From left: Maria Neria, Riccardo Puliti, Mamunur Rahman Malik, Harish Hande and Francesco La Camera at WHO COP27 event.

SHARM EL-SHEIKH, Egypt – The International Renewable Agency (IRENA), on Tuesday, said it would pump $1billion into a new effort that would electrify health facilities, along with food storage and agriculture, with solar power, while the World Bank said it also plans to triple its investments in solar electrification efforts to reach 100,000 health facilities by 2030. 

The initiative aims to tackle the gaps in health care that leave an estimated one billion people around the world reliant on healthcare facilities with either no electricity or an unreliable supply, IRENA´s Director General, Francesco La Camera.

He was speaking at a high level event, “Energizing health: accelerating electricity access in health-care facilities,” organized by the World Health Organization at its COP27 Health Pavilion. 

La Camera said that his agency is assessing the energy gaps in healthcare systems in a number of the poorest sub-Saharan African countries, beginning with Burkina Faso, Malawi and Mali in order to get a better idea of the gaps in energy access, and how they impede health service delivery.

A 2013 WHO-sponsored study of 11 sub-Saharan African countries found that 26% of health facilities had no electricity at all, and only 28% of facilities, on average, had reliable electricity access. Even at hospital level, only 34% of hospitals had reliable electricity.  Traditionally, the fallback power option for the health sector in areas with poor grid access has been diesel generators, which are not only highly polluting but costly, with fuel expense and breakdowns leaving a large proportion idle.  

During the pandemic, there was a major push to add solar powered refrigeration capacity to African health centers to roll out COVID vaccines, which require a reliable cold chain.  But there remains a lack of systematic investment, along with comprehensive data on gaps and needs on the ground. 

Francesco La Camera, director-general of IRENA

Even with the limited data available, however, it´s apparent that the lack of electricity and impacts on healthcare are particularly severe in Africa, agreed panelists at the event, which included representatives from the World Bank, WHO´s office in Somalia and a leading Indian solar entrepreneur. 

Their discussion focused on energy needs in healthcare facilities, the potential for shifting to renewable energy sources, and the funds needed for such initiatives.

“In view of the COP28, we aim to create a partnership with government, philanthropies, foundation trust, charitable funds, the World Bank and the private sector among other stakeholders, and naturally, WHO, to commit $1 billion towards the empowering lifts and livelihood, renewables, follow adaptation, initiative to connect people and livelihood through renewable energy solution in agriculture, food and health sectors,” La Camera said, of the IRENA commitment. 

World Bank also doubling finance to focus on mini-grids 

The IRENA initiative comes on top of an existing $1.3 billion a year World Bank investment  in renewable energy access for farms, schools and health facilities in off grid communities, said  Riccardo Puliti, the vice-president of the Bank’s infrastructure division. But of that amount, not more than $100 million goes towards healthcare facilities, he admitted.

Efforts to invest in healthcare facilities accelerated during the COVID-19 pandemic, he noted. In that period, the Bank developed and disseminated improved tools for facilities to estimate their energy requirements, so as to allow for the more reliable electrification of cold chains, and thus storage of vaccines. 

Riccardo Puliti, vice-president of World Bank’s Infrastructure division.

However, the Bank now plans to ramp up funding for community-based mini-grids, from which health facilities as well as homes, schools and other community functions, might all benefit. 

Mini grids are decentralized energy facilities that may involve solar arrays, battery storage and generator backup, and can be used to produce and distribute electricity within small communities that are too far removed from the grid to enjoy reliable service from conventional power supplies.  

“The idea is to provide mini grids for half a billion people and 100,000 health facilities by 2030. We plan to triple our $1.2 billion per year in order to achieve that,” Puliti said.

Learning from Nigeria and Somalia

Among sub-Saharan African countries, Somalia ranks as one of the most under-served. Some 85% of Somalia’s population do not have access to electricity. Only 28% of healthcare centres in the east African country have access to electricity and only 27% of the population can easily access healthcare, said Dr Mamunur Rahman Malik, WHO´s representative in Somalia, who also appeared at the event. 

The price of electricity in Somalia is between $1-$2 per kilowatt hour, while its neighbouring regions pay anywhere between $0.02 and $0.03. 

Calling Somalia’s plight a “social injustice”, Malik described how emergency surgeries and pediatric procedures are frequently performed under kerosene lamps or even in candle lights.

Inevitably, lack of electricity access also contributes to the country´s high rates of  childhood mortality.  

“A child who is born today (in Somalia) is 16.5 times more likely to die before the child reaches the age of five,” Malik said. “This is not the fault of the child, it´s because we don’t have health facilities which can provide health services. We don’t have refrigerators to preserve vaccines. One in seven children in Somalia is missing out on these lifesaving vaccines.”

Dr Mamunur Rahman Malik, WHO´s representative in Somalia, describing the benefits of solar electrification of health facilities in Somalia.

In January 2021, the Somalian health ministry, with WHO’s support, piloted a solar-powered oxygen delivery system at a government hospital in Galmudug. This has, in turn, saved the lives of several children who came to the hospital suffering from respiratory issues like asphyxia, pneumonia and accidents and trauma. 

Following this, the system was also set up in four more hospitals.  Then in 2022, the government  also began scaling up other solar energy systems to provide building-based electricity to 100 primary healthcare centres. 

Malik said that the reason why WHO supported the equipping of Somalian healthcare facilities with solar energy is because it is the most practical solution for a country that is arid and receives over eight hours of sunlight a day. 

Cost is also a crucial factor in this decision, he said. “A health facility or a laboratory spends $8,000 to $10,000 to pay the electricity bill (from grid services or diesel fuel based generators). If it is solarized, they’re going to pay only $30 just to maintain the electricity line, the electricity will be free.” 

He added that solar power will also help reduce medical waste of medicines and vaccines from poor storage conditions. 

Similarly, the federal power minister of Nigeria, Abubakar D.Aliyu shared his experience with switching health facilities to renewables in his country. 

The experience began when two health facilities in every district of the country, designated to receive vaccines, were equipped with solar energy.

The government also has equipped at least one million houses with solar panels over the past year, the minister said; the aim is to electrify six million homes by the end of 2023.  

“And I know it can happen. If we have a common will, if we have the will to do it, it’s gonna happen,” he declared. 

Intersectoral collaboration is key

While money could be an obvious barrier to achieving targets when it comes to the switch to renewable energy, it is more often the political will that’s missing, observed Harish Hande, the cofounder of SELCO India, a Bangalore based social enterprise company that has been deeply involved in national solar electrification efforts. 

SELCO India, in partnership with Ikea Foundation, has a target of installing solar energy systems in 25,000 healthcare facilities over the next four years. “If a very small organization like SELCO with 150 employees has taken a pledge to do 25,000 [facilities] with Ikea Foundation, the other institutions should do 20 times more. And by 2026 we should stop talking about solarizing of health,¨ he declared.

COP27
Harish Hande (second from the right)

He added that more efforts also need to be invested into harnessing the innovation capacity of the private sector – particularly in the design and manufacture of essential appliances that consume less energy. 

“We would lose out on an opportunity if we just look at this as an issue of electrification… It’s not about solar power. It’s a combination of innovations that will spur further innovation.” 

Meanwhile, La Camera stressed the need to put the necessary basic solar  infrastructure in place, which can then be harnessed for scaling up solar power. “Industrial sector should work in cooperation,” he said. 

And there is also a need to incentivise industries in the most underserved regions, such as Africa, to manufacture solar equipment at cheaper, or even subsidized prices. 

Puliti pointed out that unlike five years ago, solar arrays and batteries are affordable and competitive in almost any setting. 

In dense urban areas, more reliable grid-based power using a mix of renewable and non-renewable energy sources is the more likely short-term aim, he said. But particularly in sub-Saharan Africa, there’s a “huge urban and rural divide” with rural areas lacking any possibility to link to the grid in the near term. 

