for contraceptives and gender-based violence in the form of forced unions, child marriages and restrictions on women’s bodily autonomy.

Reproductive autonomy includes the right to determine the number of children to have and the spacing of children, and that right can be to determine whether to have no children. The negative gender social norms we face in Africa and restrictive policies do not make this possible for many women.

Her remarks were racially degrading about African women’s “reproductive responsibility”. Several feminists, human rights activists and advocates have called out Women Deliver for giving an audience to Novak in a space that is supposed to be safe. 

Safe spaces and agency must be protected

We need to stay in control of our voice and demand accountability from entities that claim to be feminist at any point that they challenge the realization and enjoyment of our rights. Women Deliver, one of the largest gatherings on gender equality, should remain a place to challenge corrosive gender norms that sustain inequality and challenge restrictive, discriminatory, and oppressive norms.

Normalization is an instrument of power and plays a role in classification and hierarchization. In this case, platforms such as Women Deliver, normalizing anti-rights groups’ access to spaces of women and gender-diverse people to spread harmful rhetoric undermines their safety and their full humanity. Countering these anti-feminist, anti-democratic trends is everyone’s responsibility. 

Platforms such as Women Deliver should be safe spaces for women to dialogue and call to account, in all their diversity. There should be accountability for surrendering these spaces to anti-rights groups and advancing politics that endanger the progress and safety of gender-diverse people and women’s rights.

Yvonne Mpambara is a Ugandan feminist lawyer and Reproductive Justice Advocate. This article was first published by African Feminism.

Image Credits: Lydia Gall/ Human Rights Watch.

RSV
GSK has sued Pfizer for patent violations over its RSV vaccine

Merely months after securing US Food and Drug Administration (FDA) approval for its Respiratory Syncytial Virus (RSV) vaccine, British pharma giant GSK has taken Pfizer to court for patent violations. 

GSK filed the lawsuit in a US federal court in Delaware on Wednesday alleging that Pfizer’s RSV vaccine, Abrysvo, violates four patents surrounding the antigen that GSK uses in its own RSV vaccine, Arexvy, Reuters reported. 

The US FDA approved both vaccines in late May, to be administered to adults aged over 60 years. RSV is common during winter seasons and kills over 100,000 children aged under five every year. While its symptoms are considered non-threatening to adults, over 14,000 adults aged above 65 in the US die due to RSV every year. The virus is estimated to affect around 64 million people every year globally, with an annual death toll of 160,000. 

In response to the lawsuit, Pfizer asserted confidence in its intellectual property position and added that it will strongly defend its case. 

The market for RSV vaccine is estimated to reach $10 billion by 2030, according to analysts. Other contenders in this market are Sanofi and its partner AstraZeneca, that are working on a prophylactic monoclonal antibody for infants, and Bavarian Nordic, and Moderna that are currently in Phase 3 clinical trials for their vaccines. 

The race to make an RSV vaccine possible started several decades ago, in the late 1960s. Between 1966 and 1968, a promising clinical trial for an RSV vaccine had to be shut down after two young children that participated in the trial died and many more children ended up being hospitalized. 

It wasn’t until years later that scientists discovered that the virus that caused RSV shifted shapes, similar to SARS-CoV-2. Finally, in 2013, scientists from the National Institutes of Health (NIH) discovered a way to freeze the shape-shifting protein in one of its forms, thus making it possible to develop an antigen. 

Common during winter seasons, RSV garnered attention during the COVID-19 pandemic when it filled hospitals across the US with ailing children and older adults in 2021 and 2022. 

Image Credits: NIAID.

A dengue prevention worker sprays mosquito repellent in Bangkok, Thailand.

The number of dengue cases in the Americas has surpassed three million this year, as climate change makes people more vulnerable to the disease and the world more hospitable to the mosquitoes that carry it. 

Rising temperatures and shifting rainfall patterns are providing a boon to the Aedis aegypti mosquito, the main carrier of dengue. Warmer year-round temperatures are allowing the mosquitoes to thrive for longer periods of the year, and extending their mating season, allowing them to reproduce in greater numbers. 

Climate change is also extending the geographical range where the mosquito can survive, as warmer winters and milder autumns lead to fewer cold-weather deaths, meaning that more mosquitoes survive to adulthood.

