University professors stand between protestors and police at Fudan University in China.

Almost three years of harsh lockdowns, enforced quarantines in state facilities and daily testing have tried the patience of many Chinese people, who since Friday have taken to the streets from Shanghai and Nanjing in the east, to central Chengdu and Wuhan and Urumqi and Korla in the north and west.

While scores of people have been arrested, protestors have also won some concessions. In Urumqi, where four million people have been in lockdown for over 100 days, officials announced on Monday that it would allow people to travel on buses to do errands and parcel deliveries would resume.

Meanwhile, Beijing officials also announced on Sunday that lockdowns of residential areas would not be enforced for longer than 24 hours.

These are small indications that Chinese leader Xi Jinping’s “zero-COVID” policy is becoming increasingly impossible to enforce in the face of people’s growing anger and desperation.

Two weeks ago, China’s State Council cut compulsory quarantine in a state facility for international visitors and the close contacts of people with COVID from seven to five days, with a further three days at home. It also did away with restrictions on secondary contacts.

But a surge in COVID cases in Beijing was followed swiftly by lockdowns, school and restaurant closures, dampening hopes that the country was quietly abandoning the zero-COVID approach.

Journalist arrested, assaulted

China is trying to both quell and downplay the protests. On Monday, there was increased military and police deployment at sites of weekend protests, and BBC reporter Ed Lawrence was arrested and reportedly assaulted in police custody in Shanghai while reporting on the protests.

The weekend protests were sparked by the deaths of 10 people in a fire in an apartment building in Urumqi, the capital of Xinjiang, on Thursday.

The screams of people trapped in the burning building last Thursday were captured on social media amid reports that apartment doors had been closed from the outside to enforce the city’s lockdown. Firefighters took more than three hours to stop the fire as cars blocked their path – many with flat batteries after months of not being driven.

@renzhiqiang2

♬ 原聲 – renzhiqiang2

Sealing the doors of COVID-19 contacts is reported to be a common occurrence in China as part of the country’s enforced lockdowns.

Outrage at the deaths in Urumqi led to vigils and protests being arranged in Shanghai, Xi’an, Chongqing and Nanjing, as well as various university campuses, and people turned up in their thousands at some of the protests. Amid chants of ‘Lift lockdown’, ‘No PCR test’ and “We want freedom’, anti-Xi and anti-Communist Party chanting could also be heard. 

Many people carried blank sheets of white paper to symbolise government censorship, but reports on the protests on Weibo, the Chinese social media platform, were short-lived.

Chinese protestors hold blank papers to signify censorship.

Back in May, WHO Secretary-General Dr Tedros Adhanom Ghebreyesus told a media briefing that China’s strategy was no longer sustainable in the face of the more infectious but less lethal Omicron.

“When we talk about the zero-COVID strategy, we don’t think that it’s sustainable, considering the behaviour of the virus now and what we anticipate in the future,” said Tedros, prompting a rebuke from Chinese officials

Aside from its zero-COVID policy, China’s vaccines, Sinopharm and Coronavac, are only about 60% effective against severe infection in comparison to over 90% protection offered by mRNA vaccines.

China still to reckon with COVID infections

However, it is possible that China will still have its reckoning with COVID as its weary citizens resist further controls and the highly infectious virus spreads through a population with little immunity.

Global data analysis group Airfinity estimates that 1.3 and 2.1 million lives could be at risk if China lifts its zero-COVID policy “given low vaccination and booster rates as well as a lack of hybrid immunity”. 

It based its risk analysis on the cumulative peak cases and deaths from Hong Kong’s BA.1 wave as a proxy for mainland China.

“Mainland China has very low levels of immunity across its population. Its citizens were vaccinated with domestically produced jabs Sinovac and Sinopharm which have been proven to have significantly lower efficacy and provide less protection against infection and death,” Airfinity said in a statement on Monday.

“This vaccine-induced immunity has waned over time and with low booster uptake and no natural infections, the population is more susceptible to severe disease. China’s current booster uptake is 40%, whilst Hong Kong’s primary series uptake was 34% back in February 2022 when it saw a large spike in cases due to the BA.1 omicron variant,” said Airfinity.

Dr Louise Blair, Airfinity’s head of vaccines and epidemiology,  called on China to “ramp up vaccinations to raise immunity in order to lift its zero-COVID policy, especially given how large its elderly population is”. 

Blair said that China needs “hybrid immunity” from both vaccinations and infections to ensure  “much less impactful and deadly COVID-19 waves”.

Localised protests 

Prior to the national weekend protests, there have been intense local protests, particularly at the Foxconn facility in Zhengzhou, which makes 70% of the Apple’s iPhones.

Workers work long shifts and usually stay in massive factory dormitories that can house up to 300,000 people.

But after a small COVID outbreak in the city in October, Foxconn closed the dining halls and introduced “closed loop” production to cut workers’ contact with the outside world to meet production demands for the launch of the iPhone14. Tesla and other factories have used this approach during lockdowns in Shanghai in March.

But Foxconn workers started to panic in fear of being forcibly quarantined there, and have clashed a number of times with police. 

Numerous reports of poor treatment and neglect at state quarantine facilities have also leaked out in public, alongside videos of small children removed from COVID-exposed parents being forced to fend for themselves in such facilities.

 

Image Credits: Twitter.

Ebola
68 days and 52 deaths into Uganda’s Ebola outbreak, authorities are hopeful the spread of the virus has been contained.

Uganda’s President Yoweri Museveni has extended quarantine measures in the two districts at the epicentre of the country’s Ebola epidemic for another 21 days, citing the need to protect gains in the fight against the virus.

This marks the third renewal of lockdowns in Kassanda and Mubende, and authorities are hopeful it will be the last. Movement in and out of the districts was first restricted on 15 October, and renewed for another 21 days on 5 November. The measures include a curfew and the closure of social spaces like churches, bars and markets.

“It may be too early to celebrate success, but overall, I have been briefed that the picture is good,” Museveni said in a televised address delivered by vice-president Jessica Alupo. While the situation is “still fragile”, Museveni said Ugandan health authorities are “very optimistic” that the outbreak will end “in the coming month.”

The government’s optimism is buoyed by Uganda’s continued progress in stamping out the outbreak. Three districts have completed over 42 days since the last case of Ebola was detected, while six districts – including the epicentres of Kassanda and Mubende as well as the capital, Kampala – remain in “follow-up” protocols.

The virus has so far claimed 56 lives, while another 22 probable Ebola deaths were registered before the government issued its official declaration of the outbreak on 20 September.

“If we open now and a case appears, we will have destroyed all the gains we have made in this war,” Museveni said. “Our healthcare workers will continue to do all it takes to save lives and bring the epidemic to an end.”

Full reopening if the 21-day mark is reached

Ebola
With numbers dropping, bed occupancy rates within the past 24 hours stood at just 27.9% in Mubende isolation units.

