Is the raccoon dog the elusive “animal X” that passed SARS-CoV2 from bats to humans?

Raccoon dogs, lab leaks and Chinese secrecy have made for high drama as scientists who think they may have found the elusive “Animal X” that passed SARS-CoV2 were excluded from a data-sharing platform for “scooping” Chinese scientists.

Nineteen scientists, including world-renowned figures such as Dr Michael Worobey and Dr Angela Rasmussen – have published a report detailing how they had been scolded and falsely accused of rules violations by the data-sharing platform, GISAID, after reporting that they had found genetic material of wild animals intermingled with environmental samples collected by the Chinese Center for Disease Control in January and February of 2020 from the Huanan Seafood Wholesale Market in Wuhan – ground zero of the COVID-19 outbreak.

This co-mingling of SARS-CoV-2 virus and animal RNA/ DNA from five animal species “identifies these species, particularly the common raccoon dog, as the most likely conduits for the emergence of SARS-CoV-2 in late 2019”, the authors concluded in their study, published on the pre-print research server base Zenodo on Monday. 

This is the first time that scientists have proposed that the elusive “animal X” responsible for virus spillover from animals to humans might have been found.

Later on Tuesday, it appeared that GISAID had removed all the authors’ access to its platform. The platform is a public-private partnership that is hosted by the German government that allows scientists to share data about infectious diseases.

Report co-author and French evolutionary biologist Florence Débarre accidentally found the Chinese Center for Disease Control and Prevention (CCDC) environmental samples on the GISAID infectious diseases database on 4 March 2023.

The samples had apparently been posted to support a CCDC preprint article published on 25 February by a group of Chinese scientists affiliated with CCDC and other governmental resaerch institutions.

In the preprint article, the Chinese authors asserted that of the 1,380 samples collected from the environment and the animals in the market in early 2020, “No virus was detected in the animal swabs covering 18 species of animals in the market” – exactly the opposite of what Worobey and his colleagues said they have found.

Of the environmental samples taken from the marketplace in the early days of the pandemic, only 73 tested positive for SARS-CoV-2 and three live viruses were successfully isolated – which 99.9% related to the genetic forms of virus strains circulating among humans in those early days, according to the Chinese authors.  

Genetic footprints of ‘multiple animal species’ co-mingling in SARS-CoV2 environmental samples 

In contrast, the Worobey-led research group, in their analysis of the same GSAID data, said they found genetic evidence of “multiple animal species” co-mingling among the SARS-CoV-2 positive environmental samples collected at the marketplace.

In particular, they identified mitochondrial genomes for the common raccoon dog; Malayan porcupine; Amur hedgehog; masked palm civet; and hoary bamboo rat “from wildlife stalls positive for SARS-CoV-2”. 

This is important, they assert, because although live mammals had been observed in the market in late 2019, an area where many COVID-19 patients with the earliest-known onset of symptoms worked, the animals’ presence and “exact locations were not conclusively known” at the time when SARS-CoV2 first surfaced in the marketplace.

The most recent data posted on GSAID, therefore, raises the likelihood that wild animals kept caged in the market could have been a conduit for passing the coronavirus, which originates amongst bats, to humans, the authors state. 

In another explosive finding, some of the animals they identified – such as the fox-like raccoon dogs – are known to be susceptible to  SARS-CoV-2 but “were not included in the list of live or dead animals tested at the Huanan market, as reported in the 2021 WHO-China joint report on the origin of the COVID-19 pandemic”, the authors state. 

The fox-like raccoon dog is susceptible to SARS-CoV-2.

Even more crucially, in some cases, there was more animal genetic material than human material “consistent with the presence of SARS-CoV-2 in these samples being due to animal infections”, say the authors.

In 2021, an international team assembled by the World Health Organization (WHO) to investigate the origins of SARS-CoV-2 identified animal transmission – through an elusive ‘Animal X’ – as the most likely route of infection in their report. But the theory stalled due to a lack of actual evidence in the WHO report about the exposure of wild animals in the marketplace at the time to the virus. 

Chinese secrecy – data withdrawn

The controversy around the data, and its implications, has been heightened by the fact that it has now been withdrawn from the GSAID site.

This happened shortly after the scientists said that they had contacted one of the Chinese preprint authors, on 9 March, and were told they could conduct an independent analysis of the CCDC data.

But on 11 March,  a day after the Worobey group told the Chinese colleague that they had found animal genetic material in the samples, the data was pulled from the site “at the request of the submitter”. 

Not only that, but the GISAID Secretariat sent emails to the scientists “admonishing us to comply with the GISAID terms of use, or in some cases falsely accusing us of having breached the GISAID terms of use”, wrote the Worobey group. 

“We are well aware of these terms of use, have not breached them, and have no intention of breaching them,” they wrote.

While the GISAID website makes no mention of a secretariat, its business affairs are run by the executive board of the Friends of GISAID, the members of which are not named, and advised by an 11-person scientific advisory council that includes US, Chinese, European, Japanese and Singaporean representatives.

However, GISAID released a statement on Tuesday accusing the Worobey group of “scooping” the Chinese group by using its data and publishing it before the Chinese scientists had done so.

“Unfortunately, GISAID learned that select users published an analysis report in direct contravention of the terms they agreed to as a condition to accessing the data, and despite having knowledge that the data generators are undergoing peer review assessment of their own publication,” according to the statement.

GISAID said it had asked the Chinese researchers whether “best efforts to collaborate have been made in this case”, and were told the Worobey group had communicated “only their intent to publish their analysis of the generators’ data. As such, the best efforts requirement has not been met”.

“GISAID’s goal is to incentivize timely and transparent data sharing by providing a trusted place for data contributors to see their rights respected.  It should be apparent to everyone that the data generators [Chinese researchers] are the ones most familiar with the details surrounding their submitted data and the context in which it was collected,” added the platform, stressing that the Chinese research should have been published first.

WHO involvement

However, it is unclear whether the international scientific community will agree, as China has long been accused of withholding data and access to Wuhan sites.

The WHO confirmed late last week that it had been informed both about the findings and the CCDC’s actions on 12 March, and it reached out to its Scientific Advisory Group for the Origins on Novel Pathogens (SAGO) and the CCDC.

After calls between SAGO and the CCDC, the CCDC confirmed that “DNA from wild raccoon dogs, Malaysian porcupine, and bamboo rats among others” had been found “in SARS-CoV-2 positive environmental samples”, according to a SAGO statement released last Friday.