“The mosquito in particular is a vector that has continually spread across the world,” Dr Raman Velayudhan, an expert at the WHO’s neglected tropical disease unit, told reporters on Wednesday. “It is a silent expansion … and right now a population of nearly 4 billion are at risk of this disease.”

The effects of global warming on the spread of Aedis mosquitoes are most visible in Brazil, which has already reported 2.4 million cases this year as mosquitoes invade its southern states, which are now hot enough to support them.

The incidence of dengue in Peru, Argentina and Bolivia has also risen sharply as a result of climate conditions. Peru has already recorded a caseload over four times higher than the average of the last five years – the country’s worst-ever outbreak of the disease. The outbreak in Argentina is also one of the largest in the country’s history. 

The World Health Organization (WHO) warned in July that the world is on track for over four million dengue cases in 2023, and that climate change is playing a significant role in its spread. The record for global dengue cases was set in 2019 when 5.3 million cases were reported. Global case numbers have risen eightfold since 2000, with 4.2 million reported in 2022.

Global dengue case numbers are vast underestimations, Velayudhan said, citing the 80% asymptomatic case rate and pandemic-disrupted reporting systems.

“We need to convey this message that dengue is a silent disease,” said Velayudhan. “We need to treat it as an endemic disease with epidemic potential.” 

Dengue can cause a range of symptoms, from mild fever to severe illness. There is no specific treatment for dengue, but early diagnosis and supportive care can help to reduce the risk of death. It is fatal in less than 1% of cases. 

A window into the future of dengue

mosquito
Aedes aegypti mosquito can spread Zika fever, dengue, and other diseases. Climate change is enabling their spread.

Computational epidemiologists at the University of Michigan have projected that Brazil’s epidemic potential for dengue could increase by 10-20% by 2040, as temperatures rise and rainy seasons get longer. This could lead to longer dengue seasons in Brazil, and could also be mirrored in other countries around the world.

The ongoing El Niño event, which is characterized by higher temperatures and extreme weather patterns, may provide a window into the future of dengue. Its effects on rainfall in the Americas and during monsoon season in Asia will likely play a large role in how close the world gets to the 5.3 million case record set in 2019.

In Bangladesh, monsoon rains have already led to a deadly dengue outbreak. Health experts in the country, including the Bangladesh Medical Association, have urged the government to declare a “public health emergency.” Some have compared the outbreak to the country’s 2019 dengue epidemic, which was so severe that many in Bangladesh refer to it as the “year of dengue.”

In July, meanwhile, changing climate patterns led the European Center for Disease Control to sound the alarm over the rising risk of mosquito-borne diseases across the continent, from which Europe has historically been protected.

“If this continues, we can expect to see more cases and possibly deaths from diseases such as dengue, chikungunya and West Nile fever,” Andrea Ammon, director of ECDC said at a press conference last month.

And the risks are not limited to dengue: Research shows the spread of over half of infectious diseases — including arboviruses like Zika, chikungunya and dengue — are aggravated by climate change.

Disease-carrying ticks, bacteria, algae and fungi and mosquitoes are all on the move. As the world warms, the diseases they carry will follow them as they expand their geographical reach to adapt to climate change.

Image Credits: Patrick de Noirmont/Sanofi Pasteur, Sanofi Pasteur/Flickr.

Bureau of Global Heath Security and Diplomacy
US Secretary of State Antony Blinken, Health Secretary Xavier Beccera, USAID head Samantha Power and new Bureau head John Nkengasong

The US has consolidated its efforts to address global health threats into a single structure, the Bureau of Global Heath Security and Diplomacy, which was launched on Monday.

Renowned Cameroonian health expert Dr John Nkengasong, appointed last year to lead the US President’s Emergency Plan for AIDS Relief (PEPFAR), leads the new structure and will report directly to US Secretary of State Antony Blinken. He also remains head of PEPFAR.

PEPFAR, the hugely successful HIV programme estimated to have saved 25 million lives over 20 years, will be incorporated into the new bureau alongside all other US efforts to address future pandemics and other health emergencies.

“We’re setting up a new bureau to focus fully on the need to drive both internal and international coordination and accelerate the State Department’s ongoing efforts to strengthen global health security so that the world can respond with immediacy and intention when the next health crisis emerges,” Blinken told the launch.

