Severe air pollution in Anyang, China in January 2022.

Ahead of the global climate talks in Egypt, the World Health Organization (WHO) has urged governments to expedite fossil fuel phase out and transition into clean energy. 

“Climate change is already impacting health in many ways, through more frequent and extreme weather events, more disease outbreaks, and more mental health issues,” Dr Tedros Adhanom Ghebreysus, the director-general of WHO said in a press briefing on Wednesday. 

Flagging the impact of climate change on various aspects of human life, including diseases and malnutrition, Dr Tedros called for governments “to lead a just, equitable and fast phase-out of fossil fuels and transition to a clean energy future”.

The 27th United Nations Climate Change Conference (COP27) will take place in Sharm el-Sheikh, Egypt from 6 to 18 November. At the conference, world leaders are expected to assess the progress in limiting global warming to 1.5 º Celsius above the pre-industrial levels. 

“Meeting that target will have massive benefits for human health. Failing to meet it comes with massive risks,” Dr Tedros warned. 

Impact of climate change on food security

Martin Griffiths, the UN Office for the Coordination of Humanitarian Affairs (OCHA), told the briefing that the world is in the grip of hunger crisis and that the pandemic and vast inequality are partly to blame.  

Listing the different crises happening across the world – the drought in the Horn of Africa, Somalia and Kenya, the floods in Pakistan, the civil war in Tigray, Ethiopia – the OCHA chief called for immediate action to control global warming. 

“This is the world at 1.2º Celsius [above pre-industrial levels]. But we’re on track to double that. And unless we act now, we’re heading for a future full of droughts, diseases and climate disasters across the whole world,” he added. 

In 2009 at the Copenhagen Summit, G20 countries pledged that they will channel $100 billion a year to less wealthy countries to mitigate the effects of climate change. Referring to this promise, Griffiths pointed out that the wealthy countries have not kept their word. “We need to come out of COP27 with clarity [about the missing money] and ability [to ensure the promise is kept].” 

He also referred to the UN Secretary General Antonio Guterres´ proposal to impose a windfall tax on the profits earned by fossil fuel and gas companies, saying that 18 days’ worth of such profits can cover the entire sum of UN’s humanitarian appeal for the year. 

“COP27 is going to be a major test for all of us to see if those commitments made so boldly in years gone past finally made land for the people who are staring climate [change impact] in the face,” Griffiths said. 

Adopt WHO 2021 air quality guidelines

In line with the theme in the coming weeks, spotlight was also put on the role air pollution plays in public health and climate change. Around 1.1 million people in Africa died from diseases related to air-pollution in 2019. 

The WHO estimates that seven million people across the world stand to lose their lives to air pollution in a year. 

But Rosamund Kissi-Debrah, founder and trustee of the Ella Roberta Family Foundation,  says that need not be the case. “Cleaning up the air will save lives and it will also reduce health healthcare costs to increase productivity, and it will save trillions of dollars from governments,” she said. 

Kissi-Debrah called for all the countries participating in COP27 to immediately adopt WHO’s air quality guidelines 2021, describing them as “achievable” and life-saving.

She further said that governments must invest in solutions to tackle air pollution and raise public awareness about the adverse effects of rising air pollution on health. 

Pointing to the example of global cooperation to develop and deliver COVID-19 vaccines, Kissi-Debrah called for a similar level of cooperation to tackle air pollution. “We definitely believe seven to 9 million people every year are definitely worth saving. I urge everybody who goes into COP27 to not forget about public health.” 

Image Credits: Chris LeBoutillier, V.T. Polywoda.

WHO Assistant Director-General Dr Ren Minghui

Two of the World Health Organisation’s top leadership team in Geneva – Dr Soumya Swaminathan and Dr Ren Minghui – are on the brink of leaving as Director-General Dr Tedros Adhanom Ghebreyesus’s long-anticipated leadership shake-up starts to take shape.

Swaminathan is WHO’s Chief Scientist, while Ren serves as assistant Director-General for Universal Health Coverage, Communicable and Noncommunicable Diseases.

Meanwhile, Stéphanie Seydoux has been appointed as the WHO Director-General’s Envoy for Multilateral Affairs, replacing Dr Agnès Buzyn, who was appointed executive director of the WHO Academy in Lyon recently and remains on the leadership team in her new role.

Seydoux is the former French Global Health Ambassador. France has been a firm supporter of WHO and is the major investor in the new academy, which is expected to open in 2024, which will offer health workers around the world access to “the latest evidence-based health guidance, state-of-the-art learning technologies and advancements in the science of adult learning”, according to WHO.

WHO Deputy Director Dr Zsuzsanna Jakab is also expected to leave soon. The 71-year-old Hungarian is well over the WHO mandatory retirement age of 65 – which can usually only be extended by three years. 

As Health Policy Watch previously reported, 63-year-old Swaminathan is still two years short of WHO’s mandatory age of retirement, but there have been hints that her style was too independent for the director-general. 

However, a source close to Swaminathan said that she was leaving voluntarily after five years in senior WHO leadership to reunite with her husband and elderly parents who remained in her hometown of Chennai, India, while she served in Geneva.

Prior to WHO, Ren was director-general for international cooperation at the National Health and Family Planning Commission of China.

Conversely, Dr Mike Ryan, executive director of WHO’s Health Emergencies Programme, who had earlier been expected to leave the organization, appears set to remain, several WHO insiders with knowledge of the pending reshuffle confirmed.