“These results provide potential leads to identifying intermediate hosts of SARS-CoV-2 and potential sources of human infections in the market,” according to SAGO.

This is despite the CCDC’s assertions to the contrary, which mention 18 animals, none of which are raccoon dogs.

But, said SAGO, “the presence of high levels of raccoon dog mitochondrial DNA in the metagenomics data from environmental samples identified in the new analysis, suggest that raccoon dog and other animals may have been present before the market was cleaned as part of the public health intervention”.

Late on Friday afternoon, WHO Director-General Dr Tedros Adhanom Ghebreysus did not mince his words at a media briefing when he appealed to China for transparency, adding that these samples could have been shared three years ago.

China has consistently refused to accept that COVID-19 might have originated on its shores, and has asserted that the virus could have been spread from imported frozen fish sold at the market – the frozen food chain hypothesis.

However, the independent origins group report stated that “there is no conclusive evidence for foodborne transmission of SARS-CoV-2 and the probability of cold-chain contamination with the virus from a reservoir is very low”. 

Lab leak revival

Dr Robert Redfield, ex-CDC head, testifies at the hearing in favour of the lab leak theory.

In early March, the Republican-dominated US House Subcommittee on the Coronavirus Pandemic convened its first hearing to examine COVID-19’s origins, focusing almost entirely on the theory that COVID-19 originated from a laboratory “leak” at the Wuhan facility studying coronaviruses. 

Dr Robert Redfield, former head of the US CDC, told the hearing that he found it implausible that a virus could jump from animals in the Wuhan wet market to humans.

The lab leak theory was initially pushed by then-US president Donald Trump and his allies in 2020.

The impetus for the lab leak theory has grown this year, particularly as the US ramps up its anti-China rhetoric – and China’s secrecy and refusal to share data has fueled it.

“The FBI has for quite some time now assessed that the origins of the pandemic are most likely a potential lab incident in Wuhan,” Christopher Wray, the head of the US Federal Bureau of Investigation (FBI) told Fox News in late February.

The Trump-appointed Wray added that “we’re talking about a potential leak from a Chinese- government-controlled lab that killed millions of Americans”.

However, the origins report described this hypothesis as “extremely unlikely”, saying that “the deliberate bioengineering of SARS-CoV-2 for release has been ruled out by other scientists following analyses of the genome”. In addition, the SARS-CoV-2 from bats and pangolin that were being studied at the Wuhan lab “are evolutionarily distant from SARS-CoV-2 in humans”. 

Meanwhile, recent polls show that roughly two-thirds of Americans believe that Covid probably started in a lab, according to the New York Times.

Image Credits: Bernd Schwabe/ Wikipedia, Ryzhkov-Sergey/ Wikipedia, CSPAN.

As the impact of drought worsens, there is a growing risk of famine in Somalia. Some 4.5 million Somalis are directly affected by the drought, and about 700,000 people have been displaced.

The worsening drought in Somalia is likely to have caused 43,000 excess deaths in 2022, of which around 21,500 are children under the age of five, according to a new report released on Monday.

“We are racing against time to prevent deaths and save lives that are avoidable. We have seen, deaths and diseases thrive when hunger and food crises prolong. We will see more people dying from disease than from hunger and malnutrition combined if we do not act now,” Dr Mamunur Rahman Malik, the World Health Organization (WHO) representative for Eastern Mediterranean region (EMRO) said. 

“The cost of our inaction will mean that children, women and other vulnerable people will pay with their lives while we hopelessly, helplessly, witness the tragedy unfold”.

The Horn of Africa, particularly southeast Ethiopia, northern Kenya and Somalia, has been experiencing one its worst hunger crisis in 70 years. Along with the

failure of six consecutive monsoon seasons, Somalia is also struggling with the effects of climate change-induced weather events, political instability, ethnic tensions, food insecurity and rising prices. The COVID-19 pandemic only exacerbated an already grim situation.  

The study was commissioned by UNICEF and the WHO and was carried out by the London School of Hygiene and Tropical Medicine and the Imperial College, London. The study involved a statistical mode, which retrospectively estimated that the crude death rate across Somalia increased from 0.33 to 0.38 deaths per 10,000 person-days between January 2022 and December 2022. 

The death rate in children younger than five years was almost double these levels. The researchers used data from 238 mortality surveys carried out by the Food Security and Nutrition Analysis Unit for Somalia to arrive at these estimates. 

“Our findings suggest that tens of thousands of Somalis lost their life in 2022 due to drought conditions, with this toll set to increase in 2023. This is in spite of Somalis’ own resilience, support by Somali civil society within and outside the country and a large-scale international response,” said Dr Francesco Checchi, co-author and professor of epidemiology and international health at the London School of Hygiene and Tropical Medicine. “Far from being scaled back, humanitarian support to Somalia must if anything be increased as the year progresses, and sustained until Somalia exits this latest crisis.”

For the year 2023, the crude death rate is forecasted to increase to 0.42 deaths per 10,000 person-days by June 2023. 

The highest death rates were estimated in south-central Somalia, around the areas of Bay, Bakool and Banadir regions, the center of the current drought. 

“We continue to be concerned about the level and scale of the public health impact of this deepening and protracted food crisis in Somalia,” said Somalia’s Health Minister, Dr Ali Hadji Adam Abubakar.

“At the same time, we are optimistic that if we can sustain our ongoing and scaled-up health and nutrition actions and humanitarian response to save lives and protect the health of our vulnerable, we can push back the risk of famine forever, else those vulnerable and marginalized will pay the price of this crisis with their lives.”

Image Credits: UN-Water/Twitter .

Some of the co-authors confer with IPCC Vice-Chair Ko Barrett (centre) before the adoption of the report over the weekend.

The world will heat up by at least 1.5ºC by the 2030s – and our best hope is that global warming does not “go blasting” way beyond this point, according to scientists from the United Nations Intergovernmental Panel on Climate Change (IPCC).

The IPCC released its sixth synthesis report on climate change in Interlaken in Switzerland on Monday after a two-day extension of its four-day meeting – largely because of disagreements from various UN member states about how to frame the temperature increases.

“Emissions should be decreasing by now and will need to be cut by almost half by 2030 if warming is to be limited to 1.5°C,” the report warns, referring to the temperature target adopted by most countries in the Paris Agreement in 2015.

But global greenhouse emissions have increased by 54% between 1990 and 2019, and the world is already 1.1ºC warmer now than it was in the pre-industrial era (1850-1900). 