“In sub Saharan Africa 52% of the population do not have any access to electricity,” he said, adding that cities have an electrification grid of 80-85% in contrast to the countries like Somalia and Central African Republic with minimal access to electricity. 

“So we have to work both on, making sure that the cities get electricity, usually on grid, and then we develop as much as possible, all kinds of off grid…with batteries.  We must understand that solar and batteries are competitive with everything we can think of. Five years ago, solar was and batteries were not competitive. It is competitive now,” he explained. 

“Only by working together – states, financial institutions, institutions like IRENA, WHO, the civil society – (can we achieve this)..,” said Puliti. “This is different from 10-12 years ago where it (the cause) was mostly ignored. I have this strong feeling that we are going to overcome this by 2030, even though we are in the middle of a big crisis, we had a pandemic and all the rest.”  

Link here to the calendar of COP27 events on climate and health, and access to livestreaming from the WHO Pavilion in Sharm el-Sheikh.

Image Credits: Megha Kaveri/HPW.

COP27 plenary on Monday as countries make their case for more climate finance and better terms on cash received.

SHARM EL-SHEIKH, Egypt – Small island states and other African and Asian developing nations stepped up their appeals Tuesday for a reboot of the global financial system to make climate finance more affordable to their debt-ridden nations, now battling a rising wave of climate emergencies along with demands to “go green”.

Reducing interest rates on climate loans; shifting more climate finance from loans to grants; imposing a carbon tax on fossil fuel producers; and a fossil fuels ¨non-proliferation treaty¨  were among the proposals tabled by countries from South Africa to Bermuda and Pakistan to Mali, in the second day of high-level statements at the UN Climate Conference (COP27). 

“The oil and gas industry continues to earn almost $3 billion daily in profits,” said Gaston Browne, Antigua’s prime minister, speaking on behalf of the Alliance of Small Island States, whose very existence is threatened by sea level rise and extreme weather. 

“It is about time that these companies are made to pay a global carbon tax on their profits as a source of funding for loss and damage,” he said. “While they are profiting, the planet is burning.”

Loss and damage pledges inadequate

Mia Mottley, Prime Minister of Barbados, has set a trend for calls to revamp climate finance.

Meanwhile, a handful of rich countries announced about $60 million in initial pledges of aid for climate ¨loss and damage”.

Civil society groups immediately decried the pledges as woefully inadequate against the more than $1 trillion a year of actual costs for low and middle-income countries, ranging from flood-ravaged Pakistan to the drought-ridden Horn of Africa, and small island states devastated by increasingly powerful cyclones and hurricanes. 

However, just getting loss and damage on the climate agenda is “a significant achievement”, observed Mia Mottley, Barbados´ prime minister.

¨It recognizes that those countries such as ours, who have not contributed greatly to the emissions of greenhouse gasses should not be crowded out of our fiscal space in order to be able to finance the reconstruction after a climatic event,¨ she said. 

But she warned that ¨we will not achieve the conclusion of it¨ at the present COP.

The even bigger challenge involves finding new ways to finance climate actions that reduce, rather than add to, the already heavy debt load – including interest rates on that debt – of low- and middle-income nations, Mottley noted.

 ¨The reality is that unless our financial institutions can speak to the current realities, they will not be able to help us transition in this new way,¨ said the prime minister. 

She added that her ¨Bridgetown agenda¨ for financial reform, including an agreement with the IMF and others on a new ¨Blue-Green¨ finance facility to preserve the ecosystem of the Caribbean region with a 10-year interest moratorium, could provide one such model. 

 Remake global financial institutions or face millions of climate refugees

Phillip Davis, Prime Minister of Bahamas warns of a tide of climate refugees if rich countries don’t act faster.

It´s in the interest of rich countries to rethink finance arrangements on all fronts – mitigation, adaptation and loss-and-damage, added Phillip Davis, prime minister of the Bahamas. 

¨What is it worth for you, the world, to keep millions of climate refugees from turning into tens of millions and then hundreds of millions, putting pressure on borders and security and political systems around the world,¨ he asked. 

¨ I´m not telling you to overhaul the World Bank for this new climate era because it´s the right thing to do, I´m telling you to get smart and act quickly,¨ said Davis who also echoed a recent World Health Organization appeal for countries to agree on a  ¨fossil fuels non-proliferation treaty to steer our models towards renewables. 

¨Let´s get real about what is coming.  Let´s get real about what we need to do next,¨ Davis added. ¨We have no other choice… The alternative compels us to present ourselves at your borders as refugees.  The alternative consigns us to a watery grave.¨

Pakistan reeling from multiple needs 

Muhammed Shehbaz Sharif, prime minister of Pakistan.

¨Estimated damage and loss has exceeded $30 billion and this despite our very low carbon footprint. We became a victim of something with which we had nothing to do,¨ said Pakistan´s Prime Minister, Muhammed Shehbaz Sharif, speaking about the August flooding.

The flooding left nearly one-third of the country under water and some 33 million people displaced. 

¨Winter is setting in and we need to provide shelter, homes, food packages and medical treatment for people … for which we are spending billions of rupees from our meager resources,” he continued. ¨And at the same time we have to spend billions to protect people against other [future] floods and emergencies.

“How on earth can we do this on our own?¨ he asked. ¨Loss and damage needs to be part of the core agenda of COP27 to meet the pressing humanitarian needs of those that are trapped in a crisis of public financing fueled by debt, and yet have to fund climate disasters on our own.¨

South Africa – only 2.7% of aid from wealthy nations is in grants   

South Africa’s President Cyril Ramaphosa

Meanwhile, South Africa´s President Cyril Ramaphosa provided a tangible example of the problematics of green finance today – with reference to a new pact with Europe and the United States to support the country´s $98 billion plan for a  ¨just energy transition.¨ 

The deal, initiated at COP26 in Glasgow but only finalized on Monday at COP27, includes commitments by France, Germany, the UK, the US and the European Union, to provide some $8.5 billion in finance for the first phases of the South African plan.  The aim is to move the country away from its heavy dependence on coal and into green energy sources, including green hydrogen, as well as electric vehicles. 

Part of the financial package also will go to ensuring that coal worker and their communities – the people most affected by a transition – are not left behind. 

But of that support, only 2.7% is in the form of grants, with the rest to be made in ¨concessional loans and investments and risk sharing instruments,” according to a press release. 

And that is a big problem for debt-ridden nations like South Africa, complained Ramaphosa.

“Because South Africa already carries a fairly sizable loan burden, which it has to service from its fiscus, we require more grant funding,” Ramaphosa said, speaking in a separate press briefing. 

However, Ramaphosa expressed hopes that negotiations underway now could help shift that balance, creating a ¨real partnership,” as well as a climate finance model that other countries could emulate.  

“Industrialized countries … need to live up to the commitments that they have made, knowing full well that they – through development of their own economies – contributed a great deal more to the [climate] damage that many countries on our continent,” said the South African president.

Europe: Ambitious targets at home and new investments in Africa

Ursula Von der Leyen, ¨let´s earn the clean ticket to heaven.¨

The IPG investment in a green hydrogen facility in South Africa was one of several such announcements made over the past two days in this emerging technology. The European Union and Norway, meanwhile, announced similar partnerships with Namibia and Egypt. . 

¨The European Union’s additional renewable capacity is set to more than double this year, up to 50 gigawatts. And if we accelerate and if we scale up – and that is our plan – we can, in the next year, meet a new all-time record of over 100 gigawatts of additional renewable capacity,¨ said EU President Ursula Von der Leyen at the opening of the day`s plenary session, The EU leader’s comments also acknowledged, for the first time, need to talk about loss and damage. 

¨Because we know that every kilowatt-hour of electricity that we generate from renewable sources – like solar and wind, and green hydrogen – is not only good for our climate, but also good for our independence and our security of supply.