 

Causa Justa activists outside Colombia’s Constitutional Court

In February, Colombia introduced one of the most liberal abortion laws in the world after activists took to the courts – but now their challenge lies in ensuring the health system is in a position to offer terminations

Not long ago, abortion in Colombia was a taboo topic that could not be mentioned during dinners or family gatherings, according to Florence Thomas, one of Colombia’s feminism most influential voices.

“It was considered such a difficult subject that people would stand up and leave my lectures when I touched upon it,” Thomas told Health Policy Watch.

 Some 16 years ago, in 2006, Colombian lawyer Mónica Roa challenged the country’s complete ban on abortion in the Constitutional Court and achieved the decriminalization of abortion on three grounds: when the pregnancy was the result of rape or incest; when there was a severe malformation of the fetus; and when the pregnancy constituted a risk to the woman’s health. 

“That ruling changed the course of history,” Thomas explains because it made it evident that the legal way to fight for safe abortions was not the Congress, but the Constitutional Court, the highest court in Colombia.

Since then, feminist movements and pro-choice lawyers like Roa have fought to extend the decriminalization of abortion in Colombia.

Lawsuit against barriers

In 2020, Causa Justa (“Just Cause”), a movement made up of over 100 organisations and 140 activists united to legalise abortion, filed a lawsuit against the criminalization of the early termination of pregnancy. 

Instead of proposing a whole new scheme of laws that would have to go through Congress, they sought a regulate abortion within the rules that were already in place and thus would not rely on politicians. 

Causa Justa showed that, despite the 2006 reforms, abortion remained a crime in the Penal Code, putting it out of reach for most women.  Causa Justa’s lawsuit, supported by more than 100 national and international experts, also showed that almost 400 women were convicted every year for having or seeking an abortion, with sentences ranging from 16 to 54 months in prison. Between 2006 and 2019, more than 5,700 women were charged for abortion.

Causa Justa’s lawyers also showed the judges that criminalization forced women to seek unsanitary and dangerous underground abortion clinics. According to Colombia’s Public Health and Epidemiology Observatory, one of the main causes of  the deaths of over 400 women from haemorrhaging in 2020 was unsafe, illegal abortions.

Between 59% and 70% of the complaints laid against the women seeking abortions had come from health workers, explains Mariana Ardila, a lawyer with Women’s Link, one of the organizations that are part of Causa Justa. 

Abortion providers could also face charges, which made most health professionals refuse to perform abortions.

Nail-bitingly close judgement

That sad reality changed with the new ruling in February this year, which established that abortion will only be an offence after the 24th week of pregnancy. 

“Women won,” said the plaintiffs after learning of the decision, surrounded by chants claiming: “It is a law! It is a law! It is a law.”

The ruling is historic because successive Colombian governments have never legislated on an issue that they consider neither a priority nor find beneficial because of the controversy it generates in the street. 

Colombia is a secular but deeply religious country. A 2017 survey revealed that 97% of citizens believe in God and the different churches, predominantly Catholic and Evangelical, have enormous power over believers, pushing them into an all-out fight against abortion.

In its final stage, the Constitutional Court judges voted on the lawsuit, and the vote was nail-bitingly close: five judges were in favor, and four against. With this final say, the court proved that Colombia is changing. Today, only 20% of the population approves that women go to jail if they get an abortion.

Health services not prepared

The Court also ruled that the government would have to implement a comprehensive public policy regarding access to safe and legal abortions in the “shortest possible time.” However, to date, such a policy hasn’t been fully defined and executed.

 Colombia’s Ministry of Health recognizes that barriers to abortion persist and are mainly associated with the denial of services – mainly due to ignorance of the changed legal framework and improper exercise of conscientious objection by medical personnel. 

On 28 September, it issued a document with instructions about how to strengthen sexual and reproductive health care, including abortion, that was addressed to all entities that are part of the health system.

Colombia is part of a “green wave” of countries in the region that have decided to expand their abortion freedoms, but it allows abortion much later than its regional counterparts.

 

Mexico’s Supreme Court ruled late last year that was unconstitutional to criminalize abortion. However, each state has to regulate the decision of the Supreme Court. 

In Argentina, Congress approved abortion’s legality up to 14 weeks, and, as in Colombia, lifted the restrictions that only allowed for abortion in cases of rape or where the mother’s health is at risk.

On the other hand, Ecuador’s National Assembly approved a bill that allows abortions if they result from rape up to the 12th week, but President Guillermo Lasso vetoed it, saying that he respects “life from conception.”

Colombia’s ruling, however, is a historic victory for the Colombian women’s movement that has fought for decades for their rights to be recognized in a traditional and ultra-catholic country. The next step is for the public policy to be fully deployed across the country and to serve as a model for the region.

Mesa por la Vida y la Salud de las Mujeres, a feminist collective that defends women’s sexual and reproductive rights, stated that during the first few months of 2022, they helped more than 90 women to overcome barriers while seeking an abortion within the new law’s parameters.

Alejandra* (not her real name) is one example. She asked for an abortion in her sixth week of pregnancy but only finally got one in her 11th week. She states that the procedure was slow and painful and that the doctors did not provide clear information about the process.

The numbers show that the path is still long for women in Colombia and that the famous feminist march slogan, “we want sex education to decide, contraceptives to avoid abortion, and legal abortion not to die,” will still echo in the streets, the mountains, the buildings, and law-making entities until Colombian women can feel free to decide, unchallenged, about their bodies.

The Rosa Luxemburg Foundation provided support for this article.

Image Credits: Causa Justa.

Alcohol is related to more than 60 different conditions, including cancers, heart and liver disease.

