Dr Tedros Adhanom Ghebreyesus speaking at the media briefing in Geneva on Wednesday.

With the sixth meeting of the Intergovernmental Negotiating Body (INB) meeting to develop a  pandemic accord currently underway in Geneva, the World Health Organization (WHO) chief minced no words when he slammed “groups with vested interests” for trying to sabotage the negotiations.

“Twenty years ago, the tobacco industry tried to undermine negotiations on the WHO Framework Convention on Tobacco Control. The same thing is happening now,” Dr Tedros Adhanom Ghebreyesus told a media briefing at the WHO headquarters in Geneva on Wednesday.  

“Groups with vested interests are claiming falsely that the accord is a power grab by WHO, and that it will stymie innovation and research. Both claims are completely false,” said Tedros.

The sixth INB meeting, which ends on Friday, when it will meet with the Working Group on the amendments to the International Health Regulations (WGIHR). The WGIHR, which is looking into how to tighten compulsory international regulations that govern public health outbreaks and pandemics, holds its fourth meeting from 24 to 28 July. 

Both groups are expected to present final drafts of their negotiations at the World Health Assembly in 2024. 

Doubling down on his displeasure with the unnamed “vested groups”, Tedros said that those who spread “lies” about the pandemic instrument are “endangering the health and safety of future generations”. 

“This accord aims to address the lack of solidarity and equity that hampered the global response to COVID-19. It’s a historic opportunity for the world to learn the painful lessons COVID-19 told us and make the world safer for generations to come.”

On Monday, as the INB negotiations resumed, co-chair Roland Driece, urged member states to complete discussions on the contentious Chapter Two of the compilation draft before a first draft could be formulated for text-based negotiations. 

“I would rather have a first draft that has substance, which we all feel is strong enough to have real line-to-line discussions on, than having something in between which is not good enough yet,” said Driece.

Tedros’ words come in light of the continued efforts to dispel mis- and disinformation about the pandemic instrument on social media. Twitter in particular has been awash with conspiracy theories about COVID-19 and the subsequent pandemic accord negotiations.

Earlier this year, Twitter CEO Elon Musk tweeted that “Countries must not cede authority to the WHO”. His tweet was in response to a speech by the Australian Senator Malcolm Roberts criticising the global health agency. 

Tedros responded that the countries would not be ceding sovereignty to the WHO as the pandemic accord will not change the sovereign status of any country. 

Tedros said on Wednesday that the pandemic accord is like a business contract signed by two companies, likening countries to companies. 

“If two companies sign a business contract and use lawyers to help them develop it, that doesn’t give the lawyers control over the contract, nor make them a party to it. It’s the same here,” he said. 

“The pandemic accord is an agreement between countries and the WHO is helping them to develop that agreement. But WHO will not be a party to the agreement…This is an agreement between countries and countries alone.”

Image Credits: WHO.

Oral polio vaccination – despite a post-COVID rebound, 20.5 million children still missed out on routine vaccinations in 2022.

Routine childhood immuniaztions rebounded in 2022 from the set-backs of the COVID pandemic.  But coverage still fell short of pre-COVID numbers in 2019, with 20.5 million children missing out on one or more routine vaccines last year as compared to 18.4 million in 2019.

The new data is contained in a report published jointly Tuesday morning by the World Health Organization and UNICEF.  The data tracks a wide range of vaccines, but uses immunization against diptheria, tetanus and pertussis (DTP) as a marker for immunization coverage globally.

In 2022, 20.5 million children missed out on one or more DTP vaccines, as compared to 24.4 million children in 2021, according to the new global data set.

Of the 20.5 million children who missed out on one or more doses of their DTP vaccines in 2022, 14.3 million did not receive a single dose, so-called ‘zero-dose’ children. The 2022 figure represents an improvement over the 18.1 million zero-dose children in 2021 but remains higher than the 12.9 million children that missed all DTP doses in 2019.

“These data are encouraging, and a tribute to those who have worked so hard to restore life-saving immunization services after two years of sustained decline in immunization coverage,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “But global and regional averages don’t tell the whole story and mask severe and persistent inequities. When countries and regions lag, children pay the price.”

Indeed, progress was greater in large, and better-resourced countries like India and Indonesia, the WHO/UNICEF report notes. It was much less so in many other low-income countries.

Of the 73 countries that recorded substantial declines in coverage during the pandemic, 15 recovered to pre-pandemic levels and 24 are on route to recovery, the report finds. However, another 34 have seen vaccination rates stagnate at pandemic levels, or even continue to decline.

“These concerning trends echo patterns seen in other health metrics,” said WHO.

Additionally, while DTP is used as a marker, vaccinations against various childhood diseases still vary widely.  For instance, vaccination against measles – one of the most infectious pathogens – has not recovered as well as other vaccines, putting an additional 35.2 million children at risk of measles infection, WHO said in a press release.

First dose measles coverage increased to 83 per cent in 2022 from 81 per cent in 2021 but remained lower than the 86 per cent achieved in 2019. As a result, last year, 21.9 million children missed the routine measles vaccination in their first year of life – 2.7 million more than in 2019 – while an additional 13.3 million did not receive their second dose, placing children in under-vaccinated communities at risk of outbreaks.

Overall, coverage with three DTP doses in 57 low-income countries supported by Gavi, The Vaccine Alliance, increased to 81% in 2022, as compared to only 78% in 2021, however, this remains below the pre-pandemic rates of  86% recorded in 2019, UNICEF said.

“Beneath the positive trend lies a grave warning,” said UNICEF Executive Director Catherine Russell. “Until more countries mend the gaps in routine immunization coverage, children everywhere will remain at risk of contracting and dying from diseases we can prevent. Viruses like measles do not recognize borders.”