¨Here, the Global South has the resources in abundance. So let us team up. That is why the European Union is signing new hydrogen partnerships with Egypt, with Namibia and with Kazakhstan. That is why we are supporting partners such as Vietnam and South Africa to decarbonise their economies,¨ she  said. “Let us not take the highway to hell, let us earn the clean ticket to heaven.¨

And Norway´s Prime Minister Jonas Gahr Støre said that national climate commitments, updated since COP26 meant the Nordic country would increase carbon taxes to €200 per ton as well as reducing its own emissions by 55% by 2030, in line with the EU goal. 

¨We will fulfill our pledge to double climate finance within the next four years … and triple adaptation finance, with a particular emphasis on Africa,” declared Støre. He also welcomed Brazilian President-elect Lula da Silva´s ¨renewed commitment to the Amazon.¨ 

¨We also need to strengthen efforts to prevent loss and damage,¨ Støre added, almost as an aside.

Healthcare workers treat a patient with drug-resistant TB in Myanmar.

Two shorter treatment regimens for multi-drug resistant (MDR) tuberculosis have proven to be safe and more effective than the current treatment, the Union World Conference on Lung Health heard on Tuesday.

Results from Stage 2 of the STREAM clinical trial, published in The Lancet on the same day, show that a fully-oral nine-month bedaquiline-based regimen and a six-month injection-containing regimen have superior efficacy to the nine-month regimen currently used, which is a combination of pills and injections.

“Until 2016, the recommended treatment for MDR-TB typically included 7,200 pills and 240 injections and took up to 24 months to complete,” according to a media release from Vital Strategies, the organisation that sponsored the trial.

“In 2017, STREAM Stage 1 confirmed that a nine-month treatment regimen was as effective as the longer regimen. Now, STREAM Stage 2 has demonstrated that both a fully-oral nine-month regimen and a six-month injection-containing regimen have superior efficacy than the control regimen.”

Some 82.7% of trial participants had a favourable outcome using the oral nine-month regimen in comparison to 71.1%  on the nine-month regimen that had both injections and pills.

Largest MDR TB trial

The six-month regimen – which comprised of bedaquiline-based injections for two months as well as pills – was also more effective than the nine-month control regimen, with 91.0% of participants having a favourable outcome compared to 68.5% in controls. 

“While we are pleased with the performance of the regimens tested in STREAM and the evidence generated, there is still an urgent need to build upon these results and improve the efficacy and safety of MDR-TB regimens available,”  said I.D. Rusen, Senior Vice President at Vital Strategies. 

The STREAM Clinical Trial is the world’s largest MDR-TB trial ever conducted, with over 1,000 participants from eight countries. It was implemented by a number of global partners, including the Medical Research Council Clinical Trials Unit at University College London (UCL), the International Union Against Tuberculosis and Lung Disease (The Union) and Liverpool School of Tropical Medicine. 

MDR-TB is resistant to two key medicines, isoniazid and rifampicin, and is expensive to treat. Some of the treatments have serious side-effects including permanent deafness.

“It is particularly encouraging to note that the findings in the fully-oral and 6-month regimens are significantly better not only in the combined outcome measure, but also in the TB-associated outcomes, namely significantly fewer failures and relapses,” said Professor Andrew Nunn, STREAM co-chief investigator, at the MRC Clinical Trials Unit at UCL.

Professor Sarah Meredith, co-chief investigator and medical lead for STREAM based at UCL, also noted, “after careful monitoring of all participants in STREAM, we were pleased that no concerning safety signals were identified. In addition, fewer participants experienced severe hearing loss in the all-oral regimen (2%) and the six-month regimen (4%) compared to the control regimen (8%). This is important information, as hearing loss has been a particular concern for patients taking earlier MDR-TB treatments.”

Image Credits: The Global Fund / John Rae.

The World Health Organization (WHO) member states are currently negotiating a pandemic treaty to prepare for the next pandemic – but how can representatives of civil society have a seat at the table? What are the rules of civil society participation inside and outside decision-making spaces and what should they be? These questions were discussed during a panel organized by the Global Health Center at the Geneva Graduate Institute recently.

“Today, governments are assisted, influenced and challenged by a variety of civil society organizations, demanding greater transparency, inclusivity and accountability,” said Courtenay Howe, senior advocacy advisor at STOPAIDS and platform coordinator at Platform for ACT-A Civil Society and Community Representatives, who moderated the event.

How it worked in environmental sector

In order to understand what best practices can be implemented in international rulemaking, the panellists shared their experiences about the processes that led to other fundamental treaties in the field of environment, human rights and other sectors, such as the Basel Convention on hazardous waste.

“The Basel Convention is over 30 years old, so I would like to start with what happened at the very beginning,” said Katharina Kummer Peiry, director of Kummer EcoConsult. 

She explained that at the time the field was dominated by one very active NGO: “They were excellent negotiators, better prepared than most governments, and as a result, they almost had more influence than many government negotiators,” she pointed out.

According to Kummer Peiry, the organization focused on protesting outside of the building where the negotiations were happening, as well as “naming and shaming” the negotiators in order to demand change. 

“This has evolved over the lifespan of the convention,” she added. “There are now three categories of observers that are admitted through the process, civil society, which is mostly environmental organizations, but also social development organizations, industry and then academic institutions.”

Today, in the environmental field the goal is to have a variety of organizations involved and encourage them to hold  events and prepare materials for the delegates carrying on the negotiations, she added.

 

A universal right

“Participating in a decision-making process is a universal desire for everyone, but not only that, it is actually a fundamental human right, protected by international human rights framework,” said Saranbaatar Bayarmagnai from the United Nations High Commissioner for Human Rights (OHCHR).

Bayarmagnai recalled the process of negotiating the Convention on the Rights of Persons with Disabilities, which was adopted in 2006. It currently has 164 signatories.

“There was an intergovernmental working group established to develop and negotiate this treaty, and initially the process wasn’t as inclusive as we wanted,” he said. 

“There was a huge outcry by civil society actors in different regions and globally, especially by persons with disabilities saying that no decision would be made about them without them.”

Eventually, member states became more open and accepted to include organizations working on disability rights.

“They had a very meaningful and inclusive seat at the table,” Bayarmagnai noted.  “What happened as a result of that is that 75% of the legal text of the Convention on the Rights of Persons with Disabilities came from those actors who were part of the process.”

Increasing participation in negotiations

In December 2021, the WHO established an Intergovernmental Negotiating Body (INB) in order to negotiate the legal framework for pandemic preparedness. 

Asked about what mechanisms have been put forward to ensure civil participation in the process, INB’s Co-Chair Precious Matsoso said making space for non-state actors was a useful tool.

“We are talking about an organization that was established through a constitution over 70 years ago, and this constitution is designed in such a way that the organization is rule bound, so we have to work within those rules,” she said.

“But I also think that the world has changed, it is more complex, more dynamic and more inclusive, so perhaps we have to look at how best we reform these processes,” she also said, adding that the attempt to involve non-state actors, despite some shortcomings, has resulted in a more open process.

Steven Solomon, WHO’s Principal Legal Officer, also offered his perspective on the ongoing negotiations for the pandemic treaty.

According to Solomon, these innovations were made possible thanks to the mandate of member states that participation should be expanded and deepened as much as possible.

The WHO official said that in his view, this mandate was due “to the level of confidence that member states had in relevant stakeholders in civil society, confidence in their commitment to constructive engagement.”

“It is remarkable to see what can be achieved,” he said.

However, there is still room for improving the mechanisms for guaranteeing civil participation.

Cedric Nininahazwe from the Global Network of People living with HIV (GNP+) suggested allowing more space for feedback and ensuring that information collected by communities reaches the relevant stakeholders in a timely manner.

“I think for the relevance of engagement and the information that people are providing, it will be great to create some feedback mechanisms where we can really engage on different issues,” he said.

During COVID, many community organizations were out in the field and they collected a lot of information.

“However, there is no way that this information can be shared,” he concluded, asking for a way to ensure that the data that has been collected reaches those involved in the negotiation of the pandemic prevention, preparedness and response treaty.

COP27
The line-up of speakers for COP27’s opening ceremony side by side before their keynotes.