Blinked outlined three main functions for the Bureau, the first being to lead US diplomacy in  “strengthening the global health security architecture so that the world is better prepared to prevent, detect, control and respond to infectious diseases”. 

“That includes by working with partners to modernise existing organisations like the World Health Organization (WHO) so that they’re more fit for purpose and by shaping new structures like the Pandemic Fund,” said Blinken.

The second function is to “leverage US foreign assistance to strengthen public health systems, including laboratories and supply chains for vital medical counter-measures” to enable countries to be better prepared to address health threats.

The third is “to elevate health security as a core US foreign policy priority” through both international diplomatic engagement and health security policymaking across the US government.

Dr John Nkengasong leads the new structure.

Nkengasong said that some of the Bureau’s immediate priorities are to “strengthen the global health security architecture to ensure greater capacity, coordination and accountability”, including through the Pandemic Fund, amending the International Health Regulations and successfully negotiating a pandemic accord.

He also flagged the danger posed by antimicrobial resistance (AMR), which is projected to kill about 10 million people a year from 2050 if nothing is done to address it.

Describing PEPFAR as the US government’s most successful global health programme, Nkengasong said that the lessons learned from PEPFAR – particularly the importance of an “all of government response” – would be applied to the new Bureau. 

“We recognise that the frequency of the health threats has increased because of the greater connectivity, globalisation, climate change, population growth, food insecurity, and many others,” added Nkengasong, who headed the Africa Centre for Disease Control during the pandemic.

Samantha Power, Administrator of the US Agency for International Development, told the launch that the odds of living through another pandemic of similar severity as COVID-19 in our lifetimes was almost 40%.

“To give a sense of the need here, the WHO and the World Bank estimate that the annual funding gap in pandemic preparedness is $10 billion annually. This new bureau is going to play an absolutely vital role in coordinating with our partners to summon the global cooperation and the resource investments needed to keep us all safe,” said Power.

Rightwing threat to PEPFAR

Meanwhile, PEPFAR is facing a right-wing backlash based on misinformation, as reported recently by Health Policy Watch.

PEPFAR’s five-year budget is due for reauthorisation by the US Congress by 30 September, but there has been unprecedented right-wing mobilisation against it over the past few months by both US and African groups.

The US right-wing groups claimed in a recent letter sent to Senate and Congress leaders that PEPFAR grantees  “are using taxpayer funds to promote a radical sexual and reproductive health agenda”. Signatories include the Center for Family and Human Rights (C-FAM), Heritage Foundation and the Dr James Dobson Family Institute.

A similar letter was sent on 6 June to the same US Senate and Congress leaders by some African politicians and religious leaders claiming that PEPFAR “is supporting so-called family planning and reproductive health principles and practices, including abortion, that violate our core beliefs concerning life, family, and religion”.

US Representative Chris Smith, who co-sponsored PEPFAR’s refinancing in 2018, has also joined its critics by recently claiming that the programme is being used to “promote abortion on demand”.

Illegal for PEPFAR to fund abortion

However, it is illegal for PEPFAR to fund or support abortion, and abortion is illegal in most of the  African countries where it operates.

“PEPFAR has never, will not ever, use that platform in supporting abortion,” said Nkengasong, as reported by Devex.

One of the PEPFAR grantees that have been singled out is DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe), which targets teenage girls in 16 African countries.

Girls and young women are up to five times more likely to contract HIV than boys and men their age, and DREAMS offered HIV prevention services to 2.9 million adolescent girls and young women in 2022.

“These people are all playing with fire, and they’re playing with people’s lives, and there can only be one reason: political motivation to kill PEPFAR,” Mark Dybul, former US global AIDS coordinator, told Devex.

Moderna
Moderna mRNA vaccine is found to be the safest for older adults. 

Older adults vaccinated with Moderna’s COVID-19 vaccine were 15% less likely to be infected with COVID-19 than those vaccinated with Pfizer-BioNTech’s, according to a peer-reviewed study, published in JAMA Network on Wednesday.

The study was based on observational data from 6.3 million adults, almost 60% women and 86.5% White, with an average age of 76 years old and were inoculated with either of the two mRNA vaccines against COVID-19. 