Image Credits: UNICEF South Africa/2013/Hearfield, Sanofi Pastuer/Flickr.

The Rwandan national ballet performs at the opening of Women Deliver 2023

Women Deliver, one of the world’s largest gatherings on gender equity and sexual and reproductive health and rights (SRHR), opened in Kigali in Rwanda on Monday amid a global backlash against abortion.

“We’re facing enormous headwinds against gender equality, including the COVID-19 pandemic, the climate crisis, and a growing anti-rights movement worldwide,” said Maliha Khan, President and CEO of Women Deliver, at the opening press conference.

“The only way we can push past them is if we double down on our efforts and work together. The time has come for us to unite against the global rollback of rights – change is inevitable, progress is not. We have to work at it.”

An estimated 6000 delegates are attending the week-long conference, which has attracted global politicians, activists and philanthropists.

“Each delegate and speaker has converged here with a collective purpose: to identify and act upon evidence-based solutions,” said Maliha. “This week centers on creating empowering spaces for the feminist movement, holding leaders accountable, and creating a groundswell of voices for gender equality. This groundswell of collective action is critical to urge political leaders to act.” 

Anti-rights president addresses opening

However, surprisingly Hungary’s rightwing president, Katalina Novak, was invited to address the opening along with Rwandan President Paul Kagame. As Family Minister in the populist government of Viktor Orban, Novak has been 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, thus excluding LGBTQ couples from adopting children, and refused to ratify the Istanbul Convention, designed to protect women from violence.

Other speakers include Nobel Peace Prize laureate Malala Yousafzai, US politician Stacey Abrahams, Mozambican former first lady Dr Graça Machel, and former Irish President Mary Robinson.

“Women Deliver underscores the vital role of democratic systems in advancing gender equality,” Phumzile Mlambo-Ngcuka, Chair of the Women Deliver Board and former UN Under-Secretary-General, told the media briefing.

“Open democracies foster an enabling environment for women’s political participation, policy and law shaping, as well as the protection of women’s rights and the creation of equal opportunities. They facilitate improved access to education and healthcare for girls and women while establishing effective mechanisms to combat gender-based violence.”

Women Deliver developed out of the Safe Motherhood Initiative, with an exclusive focus on reproductive, maternal, and newborn health, and has evolved into an independent organization focusing on gender equality.

Women Deliver itself has undergone an internal transformation after facing allegations of racism from staff members three years ago.

Meanwhile, on Monday, the World Health Organization launched a new digital resource at the conference, RESPECT, to help end violence against women and girls  

RESPECT outlines a set of action-oriented steps to support policy makers and programme implementers to design, plan, implement, monitor and evaluate programmes using seven strategies to prevent violence against women. Each letter of R-E-S-P-E-C-T represents one of these strategies. The framework, grounded in a gender equality and human rights approach, builds on an increasing body of evidence on what works to prevent violence against women.

The UN has warned that millions of people could face hunger if the deal is not saved.

Russia has withdrawn from a UN-brokered agreement that allowed Ukraine to safely export grains from its ports in the Black Sea. The move is expected to have a significant impact on global food prices, imperilling the food security of millions around the world. 

“I deeply regret Russia’s decision to terminate the implementation of the Black Sea Initiative, which has been a lifeline for global food security in a troubled world,” UN Secretary-General António Guterres said on Monday. “Hundreds of millions facing hunger and consumers confronting a global cost-of-living crisis will pay the price.”

The first months of Russia’s full-scale invasion of Ukraine saw global food prices surge as Russian naval blockades trapped around 20 million tonnes of grain in Ukraine’s Black Sea ports, triggering the worst global food crisis since 2008. 

The United Nations warned food-insecure countries in the Middle East and Africa were at risk of famine if the blockades continued, while the International Monetary Fund estimated the lives of 345 million people were put in immediate danger by the shock waves sent across global food markets by the war.

The mounting global food crisis and international pressure led to a rare instance of successful diplomacy between invader and invaded. The Black Sea grain initiative, which came into effect a year ago, created a safe corridor for commercial ships to enter and exit the Black Sea, allowing Ukrainian grain exports to resume.

The deal helped ease the upward pressure on global food prices, with around 33 million metric tons of grain and oilseeds exported under the deal.

Prices for grains and oilseeds have already risen in response to Russia’s exit from the deal. Aid agencies are bracing for further increases.

Consequences for the global food crisis

The 10 countries/territories with the highest numbers of people facing life-threatening levels of food insecurity.

As the last ship protected by the agreement set sail from the port of Odesa on Sunday morning, fears grew that the progress made in stabilising the global food crisis could be lost overnight.

The confluence of COVID-19, the war in Ukraine and climate shocks have overlapped to create the “largest and most complex hunger and humanitarian crisis in more than 70 years”, the World Food Programme said in its annual report last month. 

A record 349 million people experienced acute hunger in 2022, while 772,000 balanced on the knife’s edge of famine. Around 2.4 billion people did not have constant access to food. 

According to the UN, 47% of exports from Ukraine under the deal have gone to high-income countries, 26% to upper-middle-income countries, and 27% to low and lower-middle-income countries. 

Russia has criticized Ukraine for not exporting more to low-income countries. The UN, EU, United States and Ukraine argue the grain deal benefits people around the world due to its deflationary effect on food prices, which are at a 10-year high.

Ukraine was WFP’s top provider of grain in 2021, accounting for 20% of the total purchased by the UN agency. That number rose to 80% in the first half of this year.

European Commission President Ursula Von der Leyen condemned Russia’s “cynical move” to exit the agreement. The EU is “working to ensure food security for the world’s most vulnerable”, and will continue to help Ukraine deliver its agri-food products to global markets, she said. 