As ceremonies opened in Sharm El-Sheik’s grand plenary hall on Monday, only one word came to mind in trying to sum up the scene: surreal.

World leaders paraded into the hall to music seemingly taken from a Star Wars film. The cast of speakers taking the stage consisted of a petro-state monarch, a friendly host cum authoritarian dictator, the UN Secretary General, a few academics, a young student, and the heads of state of Barbados and Senegal, sat side by side on white leather armchairs straight out of a first class airplane cabin. 

Set against the backdrop of an existential cross-roads in the global fight against climate change and the Egyptian government’s efforts to gloss over its human rights record, COP27 is off to a complicated start. 

Appearances a focus for Egyptian government amid human rights criticisms

Sharm El-Sheikh
Egyptian President Abdel Fattah el-Sisi takes the stage to deliver his opening address.

The road to COP27 has not been easy for President Abdel Fattah el-Sisi’s public relations department. Like Qatar’s efforts to use its position as host of the FIFA World Cup this winter to better its image on the international stage, Egypt’s plans have backfired.

The video that opened the ceremony – complete with cheering children, highly saturated shots of beautiful Egyptian coastlines, and a smiling cast of happy-go-lucky characters welcoming delegates to the country – was more a tourism advertisement than a call to action. 

And the sight of President Sisi cheering as the screen faded to black was eerie to any observer aware of the subtext behind the choreography: Egypt is, by any metric, a police state.

Cop27
Scenes from the opening video played before President Sisi’s speech.

Ten years after the revolution in Tahrir Square, Reporters Without Borders (RSF) ranked Egypt 166th out of 180 countries in its World Press Freedom Index. Since Sisi took power in 2013, over 100 journalists have been imprisoned.

“Abdel Fattah el-Sisi’s government has muzzled the country’s journalists and media,” said Sabrina Bennoui, the head of RSF’s Middle East desk. “Journalists can no longer say what they think and have no choice but to repeat the official line or risk being jailed for threatening the state’s stability.”

Sisi’s government moved to release dozens of high-profile political prisoners ahead of COP27 in an attempt to soften its image. But 19 journalists remain behind bars – making Egypt one of the world’s biggest jailers of journalists. And the fate of one activist, the British-Egyptian blogger Alaa Abdel Fattah who on Sunday racheted up his prolonged hunger strike, has focused the international spotlight on the human rights issue.

No word on Alaa, King Charles address mysteriously scrapped

Alaa
Alaa Abd El-Fatah speaking to Al Jazeera in 2011 amid the uprising against the government of Hosni Mubarak.

Abd El Fattah rose to prominence as one of the faces of Egypt’s 2011 uprising. After Sisi came to power, he became a vocal critic of the regime’s use of military trials for civilians taking part in protests or speaking out against the government. Today, military trials for civilians continue to be allowed under Egypt’s 2014 Constitution.

He is currently serving a sentence handed down in 2019 for “joining a terrorist group” and “spreading fake news” in a manner threatening to national security. Human rights lawyer Mohamed al-Baqer, who represented Abd El Fattah, was prosecuted as part of the same case after authorities detained him when he showed up to represent his client. 

“After Sisi came to power, the whole country was forced to shut up,” Sanaa Seif, Abd El Fattah’s younger sister and three time political prisoner told the European Parliament’s sub-committee on Human Rights in the run up to COP27. “As an Egyptian there is no way, not in my wildest dreams, that I could imagine a local climate activist raising concerns at COP27. Not because they wouldn’t want to, but because they can’t.”

Alaa
Alaa’s two sisters, Mona and Sanaa, stage a protest for his release outside the British Foreign Office in London.

Abd El Fattah has been on hunger strike since April and began refusing water on Sunday as the curtains lifted on COP27. Without food or water, he is expected to be able to survive just a few days. 

“The only reason I am able to address these concerns is firstly because we are not having this conversation in Egypt, and secondly because I am already doomed with the label of human rights activist,” Ms. Seif told the Parliament. “I have served three prison sentences and my brother is in jail, I have nothing to lose.”

Given the hunger striker´s British citizenship, the question of whether King Charles, who was slated to speak via video address, would bring up Abd El Fattah’s case loomed large over the opening ceremony.

But despite being listed as one of the key speakers, no speech by the British monarch was screened. Who made the decision to postpone or axe King Charles’s comments – or whether the King or Prime Minister Rishi Sunak might still address the COP27 in tomorrow´s high-level segment – remains unclear. 

Well-aware of the dangers to her own freedom, Ms. Seif arrived in Egypt on Sunday night. “I am here to shed light on my brother’s case and save him,” she told a sea of cameras as she reached the conference grounds. “Today he took his last glass of water, so it’s now a matter of hours.”

Sharm El-Sheikh as a symbol: no room for civil society

Sharm el-Sheikh
Sharm El-Sheikh has long been used by the Egyptian elite to escape public scrutiny due to its isolated location.

The history of Sharm El-Sheikh is emblematic of the contradictions underpinning Egypt’s hosting of COP27. The purpose built resort town is a six-hour drive from the 22 million citizens of Cairo, and its isolated location allows Egyptian authorities to tightly control who can get close to, let alone enter, the site of the conference. 

In the week leading up to the COP27, authorities detained an Indian climate activist walking from the capital to Sharm El-Sheikh for holding a banner that said “March For Our Planet”. He and his lawyer were released some 24-hours later, but the story reflects the value of Sharm el-Sheikh’s fortress-like status in quelling official’s fears over potential civil society demonstrations around the conference. 

“Every Egyptian you will meet in Sharm El-Sheikh will be vetted or intimidated beforehand,” Seif told the European Parliament. “You need to have that in mind while going to COP27.”

When former Egyptian president Hosni Mubarak was forced to flee the uprisings of Tahrir Square in 2011, he came to his residence in Sharm El-Sheikh. When president Sisi announced plans to build “New Cairo”, a gated satellite capital in the desert outside Cairo, he issued the declaration from the very convention center currently packed with climate dignitaries. 

Over 2 millions protesting in Tahrir Square after Mubarak’s speech saying that he would not step down, February 11th, 2001.

“Sharm El-Sheikh is a dream resort where the government can exclude the majority of Egyptians, and invest huge amounts of resources to ensure that everything is under surveillance and their control,” Hussein Baoumi of Amnesty International told the Guardian. “It’s telling how the Egyptian presidency and the leadership view their ideal society, it’s a gated one without the masses.”

In response to international diplomatic pressure, a designated protest area was constructed alongside a highway far from the conference center. Without the presence of civil society, it will be up to heads of state and negotiators to remember what is at stake. 

“You cannot shy away from addressing the human rights crisis with the excuse that you are going to COP27 to talk about climate,” Ms. Seif concluded as she held back tears during her appearance before the European Parliament.

“The climate crisis is not about the planet, the planet will outlive us all. The climate crisis is about life on the planet. And if you are serious about caring for the planet, you need to push for human rights.”

Image Credits: Gigi Ibrahim, Alisdare Hickson, Rutger van der Maar, Jonathan Rashad.

In 1918, when the notorious Spanish flu started to sweep through the world, there was very little physicians could do to help those infected. A century later, things have radically changed.

This is partially due to a network of laboratories in dozens of countries that for the past 70 years have been collaborating to fight influenza.

“After the Second World War, there were efforts to try and build up virological surveillance on the viruses that were out there to see if it was possible to build up a global picture of what the virus is, instead of just counting influenza deaths,” Professor John McCauley says during the latest episode of the “Global Health Matters” podcast with host Garry Aslanyan.

McCauley is the director of the Worldwide Influenza Centre at the Francis Crick Institute in the United Kingdom. He joines Aslanyan together with Professor Mahmudur Rahman, former director of the Institute of Epidemiology, Disease Control and Research and the National Influenza Centre in Bangladesh.

The episode was produced in partnership with the World Health Organization’s Global Influenza Surveillance and Response System, also known by its acronym, GISRS, to celebrate its 70th anniversary.