A $15 million initiative to address the harms of alcohol consumption through policy change was launched Tuesday, roughly doubling the total global spending on mitigating the effects of alcohol.

Alcohol is one of the top-ten drivers of death, illness and injury, with wide-ranging social and economic harms, many disproportionately affecting young adults, according to Vital Strategies, which heads the RESET Alcohol consortium.

“RESET Alcohol is an initiative that brings together national governments, civil society, research organizations, and global leaders in public health and alcohol policy to develop and implement evidence-based alcohol policies from the World Health Organization’s WHO) SAFER technical package,” according to Vital Strategies. 

The initiative will focus on Latin America, Africa and Asia, with partners Movendi International; the University of Illinois Chicago; the Global Alcohol Policy Alliance (GAPA); the Non-Communicable Disease (NCD) Alliance; and the WHO, with GiveWell as the donor.

RESET’s primary policy focus will be on increasing alcohol taxation and other pricing policies which it describes as being “among the most effective interventions for reducing consumption”. It also aims to regulate the availability of alcohol, and restrict its marketing.

Over three years, the initiative will support 15 or more countries to develop policies including raising the price of alcohol via taxation, regulating availability, and restricting alcohol marketing.

Policies to protect kids

“Every year, alcohol use cuts millions of lives short and causes even more widespread suffering,” said Adam Karpati, senior vice president at Vital Strategies. 

“The onus can’t be on individuals. We must reset from an environment where the alcohol industry is empowered to push alcohol into nearly every aspect of our lives, including schools, sports, and media. We need policies that protect kids, make healthy choices, the easy choices, and check the industry’s influence. RESET Alcohol will do just that through strong partnerships with government and civil society leaders who are committed to action.” 

Alcohol consumption has increased in nearly all regions of the world consistently since 2005, and accelerated during the COVID-19 pandemic. It is related to more than 60 different conditions, including cancers, heart disease, liver disease, tuberculosis and HIV/AIDS; injuries and trauma including suicide, homicide, assault, falls, intimate partner violence, and vehicle crashes. Alcohol consumption is also associated with adverse economic impacts, from medical care costs to lost productivity.

RESET Alcohol’s approach builds on its partners’ successes in similar consortiums that have addressed tobacco and other harmful commodities, including contributing to 18.5% reduction in tobacco use in Bangladesh between 2009 and 2017 and a 17% reduction in India between 2010 and 2017.

“Failure to act has led to millions of preventable deaths and suffering from alcohol,” said Jacqui Drope, the new director of RESET Alcohol. “It’s time governments treat it like the public health crisis that it is. When governments take up policies proven to reduce alcohol-related harms, population health and economies will benefit.”

 RESET Alcohol will provide technical support to governments, improve national research and data collection, resource advocacy for policy change, and mount communications campaigns.

 “For governments, tax increases on alcohol are a win-win, especially given the sluggish global economy,” said Jeffrey Drope, Research Professor at UIC.

“Effective alcohol taxation reduces affordability, consumption and alcohol-related disease and premature death. This means lower healthcare costs and increased productivity from a healthier population. Taxes also create revenue for governments to fund health programs or other social priorities.

Image Credits: U.S. Air Force/Samuel King Jr. .

The World Health Organization (WHO) and World Meteorological Organization (WMO) launched the first global knowledge platform dedicated to climate and health on Monday called climahealth.info.

The global open-access platform is envisaged as being the “go-to technical reference point for users of interdisciplinary health, environmental, and climate science”, according to the WHO in a media release. 

“The use of tailored climate and environmental science and tools for public health, such as disease forecasting and heat health early warning systems, have enormous life-saving potential. These tools and resources can enhance our understanding of the connections between climate and health, help us reach at-risk populations, and anticipate and reduce impacts,” according to the media release.

“Climate change is killing people right now,” said Diarmid Campbell-Lendrum, coordinator of WHO’s climate change and health programme. “It is affecting the basics we need to survive – clean air, safe water, food and shelter – with the worst impacts being felt by the most vulnerable. Unmitigated climate change has the potential to undermine decades of progress in global health. Reducing its impacts requires evidence-based policy backed by the best available science and tools.”

Joy Shumake-Guillemot, who leads the WMO-WHO Climate and Health Joint Office, said that public health practitioners who are concerned about the environmental impacts on health “lack access to training and tailored climate information needed to address these growing issues” while  “climate experts (are) sitting on troves of research and resources that could be applied to support public health goals, but just aren’t reaching the right people”.

The initiative is supported by the Wellcome Trust.

“Collaboration between climate, health and technical specialists is crucial for helping us understand and tackle the health effects of climate change,” said Madeleine Thomson, Head of Climate Impacts and Adaptation for the Wellcome Trust. “But right now, experts can’t always partner and share information as effectively as we know they’d like to. We hope this portal will help fulfill the potential of different disciplines to work together on research and gain new insights into how climate change is affecting health around the world.”

Cities’ Malaria Framework launched

On the occasion of World Cities Day 2022 on Monday, the WHO and UN Habitat launched the Global framework for the response to malaria in urban areas, which provides guidance to city government officials, health professionals and urban planners on how to develop a  comprehensive malaria response specifically in urban areas, “where the dynamics of transmission and burden of vector-borne diseases can be different from that of rural areas”.

By 2050, nearly 70% of people globally will live in cities and other urban settings and the WHO predicts that unplanned urbanization is likely to result in a malaria disease burden that is “disproportionately high among the urban poor”.

Speakers at the launch also anticipated that climate change will see malaria in places that were previously too cold for the disease that is carried by mosquitos.