The UN has warned that millions of people could face hunger if the deal is not saved. Countries facing high levels of food insecurity such as Afghanistan, Yemen, Somalia, South Sudan and Syria will be the hardest hit. 

“Today’s decision by Russia to terminate the implementation of the Black Sea Initiative will strike a blow to people in need everywhere,” said Guterres.

Will Russia return to the deal?

Russia has pulled out of the Black Sea grain deal before. In November, Russia announced it was leaving the agreement, stoking panic in global food markets. Under pressure from Turkey, it rejoined the deal one day later. 

Kremlin spokesperson Dmitry Peskov said on Monday that the Black Sea grain deal has been “terminated”, but that Russia would rejoin the agreement “as soon as the relevant agreements are fulfilled”.

Russian demands include lifting obstacles to its own grain and fertilizer exports, reopening an ammonia pipeline from Odesa to Russia, and reconnecting the Russian Agricultural Bank to the SWIFT international payment system.

Moscow has repeatedly criticized the deal as one-sided, providing a lifeline to Ukrainian farmers without benefiting Russia. 

“Absolutely nothing has been done – I want to stress that. It’s one-way traffic,” Russian President Vladimir Putin said of the grain deal last week. “Not a single point linked to the fact Russia has its own interests has been fulfilled.” 

EU and US sanctions do not directly target Russia’s food and agriculture sectors, but have blocked the export of machinery needed for agriculture and complicated Russian efforts to export food and fertilizer.

EU officials said negotiations are still ongoing, and Turkish President Recep Tayyip Erdoğan said on Monday he believes Putin “wants the Black Sea Grain deal to continue”.

The United Nations and European Union have offered to reconnect a subsidiary of Russia’s Agricultural Bank to the SWIFT international payments system if it operates independently and agrees to regular UN audits. 

Russia was made aware of this proposal by UN Secretary-General Antonio Guterres last week, but pressed on with its exit from the deal.

Despite the stalemate, the deal still stands, a senior EU official told the Wall Street Journal on Monday. 

Image Credits: Breta Valek.

INB co-chairs Roland Driece and Precious Matsoso

Pandemic accord negotiations resumed on Monday with World Health Organization (WHO) member states expressing a hunger for text-based talks to begin on a first draft amid grave concerns about whether enough progress will be made before the northern hemisphere summer break.

Roland Driece, co-chair of the Bureau of the Intergovernmental Negotiating Body (INB), told the body’s sixth formal meeting that while he understood member states’ eagerness for a first draft on which to start text-based negotiations, discussions on Chapter Two of the compilation text (referred to as WHO CA+), focusing on equity, should be completed first.

“I would rather have a first draft that has substance which we all feel is strong enough to have real line-to-line discussions on, than having something in between which is not good enough yet,” said Driece. “So I would rather have a good first draft than a quick first draft, but we will come back with a proposal on how to get there.”

Informal inter-sessional meetings

Since the last INB meeting a month ago, member states have met in informal sessions to discuss three controversial issues in Chapter Two of the compilation draft. These sessions focused on research and development related to pandemic products, particularly vaccines and medicines (Article 9); access to these products and benefit-sharing, including sharing genomic sequencing of whatever pathogen is causing the pandemic(Article 12) and supply chain logistics (Article 13).

This week’s meeting will continue negotiations on Chapter Two, focusing on Articles 15 to 19, then Articles one to three, if there is enough time.

Member states generally regarded the informal sessions as being useful to enable them to understand countries with different positions better, as well as for elucidating how clauses could be practically implemented.

But while some countries felt that the informal sessions could be used to generate new text to enhance the compilation draft of the pandemic accord, others were adamant that the negotiations should not splinter further.

US Ambassador Pamela Hamamoto

“The informals clearly provided a valuable opportunity for member states to clarify their proposals and ask questions, which we believe helped improve our collective understanding of what may or may not be feasible for the accord,” said US Ambassador Pamela Hamamoto. 

“We suggest laying out a process this week for ongoing work by the co-facilitators, further empowering them to convene additional discussions on their respective articles, and if possible, to develop draft text to bring back to our next formal meetings,” she added.

“In this way, we can take strong collective steps under the guidance of the Bureau to move from helpful but still high-level discussions to more specific line-by-line negotiations and begin to build the first draft of the negotiating text together.”

African proposals missing amid concern about onerous meeting schedule

South Africa’s Dr Aquina Thulare

South Africa’s Dr Aquina Thulare, speaking on behalf of 47 African countries, noted that a number of suggestions from the continent had not made their way into the latest compilation text.

Nigeria posited that the informal meetings could “be used as an opportunity to highlight and discuss some of these issues and also see a way to re-import them into the document”.

But Namibia and Botswana were against “having to fight to incorporate our proposals through the informal process”. 

Kenya asked the INB’s Bureau to clarify when and where member states will be able to add text to the Bureau’s compilation. 

“In our view, this should be the preserve of the formal meetings of the INB, and as such, we propose that informal sessions maintain focus on clarity seeking and consensus building as their main mandate,” said Kenya.

Many under-resourced countries are also struggling to keep up with the heavy burden of meetings and fear being excluded if the INB splinters into even more informal sessions.

This was clearly articulated by Fiji, which said that while the informal sessions may assist in speeding up talks, “we run the risk of losing necessary representation and meaningful participation in the process”. 

“Therefore, the inter-sessional meetings should be seen as a useful method to enable better understanding and shifting negotiations forward. but the substantive negotiations must happen within the formal processes of the drafting group, and the INB.”

While sympathetic to this position, New Zealand proposed that the informal sessions could, nonetheless, be “empowered to identify convergence and divergence, restructure articles where it makes sense, and draw on member states’ proposals to help identify compromise text”.