The government’s decision to extend lockdowns by 21 days is based on the incubation period of Ebola. The three-week mark is a key indicator of whether transmission has been stopped.

Mid-way through November, Mubende appeared to be in the clear. The district had gone 13 days without reporting a new case. But on day 14, a 23-year-old medical student with links to previous cases was diagnosed with the virus.

“Without completing 21 days, as we saw with Mubende, a case can pop up anywhere,” the President said. “It is important that we complete the entire cycle.”

Kassanda has now reached 15 days since reporting a new case, while Mubende has not registered a confirmed case for 14 days. If both districts hold on for another week, Uganda’s fifth deadly encounter with the Sudan strain of Ebola may come to a swift end.

“We are relying on you to cooperate and bring this epidemic to an end,” the President told residents of Kassanda and Mubende, noting their commitment and sacrifice thus far. “If there is no case by the end of the 21-day period, we will re-open fully.”

Threat of urban transmission avoided 

Ebola
Ebola’s invasion of Uganda’s Gulu municipality and its slum-like camps for internally displaced persons in 2000 was the cause of the deadliest Ebola epidemic in the country’s history.

When six school children were diagnosed with Ebola in Kampala in late October, fears of the virus embedding itself in the capital spiked. 

On paper, Ebola’s mortality rate of up to 90% makes the virus easy to contain. Museveni also noted that as a virus transferred through contact and bodily fluids, Ebola, despite its “devastating nature”, is far easier to control than airborne threats like COVID-19.

But if allowed to embed itself in densely populated areas, things can quickly spiral out of control. “If we had allowed the escalation of the outbreak into Kampala, the consequences would have been bad, including possible exportation to our African brothers in neighbouring countries,” Museveni said. 

Despite calls from doctors and health advocates to lockdown the capital earlier this month, Museveni and Health Minister Jane Ruth Aceng elected not to bow to the pressure. So far, their decision appears to be validated. 

“The opportunity for immediate quarantine of contacts was lost for Mubende and Kassanda,” Museveni said, noting the first suspected cases were registered on 6 September, two weeks before authorities declared the outbreak.

This was not the case for Kampala. Knowledge of the threat allowed health authorities to be on reactive footing, and respond quickly to isolate infected people and their contacts. Today, over 300 contacts remain under institutional quarantine overseen by the Ministry of Health. 

Vaccine Trials Are Underway 

WHO Africa Director Dr Matshidiso Moeti visited Kassanda and Mubende earlier this month to coordinate with Ugandan health authorities and other international partners in responding to the outbreak.

There is currently no known vaccine for the Sudan strain of Ebola responsible for the Ugandan outbreak. But the outbreak presents a unique opportunity to bridge this treatment gap, and a series of trials have been set in motion with the aim of minimizing hospitalisations and deaths. 

A coalition of organizations including CEPI, Gavi, the World Health Organization and Ugandan health authorities are deploying three vaccine candidates to about 3,000 people who have been in contact with Ebola patients. “As we speak, the government of Uganda is finalizing the regulatory approvals,” Africa CDC Director Dr Ahmed Ogwell told CNN. 

If any of the candidates can succeed, authorities are hopeful this will be the last outbreak Uganda faces without medical defenses.

“By embedding research at the heart of the outbreak response, we can achieve two goals,” the WHO said in a statement. “Evaluate potentially efficacious candidate vaccines, potentially contribute to end this outbreak, and protect populations at risk in the future.”

Image Credits: WHO, WHO, WHO.

UNITE president Ricardo Leite (fourth from right) and MPs at the World Health Summit.

“There is this tsunami that is happening after the earthquake that was COVID-19 that is now coming to shore and hitting health systems across the world,” said Ricardo Baptista Leite, president and founder of UNITE, a global network of parliamentarians committed to addressing global health challenges.

“The pandemic also led to a huge economic crisis and even poor countries in the global South, who might have been less affected by the pandemic, are going to pay a very severe price due to economic consequences that will lead to challenges in responding to the health needs of those countries,” he said. 

A week before his organization brings together hundreds of parliamentarians from around the world to discuss the most pressing issues in public health at a global summit, the Portuguese MP, who collaborates closely with the World Health Organization (WHO), warned Health Policy Watch of the need to take swift and collective action before the next pandemic.

“This is the moment when international institutions and governments need to step up their game and tackle the global health crisis,” Leite said. “We must double up our efforts to make sure we are better equipped in the future and can respond to health needs.”

Leite is a long-time global health advocate. He is also a trained medical doctor in infectious diseases and heads the Public Health department at Católica University of Portugal.

False sense of security

He told Health Policy Watch that whenever the world has felt “capable of controlling infectious disease, we create a false sense of security that we can lower our guard. Whenever we lower our guard, infectious diseases come back with a vengeance.”

This can be seen throughout history with multiple pandemics over the centuries, but also in this century with the emergence of antibiotics and the belief that with penicillin we could control infections – a belief now being called into question with the development of antibiotic-resistant bacteria. Antibiotic-resistant bacteria are responsible for the deaths of some 700,000 people each year – with scientists predicting that these infections could kill more people than cancer by 2050.

The pandemic has set back the fight against many diseases by years. Take HIV/AIDS. In December 2020, UNAIDS released its 95-95-95 targets, calling for 95% of all people living with HIV to know their HIV status, 95% of all people with diagnosed HIV infection to receive sustained antiretroviral therapy and 95% of all people receiving antiretroviral therapy to have viral suppression by 2025. 

But during COVID-19, in many countries, measurement of these goals ceased altogether. Where tracking continued, in some cases, diagnoses were slower. 

“HIV is an interesting proxy for all infectious and communicable diseases out there,” Leite said. 

In addition, COVID-19 led to a rise in people being diagnosed with late-stage cancer, an increase in cases related to chronic diseases due to people being kept away from health systems, and a spike in mental illness globally.

“Pandemics are a strong demonstration of the case that infectious diseases can undermine our efforts toward prosperity for all,” Leite said.

He added that during his time as a medical volunteer in Ukraine he saw a huge rise in multi-resistant and extremely resistant tuberculosis in the region. Leite predicted that as the war continues, it will be almost impossible not to see the TB spillover into neighboring countries and then across the world.

“There has to be a clear understanding from the world that dealing with infectious diseases is not only something recommended but is a prerequisite for economic and social development worldwide,” he said.

The role of parliamentarians 

WHO parliamentarian session during the World Health Summit (UNITE)

Part of the solution is getting parliamentarians around the table, according to Leite. In 2017, the United Nations passed a resolution on the nexus of global health and foreign policy, encouraging a multi-stakeholder approach to achieve universal health coverage.

“The voice of parliamentarians was not part of the discussion,” Leite said. “One cannot expect to build a global health architecture or move forward science-based policy making if we do not keep those who write policy in the loop. We cannot make sure money gets where it needs to if we do not include those that make and approve budgets in parliaments.”

