Ukrainian couple Anatasiia and Oleksii were severely injured in the war and are now wheelchair-bound.

Spinal cord injuries, brain damage, burns, limb amputations and complex limb trauma are some of the new rehabilitation challenges caused by the war in Ukraine, Dr Volodymyr Golyk, a World Health Organization (WHO) officer dealing with disability and rehabilitation in Ukraine, told a WHO Europe media briefing on Tuesday.

Prior to the war, Ukrainians already had significant rehabilitation needs because of the country’s high burden of non-communicable diseases (NCDs).

However, WHO’s Dr Satish Mishra said that “thousands of people in Ukraine have sustained complex war-related injuries that need rehabilitation services and assistive technology”, including wheelchairs and walkers.

“Injuries resulting from war can cause devastating and long-lasting physical and psychological impact, requiring early and specialised rehabilitation interventions from multidisciplinary rehabilitation team and long-term follow-up to reduce complications and to optimise independence and quality of life,” added Mishra, WHO Europe’s Technical Officer for Disability and Rehabilitation.

 

Pre-existing conditions

Ukrainians often had pre-existing health conditions alongside “multiple complex injuries that require rehabilitation”, added Mishra. 

But the rehabilitation needs of the Ukrainian population are increasing in the face of complex barriers to accessing health care during the war, including “targeted attacks on healthcare facilities, fewer health care workers due to displacement, reduced public transportation, interrupted supply chains and power shortages”.

“Providing coordinated ongoing care and rehabilitation for those affected by war is one of the greatest challenges faced in many health emergencies. There can be significant and life-changing consequences for those whose rehabilitation needs are unmet or delayed, leaving a legacy of deprivation and exclusion from society for years to come,” he stressed.

Iuliia Sokolovska, deputy head of the Office of the President of Ukraine

However, Iuliia Sokolovska, deputy head of the Office of the President of Ukraine, said that her country had started to create “a modern effective rehabilitation system built on evidence-based medicine” before the war.

“Notwithstanding the invasion of the Russian Federation, the development of the new rehabilitation system was not stopped. We accelerated our efforts and took into account the new challenges that we have faced now.”

Sokolovska added that improved organisation meant that injured citizens and military personnel “start to receive rehabilitation assistance in the hospital immediately after surgery or medical intervention” with the involvement of multidisciplinary teams.

Ukraine was also developing its capacity to manufacture prosthetic limbs and other assistive technology.

Amputations

“Due to the war, the complexity of cases and amputations is enormous,” she added. “This stimulates the acquisition of unique skills by both doctors and other specialists, while WHO and other international partners supply assistive technologies and rehabilitation equipment to Ukraine.”

But, stressed Sokolovska, “Ukrainians also suffer from psychological stress and trauma on a daily basis. This is why psychological health should be as accessible as medical help.”

Dr Jarno Habicht, Head of WHO Country Office in Ukraine, described the health system as “resilient, even after more than 800 attacks on health facilities”.

“As a WHO, we have supported more than 4000 people in more than 25 facilities with rehabilitative services. This is related to the services, and the equipment and supplies needed to provide those services.”

Image Credits: WHO Europe.

WHO Foundation Chief Impact Investment Officer ​Geetha Tharmaratnam at OurCrowd Investor Summit.

A company that is using AI-powered technologies to help rehabilitate people with severe brain injuries, including those caused by strokes, has caught the eye of the World Health Organization (WHO) Foundation.

The foundation’s Global Health Equity Fund (GHEF), formed in September will soon be ready to make its first round of investments.  The WHO Foundation was launched by WHO Director General Dr Tedros Adhanom Ghebreyesus in 2020, with mission of supporting the goals of the global public health agency.  However, as a legally independent body, it also has a broader mandate to recruit funds from corporate donors, high-net worth individuals, and the broad public – which are not part of WHO’s traditional funding pool due to strict legal and conflict-of-interest rules. 