The framework provides guidance for city leaders, health programmes and urban planners to respond to the challenges of rapid urbanization in a targeted way that helps to build resilience against the threat of malaria and other vector-borne diseases.

Omicron
Experts have described the array of subvariants as a “swarm”.

The SARS-CoV2 virus just won’t give up. As the northern hemisphere heads into its third pandemic winter, experts say the continued evolution of Omicron’s sub-variants indicates a fresh wave is coming, but no one knows which variant will fuel it.

Scientists have catalogued 390 Omicron lineages and 48 recombinants of the virus – which occur when at least two variants co-infect the same person, allowing them to ‘exchange notes’ and evolve. The sheer number of Omicron strains circulating makes predictions complicated.

“We’re having trouble isolating which of the omicron sub-variants will have a growth advantage and will take over in dominating the spread,” WHO Senior Emergency Officer Dr Catherine Smallwood explained at a press conference last week. “Some variants like BQ.1 have been noted as potentially accelerated, but we’re not sure yet how this is going to pan out in the longer term.”

The variety of offshoots also creates the possibility of a ‘double wave’ in some places if two successive variants with different immune-dodging characteristics succeed each other.

“Looking at all the data, it seems a sizable new infection wave is certain to come,” Tom Wenseleers, an evolutionary biologist at the Catholic University of Leuven told Nature.

Subvariant surges not causing hospitalization spikes – for now

Omicron
Ranking of the immune evasion for the new variants

There is some good news: early signs show that though the BA.4, BA.5, BQ.1.1 and XBB subvariants are able to break through immune protections and resist certain treatments, they do not appear to be causing increases in hospitalizations.

“An encouraging sign for one of – if not the most – immune evasive new variants XBB: it is dominant in India and Bangladesh without a rise in cases or deaths to date,” said Eric Topol, founder and director of Scripps Research.

Despite the dominance of the highly infectious XBB variant, deaths and cases in India and Bengladesh have remained stable.

Similar findings have come out of South Africa, where the Africa Health Research Institute in Durban conducted studies on the BA.4 and BA.5 sub-lineages. The team, led by virologist Alex Sigal, found that while these Omicron families possess strong enough immune-dodging mechanisms to lead to an infection wave, they are “not likely to cause much more severe disease than the previous waves, especially in vaccinated people.”

The World Health Organization’s (WHO) Technical Advisory Group on SARS-CoV-2 Virus Evolution (TAG-VE), which released a statement singling out BQ.1 and XBB as key variants of concern on Thursday, issued a similar analysis.

“While we are looking at a vast genetic diversity of Omicron sublineages, they currently display similar clinical outcomes, but with differences in immune escape potential,” TAG-VE’s expert panel found. “So far there is no epidemiological evidence that these sublineages will be of substantially greater risk compared to other Omicron sublineages.”

World trending in the right direction – but surprises could be around the corner

WHO
WHO data as of the October 26 SARS-CoV2 weekly situation report.

The question lingering on the mind of many experts is whether the varying properties of subvariants mean infection by one will provide immunity from others – a key determinant of whether double waves will hit.

A team at Peking University in Beijing, led by Yunglong Richard Cao, has been studying the variants’ immune-evading capacities. “I have a feeling that if you’re infected with BQ.1, you might have some protection against XBB,” he told Nature. “We don’t have data yet.”

Experts warn not to rule out more surprises from the virus. With Delta still circulating in the background, the deadlier variant could return to the fore. 

“The virus has surprised us more than once,” said Dr Hans Kluge, WHO Europe Regional Director. “We are much better prepared, and the fall surge has not led to previous ICU admission or severe disease levels, but forecasting remains tricky.” 

Russia’s invasion of Ukraine – denoted by the red line above – caused the country’s ability to report cases and deaths to fall.

Reports emerged this week of yet another subvariant, BA.5.2.6 taking hold in Ukraine. The dire conditions occasioned by Russia’s invasion of the country have made it conducive ground for viral spread, and reporting since the start of the conflict has dropped off a cliff. 

Little is known about the true state of play on the ground – nor which subvariant will take over next. 

Image Credits: Nature, Stuart Turville.

A Somali boy struggles to find water

The global cholera vaccines shortage relates to the unpredictability of the disease, and the fact that it unattractive to manufacturers as it is a disease of poverty – but if preventive vaccines are part of a routine vaccine package where cholera is endemic, this could stabilise demand and outbreaks

There is no short-term solution to the global cholera vaccine shortage as “the current manufacturers are producing to their maximum capacity, and one is increasing its production capacity but this increase is limited by technical constraints”, according to Dr Philippe Barbosa, the World Health Organization’s (WHO) technical lead on cholera.

Faced with at least 29 global cholera outbreaks – Haiti, Malawi and Syria battling particularly big outbreaks – and a diminishing supply of vaccines in the international stockpile, the WHO recently recommended that affected countries administer only one vaccine dose instead of the usual two. 

 Cholera is an acute diarrhoeal infection caused when people consume food or water contaminated with Vibrio cholera bacteria, and it usually affects those with inadequate access to clean water and proper sanitation.

As the disease primarily affects “the poorest and most vulnerable”, vaccine manufacturers have “no prospect of selling to rich countries”, so production is limited, Barbosa told Health Policy Watch.

“As the demand appears limited, this makes it unappealing for new manufacture to engage in this market,” said Barbosa, adding that the challenge of limited cholera data also made it difficult to forecast of future needs.