While he admitted that UNITE is not a “silver bullet,” he said it is a valuable tool for bringing parliamentarians from more than 90 countries together to share experiences and learn how they can best bring their own country toward a more sustainable future. 

“The first step was to get the conversation going. The second was to develop regional leadership. We now have 10 regional chapters, each led by an MP or former MP. Then we developed policy hubs, specialized teams that focus on specific policy areas, so they can drill down on concrete policymaking in key areas,” Leite explained. 

“We empower policymakers to be leaders for change in their own countries.”

UNITE’s three priorities

At its founding, UNITE was focused solely on issues of infectious diseases, but COVID-19 led it to change its mandate over the summer of 2022 and the organization is now focused more generally on global health matters. 

“The pandemic has demonstrated that global health issues and infectious diseases go hand in hand,” Leite told Health Policy Watch. “We cannot solve many challenges related to infectious disease, which were the basis of our work in the  first years, without addressing all the other global health challenges out there.”

UNITE is now taking a three-priority approach, focusing on pandemic prevention preparedness and response; the future of health systems; and health as a human right. The group signed a memorandum of understanding recently with WHO to work together on these pillars and supply parliamentary feedback and insight to support WHO’s related efforts. 

Next week: UNITE Global Summit

From 5-7 December, UNITE will host its global summit in Lisbon, bringing together its parliamentarians and leaders from the global health community to expand and forge new partnerships. Members of the lawmaking, civil society, medical and academic communities will meet to talk about what they feel are the most pressing issues on the global health agenda. 

Another priority that UNITE is bringing to the forefront of the parliamentarian agenda is the use of digital health to promote universal health coverage. 

“In the last few months with the creation of the digital health hub, parliamentarians were able to discuss with other stakeholders how to build the right frameworks and increase budgets to implement digital health transformation that can promote access to millions,” Leite said.

Finally, Leite added that with its new direction in mind, UNITE members would try to answer three questions during the event: What progress have we made so far during the UN’s Sustainable Development Goals period? What have we learned to help us make even more progress by 2030? What is the role of parliamentarians in helping drive that progress?

MPs and the pandemic treaty

Session on the pandemic treaty at the World Health Summit.

In the past, parliamentary involvement has helped achieve public health goals. In Portugal, Leite cited an example from 22 years ago when the parliament decided to decriminalize the use of drugs. 

“This was not making drug use legal, but now no one goes to jail for using drugs,” he explained. “We stopped looking at people who use drugs as criminals but instead as people who potentially had a health challenge that needed to be dealt with.”

Instead of jail time, drug abusers receive harm reduction and other social and health services.

When the legislation was passed, around 1% of the Portuguese population used heroin. Since then, Leite said, the numbers have dropped dramatically. Drug-related crime is down, and new HIV cases tied to drug use have fallen from as high as 60% to only 2%. 

“The fact that we provided harm reduction services and shifted from a criminal perspective to a health perspective was transformative in achieving better health outcomes and partially solving the drug problem in Portugal,” Leite said.

A more recent example was the decision by the African Union to set up the African Medicines Agency, which will become a regulatory body for access to health technologies in the continent and creates a common standard of rules based on science to ensure the safety of citizens in the region. Leite equated the AMA to the European Medicines Agency.

UNITE founder Ricardo Baptista Leite and Dr Tedros at signing of an MOU between the two organizations.

Moving forward, UNITE Parliamentarians will play a key role in finalizing WHO’s pandemic treaty, aimed at guiding the global response to pandemics.  

“The regulations that were in place when COVID-19 hit were not sufficient or were not properly enforced,” Leite said.

He added that “there is a lack of acknowledgement and awareness among most citizens and many parliamentarians around the world that these negotiations are taking place. We need parliamentarians involved early on. If governments agree on a document, parliaments must ratify it.”

In an era of “polarized politics and fake news,” he said that if parliamentarians are not part of the process there is a risk that such a treaty would not be ratified, and the world would be left exactly where it was in December 2019.

“Everyone is committed to finding a balanced approach to what we hope will create a toolkit from a policy perspective that can help the world be better prepared to detect outbreaks early and lock them down before they transform into pandemics,” Leite said. 

“It is not acceptable that 100 years after the Spanish flu we saw so many countries react to COVID-19 the same way as they did 100 years before,” he continued. “We have an obligation to be better prepared to constrain any risk, to keep as many people as possible safe. This is a prerequisite for economic and social development.

“We need to keep peace and prosperity as our main goal,” Leite concluded. 

Image Credits: UNITE.

A special project celebrating the fifth anniversary of “Our Views, Our Voices” | Learn more

Amber Huett-Garcia at her high and low weight from 2008 to 2021.
Amber Huett-Garcia at her high and low weight from 2008 to 2021.

Amber Huett-Garcia is trying to drive global change for affordable treatment, care and support for individuals suffering from obesity.

A resident of the United States and born into a family suffering from generational obesity, she weighed 101 pounds by the time she was in kindergarten. As an adult, she lost 245 pounds and reduced her BMI from 69 to 24. She did it through a combination of treatments, including bariatric surgery, medication and mental health care.

While Huett-Garcia is lucky to have a comprehensive employer-based healthcare plan, she recognizes that many people in the United States do not. And for those who are obese, the cost of care can be enormous.

The cost of obesity

Obesity costs the US healthcare system nearly $173 billion a year, according to the latest report by the Centers for Disease Control and Prevention. Personal medical costs for people living with obesity are close to $1,500 more per year than those who do not suffer from the condition.

For people living with obesity and who are on Medicare, few treatments are covered. For example, Medicare has zero anti-obesity medication coverage. Moreover, roughly 40% of the US population lacks coverage for bariatric surgery for obesity, which has been proven most effective.

“Affordable healthcare is a human right,” Huett-Garcia said.

Amber Huett-Garcia taking part in the "Stop Weight Bias" campaign.
Amber Huett-Garcia taking part in the “Stop Weight Bias” campaign.

She has called for action to ensure that insurance plans pay for the treatment of a wider range of conditions, including obesity, by covering comprehensive science-based interventions. She has also asked that decision-makers within healthcare systems listen and amplify the voices of people with NCDs.

“The lives of people living with NCDs depend on it,” she concluded.

Read Amber Huett-Garcia’s full NCD Diary.
Read previous post. 

Image Credits: Courtesy of NCD Alliance.

A special project celebrating the fifth anniversary of “Our Views, Our Voices” | Learn more 

Nguyen Ha Linh
Nguyen Ha Linh

A young woman living in Vietnam has called on organizations and communities locally and globally to step up support for people living with noncommunicable diseases (NCDs) – especially multiple sclerosis (MS).

“I call on the Vietnamese government to give economic support packages to people living with NCDs, especially people with disabilities, because many are paralyzed, unable to support themselves and earn a living,” said Nguyen Ha Linh.