The new equity fund is a $200 million impact venture capital investment fund that focuses on breakthrough technologies that could improve health worldwide, especially in low- and middle-income countries. It has been formed with OurCrowd, a global venture investing platform that encourages investment in emerging technology companies at an early stage while still privately held

The fund is nearing a preliminary funding round of $20 million, and BrainQ’s device may well benefit soon.

One in four adults over the age of 25 will have a stroke in their lifetime, often resulting in damage to neural networks in the brain that cause impaired motor function.

The Israeli tech company, BrainQ, has developed a wearable device that “uses non-invasive, frequency-tuned extremely low frequency and low-intensity electromagnetic fields with the aim of promoting neurological recovery in the central nervous system”. 

The Israeli company has already received accelerator funding from the  European Innovation Council (EIC) in 2019, and its device is undergoing clinical trials.

“A growing body of evidence indicates that neural oscillations at specific frequencies are linked to opening neuroplasticity periods, suggesting that using non-invasive brain stimulation techniques to neuromodulate at specific frequencies can influence these oscillations and aid in neuro recovery,” according to BrainQ.

The oscillatory patterns of people who have had strokes are “measurably different from those of healthy individuals”, according to the company, which “operates on the premise that exposing such unhealthy individuals to specific EMF frequencies associated with healthy functioning may improve network plasticity and functional ability”.

Science fiction

WHO Foundation’s Chief Impact Investment Officer, Geetha Tharmaratnam, described the device as “science fiction” and said that it was significantly cheaper than existing therapies. 

“It replaces a combination of physical, occupational and speech therapy,” said Tharmaratnam.

“Being a wearable device, you can bring it into your home so your family members can become part of your caregivers. And the final thing is that the time in which recovery happens is a fraction compared to the time at which recovery happens right now for stroke,” she added,

Tharmaratnam attended the OurCrowd Global Investment Summit in Israel last month, and was on the lookout for potential investments for the GHEF. 

“The number of stroke victims worldwide is enormous,” she said. “This is not just an issue in North America or Europe; it is everywhere. So BrainQ is an example of a company which, when we start investing, we would be interested in.”

GHEF is aligned with WHO Foundation’s Access Pledge, which ensures that the portfolio companies will make their solutions for people and countries experiencing inequity. Each company is expected to develop an “access plan”. 

Tharmaratnam is supporting the fund from WHO Foundation, while OurCrowd CEO Jon Medved and OurCrowd Managing Partner Dr Morris Laster lead it. The WHO Foundation and OurCrowd will create an advisory board to assist. 

‘Technology a big part of the answer’

GHEF was conceived due to the COVID-19 pandemic, highlighting the inequitable access to health technology solutions and vaccines in low- and middle-income countries.

“COVID-19 was a wake-up call for me as an investor,” Medved said in September when GHEF was announced. “The pandemic opened my eyes to health inequity worldwide and reinforced the potential of innovative technology to save lives.”

Tharmaratnam joined WHO Foundation a year ago, and GHEF is one of her first projects. Currently, the program only runs with OurCrowd, but she hopes to develop several other partners worldwide centered on similar concepts. 

“No country or health system was ready for COVID,” Tharmaratnam said. “My mandate is to align investors with WHO’s mission and the understanding that insufficient healthcare funding is available across the board.”

She told Health Policy Watch that the first step is evaluating how healthcare is administered, and “technology is a big part of the answer.”

“Technology is the magic of our generation, but used badly, it can amplify exclusion,” Tharmaratnam said. “If you are building a diagnostic tool, it needs to be able to work in Brazil. It needs to be able to work in Nigeria. I need to be able to work in Indonesia.”

She said the foundation’s role is to spearhead a sea change in the investment space by building awareness among private companies of the value of financial and health return on investment. 

“The fund can really coalesce around the companies to help them go into markets they may not have otherwise considered by recognizing that they are huge opportunities and have huge needs,” Tharmaratnam added.