The results showed Moderna’s COVID-19 vaccine was also marginally safer with fewer post-vaccine adverse events like pulmonary embolism and thromboembolic events reported among the said group.

“The results of this study can help public health experts weigh which mRNA vaccine might be preferred for older adults and older subgroups, such as those with increased frailty,” Dr Daniel Harris, epidemiologist and the lead author of the study said. 

His team, at the Center for Gerontology and Healthcare Research at the Brown University School of Public Health, observed two groups of older adults, one with Pfizer-BioNTech’s mRNA vaccine and the other with Moderna’s mRNA vaccine for 28 days after receiving their first doses of the vaccines. 

Overall, only 1% of all the adults who participated in the study reported adverse events. Of these, those who received Moderna’s vaccine were associated with a 4% lower risk of pulmonary embolism (sudden blockage in blood vessels) and a 2% lower risk of thromboembolic events (several conditions related to blood clotting). 

Harris stressed that the risk of adverse events from contracting COVID-19 were substantially higher than the risk of adverse events from being vaccinated by either of the two mRNA vaccines.

“But in an ideal world where we can have a choice between which vaccine product is used, we wanted to see whether one vaccine was associated with better performance for older adults and those with increased frailty,” said Harris.

Long COVID clinical trials begin recruitment

Meanwhile, the US National Institute of Health (NIH), on Tuesday, launched the second phase of clinical trials to evaluate at least four potential treatments for long COVID. As part of the RECOVER Initiative, a range of  treatments will be evaluated through these trials including drugs, biologics, and medical devices.   

“The trials are designed to evaluate multiple treatments simultaneously to identify more swiftly those that are effective,” said the NIH in a press release. 

Created to study the long-term effects of long COVID, the RECOVER Initiative is currently conducting research on how COVID-19 affects the different tissues and organs in the human body, using data from over 24,000 participants, 60 million electronic health records, and over 40 pathobiological studies. 

The information gained from these studies has been used to design the second phase in which the safety and efficacy of long COVID treatments will be studied in groups of 300-400 people. 

“Hundreds of RECOVER investigators and research participants are working hard to uncover the biologic causes of long COVID. The condition affects nearly all body systems and presents with more than 200 symptoms,” Dr Walter J. Koroshetz, director of the NIH’s National Institute of Neurological Disorders and Stroke, and co-lead of the RECOVER Initiative, added. 

“Recognizing that more than one solution is likely needed, we’ve taken the lessons learned from RECOVER participants to design rigorous clinical trial platforms that will identify treatments for persons with different symptom clusters to improve their function and well-being.”

Image Credits: Gavi .

African cancer patients receiving chemotherapy

Africa has one of the highest cancer death rates in the world, yet this could be markedly improved by better access to treatments already widely available in high-income countries for the continent’s biggest killers – breast, cervical, lung and prostate cancers and Kaposi sarcoma.

This is according to a recent study by the Botswana-Rutgers Partnership for Health, which researched which cancer treatments that are effective in other regions could have an impact in sub-Saharan Africa (SSA) – but are not available or hard to get.

Cancer is in the top three causes of premature death in the vast majority of countries in SSA. Without significant intervention, annual deaths are projected to nearly double between 2020 and 2030, reaching about one million by 2030.

In high-income countries “the rapid evolution of precision oncology therapies is increasingly transforming the length and quality of life for cancer patients”. But in SSA “basic levels of cancer care, treatment and palliation are limited”, the study notes.

As a result, Africa’s cancer patients have “poor survival outcomes across most malignancies”. In 2020, Africa’s cancer incidence made up 5.7% of global cases, but its cancer mortality was 7.2% of global deaths.

There is a 30% survival rate for children with cancer in low-income countries in comparison to over 90% for children in high-income countries, WHO Director-General Dr Tedros Adhanom Ghebreyesus noted recently.

Access to high-impact treatments

“Cancer is threatening sub-Saharan African populations to a degree that demands a large-scale response,” said Richard Marlink, the director of Rutgers Global Health Institute and a study author. 

“This guidance provides a framework for how to improve access to the life-saving and life-altering medications that are proven to work. The high-impact treatments available elsewhere are needed in this region of our world.”

While there is a dearth of accurate data about cancer in the region, the study used cancer registries and other studies to get a sketch of the cancer burden.