Bureau co-chair Roland Driece reassured the INB that the informal sessions were never intended to replace formal discussions, but rather to “find the room”.

“Decisions are always here in this room and not in the informals,” said Driece, but added that the informal meetings were essential to enhance appreciation of one another’s viewpoints.

“We hear that not some of you struggle a little bit and we have to recognise as a Bureau that it’s not 100% clear on what the mandate of co-facilitators is or what the exact aim of a group is and we are working our way through this,” said Driece.

“But there is no other option than to keep on talking till we reach where we want to go,” he added. “I understand that nobody is willing to put all its cards on the table yet to show complete transparency about where they want to go or what their room to manoeuvre is, but at least everybody needs to show as much of their own cards [as possible]  in order to for the other ones to understand how to move on.”

Robust ‘One Health’ approach essential for prevention

France’s Ambassador Anne-Claire Amprou

Meanwhile, France speaking for the “One Health” group, stressed that pandemic prevention “is at the heart of the mandate” given to countries to negotiate a pandemic accord.

“We must take into consideration the ties between people and animals, both wild and domestic, and the environment in order to understand the fundamental factors and the trends that lead to the emergence and re-emergence of diseases,” stressed France’s Ambassador Anne-Claire Amprou. 

“The One Health approach is fundamental in order to fight risk factors and guarantee multiparty and multidisciplinary collaboration between the environment, human health and animal health experts.

“We have a unique opportunity to reinforce ties between these sectors by focusing on existing systems and capacities to ensure prevention preparedness and rapid response to pandemics. The pandemic accord could not be completed without a One Health approach that is robust and strong.”

New method of work 

European Union’s Director General for Health and Food Safety  (DG Santé) Sandra Gallina,

The European Union’s Director General for Health and Food Safety  (DG Santé)  Sandra Gallina, supported the “new method of work” introduced during the closed drafting session of the June INB meeting.

“The interactive and constructive discussions on key topics that prevailed during the meeting marked a significant shift and they are precisely what we need in order to increase the level of understanding of each other proposals,” said Gallina. 

“In particular, the opportunity given to delegations during the drafting group to present their proposals on access and benefit sharing, and the question and answer sessions that followed, proved to be very useful to increase the level of understanding of the various proposals,” she added.

Gallina stressed that this methodology, along with the informal inter-sessional meetings, should be applied to key topics related to the entire pandemic prevention, preparedness and response (PPR) cycle. 

Commenting that much of the current discussion had focused on response, Gallina urged “interactive and constructive discussion on key topics linked to prevention and preparedness” as “the best way of handling future pandemics is to prevent them from happening in the first place”.

Way forward to the first draft

Concluding the opening plenary, co-chair Driece said that the Bureau was “ a bit squeezed” between the time constraints of delivering an accord by May 2024 and accommodating countries’ concerns about having to attend so many meetings.

Driece added that it was not practical to reinstate the entire compilation text as the basis for negotiations and that the Bureau had done its best to summarise countries’ positions.

“We’ve always said if you feel that we left something out which you have proposed, for example, a third option where we present two or a second option where we present one, this room is the place to tell us that.”

On presenting a first draft for text-based negotiations, Driece said that the Bureau felt this was not possible until discussions on Chapter Two of the compilation text had been completed.

“I would rather have a first draft that has substance which we all feel is strong enough to have real line-to-line discussions on, than having something in between which is not good enough yet. So I would rather have a good first draft than a quick first draft, but we will come back with a proposal on how to get there.”

Médecins Sans Frontières (MSF) supporters protesting in front of the New York Stock Exchange in 2020, demanding that Johnson & Johnson makes bedaquiline available for all people with drug-resistant tuberculosis for no more than a dollar a day.

The licensing agreement reached between Johnson & Johnson (J&J) and the Stop TB Partnership on Thursday to allow the generic production of the tuberculosis drug, bedaquiline, is simply a “stop-gap” measure that applies to a limited number of countries, according to Médecins Sans Frontières (MSF).

At least nine countries in the Eastern Europe and Central Asia region with some of the world’s highest burden of drug-resistant TB are likely to be excluded from this deal, according to MSF.

While the countries included in the deal have not yet been made public, J&J has an exclusive commercial agreement with Russia’s Pharmstandard to supply bedaquiline to a number of countries in Eastern Europe and Central Asia and these are thus unlikely to benefit from the Stop TB deal.

Over the past week, J&J has faced public outrage for seeking to extend its patent on bedaquiline, the primary medication to treat drug-resistant TB. The global patent is due to expire next Tuesday but medicine access activists have accused the company of seeking secondary patents in 66 countries. 

US author John Green’s social media posts about the extension of the bedaquiline patent received significant traction, causing #PatientsnotPatents to trend on Twitter on Thursday.

In the midst of the media row, the Stop TB Partnership announced on Thursday that, “following lengthy negotiations”, J&J had granted licenses to its Global Drug Facility (GDF) to “tender, procure, and supply generic versions of bedaquiline for the majority of low-and middle-income countries, including countries where patents remain in effect”.

The GDF plans to launch a global, competitive tender for bedaquiline by the end of July and has reached out to potential suppliers about the process, according to the Stop TB announcement.

But MSF’s Christophe Perrin described the deal as “just a stop-gap because bedaquiline will only be available to a limited number of countries that will be included in this agreement, procuring through the Global Drug Facility”. 

“We remain concerned that J&J retains the global authority to determine access to lifesaving generic versions of bedaquiline in countries with a high burden of TB, even after the expiration of the main patent next week,” said Perrin.