In the past year, the world emitted more carbon dioxide than in any other year on records dating to 1900. One of the reasons was the Russia-Ukraine war, which caused a resurgence in coal use by Western nations to replace Russian gas.

The world’s two biggest polluters, the US and China, show few signs of slowing emissions. The US recently approved a massive new oil drilling project in Alaska called Willow that will produce 260 million tons of carbon dioxide,  equal to the annual output of 66 American coal plants. Meanwhile, China has approved over one hundred new coal plants.

“Keeping warming to 1.5°C above pre-industrial levels requires deep, rapid and sustained greenhouse gas emissions reductions in all sectors,” warned IPCC chair Hoesung Lee.

Political will and public support will determine whether the world reduces global warming, Lee added, but warned that “we are walking when we should be sprinting”.

IPCC chairperson Hoesung Lee

Co-author Dr Peter Thorne said that “almost irrespective of our emissions choices in the near term, we will probably reach I.5ºC in the first half of the next decade”. 

“The real question is whether our will to reduce emissions quickly means we reach 1.5ºC, maybe go a little bit over, but then come back down or whether we go blasting through 1.5ºC, go through even 2ºC and keep on going, so the future really is in our hands,” warned Thorne.

“We will, in all probability, reach around 1.5ºC early next decade, but after that, it really is our choice. This is why this the rest of this decade is key. The rest of this decade is whether we can apply the brakes and stop the warming at that level.”

Wrong direction

Petteri Taalas, Secretary-General of the World Meteorological Organisation, warned that all indicators were “going in the wrong direction” – temperature, ocean warming, melting ice and rising sea level.

Taalas urged countries to invest in early warning services, describing them as “one of the best ways to mitigate climate risk.

Meanwhile, UN Secretary-General Antonio Guterres appealed to countries to stop expanding their coal, oil and gas projects, saying that limiting global warming to 1.5ºC would require a “quantum leap in climate action”. 

Three to six times the current spending on climate adaptation and mitigation is needed to achieve targets, said Indian economist Dr Dipak Dasgupta, one of the report’s co-authors.

“Governments can do more with the public finances,” said Dasgupta. “And the financial system itself – the banks, the central banks or regulators themselves – have to start recognising the urgency and pricing in the risks.”

Another co-author, Dr Aditi Mukherji, also warned that once the world reached a certain temperature, it would be less possible for countries and communities to adapt.

IPCC report co-author, Dr Aditi Mukherji (left).

“Almost half of the world’s population lives in regions that are highly vulnerable to climate change. In the last decade, deaths from floods, droughts and storms were 15 times higher in highly vulnerable regions,“ she stressed.

Inger Andersen, Executive Director of the UN Environment Agency, said that the report tells us “we are very, very close to 1.5 degree limit and that even this limit is not safe for people and for planet”. 

“Climate change is throwing its hardest punches at the most vulnerable communities who  bear the least responsibility, as we just saw with Cyclone Freddy in Malawi, Mozambique and Madagascar, and as we saw with flash floods in Turkey just recently,” said Andersen.

 “We must turn down the heat. We must help vulnerable communities to adapt to those impacts of climate change that are already here.”

Climate-resilient development

The report proposes “climate-resilient development” as the solution, including clean energy,  low-carbon electrification, and walking and cycling as preferred methods of public transport to enhance air quality and improve health.

Lee added that there is “a great deal of room for improvement in the energy efficiencies”, and energy consumption can be reduced by 40 to 70% in some sectors over the next two decades”. 

But “climate-resilient development becomes progressively more challenging with every increment of warming”, warns the report.

“The greatest gains in wellbeing could come from prioritizing climate risk reduction for low-income and marginalised communities, including people living in informal settlements,” said Christopher Trisos, one of the report’s authors. “Accelerated climate action will only come about if there is a many-fold increase in finance. Insufficient and misaligned finance is holding back progress.”

UNEP Executive Director Inger Andersen

Meanwhile, UNEP’s Andersen said that the global community already has the solutions: “Renewable energy instead of fossil fuels, energy efficiency, green transport, green urban infrastructure, halting deforestation, ecosystem restoration, sustainable food systems,  including reduced food loss and waste.”  i

“Investing in these areas will help to stabilise our climate, reduce nature and biodiversity loss and pollution and waste,” she stressed.

Image Credits: Anastasia Rodopoulou IISD/ ENB .

Caged animals held for sale and slaughter in unsanitary conditions at Wuhan’s Huanan Seafood Market, prior to the outbreak of COVID-19, from top left: (a) King rat snake  (b) Chinese bamboo rat (c) Amur hedgehog (d) Raccoon dog (e) Marmot and (f) Hog badger.

New evidence indicating that raccoon dogs from the Huanan Seafood Market in Wuhan may have been infected with SARS CoV2 in January 2020 was published on a shared database by China’s Centers for Disease Control and Prevention in January  – but removed recently after scientists started asking questions.

This was revealed at a media briefing on Friday by World Health Organization’s (WHO) Director-General Dr Tedros Adhanom Ghebreyusus.

“This data could have, and should have, been shared three years ago,” Tedros chastised, as he appealed to China to “be transparent” in sharing data about the origins of the COVID-19 pandemic.

WHO had only become aware of the data last Sunday from China CDC relating to samples taken at the Huanan market in Wuhan in 2020, said Tedros – although this had been published on a shared GSAID online database in late January, but “taken down again recently”. 

While the data was online, scientists from a number of countries downloaded that data and analysed it, and their findings were reported earlier this week by The Atlantic.

“A new analysis of genetic sequences collected from the market shows that raccoon dogs being illegally sold at the venue could have been carrying and possibly shedding the virus at the end of 2019,” according to the publication.

Positive swabs

This evidence came from swabs of the market that had tested positive for SARS-CoV2, which also included genetic material from raccoon dogs.

The international team that had assembled the analysis consisted of “virologists, genomicists, and evolutionary biologists”, according to The Atlantic.

The evidence may finally point to the “Animal X” vector that scientists examining the orgins of the virus believe was the most likely conduit for SARS-CoV2 between carrier bats and humans – rather than the laboratory accident theory that has gained currency recently.

“As soon as we became aware of this data, we contacted the Chinese CDC and urged them to share it with WHO and the international scientific community so it can be analysed,” said Tedros. 

The WHO also convened the Scientific Advisory Group on the Origins of Novel Pathogens (SAGO) on Tuesday and asked both the scientists who had analysed the data and China CDC  to present their analysis of the data to the group.