Cervical Cancer

Cervical cancer is the leading cause of cancer-related death in women in SSA. For patients with advanced cervical cancer, the standard of care is chemotherapy in conjunction with radiation therapy. 

But a study of 29 oncology treatment centres in 12 SSA countries found an inconsistent supply of cisplatin, a preferred chemotherapy drug as well as limited access to radiation therapy.

In addition, access to radiotherapy is limited access due to a lack of trained personnel and equipment and equipment maintenance.

Breast Cancer

Elisabeth Nyiramana (left) is a breast cancer survivor from Rwanda.

Data from cancer registries show that breast cancer incidence is rising in nine countries in SSA. For example, in Harare (Zimbabwe) there has been a 4.9% average annual increase in the incidence of breast cancer and a 4.5% increase in Kampala (Uganda).

Mortality rates in southern Africa are “among the world’s highest due to late-stage presentation and lack of screening programs”, according to the study.

In a population-based registry study of 834 patients in 11 countries in SSA, only one-third received chemotherapy.

Breast cancer patients are also not routinely tested to determine their specific hormonal profiles, which means that “treatment may not include precision targeting, which is available in high-income countries where profiling capabilities are more accessible”.

“Treatment for breast cancer greatly differs based on hormonal status and human epidermal growth factor (HER2) expression status,” the study notes.

HER2-positive breast cancer is one that tests positive for the protein HER2, which promotes the growth of cancer cells. Treatments that specifically target HER2 are very effective.

Hormonal therapy with the drug tamoxifen is recommended for HER2 tumours. Tamoxifen is inexpensive or even free in some countries, so it may be prescribed even if the patient’s hormonal profiling has not taken place. This could harm the patient and provide no therapeutic advantage.

But even when hormonal profiling is available, the medications that have proven to be most effective “may be cost-prohibitive to obtain” – such as trastuzumab, which targets HER2. 

“Another barrier is that immunotherapy, using drugs such as atezolizumab and pembrolizumab, requires specialized monitoring and management protocols that usually aren’t available in this region,” the study notes.

Prostate Cancer

A leading cause of cancer death among men is prostate cancer, particularly in southern Africa where there are approximately 66 cases per 100,000 (more than double the rate recorded in West and East Africa).

Prostate cancer is also increasing. For example, in Kampala, Uganda, an average annual percentage increase of 5.2% was found between 1991–2010.

Treatment with surgical castration to remove the testicles is widespread in sub-Saharan Africa, yet “newer generation oral hormone therapy may have an expanded role in the region”.

Abiraterone with prednisone therapy is an oral hormone therapy that can improve outcomes. This is included on the World Health Organization’s Essential Medicines List, and is “expected to be available through multiple generic options and that reduced pricing is in the foreseeable future”. 

Molecular profiling, which isn’t readily accessible in the region, could also assist to identify patients with metastatic castration-resistant prostate cancer and develop treatments appropriate for them. Androgen deprivation therapy can provide symptom relief and improve survival.

Kaposi sarcoma

While Kaposi sarcoma (KS) is relatively rare worldwide, it is more common in people with weakened immune systems and has increased 20-fold in SSA since the 1980s alongside the HIV/AIDS epidemic.

Antiretroviral treatment has reduced the incidence of AIDS-associated KS, but there is still “ongoing significant morbidity and mortality from KS in the region”, according to the study.

This cancer, caused by infection with human herpesvirus-8, manifests in patches of abnormal tissue growing in the body, especially under the skin, in the lining of the mouth, nose and throat; and in lymph nodes. 

Since most cases of KS are associated with HIV, the study notes that “it is imperative for all patients living with HIV to receive antiretroviral therapy”. 

The medicine, Paclitaxel, can be used to treat advanced KS and is “much more affordable and readily available in SSA” than other medicines.

The World Health Organization’s (WHO) updated Essential Medicines List (EML) released last week includes a new KS treatment, liposomal doxorubicin.

The study also notes the lack of interest in studying new therapies for KS, despite the significant burden of disease in the region. The first large clinical trial in more than a decade that compared chemotherapy drugs used to treat Kaposi sarcoma in SSA took place in 2020. 

Lung Cancer

Greater access to tobacco products in Africa is expected to increase lung cancer.