Checks and balances

The WHO Foundation has come under fire in the past for accepting funds from companies not aligning with global health standards. In 2021, for example, it was accused of receiving $2.1 million from the multinational food and beverage company Nestlé, which had been accused of violating infant milk formula’s international marketing codes.

But the foundation has said that receipt of funds does not imply endorsement of a company’s activities. 

Tharmaratnam insisted that the foundation has “the same checks and balances” as the WHO “regarding who we can take money from. If we raise funds from you to support the activities of WHO, then you need to be in alignment with that.”

Image Credits: World Health Organization Foundation.

Anti-war protest in Germany

As Russia’s war against Ukraine intensifies around Bakhmut, a new report estimates that the invading army has had between 200,000 to 250,000 casualties – dead and wounded – in the past year.

The Center for Strategic and International Studies (CSIS) calculates that the average rate of Russian soldiers killed in Ukraine every month is “at least 25 times the number killed per month in Chechnya and 35 times the number killed in Afghanistan”.

Coming on the heels of one of the worst COVID-19 mortality rates in the world and a mass exodus of young men and their families fleeing from conscription, Russia may have lost two million people in the past three years, according to The Economist.

The life expectancy of Russian males aged 15 is currently at the same level as those in Haiti.

The country’s birth rates have been in decline since 1994 when Russia was estimated to have 149 million citizens. By the start of 2022, its population was estimated to be 145,6 million, with 3,358 births a day being more than cancelled out by a daily death rate of 3,663, according to Statistica.

Statistic: Natural population increase in Russia from 1990 to 2021 (in 1,000s) | Statista

Between 1 January 2022 and 1 January this year, the Russian population was estimated to have decreased by approximately 560,000.

Aside from deaths, estimates of people immigrating range from 500,000 to a million people in the past year alone.

Excess deaths during COVID

Using a statistical method based on changes in the population age structure, there were 351,158 excess deaths in 2020 and 678,022 in 2021 in the Russian Federation, according to an article published in the journal, PlosOne last November.

There was significant regional variation, with men and urban residents suffering the greatest mortality.

Meanwhile in 2021, there were approximately 1.04 million more deaths than births recorded in Russia, according to Statistica. 

Russia recorded one of the biggest excess mortality gaps globally, with  580,000 more deaths than expected between April 2020 and June 2021, although its official COVID-19 toll was only 130,000, according to The Economist.

In one year, the mortality rate leapt from 14.6 deaths per 1000 people (2020) to 16.7 per 1000 in 2021.

Statistic: Mortality rate in Russia from 1950 to 2021 (per 1,000 population) | Statista
Find more statistics at Statista

In 2021, the most common cause of death in Russia was circulatory system diseases (particularly, heart attacks, strokes and aneurysms), causing an estimated 640 deaths per 100,000 people. COVID-19 was the second-highest cause of death, with 319 deaths per 100,000. Neoplasms, predominantly cancers, caused over 194 deaths per 100,000 and were the third biggest cause of death.

War cancels out government solutions 

Patriarch Kirill, the head of the Russian Orthodox Church in Moscow, called for a ban on abortions to reverse the demographic trend.

Meanwhile, in 2020, Russian President Vladimir Putin’s government announced a package of tax breaks and welfare benefits aimed at stimulating the country’s birth rate. This follows the lead of Hungary, which has a wide range of tax incentive aimed at stimulating that country’s declining birth rate.

However, the war on Ukraine has effectively cancelled out whatever positive effects this stimulus package had on the country’s birth rate.

Image Credits: Dea Andreea/ Unsplash.

INB co-chair Precious Matsoso and WHO Director-General Tedros at the start of INB 4.

After spending the past week negotiating a proposed future pandemic accord in the intergovernmental negotiating body (INB) set up by the World Health Organization (WHO), member states will pick up discussions from 3 to 6 April.

Last week’s discussions were based on the zero draft developed by the INB’s Bureau after a series of meetings and public hearings during 2022 about the contents of the document aimed to guide and protect the world in the next pandemic.