“By continuing to pursue an extension of their monopoly on the drug in many countries, including 34 high-TB-burden countries where J&J still has a secondary patent on bedaquiline, J&J is maintaining control over countries’ ability to offer more people the treatments they need to stay alive and healthy.  

“We reiterate our call on J&J to publicly announce it will not enforce any secondary patents on bedaquiline in any country with a high burden of TB, and withdraw and abandon all pending secondary patent applications for this lifesaving drug,” added Perrin.

However, J&J has denied claims that its patents have prevented TB patients from access to bedaquiline.

“Unfortunately, the most significant barrier to treatment access for patients today is the fact that millions of patients with TB go undiagnosed every year. This is a challenge that we have invested significant resources to overcome and must all get behind if we are to achieve the global goal of ending TB,” said the company.

Key medicine for drug-resistant TB

Bedaquiline is the cornerstone of the best available regimens to cure drug-resistant TB (DR-TB), which is a tough-to-treat form of TB that nearly half a million people get each year, according to the Treatment Action Group (TAG).

“Many countries with high burdens of TB are unable to fully scale up access to DR-TB treatment due to the high cost, up to 70% of which is driven by the price of bedaquiline,” according to TAG.

“Recent estimates suggest that generic versions could shave up to 80% off the price of the drug, resulting in major savings for already cash-strapped TB programs in low- and middle-income countries. Around three-quarters of people in need of treatment for DR-TB live in countries affected by the secondary patents, including countries experiencing active conflicts or humanitarian crises such as Ukraine, Cameroon, Sierra Leone, and Malawi,” added TAG.

The current price that Pharmstandard currently charges the Russian Federation for bedaquiline is around 17 times higher than that agreed on between J&J and Stop TB.

Image Credits: The Global Fund / Evgeny Maloletka, Médecins Sans Frontières.

hunger
A woman shows how her maize ears have dried in the drought stricken garden. Due to droughts exacerbated by climate change, people living in the Mauritanian Sahel were at risk of food insecurity in 2012.

The world is on track to miss the United Nations’ target of eradicating hunger by 2030 by 600 million people, according to a flagship UN report on food security released Wednesday.

The report, jointly published by the Food and Agriculture Organization, the International Fund for Agricultural Development, the United Nations Children’s Fund, the World Health Organization, and the World Food Programme, found that the number of people facing hunger has increased by 122 million since 2019, to 735 million.

The number of people experiencing food insecurity stabilized in 2022 after hitting record numbers in 2021, but the situation remains grim. Hunger continued to rise in Western Asia, the Caribbean, and all African subregions. Africa continues to be the worst affected, with one in five people facing hunger on the continent — more than double the global average.

“Recovery from the global pandemic has been uneven, and the war in Ukraine has affected nutritious food and health diets,” said Qu Dongyu, director-general of the FAO. “This is the ‘new normal’ where climate change, conflict, and economic instability are pushing those on the margins even further away from safety.”

Global hunger remained virtually unchanged from 2021 to 2022 but is still far above pre-pandemic levels.

The report found that the number of people who did not have constant access to food rose to 2.4 billion in 2022, nearly 30% of the global population. Of those, 900 million faced severe food insecurity. Food inflation rose by 7% between 2019 and 2021, resulting in 42% of the global population — over 3.1 billion people — not being able to afford a healthy diet.

“One of the major messages of the report is that if we run the contrafactual – what would have happened if there was no COVID-19 – we would have seen a decline [in hungry people],” FAO Chief Economist Maximo Torero told Devex, adding that the same could be said for the war in Ukraine.

Children under five continue to be especially hard hit by the global food crisis, with millions suffering from malnutrition. Nearly 200 million were undernourished, while 37 million were overweight.

“There are rays of hope, some regions are on track to achieve some 2030 nutrition targets. But overall, we need an intense and immediate global effort to rescue the Sustainable Development Goals,” UN Secretary-General Antonio Guterres said in a statement during the report’s launch at UN headquarters in New York. “We must build resilience against the crises and shocks that drive food insecurity — from conflict to climate.”

Climate models underestimate odds of ‘synchronized’ global crop failures

The onset of the Russian invasion exacerbated the global food crisis. Russian President Vladimir Putin has leveraged the importance of the Black Sea corridor to global food security obtain concessions from the international community.

The Black Sea grain corridor that allows for the safe passage of ships carrying grain out of Ukraine’s ports is set to expire on Monday. If the deal is not renewed by Russian President Vladimir Putin, it could have dire consequences for the global food crisis. Prices could rise even further, and millions more people could go hungry.

UN Secretary-General Antonio Guterres has proposed that Putin extend the deal in return for reconnecting a subsidiary of Russia’s agricultural bank to the SWIFT international payment system, according to Reuters. All Russian banks have been cut off from SWIFT since June 2022.

The release of the UN report on food security came as the world was experiencing its hottest week on record. The unprecedented surface and ocean temperatures coincided with the onset of El Niño, a climate pattern that makes the ocean water in the Pacific Ocean warmer than usual.

El Niño events, which occur naturally but are influenced by human-caused climate change, are expected to become more frequent and intense as the planet warms. The resulting temperature spikes could have a significant impact on weather patterns all over the world.

The record-breaking temperatures “highlight the far-reaching changes taking place in Earth’s system as a result of human-induced climate change,” the World Meteorological Organization said.

“We are in uncharted territory, and we can expect more records to fall as El Nino develops further,” said Christopher Hewitt, Director of Climate Services at the World Metereological Organization. “This is worrying news for the planet.”

Climate change is already having a dire impact on the world’s food supplies, and the situation is only expected to worsen. New research suggests that climate models may underestimate the risk of simultaneous crop failures across the world’s breadbaskets, a finding that could have dire consequences for global food security.