In high-income countries, molecular targeted therapies for lung cancer have achieved substantial survival benefits – but the equipment and trained personnel to do this are lacking in SSA.

Increased affordability and marketing of tobacco products in sub-Saharan Africa is expected to increase lung cancer. The researchers emphasised the need for more advanced pathology capabilities in the region to improve precision diagnostics and therapeutics. 

Improving access is a ‘moral need’

“We recognize that costs and cost-effectiveness concerns are important factors in realistically increasing availability of a broad range of oncology drug therapies in SSA,” the study notes.

“The moral need, however, to advance therapeutics and reduce the significantly high case-fatality rates from cancer in SSA remains an urgent global imperative.”

“High drug costs are a major challenge to bridging the stark inequities in access to cancer treatments,”  said lead author Kirthana Sharma.

“To optimize cancer treatment in this region, diagnostic and laboratory infrastructure also needs to be strengthened, and the oncology workforce needs to be further trained and developed.”

The Botswana-Rutgers Partnership for Health is a collaboration between Botswana’s Ministry of Health, the University of Botswana and Rutgers Global Health Institute. Botswana’s cancer mortality rate exceeds 63%, and the partnership is engaged in efforts to strengthen the country’s health systems and provide comprehensive, patient-centred oncology care.

Image Credits: Roche, Cecille Joan Avila / Partners In Health, Flickr: Marco Verch Professional Photographer and Speaker.

One Life, One Liver campaign launched on World Hepatitis Day

Viral hepatitis could become a more lethal killer than malaria, tuberculosis and HIV combined by 2040, if current trends in undetected infection and treatment continue, warned the World Health Organisation (WHO) on Friday, World Hepatitis Day. 

In observance of the day, WHO launched a call, under the title “One life, one liver”, to scale up testing and treatment for hepatitis, a group of five diseases which infect the liver, causing deadly liver damage and cancer.  Of those diseases, hepatitis B and C are the two viruses in this group which cause the most disease and death.

Over 400,000 people die of hepatitis C annually, while of the two billion people infected with hepatitis B, over 800,000 die every year.

For some time, it has seemed that the world was on track to reduce or even eliminate hepatitis, with increasing numbers of people receiving curative treatment for hepatitis C. A global target for reducing hepatitis B infections was reached by 2020, making it the only health-related Sustainable Development Goals on track, with a real possibility of elimination by 2030.

But testing remains inadequate, with only 21% of people infected with hepatitis C diagnosed – and of those, just 13% have been treated, WHO pointed out. The picture for Hepatitis B is even worse, with only 10% of people living with chronic hepatitis B having a diagnosis, and just 2% getting treatment.

And the increase in the numbers of people receiving treatment to cure hepatitis C is slowing, while many African countries do not have access to the vaccine for hepatitis B that is administered at birth, a key intervention. “SARS-CoV-2 pandemic’s detrimental impact on the health system slowed or even suspended HCV [hepatitis C virus] elimination programs” in many countries, noted a recently published paper, adding that “HCV testing and treatment fell, which increased morbidity and mortality.

“Millions of people are living with undiagnosed and untreated hepatitis worldwide, even though we have better tools than ever to prevent, diagnose and treat it,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “WHO remains committed to supporting countries to expand the use of those tools, including increasingly cost-effective curative medication, to save lives and end hepatitis.”

Vaccination, testing and treatment: the key to saving lives

New WHO guidance for countries to tackle hepatitis effectively, include a core set of recommendations to: 

  • ensure access to treatment for all pregnant women living with hepatitis B;
  • provide hepatitis B vaccines for their babies at birth;
  • diagnose 90% of people living with hepatitis B and/or hepatitis C;
  • provide treatment to 80% of all people diagnosed with hepatitis. 

Optimal blood transfusion, safe injections and harm reduction are additional measures countries can take in the fight against hepatitis.

The time is ripe for a renewed effort to reach the goal of reducing and/or eliminating hepatitis, as treatment prices have dropped significantly, WHO aded.

When the game-changing curative fourse for heptatis C was first introduced in high-income countries, its cost was over $90,000.  Today it is just $60 for the 12-week course in low-income countries. Treatment for those living with hepatitis B costs under $30 a year.