“Annually, around a billion people get seasonal influenza, and the threat of a pandemic is always lurking on the horizon as viruses keep evolving,” says Aslanyan. “To safeguard and protect us from these public health threats, year-round surveillance is being conducted by GISRS.”

In the late 1940s, the network included only 20 to 30 laboratories. Today it has grown to include some 150 labs in 127 countries.

GISRS’ work has also had a deep impact on how individual countries have been carrying out surveillance against the flu.

Rahman shares the experience of Bangladesh.

“We developed our laboratory so that we can also have a look into the circulating influenza virus, and what is happening in the country,” he explains. “After that, we set up 12 centre sites across the country, and we were collecting data on a regular basis to understand what was happening.”

This allowed Bangladesh to appreciate how its influenza season is different from those of other countries.

“Over the years we have developed our capacity with the support of business and CDC,” he adds. “When COVID came in, we could easily and quickly diagnose COVID also in this country very quickly in our laboratory.”

According to McCauley, it is crucial to remember that influenza is a global threat and therefore international collaboration is essential.

“What we are looking at is a global threat, and so what we need to do is build up a global picture,” he says. “It is not isolated events, these events are linked because flu spreads really quickly. And so when you get a flu virus establishing in one place, basically, we’ve seen it time and again, within a year that virus has gone all around the world.”

Listen to previous episodes on the Health Policy website >>
Learn more about “Global Health Matters”>>

Image Credits: TDR.

COP 27
On 21 September 2022 people wait in the midday sun for the water troughs to fill with water at Hula Hula Springs in Marsabit County, Kenya. With the ongoing drought in Marsabit, the spring is the only available water source for the whole community.

Sharm El Sheikh, Egypt – Over 120 heads of state are expected to attend this year´s UN Climate Conference (COP 27), which begins Sunday, raising hopes that global leaders will at least give a nod to the most existential crisis facing humanity by bothering to attend in person.

But in a world paralyzed by the Ukraine war, inflation and deep North-South divides, the chances of bold climate action continue to be appear grim – even as the warnings of climate catastrophe and real life damages incurred in human lives, livelihoods and health continue to increase exponentially.

The hard decisions on the COP27 table include demands from developing countries for formal recognition of the rising toll of “loss and damage” sustained by their economies due to climate events fueled by decades emissions they had little to do with.

Rich countries will also face calls from low- and middle-income countries to commit trillions more dollars in climate finance – a sentiment echoed by multiple recent UN reports – to assure their green transition. But they are yet to even reach the $100 billion annually in support for the green climate fund goal agreed to in the 2015 Paris Climate Agreement.

Only 26 countries have made new climate mitigation commitments since the 2021 Glasgow Climate Conference (COP26), a testimony to the lack of ambition displayed by the international community at a time when experts warn the possibility of keeping warming to 1.5 C is increasingly distant –  or perhaps impossible.

Neither China´s President, Xi Jinping, head of the state of the world´s second largest emitter, nor Indian Prime Minister Narendra Modi – who forced a last minute change to the language of the Glasgow COP26 outcome statement from a “phase out” to “phase down” of fossil fuels – are expected to attend, admitted Egyptian Ambassador Wael Aboulmagd, special advisor to the incoming COP presidency in a press briefing Friday morning.

Russia´s Vladimir Putin, whose war in Ukraine has exacerbated the climate impacts of a global food crisis, is preoccupied. Besides, his country is perhaps the only one that stands to win the climate crisis.

Agenda on opening day could be first point of dispute 

Cop 27
Wael Aboulmagd, Special Advisor to the incoming COP presidency speaking at a press briefing Friday.

The deep discord could already surface in opening day talks on Sunday, when an agenda for the 12 days-long meeting will need to be approved. This will require broad agreement with developing country demands to at least convene formal negotiating sessions on provisions for loss-and-damage compensation, as well as negotiations over a ¨just energy transition¨ – code words for continued fossil fuel development in the global South.

Speaking at a press briefing Friday, Aboulmagd said he hoped the agenda be quickly finalized thanks to the ongoing intensive talks between COP parties this weekend.

He urged rivals like the United States and China to put aside their bilateral tensions, and countries more generally to ¨rise to the occasion¨ by aligning technical negotiating positions with public statements.

¨The threat is real, none of this is about getting a few gains out of a negotiated text, it is about real lives that are being lost,¨ said Aboulmagd. “We cannot continue on a path where pledges are made in front of cameras and then in the negotiating groups, we are back to an adversarial approach.”

The world is at a tipping point, and Egypt hopes to be the unlikely hero to mediate conversations between world leaders to set the world on track to a climate recovery.

“The urgency, the gravity of the challenge necessitates that we all show a spirit of compromise, show a little more empathy and understanding of the predicament of the other,” Aboulmagd said. ¨Only when we do that and rise literally to the occasion that is before us, will we be able to meet the climate challenge.¨

In an appeal to COP members issued Sunday morning, WHO called for quick action on phase out on fossil fuels, including a “fossil fuel nonproliferation treaty.”

Egypt poised to play its role

COp27
COP27 will be held from 6 to 18 November 2022 in Sharm El Sheikh, Egypt.

If Egypt is facing criticism of its human rights record, it also has the unenviable task of bringing the very disparate and, in some cases, warring parties together.

But as the third most populous country in Africa and the biggest country in the Arab world, Cairo also has the potential to play a pivotal role in the talks, based on its record as an able player in regional and global diplomacy.

Official statements in the lead up to this year´s COP have underlined that Egypt wants to push ¨win-win¨ achievements and practical implementation plans.

Aboulmagd stressed Cairo´s support for developing countries´ demands, as expressed recently by the G-7, to finally tackle the mounting losses that poor countries are facing due to climate-related weather extremes.

He also reiterated a point made by the United Nation’s Environmental Agency (UNEP)  ‘Adaptation Gap’ report released yesterday: climate finance needs increase from billions to ¨trillions¨ if developing countries are to afford the shift to more sustainable energy sources.

¨100 billion is not going to even come close to address actual needs,¨ Aboulmagd said. ¨The overall finance landscape has to be revisited.”

Stinging series of UN reports set the stage for COP 27 

UNEP
Inadequate progress on climate action makes rapid transformation of societies only option, the UNEP’s Emissions Gap report found.

The start of the conference follows the release of a series of gloomy reports about the world´s current warming trajectory. The UNEP ‘Emissions Gap’ report found that the world has both “no credible pathway to 1.5 C”, and is on track for warming of 2.8 C if current policies persist.

And Egyptian officials have concurred with UN assessments that the aim of keeping warming to 1.5 C is ´more fragile than ever.´

Without a ¨historic pact¨ between rich and poor countries, the planet is ¨doomed¨ to experience the worst of the climate crisis,¨ warned UN Secretary General Antonio Guterres on Friday. His remarks were the latest in a string of stark warnings on the crisis, which world leaders have so far largely ignored.

“There is no way we can avoid a catastrophic situation, if the two [the developed and developing world] are not able to establish a historic pact,” he told the Guardian in an interview. “Because at the present level, we will be doomed.”

Historic levels of climate-related crises in Horn of Africa in 2022

The Secretary General´s warnings were echoed by WHO officials in a series of statements this week.

In the Greater Horn of Africa, disease outbreaks and climate-related health emergencies are at their highest-ever level this century, WHO´s African Regional Office warned on Thursday.

Most of the region is battling its worst droughts in at least 40 years, with an unprecedented fifth rainy season failure now anticipated. And countries spared from drought face flooding and conflict, and 47 million people already facing acute hunger.

“Climate change is having an impact here and now on the health of Africans in the greater Horn of Africa. The failure of four consecutive rainy seasons has scorched the earth and pushed people out of their homes in search of food and water,” said Matshidiso Moeti, Regional Director for Africa of the situation of the seven countries that make-up the greater Horn of Africa region.