The study, published in the journal Nature Communications last week, found that climate models have been “excellent” at projecting the mean response to continued greenhouse gas emissions, but that the models may underestimate the likelihood of concurrent extreme weather events that could lead to crop failures.

“Concurrent crop failures in major crop-producing regions constitute a systemic risk,” said the team of scientists from University of Columbia. “Evidence for high-risk blind spots such as an underestimation of synchronized harvest failures as identified here, manifests the urgency of rapid emission reductions, lest climate extremes and their complex interactions might increasingly become unmanageable.”

The war in Ukraine has limited the world’s access to one vital breadbasket. Climate change could hit multiple breadbaskets simultaneously, with dire consequences for millions of people around the world.

Image Credits: Pablo Tosco/Oxfam, Breta Valek.

Winnie Byanyima, the executive director of UNAIDS, launching the 2023-Global AIDS update report in Geneva on Thursday.

Despite the giant strides the world has made in combating the HIV epidemic, the high rate of infections among women and girls in sub-Saharan Africa, as well as childhood HIV infections, continue to hamper progress.  

“Four thousand adolescent girls and young women acquired HIV every single week. That’s a crisis every single week. 3,100 of those are from Sub-Saharan Africa. So it’s a sub-Saharan crisis,” Winnie Byanyima, the executive director of UNAIDS, said at the launch of the 2023-UNAIDS Global AIDS Update report in Geneva, on Thursday.  

However, she asserted that ending AIDS by 2030 is an achievable goal. 

“The data and evidence in the report we are releasing today shows that there is a path that ends AIDS by 2030,” Byanyima added. “The path that ends AIDS is the same path that will help societies to be prepared for future pandemics and that will also help countries to achieve the sustainable development goals.” 

Adolescent girls and women bear higher burden of infections

In 2022 alone, women and girls accounted for 63% of all new HIV infections in sub-Saharan Africa. Less than half of the districts with very high HIV incidence in the region currently have HIV prevention programmes dedicated exclusively to adolescent girls and young women. 

saharan
On the left, change in number of new HIV infections in 2022 when compared with the numbers in 2010. On the right, number of new HIV infections, 2022, among adolescents and young people (aged 15–24 years), by sex, selected countries, eastern and southern Africa.

Targeted prevention programmes for women and young girls, among other interventions, will cause a ripple effect in the population by directly reducing the number of new HIV infections among children, the report contends. 

Between 1996 and 2022, HIV treatments have averted almost 21 million AIDS-related deaths around the world. The number of AIDS-related deaths has also dropped by 69% since 2004 when it peaked, the report added. However, the disease killed one person per minute in 2022. 

Concerted efforts targeted at women and young girls have halved the number of new infections since 2010, but young girls and women remain among those most vulnerable to contracting HIV. 

“Fewer new HIV infections in women [globally]  and higher coverage of treatment among people living with HIV have led to a 58% drop in the annual number of new infections in children globally between 2010 and 2022, to 130 000, the lowest since the 1980s,” the report states.

Political action crucial to boost progress

A common thread among the various success stories of countries that have recorded reduction in HIV/AIDS transmission and death rates is the presence of strong political commitment to draft policies that place the people and communities at its core. 

“HIV programmes succeed when public health priorities prevail, as experiences in multiple countries attest,” the report added. 

Countries like Botswana, Cameroon, Nepal, Zimbabwe, and Cambodia have all achieved tremendous reductions in the number of new HIV cases, and AIDS-related deaths due to scaling up evidence-based policies and implementing focused prevention programmes, the report said. 

In 2020, UNAIDS announced an ambitious set of goals for countries to work towards by 2025. The so-called the ’95-95-95′ plan aims for 95% of all people living with HIV to know their HIV status; 95% of those who have HIV infection to receive sustained antiretroviral therapies; and 95% of those who receive antiretroviral therapies to have their viral loads suppressed, which will help people live longer, prevents further progression of the infection and sexual transmission of the virus. 

According to the 2023 UNAIDS report, Botswana, Eswatini, Rwanda, the United Republic of Tanzania, and Zimbabwe, have already achieved the targets set by the 95-95-95 program. At least 16 other countries, including eight in sub-Saharan Africa, and Thailand, are close to achieving their targets set by the program. 

The gains in combating HIV-AIDS, however, have been limited outside of sub-Saharan Africa. 

Around 23% of the new HIV infections were in Asia and the Pacific region, and the number of new infections in eastern Europe and central Asia has increased by 49% since 2010. The number of new HIV infections in the Middle East and North Africa region has increased by 61% since 2010, the report revealed. 

“These trends are due primarily to a lack of prevention services for people from marginalized and key populations and to the barriers posed by punitive laws, violence and social stigma and discrimination.”

Byanyima condemns Uganda’s criminalization of same-sex relationships

While acknowledging the positive steps some countries have taken to prioritize community-specific HIV preventive measures, Byanyima spared no words in condemning Uganda’s recent action to criminalize same-sex relationships. 

“In 2022 and 2023, Antigua and Barbuda, Cook Islands, Barbados, St. Kitts & Nevis, and Singapore decriminalized same sex sexual relations. Unfortunately Uganda, my country, took the opposite direction and that’s not positive,” she said.  

Consensual same-sex intercourse is a criminal act in 67 countries across the world. Over 160 countries criminalise some aspects of sex work and 20 countries criminalise transgender persons. All of these actions have direct impacts on the status of the HIV epidemic in a region. 

“In 2022, compared with adults in the general population (aged 15-49 years), HIV prevalence was 11 times higher among gay men and other men who have sex with men, four times higher among sex workers, seven times higher among people who inject drugs, and 14 times higher among transgender people,” the report pointed out. 