“This data do not provide a definitive answer to the question of how the pandemic began, but every piece of data is important in moving us closer to that answer, and every piece of data relating to studying the origins of COVID-19 needs to be shared with the international community immediately,” said Tedros.

“We continue to call on China to be transparent in sharing data and to conduct the necessary investigations and share the results. 

“Understanding how the pandemic began remains both a moral and scientific imperative.”

Seafood and fresh food market in Wuhan, Hubei, China, where live mammals, including raccoon dogs, were also caged and kept for slaughter.

Molecular evidence

Dr Maria van Kerkhove, WHO lead on COVID-19, said that the scientists had told SAGO this week that there was “molecular evidence” that some of the animals sold at the Huanan Market, including raccoon dogs, “were susceptible to SARS CoV2” – evidence that had been missing until now.

“We need to make clear that the virus has not been identified in an animal in the market or in animal samples from the market, nor have we actually found the animals that infected humans,” stressed Van Kerkhove.

“What this does is provides clues to help us understand what may have happened. One of the big pieces of information that we do not have at the present time is the source of where these animals came from. Where these animals traded? Were they the wild animals or domestic animals where they farmed, where were they farmed?”

China CDC needs to explain

“The big issue right now is that this data exists and that it is not readily available to the international community,” she said.

She said that China CDC needed to explain why it had taken down the data, as all the WHO knew was that it had been uploaded to the site as part of their work and in writing a publication, a pre-print of which was available.

“I don’t know the situation or the circumstances in which the data was released and taken down,” she added.

“Unfortunately, this doesn’t give us the answer of how the pandemic began, but it does provide more clues,” said Van Kerkhove, who reiterated that there are many more studies that need to be carried out. 

“Right now, there are several hypotheses that need to be examined, including how the virus entered the human population, either from a bat through an intermediate host, or through a biosecurity breach from a lab and we don’t have a definitive answer of how the pandemic began,” she said.

Earlier evidence of links to raccoon dogs

This is not the first time, by any means, that infected racoon dogs have been linked to the early stages of the SARS-CoV2 outbreak. In July 2022, Health Policy Watch reported on research led by the University of Arizona’s Michael Worobey, that suggested that mammals in the Wuhan market place, including racoon dogs, were carrying the infection in early 2020.

The Science Magazine study found that SARS-CoV2 susceptible mammals, such as red foxes, hog badgers, and common racoon dogs, were sold at the market in late 2019 and that SARS-CoV2 environmental samples were  found in cages which had previously housed the racoon dogs, as well as other equipment used around the mammals and vendors selling those live mammals in early 2020.

The clusters of early cases around the market also occured at a frequency that was far higher than could be expected in comparison to the volumes and frequency of visitors to other major commercial locations in the city, Worobey’s study found.

The researchers also found that both early lineages of SARS-CoV-2, dubbed A and B were “geographically associated” with the market: “Until a report in a recent preprint, only lineage B sequences had been sampled at the Huanan market,” the researchers added.

“If SARS-CoV2 did not emerge at the Huanan market, how surprised should we be at the coincidence of finding the first cluster of a new respiratory virus at – of all places – one of a handful of markets in a city of 11 million,” said Michael Worobey of the University of Arizona and one of the authors of the study, said in a tweet on the study.

Image Credits: Nature , Arend Kuester/Flickr.

A child getting an oral polio vaccination.

Health authorities in Burundi have declared a national public health emergency response to an outbreak of circulating poliovirus type 2.

The World Health Organization’s (WHO) Africa region announced on Friday that polio had been detected in an unvaccinated four-year-old boy in Isale district in western Burundi and two other children who had been in contact with the child. 

Five samples from wastewater surveillance confirmed the presence of the circulating poliovirus type 2. 

Circulating vaccine-derived poliovirus are variant polioviruses that can emerge if the weakened live virus contained in oral polio vaccine, shed by vaccinated children, is allowed to circulate in under-immunized populations for long enough to genetically revert to a version that causes paralysis.

The Burundian government plans to implement a vaccination campaign to combat polio in the coming weeks, aiming at protecting all eligible children under the age of eight against the virus.

Meanwhile, the Global Polio Eradication Initiative (GPEI) announced on Thursday that a further six cases of circulating poliovirus type 2 had been detected in children in the DRC’s eastern Tanganyika and South Kivu provinces.

“The detection of the circulating poliovirus type 2 shows the effectiveness of the country’s disease surveillance. Polio is highly infectious and timely action is critical in protecting children through effective vaccination,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “We are supporting the national efforts to ramp up polio vaccination to ensure that no child is missed and faces no risk of polio’s debilitating impact.”

According to WHO, circulating poliovirus type 2 is the most prevalent form of polio in Africa and outbreaks of this type of poliovirus are the highest reported in the region, with more than 400 cases reported in 14 countries in 2022. 

These are the first instances of circulating poliovirus type 2 that are linked with novel oral polio vaccine type 2 (nOPV2) since roll-out of the vaccine began in March 2021. 

“While detection of these outbreaks is a tragedy for the families and communities affected, it is not unexpected with wider use of the vaccine,” according to GPEI.

“All available clinical and field evidence continues to demonstrate that nOPV2 is safe and effective and has a significantly lower risk of reverting to a form that cause paralysis in low immunity settings when compared to monovalent oral polio vaccine type 2 (mOPV2),” it added.

“To date, close to 600 million doses of nOPV2 have been administered across 28 countries globally, and the majority of countries have seen no further transmission of cVDPV2 after two immunization rounds.”

Equatorial Guinea’s Marburg testing conundrum

Dr Ahmed Ouma, acting director of the Africa CDC

Meanwhile, in mid-February, health authorities in Equatorial Guinea confirmed the country’s first ever case of Marburg virus disease in the western Kie Ntem province with concerns that cases may be undetected as the country has limited testing capacity. 

Over one month later, 12 cases — one confirmed case and 11 probable – and 12 deaths have been reported. The Africa CDC on Thursday attributed the inability to confirm the suspected cases to limited testing capacity in Equatorial Guinea.

According to the US Centers for Disease Control and Prevention (CDC), the polymerase chain reaction (PCR) test is one of the methods for diagnosing Marburg virus disease. 

While noting that Equatorial Guinea and several other African countries acquired and expanded their PCR testing network during the COVID-19 pandemic, Dr Ahmed Ouma, acting director of the Africa CDC, told Health Policy Watch that availability of the infrastructure for testing is just one of the several elements required for testing for the disease. 