In addition, west and central African countries, where mother-to-child transmission of hepatitis B remains high, will benefit from Gavi’s Vaccine Investment Strategy 2018, which was recently restarted, and includes those interventions.

In a separate statement, the Africa Centre for Disease Control and Prevention said: “The World Hepatitis Day on 28th July gives us an opportunity to join all stakeholders such as the World Health Organization and the World Hepatitis Alliance to raise awareness on the public health importance of this silent killer and to call on member states to invest more in the fight against Hepatitis B and C in Africa to reach viral hepatitis elimination by 2030.”

Temperature around the Mediterranean Sea on 24 July.

July 2023 may have experienced temperatures last seen in prehistoric times, as climate scientists confirm that once rare heatwaves are now routine events. 

Record heatwaves have been seen this year from the US to India, and according to the latest analysis, this July may be the hottest ever recorded.  

Dr Karsten Haustein, a climate scientist at Leipzig University, says that July’s average global temperature is projected to be 1.3-1.7°C above the average July temperature experienced before humans began warming the planet by burning fossil fuels. This is hotter by 0.2°C than the previous record, set in July 2019.

“Not only will it be the warmest July, but the warmest month ever in terms of absolute global mean temperature. We may have to go back thousands, if not tens of thousands of years, to find similarly warm conditions on our planet,” Haustein said. 

European Union’s Earth Observation Programme, Copernicus, and UN’s World Meteorological Organization have also confirmed that the “first three weeks of July have been the warmest three-week period on record and the month is on track to be the hottest July, and the hottest month on record.”

Scientists attribute the record temperatures to the continued burning of coal, oil, gas and other human activities since the beginning of the industrial era. They are also clear that this is not the new norm: temperatures will continue to rise and extreme weather events will worsen until the world drastically cuts fossil fuel use and reaches net-zero emissions. 

Climate change makes heatwaves routine

Earlier this week an international team of scientists with the World Weather Attribution (WWA) released their analysis of the impact of climate change on this year’s multiple heatwaves spanning the Americas, Europe and Asia. 

Heatwaves hit parts of the US and Mexico, southern Europe and China this July. Both Death Valley in the US and northwest China saw temperatures exceed 50°C. In Europe, too, temperature records were broken in Spain. The analysis was clear: climate change is to blame for once rare heatwaves becoming routine occurrences now. And more is to come.  

The heatwave in China would have been about a one in 250-year event before accelerated heating, while maximum heat like that recorded in July 2023 would have been virtually impossible in the US-Mexico region, as well as in southern Europe, before human-made global heating set in, the WWA analysis found. 

“On the one hand, we really need to stop burning fossil fuels to stop these records from continuing to be broken. But we also need to adapt. We need to adapt because even when we stop burning fossil fuels tomorrow, we will not go back, it will not get cooler,” said Dr Friederike Otto, senior lecturer in Climate Science at Imperial College London.

“We have to live with these and make it possible for people to live with these extreme conditions in summer because they are not rare. And the later we stop burning fossil fuels, the more frequent they become.”

Heat impacts on health set to worsen

Heatwaves are known to be silent killers; in Europe alone, an estimated 62,862 heat-related deaths occurred in 2022, according to a study published in Nature this July.

“Since the inception of the Lancet Countdown eight years ago, we have consistently seen an increase in the health impacts of climate change through our heat-related indicators: heat-related deaths among the elderly are rising; productivity is decreasing globally because of the heat, affecting people’s livelihoods and wellbeing,” said Dr Marina Romanello, who is the executive director of the Lancet Countdown on Climate Change and Health.

This year, news reports in central India linked dozens of deaths to the heatwave but the toll is yet to be confirmed by the government. With most countries lacking high-quality death records, it is easy for deaths linked to heatwaves to be underreported or dismissed.

“These heatwaves and wildfires are another reminder of the urgent need to reduce greenhouse gas emissions and protect the planet on which all life depends,” World Health Organisation Director-General Dr Tedros Adhanom Ghebreyesus said of the ongoing extreme weather events in Europe. He called for immediate climate action. 

All eyes on COP28 negotiations

Later this year, world leaders will meet in Dubai at the annual climate conference, or Conference of the Parties (COP), now in its 28th year. This year’s COP has already come under intense criticism, as the negotiations will be chaired by Sultan al-Jaber, CEO of the Abu Dhabi National Oil Company. 