Barriers hold back more rapid progress 

Lack of access to, and continuity of treatment is one of the key barriers holding back more progress, the report finds, in addition to delay in diagnosing the infection in regions like Latin America, European Union, and European Economic Area. 

In 2022, around 9.2 million people living with HIV were still not receiving treatment and around 2.1 million who were receiving treatment were not virally suppressed. 

Only around 50% of those living with HIV in eastern Europe, central Asia, the Middle East, and North Africa, were receiving treatments in 2022, according to the report. 

When it comes to children and adolescents living with HIV globally in 2022, only 57% receive treatment. While the number of AIDS-related deaths among children reduced by 64% between 2010 and 2022, HIV still claimed the lives of 84000 children in 2022. 

“Early infant diagnosis coverage has risen in eastern and southern Africa (to 83%) but remains very low in western and central Africa (23%),” it said.  

Another barrier preventing poor countries from implementing HIV prevention and treatment programmes is the lack of funds. From the substantial increase in HIV funding recorded in early 2010s, funds have now declined to 2013 levels, the report finds.  

In 2022, US$20.8 billion was available for HIV programmes in low and middle income countries. This is 2.6% less than the amount that was available in 2021. By 2025, the world requires US$29.3 billion to combat HIV. 

“So there is a gap of eight and a half billion [USD]. What this shows is that we are in a world where we are not yet on the path that ends AIDS, but we also show that we can choose to get on that path. It’s a choice,” Byanyima remarked. 

Saharan
Resource availability for HIV in low- and middle-income countries by source, 2010–2022 and 2025 target.

Decline in HIV incidence is directly related to an increase in HIV funding. 

“Some countries where HIV incidence is declining, including the Dominican Republic, India, Kyrgyzstan and Togo, are putting between 3% and 16% of HIV spending towards prevention programmes for people from key populations,” the report said. 

In 2022, around 90 countries together signed a voluntary licensing agreement to purchase generic versions of a pre-exposure prophylaxis (PrEP) drug for HIV. Several upper middle-income countries with significant HIV burden were not included in this purchase deal, thus placing those populations in a more vulnerable position. 

“It could take years before generic manufacturing of the medicine is in full swing… Removing these hurdles would give HIV prevention a major boost,” the report stated.

Image Credits: UNAIDS, UNAIDS.

Europe could face an average of 120,000 premature deaths attributable to heat each summer by 2050 if more effective adaptation plans are not implemented, according to a team of researchers from the Barcelona Institute for Global Health (ISGlobal). 

Meanwhile, as record heat was experienced across the world, lawmakers in the European Parliament voted on Wednesday to restore at least 20% of degraded land and sea ecosystems by 2030, despite opposition by several conservative Members of the European Parliament.

Some 68,000 premature heat-related deaths are anticipated by 2030 and 94,000 by 2040, according to the ISGlobal research published in Nature Medicine on Monday. Last summer (2022) was the hottest on record in Europe, and 61,000 people died due to the high temperatures, they said.

“We call on national governments and European agencies to create more ambitious and effective adaptation plans to avoid all these deaths in Europe,” IsGlobal senior researcher Marcos Quijal, who contributed to the study, told Health Policy Watch in an interview.

The study was released on the heels of an announcement last week by the World Meteorological Organization (WMO) that the first week of July was the hottest week on record for the planet as a whole, highlighting “the far-reaching changes taking place in Earth’s system as a result of human-induced climate change”. 

Europe is experiencing up to 1°C more warming than other continents, Quijal said. The team’s paper raises a red flag about the threat exposure to heat poses, especially to high-risk populations in Europe and globally. 

Italy has the most deaths overall, per capita

The summer of 2022 was the hottest season on record in Europe and included a series of acute heat waves and droughts. Eurostat, the European statistical office, reported unusually high mortality during that summer. 

However this latest report, conducted in collaboration with the French National Institute of Health, provides the first robust estimates of the premature mortality directly attributable to excessive heat, as such. 

The researchers examined mortality data between  2015 and 2022 for 823 regions in 35 European countries, representing 543 million people. Then, using epidemiological models, they predicted temperature-attributable mortality for each region and week of the summer. Specifically, they looked at deaths between 30 May and 4 September 2022, finding 61,672 heat-related deaths with a 95% confidence interval. 

The country with the highest number of heat-attributable deaths over the entire summer of 2022 was Italy (18,010), followed by Spain (11,324) and Germany (8,173). However, when looking at deaths per capita, the top three countries to experience heat-attributable deaths were Italy (295 deaths per million), Greece (280) and Spain (237).

The European average was around 114 deaths per million.

When looking at how hot each country was, France was the warmest country, experiencing temperatures that were 2.43°C above the average values for the period 1991-2020, followed by Switzerland (+2.30°C) and Italy (+2.28°C).

The worst temperatures fell between 11 July and 14 August, causing 63% (38,881) of total heat-related deaths. 

Women and elderly are most at risk

“Climate change projections for the continent indicate that temperatures, and their health impacts, will rise at an accelerated rate unless strong mitigation and adaptation actions are put in place,” the researchers wrote, highlighting that the most vulnerable people are at the most significant risk of premature heat-associated mortality. 

Quijal told Health Policy Watch that more data would still be needed to understand better what makes individuals vulnerable and then target the continent’s plan and policies to assist those people. 

Using epidemiological models to estimate the sex- and age-specific mortality burden associated with the heat, the researchers found that older adults with pre-existing cardiovascular and respiratory diseases, women and socially isolated or socio-economically disadvantaged individuals are at highest risk. 