Ha Linh lives with MS. Since the age of 23 she has been rapidly deteriorating. While at first she worked as a graphic designer, gradually her arms and legs weakened until she became paralyzed. She developed atrophy of the nerve in her eyes. Today, all of her activities depend on the care of her relatives.

Nguyen Ha Linh
Nguyen Ha Linh

Access to care

But her greatest challenges have been access to care and finances.

“Multiple sclerosis is not covered by insurance in Vietnam, so I must pay for my care out of pocket, with financial support from my relatives,” Ha Linh explained. “Multiple sclerosis is considered a rare disease in Vietnam. People living with this condition find it very difficult to access diagnosis and care, and not all major hospitals have the resources for treatment. For those that manage to access care for multiple sclerosis, this is very expensive.”

Government must take action

She said that people living with MS often focus on getting funding from philanthropists who care about people living with disabilities. However, she believes that the government should be the one to take action first.

“Many challenges related to treatment, care and support for people living with NCDs remain largely unaddressed,” Ha Linh said. “In particular, the components of care and support are weak, which therefore means that relatives play an important role for those who have a good support system at home. This is not always the case.

“People living with NCDs would like to call on the government to change the regulations around health insurance to allow access to affordable diagnostics and care to help us have a better life,” she concluded.

Read Nguyen Ha Linh’s full NCD Diary.
Read next post.

Image Credits: Courtesy of the NCD Alliance.

women

Women and girls are more at risk of getting killed at home by intimate partners or family. A new report by UN Women and the UN Office on Drugs and Crimes (UNODC) said that more than five women or girls are killed every hour across the world by their partners or families. 

The report, released ahead of the UN’s International Day for the Elimination of Violence Against Women on Friday, said that while men are subjected to higher rates of homicides across the world, women and girls are disproportionately affected by higher rates of homicides in private spaces.

In 2021, 81,000 women and girls were killed intentionally, of which around 45,000 – some 55% – were killed by their own intimate partners or family members. By comparison, 11% of the total male homicides happened in private spaces. 

Covid-19 huge push to fatal violence against women

The report found mixed trends on femicide across the world. 

Between 2010 and 2021, the total number of female homicides by intimate partners or families fell by 19% in Europe. But that number rose by 6% in the Americas overall even as South America reported a decrease.

COVID-19 and the subsequent confinement to homes seems to have led to an increase in gender-related killings of women and girls in North America, Western and Southern Europe in 2020, according to the report.

“Other sub-regions in Europe and the Americas recorded negligible changes or decreases in the number of killings between 2019 and the end of 2020, which suggests that the onset of the COVID-19 pandemic had heterogeneous impacts,” it said. “The decreases in some sub-regions may reflect delays in recording due to COVID-19 rather than reductions in the number of killings.” 

The report did not mention similar trends in Asia, Africa or Oceania, due to a lack of data. 

A World Health Organization-led report last year found almost one in three women experience physical and/or sexual violence across the course of their lifetimes, and in the previous 12 months, more than one in ten women suffered from physical and/or sexual intimate partner violence.

More data key to policy formulation

UN
Women and girls in all regions are affected by gender-based killings. While Asia is
the region with the largest absolute number of killings, Africa is the region with the
highest level of violence relative to the size of its female population.

Highlighting the lack of sufficient and comprehensive data on global femicides, the new report from UN Women and UNODC said more data will enable policy makers to gain a better understanding of the issue and to push for changes. 

“Additional data beyond identification purposes, such as age of perpetrators and victims, including information surrounding the event of the killing should be collected for analytical purposes,” the report said, adding that will help policy makers detect failures in responses and protection, develop better preventive measures and improve access to justice.

Solutions include survivor-centric approaches

The report also called for more survivor-centred responses to address gender-based violence in the world, saying it’s an approach that’s “fundamental to preventing and eliminating gender-based violence against women and girls and ensuring it does not escalate to femicide/gender-related killings.”

Providing victims with a positive experience when they first report gender-based violence can increase trust and potentially save lives, and encourage other victims to report and disclose crimes.

Another measure called for in the report is stronger civil society organisations that work in the women’s rights sector, the report said, because they serve “an important role in preventing gender-based violence against women and girls, by advocating for and securing normative and policy change, providing psycho-social support services and holding governments to account.”

Image Credits: Artem Maltzev, UN Women.

Issa Abdul’s single solar panel powers his barber shop.

DAR ES SALAAM, Tanzania – Issa Abdul’s desperate urge for solar power began when he realised a smoke-spewing generator at his barber shop was costing him too much.

“Solar power is very cheap. I regret spending my money on this fuel-guzzling machine,” he told Health Policy Watch.

The 32-year-old barber in Tanzania’s port city spent roughly Tanzanian shillings 150,000 ($65) to purchase a small solar system and this now powers his hair cutting business.

“I am very happy to have my own solar system. It is very useful,” he said.

On a humid Sunday morning, Abdul adeptly digs a buzzing clipper through the hair of the client sitting on a leather chair before him.

“I was spending a lot of money every month buying fuel, that is history now,” he said.

Perched on a rusty roof, Abdul’s lone solar panel produces enough electricity to run two clippers, three bright lights and a cell phone charger.

“There’s plenty of sunshine, I don’t disappoint my customers,” he said.

Drought cripples hydropower facilities 

However, like other east African countries such as Kenya and Uganda, solar power still remains a small part of the country’s energy mix. 

While Tanzania’s electric grid has been primarily powered by hydroelectric power, another renewable source, for some time, hydro’s dominance is slipping now. 

Climate-related spells of drought have crippled the country’s hydropower facilities and the ageing distribution infrastructure, and the country is experiencing an electricity crisis affecting various sectors of the economy.

Hydropower, which can potentially generate 4.7 GW of electricity according to government estimates, is only producing 12% of its power potential, and is prone to weather variability.

And as drought tightens its grip, Tanzania, which has 57 trillion cubic feet of natural gas reserves, is now poised to tap this chunk of fossil fuels to cover the electricity deficit

Natural gas, oil and coal will almost certainly remain dominant in the country’s energy mix in the near future, according to experts.

A motorcyclist riding outside TPTL plant in Dar es Salaam that uses heavy furnace oil to produce electricity.

Addressing climate change impact with fossil fuels 

Tanzania’s experience is just one example of an emerging paradox of addressing climate change impacts with more climate-changing fossil fuel.

Tanzania, Kenya and Uganda have been dependent on hydropower, but as all three countries grapple with climate-related drought, they may also find it easier to tap their fossil fuel reserves with the help of multinational investors standing by than develop greener alternatives. This is even as technologies exist for large-scale grid-quality solar power that is ultimately cheaper, industry observers say.   