In addition, he said there is also the need for manpower (laboratory scientists) and reagents. These three, he said, need to be at the same place for an effective diagnosis strategy.

“In the beginning, there was no capacity within Equatorial Guinea. That capacity has now been made available. Training is ongoing, and we expect that the situation of not being able to get laboratory diagnosis out quickly is going to change,” Ouma said.

Noting the variation in testing capacity on the continent, Ouma added that access to the affected population was a challenge in some areas, as the required equipment may not be easily deployable in rural areas affected by Marburg.

“We have a situation here where it was a very rural community that was affected and we are working around the clock with the government of Equatorial Guinea to ensure that laboratory capacity is on the ground,” he added.

Despite the challenges of diagnosis, Ouma revealed available knowledge regarding clinical diagnosis and management are being deployed in responding to the outbreak. This includes quarantining and managing cases that present like human hemorrhagic fever — monitoring individuals with such symptoms “so that they are not a danger to themselves and the rest of the community”.

Cyclone Freddy linked waterborne disease outbreaks

On 12 March, Malawi experienced landfall of Cyclone Freddy that has caused flooding, displacement of people and massive destruction of sanitation facilities now impeding current response efforts. Other countries affected by the cyclone are Madagascar and Mozambique. 

“The second passage of Cyclone Freddy has displaced 87,603 people and caused 238 deaths in Madagascar, Malawi and Mozambique. This is a 111% increase in the number of new displaced persons and a 1,685% increase in the number of new deaths. Cumulatively 70,014 displaced persons and 132 deaths have been reported from three AU Member States,” Ouma said.

Regarding the health impacts of the cyclone, Ouma said Africa CDC is working with several agencies including the World Food Programme (WFP), particularly focusing on mitigation initiatives to ensure that those who have been displaced are in an environment that has decent and acceptable sanitary facilities.

“We are ensuring that we avoid any outbreak of waterborne diseases and we are also working with the government to provide health facilities where they can be able to access health whenever they need it. Other arms of governments in the affected countries and other partners are actually also working very hard to provide water, food and transportation to safer ground and mitigate the possibilities of unhealthy and unsanitary living conditions. This is how we reduce or completely stop the outbreak,” Ouma said.

Image Credits: Sanofi Pastuer/Flickr.

A genetic revolution is coming. It’s time the medical community and policymakers discuss it.

As technology advances and the price for genetic testing decreases, it is likely that within the next five years, DNA sequence information will be part of a patient’s medical records. Such a move would revolutionize the way doctors diagnose and treat medical conditions while at the same time raising complicated ethical questions.

By allowing access to a patient’s complete DNA sequence, doctors could more accurately diagnose various medical conditions, including genetic disorders. In addition, it would help doctors to better decide which medical tests are needed to establish a diagnosis and better understand how a patient’s genetics may affect the results of those tests.

At the same time, doctors could preempt the risk for certain medical conditions, at a different level of certainty, from cardiovascular disease to Alzheimer’s, Huntington’s disease to breast cancer.

Taking cardiovascular disease as an example, if doctors could see that a particular patient has a strong predisposition to it, they could tailor a personalized treatment plan designed to prevent or mitigate the condition. Of course, the plan would not only be based on genetics but would include historical information and a current medical workup. However, the patient’s genetic information would be the catalyst for the prevention and treatment plans.

 Another aspect would be the impact on treatment allocation, whereby doctors could start prescribing medication according to genetic characteristics, improving many of today’s anguishing patient journeys. Instead of testing medications until the right drug is discovered, doctors could match the most suitable medication to each patient right away. That would be a considerable leap in the quality of care.

Barriers to integration

 The increased availability of direct-to-consumer genetic testing has spawned the shift toward integrating DNA into medical records. These tests provide people access to their genetic information without involving a healthcare provider or health insurance company.

However, when people receive the results, they often bring them directly to their physician, who then must deal with whatever has been discovered. 

For example, a woman concerned she might have the BRCA gene that puts her at much higher risk of developing breast cancer or ovarian cancer, could send a saliva sample to the US and find out if she is BRCA positive within a few weeks. Then, if she is, she will most likely approach her physician concerned, asking for additional tests, such as an annual MRI or information about surgical preventive measures.

Financial burden

However, as a physician can only address results from a high-quality, clinically validated laboratory, they will have to explain that a second genetic test, and likely a more expensive one, is first needed. 

Of course, insufficiently reliable direct-to-consumer genetic testing can have a high emotional cost and uncertainty during the interim period prior to validating the results. 

Moreover, this information would inevitably increase the financial burden on the health system. While early detection undoubtedly saves lives, when insufficiently reliable or inconclusive in terms of the results or what can be done with them, can also lead to a lifetime of excessive testing and medical consultations and follow-ups.

An additional barrier would be the need to re-educate a large number of healthcare practitioners, as many doctors and other medical professionals will need to learn how to read and interpret genetic information.

Ethical questions arise

However, the most significant barrier to implementation should be the multitude of ethical questions that must be addressed before DNA sequencing is available to almost everyone. The medical community and policy makers must develop new regulations for managing personalized genetic data.

 For example, there are significant risks of invasion of privacy if a person’s genetic information gets out. There is also a possibility that this genetic information could be misused by an insurance company, which could raise rates due to a ‘high risk’ marker to develop a future medical condition found in a person’s genetic makeup. 

A more liberal stance is to provide the patient with their full genetic workup. An alternative is to provide him or her access to solely genetically actionable genes (ie. genetic findings that have defined and known medical consequences and treatment recommendations).

However, ‘actionable’ is a dynamic concept, whereby as research develops, and our knowledge increases exponentially – and what is not actionable today, might be actionable in a year. Should the physician be responsible to constantly re-check the patient’s genetic makeup and notify them? 

Should patients have to opt-in or sign a consent to see their DNA sequence? Or should they opt out if they do not want to see it?

The future standard of care will include the integration of genetic information into the medical decision process. This calls on medical professionals and policy advisors to be prepared and address ethical, legal and regulatory issues – today.

Dr Tal Patalon is Head of KSM Research and Innovation Center, which helps to develop tech-based medical solutions to inform global health policies and enhance healthcare services. She also oversees the Tipa Biobank Project, the largest Israeli biosample repository. She is also an active clinician, specializing in family and emergency medicine. 

Image Credits: Sangharsh Lohakare/ Unsplash.

Professor Anna Gilmore

When London Mayor Sadiq Khan introduced a ban on junk food advertising on the city’s buses and tubes, he faced a backlash from big food companies.