During the closing session of Friday’s meeting, a number of delegates expressed the hope that it would be possible for the INB Bureau to develop a first draft of the accord after the April meeting, but the INB ultimately chose not to commit to this.

“The start of discussions of concrete language for the WHO pandemic accord sends a clear signal that countries of the world want to work together for a safer, healthier future where we are better prepared for, and able to prevent future pandemic threats, and respond to them effectively and equitably,” said Roland Driece, co-chair of the INB Bureau.

He noted at the start of last week’s fourth INB meeting that the April meeting would be taken as a continuation of the current meeting, the bulk of which was held in private.

Co-chair Precious Matsoso described the meeting, which ended last Friday, as “a critical step in ensuring we do not repeat the mistakes of the COVID-19 pandemic response, including in sharing life-saving vaccines, provision of information and development of local capacities”.

“That we have been able to move forward so decisively is testimony to the global consensus that exists on the need to work together and to strengthen WHO’s and the international community’s ability to protect the world from pandemic threats,’ Matsoso added.

The INB Bureau is to convene informal intercessional meetings between meetings to help facilitate agreements, but Matsoso urged delegates to have their own informal meetings before April to “iron out the wrinkles”.

A progress report on the accord will be given to the World Health Assembly in May, with the final draft due to be considered by the 77th World Health Assembly in 2024.

Also present at the INB meeting were the co-facilitators of the United Nations General Assembly High-Level Meeting on Pandemic Prevention, Preparedness, and Response, set for 20 September.

The co-facilitators, Morocco and Israel’s ambassadors to the UN in New York, told INB members that they wanted to ensure that the INB process and the high-level meeting were in sync.

The co-facilitators also meet with the World Intellectual Property Organization (WIPO) and the World Trade Organization (WTO).

Syria
WHO Director-General Tedros Adhanom Ghebreyesus (centre) is the first top UN official to visit Syria since the start of its civil war.

World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus is the first senior United Nations (UN) official to visit northwest Syria since the war began 12 years ago.

The visit was a bid to underline the organization’s commitment to the region, which has provided around a third of all medicines to arrive in northwest Syria in the past decade. Since the earthquake, that number has risen to two-thirds.

According to the UN, the devastating earthquakes have killed at least 50,000 people across Turkey and Syria. Tens of thousands more are still missing, hundreds of thousands have been left homeless, and thousands of families are yet to be reunited.

“The suffering is impossible to describe in words or even in pictures,” Tedros said at a Friday press briefing. “The destruction is immense.”

While NGOs and local authorities expressed gratitude for the WHO chief’s visit, they also voiced deep “disappointment” in the UN’s high-level team for avoiding setting foot in the region since the beginning of the war.

The scale of devastation in Turkey has been extreme, counting at least 44,000 deaths and $34.2 billion in infrastructural damage. A World Bank report published on Monday estimated the costs of reconstruction and economic disruption will likely cost twice that amount.

In Syria, about 6,000 people have been confirmed dead, mostly in the rebel-held northwest. But while the challenges and trauma faced on both sides of the Turkish-Syrian border are similar, the Syrians are working with far fewer resources.

“Twelve years of war has destroyed infrastructure, homes and hope,” Tedros said, “Drought, economic collapse, the COVID-19 pandemic, and the ongoing cholera outbreak have heaped misery upon misery. The risks now being faced by people on the Syrian side are far higher than those living just a few kilometers away.”

Before the earthquakes, 15.3 million Syrians – 70% of the country’s population – needed of humanitarian assistance. Price increases of more than 800% in the past two years had driven another 90% below the poverty line and led to food insecurity for 12.4 million people.

In an address to the UN Security Council on Tuesday, UN Emergency Relief Coordinator Martin Griffiths called the situation in Syria an “almost unbelievable tragedy.”

“Amid the harsh winter season, the earthquake has destroyed entire neighborhoods, rendering them uninhabitable … In many areas, four to five families are packed into tents,” Griffiths said. “The risk of disease is growing amid pre-existing cholera outbreaks. Women and children face increased harassment, violence, and risk of exploitation.”