But Gavi, the global vaccine alliance, believes that it may be possible to stabilise vaccine production and supply by introducing preventative vaccines in cholera “hot spots”.

“We’re trying to get some preventive vaccination going in regions where cholera is endemic and that will help obviously to prevent outbreaks from a public health perspective,” says Gavi special adviser Aurelia Nguyen.

“It will also help with this ‘peaks and troughs’ view. As you can imagine from a manufacturing perspective, it is difficult to be able to just turn production on and off at very short notice,” added Nguyen, who has over a decade of experience in vaccine supply, most recently as managing director of COVAX, the international COVID-19 vaccine platform.

Gavi advisor Aurelia Nguyen

Only two suppliers

At present, only two suppliers make cholera vaccines available for mass vaccinations. Shanchol is produced by Shanta Biotechnics, a Sanofi subsidiary in India, and Euvichol-Plus, made by EuBiologics in South Korea.

Both companies supply the international cholera vaccine stockpile managed by the International Coordinating Group (ICG), a mechanism that coordinates the provision of emergency vaccines and antibiotics to countries during major outbreaks. The ICG is made up of members from the WHO, UNICEF, Médecins Sans Frontières, and the International Federation of Red Cross and Red Crescent Societies.

All countries that need cholera vaccines apply to the ICG, and those that qualify for Gavi financing get free vaccines while the others need to reimburse the stockpile.

“What we’ve done with Gavi financing is show manufacturers that there is a certainty of regular funding for vaccines, and the minimum stockpile that we want to have at any point in time for outbreak is five million doses,” says Nguyen.

But Shanta Biotechnics announced a while back that it will stop making Shanchol next year, while production at EuBiologics is currently constrained as the company is expanding its facilities. The expansion will ultimately enable it to produce 50 million vaccines a year. 

Nguyen said that “production economics” were behind Shanta Biotechnics’ decision to quit the field, and Gavi has been working “very closely” with EuBiologics “and their volumes are going to keep increasing over the course of next year”.

Neither company responded to questions Health Policy Watch sent to them.

However, Gavi has also “been in very active discussions” with other manufacturers to enter the market in the next two to three year to ensure “resilience in the market”.

“We’ve been discussing with potential new entrants what it would take in terms of their developments, and it also links to another conversation in terms of regional manufacturing on the African continent,” said Nguyen.

Gavi has been in discussions with the African Union, and in the past week with the G7 and G20, about having “a stronger and more sustainable manufacturing base in Africa, and this is one of the vaccines that would be perhaps suitable for a new entrant coming from the continent”, she added.

Unpredictable demand

Typically, the international stockpile has about five to seven million vaccine doses which get replenished as it is used – but the unpredictability of outbreaks has made it hard to ensure regular supply.

“In 2020, we used five million doses for outbreak response. This year, so far we’ve already shipped 18 million doses and we have just seven million doses on hand at the moment and we plan to buy another five million through to the end of the year.”

However, what is more predictable is that climate change will drive more cholera outbreaks. The recent floods in 33 of Nigeria’s 36 states  – the worst in a decade – are expected to increase cholera cases, while Pakistan has been bracing itself for more cases after its recent devastating floods.

“The consequences of a humanitarian crisis – such as disruption of water and sanitation systems, or the displacement of populations to inadequate and overcrowded camps – can increase the risk of cholera transmission, should the bacteria be present or introduced,” the WHO warns.

Meanwhile, earlier this week UNICEF described the cholera outbreaks in Syria and Lebanon as “alarming”.

“The acute epidemic in Syria has left over 20,000 suspected cases with acute watery diarrhoea and 75 cholera-associated deaths since its start. In Lebanon, confirmed cholera cases reached 448 in just two weeks, with 10 associated deaths,”  UNICEF warned in a media release.

“Malnourished children are more vulnerable to developing severe cholera disease, and the cholera outbreak is yet another blow to already overstretched health systems in the region.”

Image Credits: CNN, UNICEF.

ACT-A is going to work more in-country as it transitions out of pandemic mode.

The Access to COVID-19 Tools (ACT) Accelerator is going to focus on vaccinating high-risk populations, introducing new treatments, boosting testing and securing sustained access to COVID-19 tools in the next six months.

ACT-A announced its new transition plan at a meeting on Friday as the world moves to long-term COVID-19 control.  

“Recognizing the evolving nature of the COVID-19 virus and pandemic, the plan outlines changes to ACT-A’s set-up and ways of working, to ensure countries continue to have access to COVID-19 tools in the longer term, while maintaining the coalition’s readiness to help address future disease surges,” according to a media release.

“Through 2023, COVAX will continue to support lower-income countries to protect their populations. In parallel, we will be supporting countries to integrate COVID-19 vaccination into routine national immunization programs, while also preparing for surges and other worst-case scenarios,” said Seth Berkley, CEO of Gavi, the Vaccine Alliance.

Developed through a consultative process with ACT-A agencies, donors, industry partners, civil society organizations (CSOs) and Facilitation Council members, the plan summarizes priority areas of focus for the partnership’s pillars, coordination mechanisms and other core functions, and highlights the work to be maintained, transitioned, sunset, or kept on standby. The transition plan supports the work of ACT-A agencies as they evolve the financing, implementation and mainstreaming of their COVID-19 efforts.