Meanwhile, tobacco companies went all-out trying to stop Montevideo in Uruguay and Kampala in Uganda from banning smoking in public areas, including resorting to litigation.

Tobacco company Phillip Morris took the government of Uruguay to court to try to prevent it from banning smoking in closed public spaces, Mayor Carolina Cosse told the inaugural Partnership for Healthy Cities Summit on Wednesday.

The summit brought together mayors and officials from more than 50 cities to discuss how to prevent noncommunicable diseases (NCDs) and injuries.

Not only did Uruguay win its case, but the court ruling set a precedent by establishing that commercial benefit should not be considered above public policy, said Cosse.

“So in Uruguay, we know very, very well that, when we talk about multinationals, their ambition is limitless,” said Cosse.

Montevideo’s Mayor Carolina Cosse

In Uganda, British American Tobacco (BAT) fought the government’s efforts to eliminate smoking in public areas, said Kampala’s Mayor Erias Lukwago.

In 2016, Uganda’s Parliament introduced a Bill to ensure public spaces were smoke-free – but BAT “fought our efforts left, right and centre, even mobilising local farmers”, added Lukwayo.

After Parliament passed this Bill, BAT took its opposition to the Constitutional Court.

“We got embroiled in protracted litigation until 2019 when we won the case, but even after winning the case, they started indulging in some other shenanigans,” said Lukwayo.

These involved overt efforts such as mobilising and transporting tobacco farmers to demonstrate against the law, and more covert efforts to undermine the implementation of the law.

“We banned single cigarette sales, apart from banning cigarette adverts and smoking in public places,” said Lukwayo. 

“But implementation is a challenge thanks to BAT and all those struggles they have engineered. What BAT does is to instigate small traders to violate the law and enforcement is a challenge on our side because we are very thin on the ground.”

Kampala’s Mayor Erias Lukwago

Addressing the big four

Anna Gilmore, Professor of Public Health at the University of Bath in the UK, said that the “commercial determinants of health” was complex, and that “most commercial actors play an incredibly vital role in society”. 

However, she singled out four products – alcohol, tobacco, ultra-processed food and fossil fuel – as being responsible for between 19 and 33 million deaths a year.

“That’s at least a third of all global deaths. Just by addressing those we can really achieve a huge amount,” said Gilmore.

“The problems aren’t just these products,” said Gilmore, adding that the World Health Organization’s (WHO) Best Buys report, published in 2017, explained how to tackle NCDs and harmful products.

“But many countries and cities and local governments are struggling to put these policies in place because they face opposition from incredibly powerful commercial actors,” added Gilmore.

Big corporations consistently opposed Best Buy policies “using the same arguments and strategies” – and that it was possible to “predict and prepare and counter those industry efforts to derail policy”, said Gilmore.

“But at the end of the day, of course, political will is vital.”

Stick and carrot

A newer tactic being used by some cities was “carbon advertising bans” such as for holidays, for large vehicles, or anything that’s going to increase pollution”, said Gilmore.

Cities could also expand smoke-free, alcohol-free, junk-food-free public places, and reduce the density of outlets selling unhealthy food products. 

“What about introducing ‘polluter pays’ type approach? We’ve seen that recently in Spain, tobacco companies have to pay for the litter that they create?” asked Gilmore.

However, she also said that incentives could be used to reward positive contributions. Cities could use their local procurement and contracting policies to “contract people who pay a fair wage and who limit their ratio between executive pay and average worker pay” to address growing inequality

They could also contract small accountancy firms instead of large ones, and use locally sourced food from small producers for school feeding schemes.

London Mayor Sadiq Khan

Incentives for healthy canteens

Montevideo’s Cosse, who won an award for her city’s food policy innovations, said her city used incentives to promote healthy canteens in the city’s public institutions and hospitals.

“A healthy canteen can sell soft drinks, but they cannot publicise them. They’re obligated to have a healthy menu with vegetables and fruit and easily accessible clean water,” said Cosse. 

If an institution was awarded a healthy canteen certificate, they were entitled to “freebies” such as a free audit, which could save them $3,000 a year.

At the start of the summit, Michael Bloomberg, WHO Global Ambassador for NCDs and Injuries, warned that, ‘in low- and middle-income countries, 40% of all deaths are people under 70 dying from NCDs and injuries”. 

“Sadly, the death toll will only grow, unless we do something. It won’t take a miracle. It will take smart policies – and the political will to implement them and defend them,” added Bloomberg.

The Summit was hosted by Bloomberg Philanthropies, WHO, Vital Strategies, and Mayor Khan.

Image Credits: Bloomberg Philanthropies.

Cholera
Floods and cyclones increase the risk of cholera outbreaks.

Five months after the World Health Organization (WHO) announced that countries affected by cholera had to start rationing vaccine doses due to shortages, there is no immediate solution – yet cases are spiking.

In 2022, 36 million vaccine doses were produced and a similar number is expected this year.

“The South Korean manufacturer is making significant efforts with the help of [vaccine platform] Gavi, Bill and Melinda Gates Foundation and others to improve their production. Whether this will suffice to meet the need, that’s another story,” Philippe Barboza, team lead for cholera at the World Health Organization (WHO) told a briefing on Wednesday.

He added that there are plans to bring in a new manufacturer from South Africa for oral cholera vaccines but that will take time. 

“This is possibly a long-term solution. The question is what are we going to do in between?” 

The caseload for cholera during the first two months of 2023 is 40% higher than the caseload for the whole of 2022, according to WHO. The outbreak is severe in Burundi, the Democratic Republic of Congo (DRC), Malawi, Mozambique and Tanzania, said Barboza.

Barboza added that it is important to go back to the basics – improving access to clean water and sanitation – to achieve the goal of ending cholera by 2030. 

“Access to basic water and sanitation is a long-term solution. Many northern countries have controlled cholera only by improving water and sanitation. Unfortunately, this is something which still requires more political engagement and support,” Barboza said. 

African countries are particularly vulnerable

Cholera
Case Fatality Rate chart that shows Africa suffers worse than other countries across the world.

The case fatality rate (CFR) is 2.9% in Africa while the global average is 1.9%, according to Dr Otim Patrick Ramadan, the incident manager for cholera at the WHO African Regional Office. 

Along with the lack of clean water and sanitation, African countries suffering from cholera outbreaks are also grappling with several other climatic and non-climatic issues. 