“It is critical that world leaders reach agreement on stemming the rise in temperatures at the 27th United Nations Climate Change conference (COP27) which is very appropriately taking place in Africa,” she said. “As a continent we are the least responsible for global warming, but among the first to experience its tragic impact.”

The WHO analysis of the seven countries – Djibouti, Ethiopia, Kenya, Somalia, South Sudan, Sudan and Uganda – recorded 39 disease outbreaks. These included anthrax, measles, cholera, yellow fever, chikungunya, meningitis, and other infectious diseases, compounding the toll exacted by the droughts, flooding and other disasters that have struck this year.

Millions of children under the age of five in the region are estimated to be facing acute malnutrition, increasing their risk of not only starvation, but also of more severe outcomes from common childhood diseases, the WHO analysis reported.

Horn of Africa is just a taste of what is happening globally

June floods in Pakistan killed 1,717. The health impacts of the devastation are still unfolding.

And these figures are just a glimpse of the global situation, WHO´s Maria Neira and Diarmid Campbell-Lendrum noted at a Thursday Geneva press conference focused on health and climate.

“In Pakistan the floods affected about 33 million people, but also impacted about 1500 health centers,” Campbell-Lendrum said. “Climate change and extreme weather are actually destroying our capacity to protect people from their impacts.”

Policymakers have yet to pay serious attention to the slower-moving increases in extreme heat exposures for older people and outdoor workers. Heat extremes are changing patterns of vector-borne diseases, impacting mental health, and providing fertile ground for noncommunicable disease conditions triggered and exacerbated by air pollution from fossil fuel emissions to develop. The air pollution question is one that WHO as well as climate and health experts around the world have documented over and again.

Climate change also is affecting water access and food security. As the important natural water reservoirs for countries from the Himalayas to Europe contained in glaciers melt, and once fertile ground across Latin America and Africa becomes unlivable, the health consequences project to be as extreme as the climates that catalyze them.

“A few years ago, WHO estimated that we would be experiencing a minimum of 250,000 additional deaths from climate change by the 2030s,” Campbell-Lendrum said. “Everything that we’re now observing in the real world suggest that those impacts we will either hit that number, or exceed it.”

Health consequences grabbing more attention – but not enough in core negotiations  

Cop 27
With 11 thematic days on the schedule, none are reserved to discuss the impacts of climate on health.

While the health impacts of climate extremes have started to grab more headlines, it has not been enough to place health at the center of COP27 talks. The WHO has its own pavilion, but as in previous years, official talks will continue to be dominated by climate conversations driven by energy, environment and foreign ministers, as well as heads of state.

This year´s COP conference will feature the most extensive centering of health in its discussions, but the bar was low: the word ´health´´ was not even mentioned in the final outcome document of Glasgow. And with no dedicated thematic day, health continues to rank outside of the key issues of finance, youth, science, agriculture and other topics.

“Governments still sometimes think that climate action competes with saving money and other priorities”, Campbell-Lendrum said. “In many cases, I don’t think it is that government’s don’t care, but that they don’t realise health does not compete with these priories, it reinforces them.”

The case of fossil fuels, renewable energy and air pollution

Cop 27
Dr Diarmid Campbell-Lendrum, Head of the Climate Change and Health Unit at WHO, speaking at a press conference on Thursday.

As one case in point, the war in Ukraine has led to a renewed push for more fossil fuel development, particularly in Africa, as energy ministers in rich countries scramble to make up for shortfalls left by sanctions on Russian oil and gas.

At the same time, the lack of metrics to quantify the health impacts of fossil fuel use in climate and carbon accountancy means that the real costs of fossil fuels, including some $5.9 trillion annually on fossil fuel subsidies and dependency continue to be drastically undercounted.

Those costs include not only 7 million lives lost to air pollution every year, but also related healthcare costs and loss of economic productivity.

¨The most common objection to taking climate action up until now is the idea that it costs us money, that it’s too expensive to protect the global climate,¨ Campbell-Lendrum pointed out. ¨That never made much sense. And it makes even less sense now as we’ve seen the prices of fossil fuel energy spike around the world to the extent that in Europe, at least gas is about nine times more expensive than renewable energy.

Solar energy, now the cheapest energy in history, Campbell-Lendrum remarked, is a quintessential example of how progress on health can go hand-in-hand with financial savings.

“Solar is the healthiest form of energy because it doesn’t produce the air pollution that currently causes about one death every five seconds,” he explained. “This has started to raise awareness around the world that there are many reasons why we should get off our addiction to fossil fuels: they are killing us through air pollution, killing the planet, and draining our financial resources.”

Costs of investments to transition nothing compared to benefits

WHO
Dr Maria Neira, Director of Environment, Climate Change and Health at WHO providing closing remarks to Thursday’s press conference.

¨If we are able to transition to renewable sources of energy, the cost of the investment you need at the beginning will be nothing compared with the benefit that we will obtain in terms of health and the cost for the health system,” Dr Maria Neira, director of WHO´s Department of Environment, Climate and Health said in concluding Thursday’s press conference.

“Reducing the reliance on fossil fuels will decrease the mortality and morbidities caused by air pollution. That means reducing asthma, lung cancer and other chronic pulmonary disease cases. It means reducing strokes. These are directly linked to exposure to the pollution resulting from the combustion of fossil fuels,¨ she pointed out.

Cutting carbon emissions will also provide benefits in tackling food insecurity, water- and vector-borne disease spread, and reducing health care costs, Neira continued. For every $1 invested in renewables, they generate four times more than fossil fuels in terms of jobs. 

“There are so many wins we can obtain by doing just one thing: cutting carbon emissions,” Neira concluded. “The question is why we are not doing more.”

Image Credits: WHO Africa, OXFAM.

Ebola
Health workers at the Madudu Health Center meet with Mohamed Fall, UNICEF Regional Director for Eastern & Southern Africa.

On Friday, the Ebola taskforce of Kassanda district in Uganda delivered the remains of four people that succumbed to the the virus for burial to their home village of Kitongo.

Three of the bodies belong to family members who died from exposure to the virus after they exhumed a loved one they had lost to Ebola the week before so they could rebury the body based on local religious traditions.

Authorities insist the outbreak is under control. But despite its relatively limited spread, the deadly Sudan strain of Ebola continues to take a tragic toll on villages and families around the country – because there is currently no authorized vaccine against that particular Ebola virus strain.

However, the World Health Organization (WHO), Uganda and a number of other international partners have announced plans to launch clinical trials of several promising vaccine candidates, in an effort to halt the deadly outbreak. 

The trials will be conducted with the support of Uganda´s Makarere University, as well as with Coalition for Epidemic Preparedness Innovation (CEPI) and the Vaccine Alliance (GAVI), the partners said in a joint statement.

Embedding research into outbreak response

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

¨The Ministry of Health has designated the Makerere University Lung Institute to conduct vaccine and therapeutics clinical trials. A Principal investigator from Makerere University Lung Institute will lead the vaccine trial.¨

WHO, CEPI and Gavi are providing support to ensure that sufficient doses of candidate vaccines are available for the trial and beyond, the statemend added. ¨The aim of the vaccine trial would be to establish how effective the candidate vaccines are in diverse populations.¨

The vaccine candidates are being made available through the University of Oxford and the Serum Institute of India, the Sabin Vaccine Institute and the US government institutions Biomedical Advanced Research and Development Authority (BARDA) and National Institutes of Health (NIH), as well as International AIDS Vaccine Initiative (IAVI) and MSD, the statement added.

Outbreak has spread to the capital

Following the declaration of the outbreak in the country on 20 September, the virus has spread to seven districts, including the Ugandan capital of Kampala, thereby increasing the risks of further spread within the country and across borders. The Ministry of Health has confirmed 131 cases, 56 recoveries, and 48 deaths to date.

There is currently no known vaccine for the Sudan strain of Ebola – and thus the outbreak represents a window of opportunity to bridge that gap.  A similar strategy was tested in the deadly outbreaks of the Zaire strain of Ebola that ripped through West Africa in 2014-2016, followed by an outbreak in the Democratic Republic of Congo in 2018-2020.  In both cases, the deployment of vaccine candidates, which ultimately were approved by regulatory agencies, eventually helped squash the outbreaks.  