There were 63% more heat-related deaths in women than men, with women over the age of 80 being the most vulnerable. Moreover, the older people got, the more susceptible they were to heat-related deaths, with 4,822 people under the age of 64 dying in 2022, compared to 9,226 between the ages of 65 and 79 and 36,848 over the age of 80. 

“Our results call for a reevaluation and strengthening of heat surveillance platforms, prevention plans and long-term adaptation strategies,” the researchers concluded.

European lawmakers vote for biodiversity – urban green spaces reduce air pollution and excess heat

On Wednesday, lawmakers in the European Parliament voted 336 to 300 in favor of a bill that will restore at least 20% of degraded land and sea ecosystems by 2030, despite opposition by several conservative MEPs.

Thirteen MEPs abstained in the vote for the Nature Restoration Law, initially proposed by the European Commission in June 2022. 

More than 80% of habitats in Europe are in poor condition, according to the Commission.

This is the first “continent-wide, comprehensive law of its kind,” the European Commission explains on its website. “It is a key element of the EU Biodiversity Strategy, which calls for binding targets to restore degraded ecosystems, in particular those with the most potential to capture and store carbon and to prevent and reduce the impact of natural disasters.”

The Commission said restoring ecosystems would thus help limit global warming.  In cities, green spaces also help mitigate the urban “heat island” impacts of warming, whereby temperatures in cities can be 5-8 °C above surrounding rural areas, due to their large expanses of heat-absorbing concrete. The same green spaces filter and thus reduce air pollution, which can compound the health effects of excess heat. Conservative MEPs, however, who opposed the bill said that it could threaten food security, block new renewable energy projects and put farmers at risk.

In a letter signed by 6,000 researchers and now published as a preprint article, scientists debunked several of the myths presented by the conservative MEPs. For example, they write that “protecting  and  restoring  nature,  and  reducing  the  use  of  agrochemicals  and pollutants, are essential for maintaining long-term production and enhancing food security.” 

Specifically, the bill was supported by MEPs from Europe’s Socialists & Democrats, Left, Greens and Renew Europe parties. MEPs in the European People’s Party, the European Conservatives, Reformists and the Identity and Democracy parties were opposed. 

The European Commission, the European Parliament and the Council of the EU will now start inter-institutional negotiations with EU countries to develop a final set of rules and regulations that must be implemented.

After the vote, rapporteur César Luena (SD, ES), said: “The Nature Restoration Law is an essential piece of the European Green Deal and follows the scientific consensus and recommendations to restore Europe’s ecosystems. Farmers and fishers will benefit from it and it ensures a habitable earth for future generations. “

Image Credits: Pawel Janiak/ Unsplash.

Grammy-award-winning musician Ricky Kej (centre back) and band perform at the World Rehabilitation Alliance launch

After seven years of planning, the World Rehabilitation Alliance (WRA) was launched in Geneva on Tuesday with a founding membership of 82 organisations.

Welcoming the launch, actress Emilia Clarke, who played Daenerys Targaryen (Khaleesi) in Game of Thrones, said that it was an “absolute joy” that her organisation, SameYou, is a founding member of the alliance. 

“I’ve suffered two brain haemorrhages, so I know firsthand just how vital rehabilitation was to my recovery,” said Clarke in a video message. “It’s something that matters to millions and millions of people all over the world, and yet still so many people don’t get access to what they need.”

Emilia Clarke

Grammy Award-winning singer Ricky Kej performed a song specially composed for the alliance, which was launched at the end of a two-day global summit convened by the World Health Organization (WHO) to assist countries to integrate rehabilitation care into their health systems.

Earlier, Ukraine’s Deputy Health Minister, Mariia Karchevych, told the summit that her country had suddenly found itself having to provide rehabilitation for “thousands of people” injured by rockets fired on them by Russia.

“In the midst of the war, we had to create a rehabilitation strategy and fully integrate it into our healthcare network,” said Karchevych.

“Our lives changed in the war, but our principle remains the same. Everyone matters,” she added, expressing gratitude to the international community for its support, which she described as a “manifestation of love”.

WHO Director-General Dr Tedros Adhanom Ghebreyesus described rehabilitation as “a universal right”. 

“This new alliance is a powerful demonstration of the collaborative spirit of the rehabilitation community. By uniting our voices across sectors, we can raise the profile of rehabilitation and support its integration in the continuity of care across all countries,” Tedros told the launch in a recorded message.

“The need for rehabilitation is far, far greater than most people assume,” Dr Jérôme Salomon, Assistant Director-General and head of Universal Health Coverage at WHO, told the summit.

“More than 2.4 billion people, almost a third of the global population, have health conditions that could benefit from rehabilitation.

WHO’s Alarcos Cieza addresses the launch in Geneva.

The summit came shortly after a watershed first-ever resolution on boosting access to rehabilitation care was passed by the World Health Assembly with unanimous support from the 193 member states in May.

The resolution notes that global rehabilitation needs are “largely unmet”. In many countries, less than half of people receive the care they require. 

Integrating rehabilitation into health systems

The summit launched a Package of Interventions for Rehabilitation aimed at assisting countries to integrate rehabilitation into their national health services, including training health workers to address the need.

“The purpose of this package of interventions is to support the planning, the budgeting and the integration that we’ve talked about,” said Dr Binta Sako, WHO’s lead on rehabilitation in the Africa region.

“It provides a lot of information on the type of evidence-based interventions that are needed. What is required to make the services available in terms of material and also human resources.”

The package focuses on 20 health conditions spread throughout seven areas of health, added Dr Alexandra Rauch from the WHO’s Rehabilitation Programme.

“It really shows the comprehensiveness of rehabilitation. It’s not about only improving body functions. It’s about improving life areas of people, and also including carers and families in rehabilitation programmes,” said Rauch.

Image Credits: Megha Kaveri.