“The cholera outbreak is happening in several contexts. We have had natural disasters, like Cyclone Freddy and we are currently trying to understand the extent and impact of the cyclone on Madagascar, Mozambique and Malawi. This has caused a lot of flooding.

“So we have seen outbreaks happen in the context of this cyclone, the flooding in Nigeria, Mozambique, and Malawi. And then the extreme end of those climatic events is also the drought in the greater Horn of Africa, Kenya, Ethiopia and Somalia,”  Ramadan explained.

Cholera transmission is closely linked to inadequate access to clean water and sanitation facilities. The Vibrio cholera bacteria spread in dirty water, and the spread can be accelerated during floods as well as when there is a shortage of clean water.

Regions with conflict are also vulnerable to cholera, such as parts of Cameroon, northeastern Nigeria, DRC, the North Kivu area of South Sudan, Somalia and Ethiopia, he added.

These challenges grouped with already existing public health challenges like Mpox, polio and measles cripple the countries’ capacities to respond. 

The vaccine challenge

 In October 2022, the WHO advised countries with cholera outbreaks to ration vaccine shots since the global stockpile of the vaccine was depleting rapidly. Countries were asked to administer single doses of the cholera vaccines instead of a two-dose regimen. 

The standard preventive approach to cholera is a two-dose regimen, in which the second dose is administered within six months of the first dose. This provides immunity against cholera for three years. 

WHO Director-General Dr Tedros Adhanom Ghebreyesus said that a single dose has proven to be effective in previous outbreaks, although the immunity it provides is limited. 

However, he emphasized that this is only a temporary solution and that a holistic and strategic approach must be adopted to prevent cholera outbreaks. 

“In the long term, we need a plan to scale up vaccine production as part of a holistic strategy to prevent and stop cholera outbreaks. The best way to prevent cholera outbreaks is to ensure people have access to safe water and sanitation”. 

Explaining that the situation around vaccines at present is not any different than what it was in October 2022, Barboza said that the demand for vaccines is increasing and unmet. 

Image Credits: World Health Organization (WHO), World Health Organization (WHO).

IQAir air pollution map for PM 2.5 (2022). Only countries in blue meet the WHO guidelines.

Ninety percent of 131 countries exceeded the World Health Organization’s (WHO) air pollution guidelines for fine particulate matter (PM 2.5) in 2022, according to a new report that combines data from official monitoring stations and “citizens science” monitors around the world. .

The report was the fifth such World Air Quality Report to be released Tuesday by the Swiss firm managing the air quality monitoring site IQAir, which crowd sources real-time monitoring data from both citizen scientsts and more official sources. Altogether, that includes data from over 30,000 air quality monitoring sensors and stations across 7,323 locations in 131 countries. 

However, critics point out that the reporting combines data from low-cost monitoring sensors and stations with the more robust monitoring by governments and research institutions, which is typically reported on by WHO and research institutions. That, mix, some scientists and researchers, contend, can point to general trends, but it is not always reliable or consistent.

“The IQ database raises awareness and that is OK, but the transparency of the data is not a given. It is what it is,” one expert, who asked not to be named, told Health Policy Watch.

Low cost monitors becoming more reliable

On the other hand,  low-cost air quality monitors are becoming increasingly reliable, as well as popular – to cover critical gaps in coverage in low- and middle-income countries that cannot afford more expensive tools, supporters of the initiative maintain.

“In 2022, more than half of the world’s air quality data was generated by grassroots community efforts. When citizens get involved in air quality monitoring, we see a shift in awareness and the joint effort to improve air quality intensifies. We need governments to monitor air quality, but we cannot wait for them. Air quality monitoring by communities creates transparency and urgency. It leads to collaborative actions that improves air quality,” states Frank Hammes, Global CEO, IQAir.  The firm’s for-profit branch also markets air purifiers, filters and face masks.

PM 2.5 is made up of tiny particles in the air, including sulfates, nitrates, black carbon, and ammonium, which are considered among the most health-hazardous air pollutants.  PM 2.5 concentrations are also considered to be the best metric for estimating health impacts from air pollution. In line with this, updated WHO guidelines recommend that countries should ensure an annual average of five micrograms per cubic meter (μg/m3) or less to protect people’s health – a measure that even high income countries with strong air quality management systems often fail to meet.

Only six countries meet WHO guidelines

In fact, according to the data published by the company, only Australia, Estonia, Finland, Grenada, Iceland, and New Zealand met the WHO guideline in 2022.  

Countries with the most polluted air were Chad, (89.7 µg/m3, over 17 times higher than the WHO guideline), Iraq (80.1 µg/m3), Pakistan (70.9 µg/m3), Bahrain (66.6 µg/m3) and Bangladesh (65.8 µg/m3). However in the case of arid states in Africa, the Middle East and South Asia, dust storms can also be a huge factor in pollution levels, experts say.  

Pakistan’s Lahore was the most polluted metropolitan area in 2022, while eight of the world’s 10 worst polluted cities were in Central and South Asia.

The most polluted city in the US was Coffeyville, Kansas, while 10 of the 15 most polluted cities in the US were in California. Las Vegas was deemed the cleanest major city.

WHO has not published country-by-country averages for the past several years – so it is difficult to make comparisons between the IQAir’s “citizen science” findings and more official sources of data. 

Six million die annually from air pollution

Air pollution is the world’s largest environmental health threat, killing an estimated 6-7 million people each year, according to WHO and the Global Burden of Disease report 2019.

The total economic cost equates to over $8 trillion dollars, which is over 6% of the global annual GDP, according to the World Bank. Exposure to air pollution causes and aggravates several health conditions which include, but are not limited to, asthma, cancer, lung illnesses, heart disease, and premature mortality.

“Sustained exposure to PM2.5 concentrations above the annual average guideline level result in a chronic impact on individuals’ respiratory and circulatory systems leading to long-term complications such as heart disease and decreased lung function,” according to the report.

While the number of countries monitoring air has steadily increased over the past five years, there were “significant gaps in government-operated regulatory instrumentation in many parts of the world”, according to IQAir. 

“Low-cost air quality monitors sponsored and hosted by citizen scientists, researchers, community advocates, and local organizations have proven to be a valuable tool to reduce the massive inequalities in air monitoring networks across the world, until sustainable regulatory air quality monitoring networks can be established,” it added.

Only 19 African countries had the ability to monitor their air quality, and only 156 stations producing all the included data for the continent,

“In 2022, more than half of the world’s air quality data was generated by grassroots community efforts,” said IQAir CEO Frank Hammes. “We need governments to monitor air quality, but we cannot wait for them.”