UN efforts to mobilize international relief funding are underway, but underfunded. The emergency appeal for $397.6 million in aid for Syrian quake victims has raised just 42% of its target. Meanwhile, the 2023 Syria Humanitarian Response Plan – the largest humanitarian appeal in the world – needs $4.8 billion to address needs pre-dating the earthquake.

Children have also been caught in the crossfire, with thousands separated from their parents, without access to education, or displaced from their homes.

“I met a 15-year-old boy who broke his arms when he jumped out of a window during the earthquake,” Tedros said. “He hasn’t been to school since he was nine years old.”

With world leaders set to gather for a donor conference in Brussels next week on the 12th anniversary of the Syrian war, Tedros called on the international community to confront the humanitarian crisis.

“The Syrian people have suffered more than most people ever will, or ever could,” he said. “Their needs, dreams and hopes are the same as all people; for health, food, water, shelter, and peace for a better future for their children.”

Image Credits: WHO.

WHO Assistant Director General, Ranieri Guerra

Italian prosecutors in Bergamo have indicted Ranieri Guerra, a former World Health Organization (WHO) Assistant Director General, for making false statements before a public prosecutor about his role in the suppression of a major WHO report on Italy’s response to the pandemic. 

The WHO report had criticized the Italian government for failing to update a pandemic preparedness plan prior to the COVID outbreak – and at a time when Guerra was in fact in charge of updating the plan as the Italian Ministry of Health’s General Director for Prevention. 

Published on WHO’s website on May 13, 2020, and deleted a day later, the 102-page report “An Unprecedented Challenge”, revealed that the country’s pandemic preparedness plan had not been updated since 2006 – despite European Union instructions to countries to update their plans in 2013-2014 – when Guerra was in charge.

“Just one word: Finally,” tweeted Francesco Zambon, the whistleblower who left WHO in protest over the suppression of the report, in response to news of the indictments.  

Speaking to Health Policy Watch, Zambon added that “after three years no investigation whatsoever was conducted by WHO to assess the illicit conduct that I denounced, which concerned some of the most senior officials in the organization.” 

Guerra, a WHO ADG for special initiatives, was dispatched exceptionally by WHO’s Director General Dr Tedros Adhanom Ghebreyesus to Italy in early 2020 to support the initial phase of the country’s pandemic response – as one of the first and hardest hit countries in the world initially. 

A few months later, WHO’s Venice Office, under the direction of Francesco Zambon prepared an independent WHO report on Italy’s pandemic response, that frankly addressed Italy’s lack of an updated preparedness plan, in just a few phrases. 

After seeing a draft of the report, Guerra demanded that the language referring to the lack of preparedness, be redacted.  When Zambon refused, the report was deleted from WHO’s website – only a day after its publication. 

At the time, Guerra publicly denied that he had had a role in suppressing the report – which had sought to highlight both the successes as well as the weaknesses in Italy’s pandemic response. 

However a series of publications in both the Italian media and abroad, including in Health Policy Watch, revealed a trail of emails that reflected the pressure Guerra had applied on Zambon and his superiors in WHO’s European Office to have the report redacted and then suppressed. 

Following that, other revelations in the Italian media suggested that Guerra had even bragged to Italian officials about his role in convincing WHO’s Regional Director for Europe, Hans Kluge and others to delete the report.

It was on the basis of those communications that Guerra was finally indicted by Bergamo legal authorities.  WHO, meanwhile, staunchly stood by Guerra, refusing to answer questions about his role – citing UN immunity. 

Zambon ultimately resigned in protest after being frozen out of his management role at the Venice office. 

Speaking to Health Policy Watch on Friday, Zambon said of the indictment: “Yes, it is quite a big thing actually. It would be worth noting that, after three years, no investigation whatsoever was conducted by WHO to assess the illicit conduct that I denounced, which was about the highest officials in the organization. 