While nations worldwide are shifting to renewable energy to reduce the global carbon footprint and ease the toll that fossil fuels take on people’s health, economy and climate, the majority of Tanzanians, like those in large parts of Africa, still use dirty energy sources that pollute the air, causing some 1.1 million deaths annually on the continent, according to a recent study. 

Air pollution is the second risk factor for death in Africa after malnutrition, concluded the study by the Boston-based Health Effects Institute.   

Tanzania’s electricity generation comes mostly from natural gas (48%), followed by hydropower (31%), petrol/diesel (18%), solar (1%), and biofuels (1%). 

In Kenya and Uganda, hydropower and geothermal power are the dominant portions of the electricity generation mix, with solar power making up a very minor proportion of the mix.  

As demand for energy continues to grow, it is unclear how to ensure that renewables become more attractive than fossil fuel. Investments in fossil fuels far outweigh that of  renewables in most parts of Africa, and oil and gas exploration and exploitation continues apace in Kenya, Uganda and  Tanzania. 

Dirty diesel

At Kariakoo, a business hub in Dar es Salaam dotted with shopping centres, a toxic haze of diesel hangs in the air as generators roar so loudly that they drown out people’s conversations.

Like the lone solar panel precariously hanging on Abdul’s salon, smoke-spewing generators are widely used when grid electricity goes off. They power everything from ceiling fans to television sets, air conditioners and freezers – the latter two items pulling too much power to make a rooftop solar system reliable.

Among the available choices, portable diesel generators are among the dirtiest, spewing particulate-laden emissions into the air directly into spaces where people live and work. But they remain the go-to solution in much of Tanzania and Africa more broadly. 

“To me, a diesel generator provides the necessary power,” said Aloycia Mosha who runs a cold fish store.

Soaked with sweat, Mosha repeatedly pulls a string to rev the engine of her generator.

“If I don’t switch it on now, all my fish stock will get spoilt,” said Mosha.

The 45-year-old entrepreneur has often found a trail of blood oozing on her shop’s tiled floor, a clear sign that the fish defrosted overnight.

Vendor stand near a standby diesel generator in Dar es Salaam

Power cuts are part of daily life 

Power cuts are part of daily life in Dar es Salaam, a busy city that is home to 5.8 million people, and accounts for 40% of the country’s GDP.

While  a few city dwellers have installed solar power on their roof tops to save spiralling energy costs, analysts say the lack of clear financing mechanism to cover initial installation costs, coupled with an unreliable distribution network, have made solar systems a distant luxury to many families. 

Asteria Mchomvu, a resident of Upanga, a middle-class neighborhood in Dar es Salaam,  began to dream of installing solar panels on her roof a decade ago.

At first, Mchomvu, who works as a teacher, was excited to learn that solar technology could help her save money and protect the environment. But a home solar system was too expensive for her t the time. 

A modest 8-kilowat system would roughly cost Tanzanian shillings 10, million ($4347) in 2012, according to Tanzania’s Rural  Energy Agency.

Prices for solar systems in Tanzania have since fallen by more than 60% and companies are aggressively jostling to pitch their sales.

Yet still, the numbers didn’t work for Mchomvu, who teaches geography and science

Then early in November, at the Dar es Salaam International Trade Fair, Mchomvu caught up with Richard Tairo, a salesman from Arti energy, a solar company focusing on mid and low -income customers.

Tairo understood Mchomvu’s passion for solar and her financial dilemma and he introduced her to Mali Kauli, a program that finances residential solar systems and offers borrowers, below-market rates.

Mchomvu accepted the offer after the company assured her that the system could lower her energy bills and spare her the agony of power cuts.

“I wanted to be 100% sure it is worth investing,” she told the Health Policy Watch.

Skewed regulatory framework disadvantages solar  

Despite the growing public awareness, renewable energy penetration in Tanzania is still facing major hurdles due to a skewed regulatory framework and limited market.

Samuel Wangwe, a research associate with Research on Poverty Alleviation (REPOA) said solar power market has seen sluggish growth due to  fragmented financing plans, uneven service after equipment sale and technical weaknesses in batteries and solar lamps, which are often cheap items imported from China with warranties that cannot be honoured. 

“The most obvious barrier to renewable energy, notably solar is cost. The upfront expenses that people pay to get solar panels installed at their homes are still too high,” Wangwe said.

Many investors are discouraged to take on renewable energy projects because of high capital costs and a long net payback period, he added.

Wangwe says that the industry is also dogged by a lack of training institutes, which has prevented renewable energy technologies from scaling up.

“We must encourage our children to take renewable energy courses and hone their technical skills,” he said.

A shop for solar equipment at Kariakoo business centre in Dar es Salaam

Bigger subsidies for fossil fuels 

Although some subsidies are offered for rooftop solar, the subsidies the government provides to fossil fuel sources are much higher, Wangwe said. 

In fact, in July, the Tanzanian government introduced a new fuel subsidy of a whopping Tanzanian shillings 100 billion ($43 million) monthly to stabilise the domestic price of fuel, Wangwe said.

While solar panel and wind turbines are exempt from VAT and are not charged import duties, accessories including the batteries essential to operating a household solar package  are charged up to 35% import duty, said Wangwe.

“This is the reason why solar technology is not scaling up as fast as possible” he said.

Coal, oil and gas are by far the largest contributors to climate change, experts say.  In addition, some 65% of deaths from air pollution are generated by fossil fuel combustion, including the noisy and smokey generators that are omnipresent in households and big African cities like Dar es Salaam. 

While global leaders have endorsed the scientific consensus to limit global warming to 1.5°C above pre-industrial level, as spelled out in the Paris Agreement, there is a growing rush for oil and gas exploration in the global south.

This is what COP27 civil society participants called the “dash for gas” reminiscent of  the colonial scramble for Africa.

More fossil fuel exploration 

Tanzania has enough gas reserves to put the country on a path of economic prosperity, and may unlock as much as $30 billion in liquified natural gas (LNG) investments.

At the same time, if the historic pattern long followed in east and west Africa remains the same, many of the new LNG is likely to be sold to Europe and other countries to generate foreign currency, rather than used at home. 

“Our political leaders are caught up in a dilemma. Such investments are worthwhile economically but bad for the environment,” said Wangwe.

While many have argued that off-grid solar solutions hold the key to Tanzania’s urban and rural electrification, fossil fuels subsidies have reduced its competitiveness. 

Yusto Mugisha, professor of renewable energy at the school of engineering and technology a Sokoine University of Agriculture, said in order to build a sustainable future, Tanzania needs to invest in clean, accessible and affordable energy sources.

“Renewable energy sources are available and their potential is not fully harnessed,” said Mugisha.

Although upfront costs for renewable projects can be daunting, Mugisha said efficient and more reliable renewable technologies can create a system that is less prone to market shocks and improve energy security.

Unlike fossil fuels, which need to be extracted and transported to large power plants and require a grid network extending to remote areas, renewable sources like solar and wind can be developed in various flexible arrays. 