 Aidan Farrow, Greenpeace International’s air quality scientist, said that “too many people around the world don’t know that they are breathing polluted air”. 

“Air pollution monitors provide hard data that can inspire communities to demand change and hold polluters to account, but when monitoring is patchy or unequal, vulnerable communities can be left with no data to act on. Everyone deserves to have their health protected from air pollution,” added Farrow, whose organisation collaborated with IQAir on the report.

Healthcare workers
Countries rich and poor suffered during the COVID pandemic due to healthcare worker shortages, but rich countries were able to import more workers.

Eight more countries in the global south have dangerously low numbers of healthcare workers in the wake of the COVID pandemic, a new WHO report has found. 

The World Health Organization’s 2023 report on “Health workforce support and safeguards” found that some 55 countries now rank below the global median in terms of their density of doctors, nurses and midwives per capita. 

That is in comparison to 47 countries in 2020 when the last report was produced, based on data collected just prior to the outbreak of the COVID pandemic. 

The WHO report series tracks countries where the number of professionally trained healthcare workers falls below the global median of 49 per 10,000 population. It also examines countries’ rankings in terms of a Universal Health Service coverage index. 

The negative health, economic and social impacts of COVID-19, coupled with the increased demand for healthcare workers in high-income countries experienced during the pandemic, likely helped trigger more outward migration of healthcare workers from countries that are already suffering from low health workforce densities, the report found. 

“Health workers are the backbone of every health system, and yet 55 countries with some of the world’s most fragile health systems do not have enough and many are losing their health workers to international migration,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General, in a press release that accompanied the report. 

Rich countries still falling short on global code of practice for international recruitment of health professionals 

The outward migration of healthcare workers from low or middle income countries in search of better wages and working conditions is a longstanding issue, which has only become more serious as the global workforce becomes more mobile generally. 

For instance, the proportion of foreign-trained physicians increased from 32% in 2010 to 36% in 2020, in eight OECD countries already blessed with a high density of healthcare workers.

The voluntary Global Code of Practice for the International Recruitment of Health Personnel, adopted at the 2010 World Health Assembly, aims to curb aggressive recruitment of healthcare workers from the global south by rich countries – as well as supporting fair and transparent employment terms for those who do choose to migrate elsewhere.  

Healthcare Workers
Factors acting on healthcare workers demand and supply in the market.

Accompanying the code, WHO was mandated to track and periodically update member states on trends in health workforce numbers in countries deemed “vulnerable”, as well as examining how such worker migration is affecting progress toward the goal of Universal Health Coverage. 

Since 2010, member-states have reported every three years on data and trends regarding international migration of healthcare workers. 

The fourth round of review was launched in May 2021 against the background of the COVID-19 pandemic, which caused severe disruptions to healthcare services in many countries, as well as increasing rich countries’ reliance on international healthcare workers, the report stated. 

African countries are the hardest hit 

Among the countries that recently joined the list of those with vulnerable health workforces are Rwanda, Comoros, Zambia and Zimbabwe in the African region; Timor-Leste in the South-East Asia region; and Lao People’s Democratic Republic, Samoa and Tuvalu in the Western Pacific region of the WHO. 

Among all 55 countries with sub-par numbers of health care workers, 37 are WHO’s Africa region, eight in the Western Pacific region, six in the Eastern Mediterranean region, three in south-east Asia region and one country in the agency’s Americas region, the report found.  All of these countries have a healthcare workforce density of less than 49 workers per 10,000 people. 

These countries also rank at 55 or less on WHO’s Universal Health Coverage (UHC) service coverage index – which tracks access to key, lifesaving services on a scale of 0, to 100. Service coverage is calculated as the average of 14 “tracer indicators” for access to four broad groups of health services: reproductive, maternal, newborn and child health; infectious diseases;  noncommunicable diseases; and service capacity and access. 

Policy research has documented the linkages between the size of a country’s healthcare workforce and health outcomes. And the global data collected by WHO also shows a strong association between health workforce density, and UHC coverage rankings overall. 

Healthcare workers
Healthcare workforce density per 10,000 population. The countries in the blue rectangle are the ones added in the updated list, with healthcare worker density less than 55 per 10,000 population.

Approximately 15% of health care workers globally are working outside of their country of birth, WHO has found. But this varies widely by region – with the proportion of foreign-trained nurses reaching 70% to 80% in some affluent Gulf countries in WHO’s Eastern Mediterranean Region. About 10-12% of foreign trained doctors and nurses hail from countries deemed vulnerable by WHO due to their lack of sufficient numbers of indigenous healthcare workers.  

While the 2010 WHA resolution did not prohibit international recruitment of healthcare workers, it calls on the countries, particularly the high income countries, to ensure that their recruitment does not adversely affect the healthcare systems and delivery of healthcare services in the source countries. 

Call to countries to reduce adverse effects of international recruitment 

The WHO also recommends that healthcare workers migration agreements signed between two governments should explicitly ensure that benefits to the source country are “commensurate and proportionate” to the benefits accrued by the healthcare system of the destination country. 

It also recommends that such safeguards be applied to all low and middle income countries, regardless of their ranking on the list. 

Scarcity of healthcare workers in low and middle income countries, and their outward migration in search of better pay and conditions, has been a longtime global health policy issue. The COVID-19 pandemic only exacerbated an existing inequalities that hobble the development of robust health systems in many developing countries.

In 2020, the International Council of Nurses estimated that there is a global shortage of six million nurses and the effects of the pandemic will drive health worker migration from the low and middle income countries. A WHO report on the State of the World’s Nursing profession, published in that same year, estimated that one in eight nurses globally have migrated from elsewhere. 

Healthcare workers
Estimation of healthcare workers shortage across the world in 2013 and in 2030.

In 2020, when the list of vulnerable countries was first compiled, the UHC service coverage index benchmark was was 50 out of a score of 100. However, after COVID-19 caused widespread health, social and economic impacts, WHO increased the threshold to 55. 

“The increasing demand for health and care workers in high-income countries might be increasing vulnerabilities within countries already suffering from low health workforce densities,” observes the new WHO report. 

“WHO is working with these countries to support them to strengthen their health workforce, and we call on all countries to respect the provisions in the WHO health workforce support and safeguards list,” stated Tedros.

Image Credits: Photo by Carlos Magno on Unsplash, World Health Organization (WHO), World Health Organization (WHO).