At a time when fossil fuels need to be phased out, and renewables ramped up at a record pace, the selection of an oil baron to head critical climate talks has evoked dismay among advocacy groups and climate activists. 

Stakeholders remain hopeful that the large-scale acceptance of renewable energy will receive financial support from governments and banks.  

“We are already seeing this exponential build-up of renewable energy happen. 2022 was a banner year for renewables and energy efficiency and we need to see that expanding and going even faster,” said Catherine Abreu, Executive Director of the advocacy group, Destination Zero. 

Image Credits: Copernicus, European Union, Karsten Haustein.

Health workers in Cape Town, South Africa, getting vaccinated against COVID-19 in March 2021. Vaccines only became available for health workers at the end of this study.

A single healthcare worker infected with COVID-19 cost the Kenyan economy over $33,000 – around 18 times the country’s per capita GDP.

This is according to a new report on the economic cost of COVID-19 infections among healthcare workers in Eswatini, Colombia, Kenya and South Africa (the provinces of KwaZulu-Natal and Western Cape) during the first year of the pandemic, which has been compiled by the World Bank and Resolve to Save Lives.

The estimated cost per health worker infection ranged from $10,105 in Colombia to $35,659 in Eswatini, with $34,226 in South Africa’s KwaZulu-Natal province and $33,781 in its Western Cape province.

These figures are based on three calculations: the direct cost of healthcare worker’s infection in terms of their healthcare costs and loss of productivity; the costs of infections transmitted by sick healthcare workers; and the disruptions to essential health services.  

The economic burden was highest in areas with the fewest health workers. In South Africa’s Western Cape, the total cost of health worker infections was equivalent to 8.38% of the total health budget. 

In Kenya, where maternal and child death rates were high before the pandemic, health care worker illness disrupted essential services for these vulnerable populations and caused a substantial increase in deaths. This was the biggest “expense” in that country’s calculations.

“Immunisation, chronic disease management, emergency services, and surgery were also severely disrupted, leading to increased non-Covid deaths,” according to the report.

No vaccines for African health workers

At a press conference on Wednesday to launch the report, Dr Keith Cloete, head of health in the Western Cape, South Africa, reminded the audience of the impact of vaccine inequity on health workers.

“Everybody knew that the most important thing was to vaccinate healthcare workers. Our delay in having access to vaccines meant that, in your study period from 1 March 2020 until 28 February 2021, we had vaccines for two weeks,” said Cloete. 

The first South African health worker was vaccinated on 17 February 2021; health workers only got access to vaccines via a clinical trial of Johnson and Johnson vaccines rather than as part of a vaccine rollout for the general population.

In the absence of vaccines, the Western Cape had to try to assuage health workers’ fear by ensuring that they had personal protective equipment (PPE), and by improving its occupational health and safety and employee wellbeing policies, added Cloete.

The province also invested in good data to enable it to predict COVID-19 waves and plan accordingly.

“At the height of the waves is when you have the most healthcare workers in quarantine and in isolation, so you’re going to have the lowest number of available staff. So that’s one of the first predictive models we did, and we then intentionally employed people on contract to cover these waves,” explained Cloete.

The COVID-19 incidence among HCWs was higher than in the general population in all study sites – almost 10 times higher in Kenya and seven to eight times higher in the two provinces of South Africa 

“The economic burden due to SARS-CoV-2 infection among HCWs makes a compelling investment case for pandemic preparedness, particularly the protection of HCWs, and resilient health systems going forward,” argues the report.

Juan Pablo Uribe, the World Bank’s Global Director for Health Nutrition and Population, warned that there was a projected shortage of 10 million health workers by the end of the decade and that health workers from low-income countries were moving to high-income countries, exacerbating shortages in poorer countries.

“Many of our health workers are still very much unsatisfied or frustrated in their workplaces. And more important, they’re facing incredible risks of infection, of disability and injuries and in many places, even of violence,” said Uribe.

Resolve CEO Dr Tom Frieden said that health workers needed to be protected during pandemics by policies, protective equipment, and data systems and information “to hold us all accountable for protecting people who protect and care for us so that they can be safer and healthier, and societies can be safer and healthier”. 

Image Credits: Western Cape government.