The next phase of ACT-A partners’ work will centre on three overarching areas:

  • research and development (R&D) and market-shaping activities to ensure a pipeline for new and enhanced COVID-19 tools
  •  institutional arrangements for sustained access for all countries to COVID-19 vaccines, tests and treatments, including oxygen
  •  in-country work on new product introduction (eg new oral antivirals) and protection of priority populations in support of national and international targets

“As the world moves towards managing COVID-19 over the long-term, ACT-A will continue to support countries by providing access to vaccines, tests, and treatments,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “But as this plan lays out, we still have a lot of work to do to achieve equitable access to these life-saving tools, with health workers and at-risk populations as our top priority.”

Other changes outlined in the plan include the transition to a new ACT-A Tracking and Monitoring Taskforce, co-chaired by senior officials of India and the US, with the political-level Facilitation Council going into ‘standby’ mode, with the capacity to reactivate if needed due to a surge in severe disease.

Ebola
Contact tracers and village health teams take on Ebola in Uganda.

Six schoolchildren in the Ugandan capital of Kampala are the latest to be infected with Ebola, according to the country’s health minister on Wednesday – and with 15 cases in the densely populated city, some want the government to impose a lockdown.

So far, there have been 109 confirmed cases, including 30 deaths, of the Sudan strain of Ebola for which there is no vaccine – although two vaccines exist for the Zaire strain.

Ebola is highly infectious and has a mortality rate of up to 90%. The 2014-16 Ebola outbreak in West Africa, the largest on record, killed more than 11,000 people. In 2000, Uganda suffered an outbreak of Ebola that killed over 200 people.

After a slow start, contact tracing kicks into gear

With support from the World Health Organization (WHO) and partners, the Ugandan Ministry of Health has trained and deployed around 300 contact tracers, who play a critical role as the country looks to minimize the spread of the virus.

“When the community cooperates in the response and contacts are identified, it becomes easier to contain the disease,” said Dr Bernard Logouomo, the Ministry of Health Surveillance Lead in Mubende district, the outbreak’s epicenter.

In the first days of the outbreak, only 25% of contacts were properly traced, the WHO said. But by mid-October, nearly 94% of people who had come in contact with the virus were being properly monitored.

Despite dangers of urban Ebola, president resisting Kampala lockdown

Uganda
Kampala is home to 1.5 million people. Doctors worry Ebola could escape containment if it spreads throughout the city.

Ugandan President Yoweri Museveni has so far resisted calls to lock down the capital, although he announced a three-week lockdown in Mubende and Kassandra districts, where the outbreak started, on 15 October. 

However, the Kampala schoolchildren’s infections have been traced to a man who travelled to the city from Mubende.

On Tuesday, the head of the Uganda Medical Association, Dr Samuel Oledo, urged health authorities to impose a lockdown in Kampala. “The earlier we lockdown Kampala, the better,” he told reporters. “People are not even reporting cases right now.”

Uganda’s Ministry of Health acknowledged in a press statement on Thursday that urban Ebola can create “a situation of rapid spread,” but that lockdowns would remain limited to the epicentres of Mubende and Kassanda. 

“The situation in Kampala is still under control,” said Health Minister Jane Ruth Aceng. “There is no reason to restrict people’s movement.”

Trials are working

Without any known treatments available, trials are ongoing amid the outbreak. Uganda’s Ministry of Health said that a number of treatment options are being explored, including monoclonal antibodies, and repurposed drugs like Remdeservir donated by the US government. But doses are scarce.

“Thirteen patients have received these trial drugs with relatively good outcomes,” said health authorities. In total, 34 people have recovered from the virus. Four patients admitted in critical condition died despite treatment, highlighting the importance of early reporting and detection of symptoms.

“The spread of the outbreak relies on reducing the time between the first symptoms of the disease and its management,” said Denis Mbae, outreach project coordinator of Médecins Sans Frontières activities in Uganda. “The earlier patients are treated, the greater their chances of survival and the less risk there is of the disease spreading within the community.”

 

 

 

 

 

 

 

 

 

Image Credits: WHO, Angella Birungi.

Climate
Two deer take refuge in a river during a wild fire in Bitterroot National Forest, Montana, United States.

The existential project to save the planet set out by the 2016 Paris Agreement is in tatters. There is currently “no credible pathway” to limit increases in global temperatures to the 1.5°C degree target detailed in the accords, the UN Environmental Programme (UNEP) said in its global emissions gap report released Thursday.

The chance of temporarily exceeding 1.5°C has risen steadily since 2015, when it was close to zero.  That probability has increased to nearly 50% for the 2022-2026 period. 

The language of the UNEP report stands in stark contrast to the diplomatic assessment by the UN Framework Convention on Climate Change (UNFCCC) Secretariat released on Wednesday.

The UNFCCC report refers to “glimmers of hope,” noting that progress over the last year shows “a strong signal that the world is starting to aim for net-zero emissions.” But the UNEP does not mince words.

“Inadequate progress on climate action means the rapid transformation of societies is the only option,” the report states. “This lack of progress leaves the world hurtling towards a temperature rise far above the Paris Agreement goals.”

Despite a year of devastating climate-driven disasters, updated pledges by the international community since COP26 in Glasgow represent less than a 1% reduction in projected 2030 greenhouse gas emissions. Emissions in 2021 were also likely the highest on record, breaking the ceiling set by 2019 levels, the report found.

UNEP
To get on track to limiting global warming to 1.5°C, the world would need to cut 45 per cent of current greenhouse gas emissions by 2030.

If countries fully implement all present and future plans to reduce emissions, and additional net-zero commitments, the world will be on track for a 1.8°C temperature increase by the end of the century. But even this scenario is “not credible” given the snail’s pace of progress, the UNEP said.