They can be just a few panels on a  household installation, part of a community mini-grid, or as a solar power plant feeding into the large grid. 

That, according to the International Energy Agency and countless other assessments means that solar could leap-frog over grid-dependent fossil fuel technologies much like portable phones leap-frogged over fixed phone lines in Africa, providing better service much faster.  

But renewable energy versus fossil fuels has seemingly placed Tanzania politicians in the moral dilemma. While fossil fuel provides badly needed energy, it leaves behind a carbon footprint that’s proving catastrophic to humans and the planet.

Yet, in the short term, policymakers strongly support fuel subsidies to stabilise the prices of other commodities. Meanwhile, renewable energy subsidies, notably on solar, are indirectly offered mostly through the Rural Energy Agency, and are clustered depending on the scale of the project.   

Despite its small market share local experts say renewable energy has the potential to respond to present and future challenges by enhancing energy security, generating income, and providing employment.

Rural dependence on kerosene 

William Kahise, a student at Itetemia primary school, persuaded hus mother to buy a solar lamp as the kerosene one made him cough.

In the dusty western town of Tabora, 12-year-old William Kahise and his sister Juliana routinely huddled around the faint glow of kerosene lamp when the darkness sets in, struggling to get their homework done before their mother blows off the lamp to save the fuel cost.

“I must finish my work, otherwise my teacher will be very angry,” Kahise told Health Policy Watch. 

The paraffin lamp, made from a discarded cooking oil tin, emitted choking smoke and casts scary shadows on the walls.  Kerosene is one of the household fuels that WHO has recommended not be used at all, because of its health harmful effects, including impaired lung function, asthma and cancer. 

The Itetemia primary school pupil may not know about the WHO recommendation, but he knew the smoke made him cough and convinced his mother to ditch the kerosene lantern, for a cheap solar version. 

Kerosene is used by millions of rural households i to meet basic lighting needs and subsidies have long been used to make the fuel more affordable.

Kerosene subsidies have been at the centre of energy policy debate, with renewable energy activists arguing that, for health, safety and environmental reasons, a switch to solar power is better.

“The subsidized kerosene is extremely costly and wasteful, the government is spending a lot of money every month to keep the price low,” said Mugisha.

But for Abdul, who enjoys solar power, the challenge arises when his Chinese-made panel starts to age and needs to be replaced as Africa produces virtually no panels of its own. 

–First of two parts on the barriers to clean, renewable energy in Africa.

-Research and reporting for this story was supported by the Rosa Luxembourg Foundation.

Image Credits: Peter Mgongo.

COP27
Global Young Greens protestors demanding the end of fossil fuels at COP27.

(SHARM EL-SHEIKH, Egypt via The New Humanitarian) – Climate justice played a central role at COP27, where the snail’s pace of progress on addressing the climate emergency once again stood in stark contrast to the realities on disaster front lines.

Negotiators and policymakers emerged from the annual summit in Egypt hailing a breakthrough on so-called “loss and damage” financing, agreeing to create a new fund to help countries facing the worst impacts of the crisis.

After 30 years of advocacy and pushback on the issue, arguments leaning on climate justice had a clear influence on the political agenda, with vulnerable countries and climate campaigners alike pushing similar messages.

Yeb Saño, a prominent former diplomat from the Philippines and the Southeast Asia director for Greenpeace, called it a “new dawn for climate justice”. UN Secretary-General António Guterres said it was a badly needed step “to rebuild broken trust”. Humanitarian groups branded it a “monumental win”, though the crucial details of how the fund work still need to be thrashed out in the coming months.

Yet in spite of the diplomatic negotiations and last-minute theatrics, results came up short in other key areas. “It has been a good pitch to say that it’s a COP for Africa. But the negotiations haven’t had Africa at the centre, and the needs of several millions of Africans facing starvation.”

Funds to help countries adapt to and mitigate climate change are still far short of the annual $100 billion previously pledged. Stronger wording on the phasing down of fossil fuels wasn’t included in the final negotiated text. And there were no major new promises to ratchet up emissions cuts – despite signs that country-level plans to limit temperature-rise to 1.5 degrees Celsius are significantly off target.

COP27 had been presented by its Egyptian presidency as “the implementation COP”, and as Africa’s summit, though many participants here felt that the talks disappointed on both fronts.

“It has been a good pitch to say that it’s a COP for Africa. But the negotiations haven’t had Africa at the centre, and the needs of several millions of Africans facing starvation,” Isaiah Kipyegon Toroitich, head of global advocacy at the Lutheran World Federation, told The New Humanitarian.

Frustrated by years of roadblocks by powerful countries at these summits, some civil society groups and humanitarians have concentrated their advocacy outside the negotiation rooms in an attempt to drive the needle forward. At this COP, issues like debt, gender justice, and migration emerged as hot-button concerns on the summit sidelines, if only blips on the official radar.

Here are some of the key issues that emerged – or were overlooked – during COP27, and what the next steps may include.

Loss and damage

Described as a “down payment on climate justice” by Pakistan’s climate minister, the agreement to set up a loss and damage fund must be just the start, humanitarian groups and civil society advocates say.

Farah Naureen, Pakistan director for aid group Mercy Corps, said more public funding and more innovative financing sources were needed, adding “the real work will only begin after COP27”.

While advocates view acknowledgement for loss and damage as a core part of climate justice, discussions on the new fund were only able to proceed after negotiators agreed to remove references linking funding to any form of “reparations” or “liability”, which wealthy countries worried may usher in unlimited claims.

Questions over who will pay into the fund and how the money will be distributed are still to be negotiated. European countries argued in Sharm el-Sheikh that China and oil and gas producers such as Saudi Arabia and Qatar – all considered by UN definitions as developing countries – should pay. They also want Russia to be included.

COP27
Protesters at COP27 demanding debt relief for poorer climate-vulnerable countries. (via The New Humanitarian)

A sense of who would be eligible to receive money was at least partially provided during the last sleepless night of negotiations: Negotiators agreed to a final wording that cited “developing countries that are particularly vulnerable to the adverse effects of climate change”.

“The loss and damage outcome was one that was vital for solidarity with [climate-vulnerable] countries, because it’s about the entire ecosystem that needs to happen,” Jennifer Morgan, Germany’s special climate envoy and former executive director of Greenpeace, told The New Humanitarian.

Germany and other G7 nations, along with their counterparts in the Vulnerable 20 (V20) negotiating bloc, used COP27 to announce an insurance and disaster risk finance mechanism called the Global Shield. Some critics saw it as a distraction, especially if it becomes a substitute for new funding.

But Sara Jane Ahmed, finance advisor to the V20 group, said the shield would complement a loss and damage fund. Generally, the V20 countries pushed for new loss and damage financing on top of other solutions. “We have a timing mismatch,” she said. “We need resources today; we cannot wait two to three years to get new resources to come through. We need to keep going at the same time that they find resolution working on [loss and damage].”