“We are doing what we can with experimental options, and there are vaccines in clinical trials that we hope to deploy soon,” Dr Henry Kyobe Bosa, national incident manager for Ebola for Uganda’s Ministry of Health wrote in the New York Times on Thursday. “This outbreak is a test of how much faster we can secure vaccine access this time around [compared to the early days of COVID-19], and groups like CEPI and the WHO are helping us get that early access.”

Goals of intervention: immediate impact with an eye on the future 

Ebola
Ugandan Health Minister Dr. Jane Ruth Aceng visits a proposed site to construct an isolation facility in Kassanda District.

Ebola has a fatality rate of up to 90%, making immediate support in areas like contact tracing key to limiting the damage caused by the virus.

WHO has already helped the Ministry of Health train and deploy over 300 contact tracers, who have contributed to a rise in the success rate of contact tracing from 25% at the start of the outbreak, to nearly 94% in recent days, WHO said.

“Today there is an outbreak in Uganda. Tomorrow it could be somewhere else,” Bosa said. “After the last major Ebola outbreak in West Africa, the world began to undertake changes to ensure it wouldn’t happen again, but then moved on. We need to finish the job this time.”

Image Credits: UNICEF, Uganda Ministry of Health .

Africa only produces 1% of the vaccines it uses.

Gavi, the global vaccine alliance, has undertaken to adapt its approach to procuring vaccines in order to support African vaccine manufacturing.

In a plan released on Thursday, Gavi has committed to placing “a higher value on the benefits of diversification to supply security, with a focus on Africa”.

The 10-point plan, developed in consultation with the African Union and other key partners, also allocates responsibilities to other key players – G7 Development Ministers, African countries, international partners including development financial institutions, and the private sector – to support sustainable African manufacturing capacity.

However, Gavi will drive and coordinate the plan, given its enormous clout as the world’s biggest buyer of vaccines.

“For 22 years, as the largest buyer of vaccines in the world, Gavi has worked closely with African countries and manufacturers to favourably shape the market for essential routine and outbreak vaccines,” said Gavi CEO Dr Seth Berkley. 

“Gavi is committed to contributing to the AU’s vision. The plan published today provides a pathway to ensuring vaccine supply security for Africa during pandemics and expanding access to other life-saving vaccines at sustainable, affordable prices.”

The COVID-19 pandemic exposed Africa’s vulnerability when the entire continent was unable to get vaccines for months as wealthy countries had bought up all the doses made by Pfizer and Moderna and India stopped the export of generic vaccines made by the Serum Institute of India destined for the continent.

Stung by the COVID-19 experience, the AU has set a target to produce and supply more than 60% of its vaccine doses on the continent by 2040 – it currently supplies 1%. 

Although Africa consumes vaccines valued at over $1 billion every year, the cost of much of this is carried by Gavi, UNICEF and donors.

At present, Gavi chooses vaccine suppliers on price, and “does not systematically permit the accommodation of higher prices in the name of geographical diversity and supply security”, it acknowledged. 

“New accommodations in the way Gavi assesses products against supply security as a new market health objective, could have a substantial impact,” it acknowledges. 

The risk of supporting more expensive African-made vaccines could be mitigated by countries committing upfront to vaccines which would enable “predictable pooled procurement volumes”. 

African countries themselves also need to “send clear demand signals to the market on willingness to select and procure from African suppliers”.

“In the last 18 months alone, more than 30 new African manufacturing projects have been announced and estimates indicate that the African vaccine market across all existing and projected novel products could range between US$ 2.8 billion and US$ 5.6 billion by 2040, demonstrating the potential for a thriving regional industry to emerge,” according to Gavi.

However, the report also acknowledges that “a disorderly expansion risks unhealthy competition, potentially undermining the impact of market-shaping initiatives that have delivered low vaccine prices to lower-income nations, while also failing to realise Africa’s manufacturing aspirations”. 

It calls for a  “business model” that “actively shapes markets in support of the AU’s vision: meeting the mutually reinforcing objectives of continued global market health, and a sustainable regional manufacturing sector”.

Nonetheless, the price of setting up new manufacturing facilities in Africa may mean that their products are way too expensive to be viable.

“Modelling indicates that price differentials for new entrants may be in excess of levels that could be accommodated during standard Gavi/UNICEF competitive tenders, without impact on programme coverage,” Gavi warns.

“Ways must be found to support new entrants, whilst at the same time, avoiding a situation in which incumbent manufacturers increase their prices for vaccines due to lost volumes. This carries a potential risk of increasing the costs of immunisation worldwide.”

To address the high cost for new entrants, the plan proposes “a time-limited financial instrument that can help mitigate the high cost of vaccine production at market entry”. 

It also advocates that this financial instrument supports African manufacturers to make the most commercially viable antigen-based vaccines – starting with cholera and Ebola.

For their part, African countries are tasked with accelerating investment in the enabling environment, including “strong regulatory authorities, robust supply chains, skilled human capital, reduced trade barriers and empowered regional coordination”.

Image Credits: Gavi/Karel Prinsloo 2017.

Roast chicken vendors prepare their meals in Dar es Salaam                                                             

DAR ES SALAAM, Tanzania—At a smoky kitchen in the port city of Dar es Salaam, none of the customers jostling to place their orders knows that the irresistibly tasty roast chicken may be harbouring bacteria that could make them sick.

“I don’t think poultry farmers would do anything likely to cause harm,” said 34-year-old Lilian Kiswale a regular customer at this popular fast-food joint.

However, what is not clear to Kiswale, is that strains of bacteria that are resistant to antibiotics have repeatedly been found in chickens at farms where city’s street kitchens source their poultry products.

“None of our customers has ever complained about the smell of antibiotics in the food we have prepared,” said Kelvin Massawe who works as a chef at the chicken restaurant that is a culinary delight in the neighbourhood. 

But it’s not about antibiotics ruining the taste of roast chicken. The antibiotic-laced food that poultry farmers in Tanzania give to their birds, ostensibly to increase muscle weight quickly and keep infections at bay, poses a threat to humans as well.

According to a recent study by Tanzania’s Muhimbili University of Health and Allied Sciences (MUHAS), excessive amounts of antibiotic residue had been found in broiler chicken tissues – a perfect condition for antimicrobial resistance (AMR).

Using the liver samples of 84 commercial broiler chickens, the researchers found that 100% had the antibiotic tetracycline – and 90% at levels that exceeded acceptable daily limits. In addition, 21.4% of the samples also had sulphonamide, although this was within the maximum limit, according to the study, which was published in the journal, Antibiotics.

Worse still, researchers say that poultry farmers have unrestricted access to prescription-only antibiotics including tetracycline, sulphonamides, penicillin, aminoglycosides and macrolides.

Shop owner Jesca Anthony confirms that she sells antibiotics to farmers without prescription

This was confirmed by shop owner Jesca Anthony, who said that she sells antibiotics, without prescriptions to farmers.

“Random use of antibiotics in animal feeds heighten the risk of drug resistance not just to animals but in humans as well,” Professor Mecky Matee, head of microbiology at MUHAS and the study’s lead author, told Health Policy Watch.

“The use of antibiotics as growth promoters for chicken should be banned,” Matee stressed.

Antibiotics are losing their power

When an antibiotic is used, it wipes out susceptible bacteria, leaving behind resistant ones. These resistant bacteria can grow and become dominant, and pass from chicken products to humans who eat or handle the meat. Once inside a person, these resistant bacteria can take over the colon, which is then unable to fight infections.

Antibiotics are increasingly losing their efficacy due to indiscriminate use in humans and for stimulating animal and birds’ growth.

The rise in drug-resistant bacteria has the potential to inflict a devastating human and economic toll globally, according to the United Nations.