“We are headed towards global catastrophe,” UN Secretary-General António Guterres said at a press conference accompanying the release of the report. “Our world cannot afford any more greenwashing, fake movers or late movers.”

Current policies set the world on pace for global warming of 2.8°C by the end of the century. The two realistic scenarios laid out in the report – in which countries follow through on their “nationally determined commitments” – reduce warming to 2.6°C and 2.4°C.

“We had our chance to make incremental changes, but that time is over,” said Inger Andersen, executive director of the UNEP. “Only a root-and-branch transformation of our economies and societies can save us from accelerating the climate disaster.”

A decimal can make all the difference

 

Temperatures during the last ice age, known as the Last Glacial Maximum, were an average of just 6 degrees cooler than today.

These temperature discrepancies can appear insignificant, but even minute shifts in the earth’s temperature have drastic impacts. At the peak of the last ice age, when glaciers covered about half of North America, Europe, South America and many parts of Asia, average temperatures were only 6°C degrees colder than today.

“In your own personal experience that might not sound like a big difference, but it’s a huge change,” said Jessica Tierney, primary author of the report on ice age temperatures.

Warming to 2°C, compared with 1.5°C, is estimated to increase the number of people exposed to climate-related risks and poverty by up to several hundred million by 2050. As the most affected regions are among the poorest in the world, possessing little ability to adapt on their own, the impacts will be devastating.

“Nature has been telling us all year, through deadly floods, storms and raging fires: we have to stop filling our atmosphere with greenhouse gasses, and stop doing it fast,” Andersen said. “Every fraction of a degree matters.”

For millions, the climate crisis is already here

Expansion of extremely hot regions in a business-as-usual climate scenario. Black and hashed areas represent unlivable hot zones. Absent migration, that area would be home to 3.5 billion people in 2070

Climate change discourse often unfolds in future-oriented language, but the consequences of the present 1.1°C degree increase in global temperatures are already hitting millions, and many are being forced to flee.

Amid unpredictable monsoon rainfall and increasingly strong droughts, more than eight million people in Southeast Asia have moved toward the Middle East, Europe, and North America, the World Bank found. Droughts and crop failures have impacted millions of rural people in the African Sahel, too, creating streams of internal displacement towards the coasts and cities.

And this is just the beginning. A groundbreaking study in the journal Proceedings of the National Academy of Sciences (PNAS), found that by 2070, up to 19% of land currently inhabited by people could become unlivable hot zones, akin to the Sahara, placing billions – one of every three people alive – in climate situations that will force them to leave. 

Should the flight away from hot climates reach the scale that current research suggests, it will amount to a vast remapping of the world’s populations, a joint investigation by the New York Times and ProPublica reports.

And the visible impacts of climate shifts are already staggering. Bangladesh, a country of 168 million people, now has over 10 million climate refugees – and an estimated 2,000 people move to its capital, Dhaka, every day, according to the Mayor’s Migration Council.

People who have lived in the coastal areas of Bangladesh for generations are migrating to escape flooding, and the government predicts that by 2050, one in every seven Bangladeshi citizens will be displaced by climate change. 

Financial hurdles present big challenges

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

In neighboring Pakistan, historic floods in June devastated millions, killed 1,717, and placed the country at the center of a developing international dialogue set to define the upcoming COP27 climate conference about who should foot the bill for the consequences of our shifting climate.

Cycles triggered by natural disasters and their rebuilding efforts trapped many countries in inescapable debt before the question of infrastructure investment for a clean transition even entered the conversation.

According to the IMF, 60% of low-income countries are in or at risk of debt distress due to climate change-induced events. A study by the World Weather Attribution group showed that climate change contributed to up to 50% of the rains that made this August the wettest on record in Sindh, the region of Pakistan where the floods struck.

“It is imperative to reform financial systems so that indebtedness is not a barrier for access to finance when countries are in need,” Andersen said. “These institutions were created in the shadow of the Second World War, but we are in a different time now. There is homework to be done in the halls of 193 capitals.”

As disasters hit populations in vulnerable regions, they also take a significant toll on the development journey of the countries they call home. All progress towards larger development goals can be wiped out overnight, and countries seeking funds to develop are forced to take out loans to pay for the cost of recovery – trapping them in an interminable cycle.

Pakistan is preparing to issue a request for new loans to rebuild infrastructure that would survive the extreme weather patterns, an effort it estimates will cost $30bn.  

“If you look at the numbers, it is the climate event of the century, not just for Pakistan but for the whole world,” Sherry Rehman, Pakistan’s climate change minister told the Financial Times. “It surpassed all numbers for climate events, and it is now creating a catastrophic health crisis.”

For governments grappling with the human, health, and economic impacts of increasingly frequent natural disasters, green energy is just one piece of a bigger puzzle.

COP27: slim hopes for urgent action amid divisions over funding responsibilities

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

As alarm sirens sound across the world, hopes for a watershed moment in the international community’s approach to combating the climate crisis at next week’s COP27 in Egypt remain slim.

The event will unfold against the backdrop of compounding energy, food and cost of living crises exacerbated by the war in Ukraine, coupled with the deep divisions around who should be responsible for funding the energy transition.

In addition to money for adapting to a shifting climate, low- and middle-income countries require technical assistance and investment to facilitate the envisioned transition directly to sustainable energy sources. The UNEP coordinates a technology sharing mechanism, but getting financing on the table is difficult.

“Climate finance structure today is biased against climate-vulnerable countries. The more vulnerable you are, the less climate finance you receive,” Kevin Chika Urama, chief economist at the African Development Bank, told Reuters.