Adaptation finance

With much of the public focus on loss and damage, there was little progress on increasing funding for a less-controversial branch of climate finance: adaptation.

Long-standing promises of $100 billion a year have consistently been unmet. At 2021’s COP26 summit in Glasgow, countries agreed to double the funding available for adaptation – the money used to help countries prepare for and reduce the risks of climate change.

Negotiators in Sharm el-Sheikh wrangled over issues such as what baseline to use, before finally recommitting to the previous COP’s promises. They also agreed to set up a framework to track progress on adaptation.

While heads of state from traditional donor governments touted new contributions at COP27, vulnerable countries made clear it was far short of what’s needed. They have long said that adaptation funding – which could be used, for example, to make homes more storm-resistant, to restore coastlines, and to build flood defences – should be more balanced with financing available for mitigation or reducing emissions, which traditionally sees the bulk of the climate funding.

For aid agencies and NGOs, which maintained a strong presence at COP27, insufficient adaptation means climate impacts have become even more challenging to respond to.

Andrew Harper, chief climate advisor at the UN’s refugee agency, UNHCR, said high-profile crises such as the conflict in Ukraine have left less money for “forgotten” emergencies worsened by climate change.

With only 4% of climate finance directed to Africa, mostly in the form of loans instead of grants, and most of it going to mitigation, Harper said: “it is clear that the developing countries who have been doing the most to protect and support refugees, sometimes for decades, demonstrating a level of global solidarity that many in the [Global] North could learn from, are not benefitting at all from even the miniscule funding that is available.”

Reforming the global financial system

Some of the most far-reaching reform proposals weren’t found on the COP27 agenda, but became talking points throughout the summit.

Trapped in a cycle of climate-linked disasters and crushing rebuilding debt, countries like Barbados have led the push to reform the global financial system. Prime Minister Mia Mottley, has called for a range of reforms including loan conditions that would suspend payments after they are hit by disasters or pandemics. Her Bridgetown Agenda suggests that substantial funds could be unlocked through debt relief, more accessible loans, and other reform measures – allowing countries to spend on recovery and reconstruction instead of paying down debt.

Mottley and others used the COP27 stage to call for an overhaul of the global financial system that has trapped climate-vulnerable countries in a cycle of debt. She argues that the Bretton Woods institutions set up following World War II, including the International Monetary Fund and the World Bank, are not serving countries that regularly face increasingly intense and unpredictable disasters.

While loss and damage remains divisive despite progress in Egypt, there’s much greater appetite for financial reforms. Humanitarian groups and the UN’s Guterres are also pushing for debt relief. The US has echoed calls to reform multilateral lending. Even David Malpass, the head of the World Bank, has cited the need to “make progress in the debt agenda”.

Migration

Human mobility was not on the official COP agenda, but displacement – particularly from conflicts worsened by climate change – was a key concern in sideline discussions, especially those attended by the humanitarian aid sector.

Floods and storms, which are aggravated by climate change, pushed at least 21.6 million people from their homes last year, and climate change can also intensify other causes of displacement.

Some believe mobility should be viewed as a way that people adapt to climate change, and say financial support for programmes that assist displaced people should be a part of much-needed adaptation finances in the future.

The final COP27 text cited “displacement”, “relocation”, and “migration” as some of the many “gaps” that need to be tackled in the coming months as the new loss and damage financing is discussed – potentially carving out more space for mobility in coming climate negotiations.

And refugees and displaced people themselves need seats at the COP28 table in Dubai, UNHCR said.

Gender justice

Gender justice has for years been sidelined as a “fringe” issue at climate talks. But women activists have pushed for greater representation at the negotiating table, unique financing, and attention to the climate costs faced by women and girls.

Little of substance on gender issues was mentioned in the final COP27 text, leaving observers disappointed.

“Gender was only marginally mentioned, if at all, in the climate talks’ decisions,” Oxfam said.

Reem Alsalem, the UN special rapporteur on violence, has said that climate change represented the “most consequential threat multiplier for women and girls” and increased the risk and prevalence of violence against them.

Beverly Musili, a gender justice activist and lawyer with the Kenya Institute for Public Policy Research and Analysis, or KIPPRA, said gender still remained very much on the backburner during COP27.  “Gender was only marginally mentioned, if at all, in the climate talks’ decisions.” 

She noted that in pastoralist societies in Kenya – where gender inequalities are present – drought is exacerbating impacts on women and girls. “Due to climate change, poverty has been growing and child marriage will most likely regress,” she said.

Her organisation has been trying to educate families about the importance of girls attending school, but “with climate change come more fundamental questions of, ‘Are we going to send our children to school or are we going to look for food?’”

Indigenous women and rural women play key roles in ensuring food security for their communities, as well as in climate change adaptation efforts. In many communities, however, women are marginalised, putting them at greater risk, particularly in the face of climate change.

In spite of the distance and logistical difficulties of travelling to Egypt, Indigenous women from the Amazon were prominent at COP27. They have been leading the drive to recognise the role their communities play in protecting forests; the final text from COP recognised nature-based solutions, a mechanism that can be used to cut carbon emissions, an implicit acknowledgement of the importance of preserving natural ecosystems.

There’s still a clear gender imbalance when it comes to the COP negotiating table, as underlined by the “family shot” of heads of state taken at the summit’s opening: Only 7 of the 110 pictured were women.

In an effort to change the balance, one group, She Changes Climate, encouraged the United Arab Emirates, which will host next year’s climate talks, to appoint a woman as COP28 president: the current minister of climate change and the environment, Mariam Almheiri.

Global climate action beyond COP27

Facing slow progress at the annual UN-led climate summits, countries are finding other ways to accelerate climate action.

The campaign for debt relief and systemic financial reform is one example. The push to bring climate change and human rights to the International Court of Justice is another.

Backed by a catchy music video, the Pacific island nation of Vanuatu used COP27 to announce that its allies have almost finalised a resolution that could put the issue before the UN General Assembly and – if passed there – the UN’s top court.

Years of inaction at COP summits contributed to initial plans for legal action.

“What we have seen this week is that negotiations are not working for the most vulnerable,” said Ralph Regenvanu, Vanuatu’s minister for climate change.

Image Credits: Twitter/Global Young Greens, Paula Dupraz-Dobias/TNH.

Civil society in Geneva call for an IP waiver for COVID vaccines with UNAIDS Executive Director Winnie Byanyima earlier in the year.

Little agreement emerged from an informal World Trade Organization (WTO) meeting on Tuesday about whether an intellectual property (IP) waiver should be extended to COVID-19 therapeutics and diagnostics.

But low and middle-income countries (LMIC) that qualify for free COVID-19 anti-virals Paxlovid (nirmatrelvir) and Molnupiravir have shown so little interest in accepting donations that some question whether debating the waiver extension is a waste of time.