According to the most comprehensive estimate of the global impact of antimicrobial resistance (AMR), published in The Lancet in January 2022, an estimated 1.2 million people died in 2019 from antibiotic-resistant bacterial infections – more deaths than those from HIV/AIDS or malaria.

“Many types of common antibiotics are no longer effective enough to treat bacteria, in many cases patients need hospitalisation,” said Hellen Sabuka, a senior epidemiologist at Shree Hindul Mandal Hospital in Dar es Salaam.

Sabuka urged Tanzania’s health authorities to adopt strict regulations and control on the use of antibiotics in animal production.

A customer at the Tegeta slaughter house

Although Tanzania has policies and guidelines for the use of antibiotics in animal feed, such policies are poorly enforced due to weak systems for food and agricultural productions.

In Dar es Salaam, one of Africa’s fastest-growing cities and home to 5.8 million inhabitants, poultry farmers routinely mix an array of human antibiotics into chicken feed to try to ensure they grow faster and don’t get sick.

It is a humid Sunday evening at Kibamba, a suburb in the western part of Dar es Salaam, and Salma Libuhi is busy mixing a concoction of medicines into rice husks to feed her caged chickens.

Amid smouldering heat, she methodically mixes in a cocktail of three antibiotics— oxytetracycline, doxycycline and enrofloxacin – and sets the food in cans.

“When they eat this food, they grow faster,” she told Health Policy Watch. For the 38-year-old mother of four, poultry farming is her livelihood. In 2017, quit her job as a teacher and ventured into entrepreneurship.

“Raising chicken is very profitable,” she said.

To educate herself about animal husbandry, Libuhi joined a whatsapp groups where she gets all the information about diseases and antibiotics.

“I never consulted a vet. The information I get from the group is enough,” she said.

 At Libuhi’s farm, broiler chickens usually take six weeks to reach market weight. Once they’ve reached the proper size and weight she catches each chicken by hand and transfers them to holding cages ready to be sold.

Unlike wild chickens that traverse a range of habitats as they forage for seeds, insects and fresh leaves, broiler chicken are often kept in overcrowded, poorly ventilated and unhygienic shacks.

Lack of controls in Africa

Across Africa, antibiotics are heavily in the farming of cows, pigs and chickens to fight infections and promote growth. With the indiscriminate use of antibiotics, particularly in agriculture for stimulating animal and birds’ growth, these essential medicines are losing their efficacy.

“Many types of common antibiotics are no longer effective enough to treat bacteria, in many cases patients need hospitalisation,” said Hellen Sabuka, a senior epidemiologist at Shree Hindul Mandal Hospital in Dar es Salaam.

Sabuka urged Tanzania’s health authorities to adopt strict regulations and control on the use of antibiotics in animal production.

While over-use of antibiotics as growth promoters is not a new phenomenon, global experts think preventing drug-resistant bacteria that kill millions of people every year, requires a coordinated approach.

Mohan P. Joshi, technical lead for antimicrobial resistance and global health security at the non-profit, Management Sciences for Health, said the overuse of antimicrobials in animals, especially as growth-promoters in food-producing animals, is common in many countries.

 “In some countries, the proportion [of antibiotics] used in the animal sector is as high as 80% of the total antimicrobials consumed. Alternatives such as good animal husbandry, vaccinations, and biosecurity measures including hygienic practices are critical farming approaches that can help reduce antimicrobial use in animals raised for food,” he said.

While 144 countries have national plans to combat AMR, according to a 2021 World Health Organization (WHO)  report, Joshi says sectors differ in the amount of progress they’ve made, with the human health sector generally making the most progress and the animal sector lagging.

“We need collaborative, multisectoral coordination to address public health threats at the intersection of humans, animals, and the environment. A One Health-focused approach is the only way to effectively address this widespread issue,” Joshi said.

According to him, the fight against AMR needs coordinating bodies with adequate funding, political support and authority to act.

“Countries need to establish functional multi-sectoral task forces to contain AMR that include high-level government officials and stakeholders from both human and animal health, along with the agricultural, environmental and food sectors, and ensure that such bodies are effectively facilitating One Health coordination, helping build capacities of local stakeholders, and mobilising diversified funding,” he said

In 2019, five million human infections were associated with bacterial antimicrobial resistance worldwide, including more than 1.2 million human deaths attributable to bacterial AMR. The burden was highest in sub-Saharan Africa and South Asia, with children below five years of age the most affected.

Pushed by the rising demand for cheap poultry products, the broiler value chain in Tanzania, is a big user of antibiotics. Most poultry farmers in Tanzania treat chicken with a concoction of antibiotics often without consulting veterinary doctors.

Despite the growing adversity, global experts are cautiously optimistic about prescription-only system where veterinarians will have the upper hand in dispensing drugs used in animal production.

Chicken dealers waiting for customers at Tegeta slaughter house.

Thomas Van Boeckel, from the public research university, Zurich ETH, said the best way to curb antibiotic use in animals is to move to a prescription only –system where only trained veterinarian would be authorized to sell the antibiotics rather than retail shop owners.

“However, even in Switzerland where such a system is in place, this does not resolve all problems because vets may still have a financial conflict of interest in prescribing for profit,” Boeckel said.

He says that a better solution would be to “remove the profit margin from vets on drug prescription,” as is the case in Sweden.

Meanwhile, Emma Berntman, senior engagement specialist at FAIRR initiative, said low and middle-income countries, including Tanzania have the largest share of global antimicrobial consumption in animals and agriculture, due to the routine use of antimicrobials in farming for growth promotion and prophylaxis.

She blamed the countries’ lack of checks and balances and low awareness on overuse of antibiotics.

“Tanzania is no exception to this. The country lacks regulation that is sufficient to adequately address the issue of excessive antimicrobial use and antibiotic are cheap and widely available,” said Berntman. FAIRR is an investor-run initiative to address threats to the global food supply.

According to her, even when regulation exists in the emerging market, it can be hard to enforce when there is a lack of access to veterinarians and poor awareness of the impacts of overusing antibiotics.

“On-the-ground initiatives are needed to help support farmers to reduce their dependence on these drugs,” she stressed.

Growing appeal of organic products

Although Switzerland launched an AMR strategy in 2015, FAIRR experts say the highest priority critically important antibiotics (HPCIAs) including fluoroquinolones, are still excessively used in farms, notably in broiler production, with authorities warning of high levels of resistance.

“These antibiotics are deemed ‘the last line of defence’ in human medicine and are the only antibiotics available to treat certain bacterial infection. If they become ineffective, it poses a significant threat to human health,” Berntman said.

“Resistant bacteria developed in broilers can spread to humans through direct contact with the birds, eating chicken or via the environment. There is also a risk to flock health due to the reduced efficacy of antimicrobials used to treat them.”

Despite the growing threat, experts see glimmer of hope in reducing the use of antibiotics in broiler farms and other antibiotics used in human medicines.

“The government can support reductions by further restricting the use of antibiotics in animals in line with the latest EU regulations, so that antibiotics can only be used to treat infections and routine use is prevented,” Berntman said.

Moreover, Berntman said the government can facilitate antibiotic stewardship activities to support the adoption of alternatives to antimicrobials including vaccination programmes and improved nutrition.

According to Berntman the rising awareness of the risk of AMR in Europe and North America has triggered a surge in demand for products associated with or lower antibiotic use.

“Many consumers are willing to pay a price premium to purchase organic chicken or chicken raised without antibiotics,” she said.

Approximately 60% of broilers in the US are now raised without antibiotics, according to Berntman. Moreover, the number of broiler chicks receiving antibiotics in the hatchery has dropped by 90% to nearly zero.

 “It is important that poultry producers improve animal welfare, vaccinate their flocks, and implement routine health monitoring programmes to meet consumer demand for broilers raised with less or no antibiotics while simultaneously creating environments where healthy flocks can be raised no antimicrobials required without impacting animal welfare,” Berntman said.

But for chicken lovers in Dar es Salaam, antibiotic-free roast chicken meat is probably a distant dream.

Image Credits: Peter Mgongo.