Leaders of impacted countries are keenly aware of the threats posed by climate change, but the question of how to balance emissions targets with lifting people out of poverty has no easy solution. For them, energy is not a simple question of emissions: it is one of poverty, health, and survival. 

A disproportionate burden

CFR

“For Africa, the problem of energy poverty is as important as our climate ambitions,” Nigerian Vice-President Yemi Osinbajo said in a video address announcing his country’s aim to raise an initial US$10 billion in funding to implement its energy transition plan ahead of the conference. “Energy use is crucial for almost every conceivable aspect of development — wealth, health, nutrition, water, infrastructure, education and life expectancy.”

The perceived hypocrisy displayed in recent months by countries that have fashioned themselves as leaders of the green energy transition have made this conversation even more difficult.

Since the onset of Russia’s invasion, Europe has raced to import as much natural gas from Africa as possible to shore up its domestic supplies. It has provided no additional funding for projects that would allow the world’s poorest continent to burn more gas at home.

Meanwhile, in South Sudan, only 6% of people have access to modern energy. “Energy poverty and injustice is real, but we need to make sure that energy expansion is done sustainably,” Andersen said.

Recent IEA findings estimated the exploitation of all proven natural gas reserves in Africa would amount to an increase of just 0.5% in Africa’s global emissions burden, to 3.5% up from 3.0%. In July, the EU voted to classify natural gas as ‘green’, freeing up public subsidies and greenlighting new infrastructure projects set to extend the bloc’s reliance on fossil fuels.

Together, G20 countries contribute 75% of greenhouse gas emissions annually, and any consensus will likely depend on new commitments from rich countries to invest in the climate transition beyond their own borders.

“The worst impacts of fossil fuel-driven climate change are being felt by developing countries – those least responsible for having caused it,” said Dr Jeni Miller, Executive Director of the Global Climate and Health Alliance. “High-income countries must provide developing countries with the necessary financial and technical support for the equitable access to the clean energy their people need.”

Total systemic change is a big ask

UNEP
The window to reach climate change goals is closing fast: inadequate progress on climate action makes rapid transformation of societies the only option, the UN said.

Though the future of the planet is at stake, success at COP27 appears unlikely. Multilateral negotiations – in the best of circumstances – are exceedingly complicated affairs. The EU and Canada spent over seven years negotiating a mutually beneficial trade deal, and it nearly collapsed at the last hurdle.

That a total transformation of global financial, food, electricity and financial systems is the requirement set out by the UNEP makes the stakes of COP27 as daunting as they appear unfeasible, the report acknowledges.

“The task facing the world is immense: not just to set more ambitious targets, but also to deliver on all commitments made,” it states. “This will require not just incremental sector-by-sector change, but wide-ranging, large-scale, rapid and systemic transformation. This will not be easy, given the many other pressures on policymakers at all levels.”

In this context, any progress will be welcomed.

“Even if we don’t meet our 2030 goals, we must strive to get as close as possible to 1.5°C,” said Andersen. “This means setting up the foundations of a net-zero future: one that will allow us to bring down temperature overshoots and deliver many other social and environmental benefits, like clean air, green jobs and universal energy access.”

The clock is ticking, but there’s a roadmap: energy, finance, building and food practices must change

UNEP roadmap for a sustainable transition outlined in the report.

If the UNEP report’s findings are dire, they are also constructive. The report is formatted as a roadmap for achieving net-zero greenhouse gas emissions in electricity supply, industry, transportation and buildings, providing a groundwork for launching towards a carbon-neutral future.

“The recommendations in today’s report are clear,” Secretary-General Guterres said. “End our reliance on fossil fuels. Avoid a lock-in of new fossil fuel infrastructure. Invest massively in renewables.”

And significant progress has already been made. The falling prices of renewable power sources like solar and wind make energy the closest sector to attaining the necessary transition outlined in the report. But while market prices have caught up and requisite technologies exist, the world is not transitioning to them fast enough.

On the other extreme, food systems are in critical need of an overhaul. The sector already accounts for one-third of all emissions, and if current practices remain in place, this is on track to double by 2050.

Global systemic change is a tall order, but “we have to try”

Inger Andersen, executive director of the UNEP, speaking to reporters on Thursday.

Without a systemic reform of the global financial system, the targets set out by the UNEP are unatainable: change requires capital.

The report estimates that an international transformation to a low-carbon future will require at least $4-6 trillion per year. For scale, the World Economic Forum estimates India’s transition to net-zero emissions will require $10 trillion in investment. Financial systems must play a crucial role in enabling the energy transition, Andersen said, and massive reform is required.

“There is a conversation that needs to take place in capitals across the world between the governors of central banks, ministers of finance, and their environmental or meteorology counterparts,” she said. “Unless these talks happen, and a broader understanding of how climate shifts hurt our chances of reaching the Sustainable Development Goals is understood, we will be stuck.”

Hopes for increased climate investment hinge on the successful communication of the win-win opportunity renewables present. Researchers at Stanford University found that while a global transition to 100% renewable energy sources would cost countries $73 trillion upfront, it would pay for itself in less than seven years and create 28.6 million more jobs. 

Decisions made today can define emissions trajectories for decades to come. If the international community does not act decisively, the window of opportunity will close by 2030.

“I don’t want to waste your time talking about the impacts of climate change, we all know they are going to get worse,” an impassioned Andersen told reporters. “Is it a tall order to transform our systems in just eight years? Yes. Can we reduce greenhouse gas emissions by so much in that timeframe? Perhaps not. But we must try.”

Image Credits: PNAS, OXFAM.