Singapore, Switzerland, Japan, Korea, the European Union and the United Kingdom wanted to see proof of IP barriers hampering access to therapeutics and diagnostics before they supported any waiver extension, according to a Geneva-based trade official at the WTO meeting.

Meanwhile, Switzerland and Mexico argued that the ship has already sailed as there is little demand for therapeutics.

The WTO’s TRIPS Council has until 17 December to decide on whether to extend June’s Ministerial Decision on a patent waiver on COVID-19 vaccines. 

But at Tuesday’s meeting, there was no new movement towards consensus, according to the trade official.

Parties still pushing for the waiver include South Africa, India, Sri Lanka, Nepal, Nigeria and Indonesia – all part of the core group that first introduced the notion of a TRIPS waiver for all COVID-related products.

Meanwhile, China and Mexico are part of a group that supports a limited waiver on specified products.

Lack of access – or lack of interest?

Shortly before the WTO meeting, Oxfam and the People’s Vaccine Alliance (PVA) decried the fact that rich countries have secured almost three times as many courses of a World Health Organisation (WHO)-recommended COVID-19 medicine, Pfizer’s Paxlovid.

“Just a quarter of orders for the treatment will go to low- and middle-income countries (LMICs), despite the fact they make up 84% of the world’s population and have a much greater need as far fewer people are vaccinated against COVID, unlike rich nations which are largely protected,” said the two bodies in a media statement this week, warning of “the same worrying trend of inequity that we saw with COVID vaccines”. 

However, the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) disputed this, saying that “of the 105 lower-income countries eligible for COVID-19 treatments coordinated by the ACT Accelerator, very few countries have expressed an interest and barely a handful have so far placed very low volume orders.”

“The lack of demand means that, of the 38 generic companies lined up to produce Paxlovid and the 27 companies with licenses for Molnupiravir, there is currently barely a market for even a handful of companies to operate,” the IFPMA told Health Policy Watch.

The Oxfam-PVA figures were drawn from Airfinity, an independent provider of global health analytics and data.

Airfinity’s CEO, Rasmus Hansen, told Health Policy Watch that it was correct that only around 25% of purchased doses of Paxlovid were going to LMIC.

“But it’s a bit of a mistake only to look at that number without looking at some other demand indicators,” Hansen added.

One important indicator was the demand for Paxlovid doses from countries that qualified for the medication for free through the ACT Accelerator, he added.

“Only around 7% of the Paxlovid doses that are available for donation have been accepted by low-income countries. When I saw that number, I was really surprised you because that’s not a pricing issue,” said Hansen.

Meanwhile, the total demand from LMICs for both WHO-approved antivirals – Molnupiravir and Paxlovid – available free via the ACT-Accelerator had only reached 13%, and there had been zero demand for either medication in the fourth quarter of the year, said Hansen.

‘This available number of doses is not even the full 25% of doses available for donation. I think this is about 10% of the donations promised,” he added.

More complicated than availability

“The story is more complicated than doses not being available. There seems to be an issue with a country’s ability or willingness to use the medicine.”

Hansen speculated that factors influencing this could include countries’ inability to conduct systematic COVID-19 testing as antivirals have to be given early to prevent serious illness, as well as them having other health priorities.

He also said that a country might not accept a donated drug not because they didn’t need it but because they lacked the capacity to roll it out.

Hansen also said that the lack of data about hospitalizations, particularly in Africa, meant that deciding on what was needed “is a little bit like shooting in the dark because we don’t actually have factual data on how many are severely ill by COVID”. 

Image Credits: @FilesGeneva , Airfinity.

Bacteria
Bacterial infections are the secong leading cause of deaths in 2019.

Some 7.7 million people are estimated to have been killed by bacterial pathogens in 2019 according to a study published in The Lancet this week, making this the second leading cause of death globally in2019. 

Some 33 bacterial pathogens across 11 infectious syndromes were linked to 13.6% of all global deaths in 2019, according to the study, which was led by the Institute of Health Metrics and Evaluation (IHME) at the University of Washington

Almost 55% of these bacterial deaths came from just five pathogens – Staphylococcus aureus, Escherichia coli, Streptococcus pneumoniae, Klebsiella pneumoniae, and Pseudomonas aeruginosa. 

The worst impact of these bacteria is in sub-Saharan Africa, where the mortality rate is 230 deaths per 100,000 population in comparison to 52 deaths per 100,000 in high-income countries. 

“Effective antimicrobials exist for all 33 of the investigated bacteria, yet much of the disproportionately high burden in LMICs might be attributable to inadequate access to effective antimicrobials, weak health systems, and insufficient prevention programmes,” the study added. 

In January, the IHME reported on deaths associated with 23 pathogens and pegged the number of deaths due to antimicrobial-resistant pathogens at 4.95 million. However, the current study analyses deaths caused by bacteria that are both susceptible and resistant to antimicrobials. 

More R&D funding 

Bacterial pathogens such as E coli and K pneumoniae are collectively associated with more deaths than S pneumoniae or tuberculosis, but they receive much less funding and attention than other diseases. 

“A 2020 analysis of global funding for infectious disease research found that HIV research was awarded $42 billion in funding compared with $1.4 billion for research on Staphylococcus spp and $800 million for E coli research over the same period (between 2000 and 2017),” the paper stated. 

IHME director Chris Murray urged those who invest in research and development to take a “pathogen view” when making decisions, adding that governmental research authorities and private players like pharmaceutical companies need to keep this in mind when developing new antibiotics and vaccines. 

“It also helps get a sense in different parts of the world. We put a lot of emphases, appropriately so, on HIV, TB, and malaria but we probably need to pay as much attention to something that’s quite neglected, like Staph aureus, that’s affecting poor countries as well as rich countries.”

Need for coordinated action

Targeted efforts must be made to improve access to healthcare and antibiotics in order to reduce mortality due to bacterial pathogens, according to the report. 

However, it warned that while addressing access issues, it is crucial to also assess the risk of misuse of antibiotics. 

“Improving access to antibiotics requires a nuanced and location-specific response because ease of access must be weighed against the risk of antibiotic overuse (a problem compounded by the issue of self-medication in LMICs), which contributes to the increase in antimicrobial resistance.”

The study also advocates for higher uptake of vaccines that target the most common pathogens and vaccine development for bacteria for which no vaccine exists.

In July, the WHO released a report on the antibacterial vaccines in the pipeline, calling for higher investment into vaccine candidates that can tackle drug-resistant bacteria. 

Vaccines exist to tackle four of the priority pathogens identified by WHO, but there are no vaccine candidates in the pipeline against six of the priority pathogens in WHO’s list including those that cause common infections like urinary tract infections and gastro-intestinal illnesses.  

Image Credits: Photo by CDC on Unsplash, Photo by Myriam Zilles on Unsplash.