“Nor was any apology provided to me for being a whistleblower who tried to protect WHO from scandals. To the very contrary, WHO continues stating I am not a whistleblower as – in their opinion – there was no retaliation. Even Transparency International and 40plus organizations wrote to Tedros about this untenable position. They never got a reply.

“WHO lost a huge opportunity of being a credible and transparent agency towards national authorities. Also not being compliant with the same privileges that it benefits from, which unequivocally states that immunity MUST be waived when interfering with a national investigation. This certainly was the case.

“I wonder and I ask citizens of the world: where is WHO’S accountability? How much should the world wait for having a ground-shaking reform permitting WHO to be at the ethical standard it should be?”

Reportedly Guerra is also under investigation for “neglect of official duties” in relation to his failure to update the 2006 pandemic preparedness plan during the time in which he served as head of prevention. 

World AIDS day Report UNAIDS
UNAIDS Executive Director Winnie Byanyima (left), has warned that laws criminalising same-sex relationships are exacerbating HIV.

Over the past week, there has been a steep rise in anti-LGBTQ activity organised by  prominent politicians and religious leaders in Kenya and Uganda, which has sparked condemnation by health and human rights activists and fears that this will result in violence.

On Thursday, Kenya’s newly elected evangelical president, William Ruto, said he would not allow “homosexual acts or same-sex marriage” during his term. 

His remarks came after an outcry led by conservative Christian and Muslim groups after last week’s Supreme Court judgement confirming that LGBTQ people had the right of association and that the NGO Board’s decision to bar LGBTQ people from forming recognised groups is discriminatory.

Meanwhile, Ugandan opposition Member of Parliament Asuman Basalirwa tabled a private Member’s Bill in that country’s parliament on Tuesday seeking life in prison for homosexuality.

That same day, Anitah Among, Uganda’s Speaker of Parliament and a prominent member of the ruling party, told religious leaders that “a Bill will be introduced as soon as possible to deal with homosexuality and lesbianism”, and that voting on it would be “by show of hands” not secret ballot.

This followed a national anti-homosexuality protest on 24 February called by the Uganda Muslim Supreme Council.

The Uganda Muslim Supreme Council held a national protest against homosexuality on 24 February.

Fuelling HIV

Ironically, the anti-LGBTQ frenzy coincided with Zero Discrimination Day on 1 March, when UNAIDS highlighted the need to remove laws that criminalise people living with HIV and “key populations”, its term for those most vulnerable to HIV, including LGBTQ people.

“Criminalizing laws chase people away from life-saving treatment. Those need to be removed,” said Winnie Byanyima, Executive Director of UNAIDS.

Byanyima added that “at the country level, repealing criminal laws that are driving people away from HIV prevention and treatment is critical.”

Research in sub-Saharan Africa has shown that the prevalence of HIV among gay men and other men who have sex with men was five times higher in countries that criminalise same-sex sexual activity compared to those that do not, and 12 times higher where there were recent prosecutions.

‘Homo-hysteria’

“The current wave of homo-hysteria in Kenya began earlier this year with the death of [gay activist and fashion designer] Edwin Chiloba,” human rights lawyer and Amnesty International Kenya Board member Tabitha Saoyo told Health Policy Watch.

“This was exacerbated by the Supreme Court judgement favouring LGBTQ groups. What we are now currently witnessing is an attack on the judiciary, massive disinformation on the contents of the judgement coupled with intentional fear, hate and panic from religious groups, politicians and public influencers.

“This wave of hate is manifesting through formation of anti-LGBTQ WhatsApp groups, public protests, online threats of rape, death and myriad of other harmful attacks in grassroots communities,” she added.

Thirteen Kenyan human rights organisations and LGBTQ organisations including the Kenya Human Rights Commission and the International Commission of Jurists (Kenya Section) issued a statement on Thursday expressing alarm at the misinformation and disinformation that has followed the Supreme Court ruling.

Noting that the Kenyan Constitution “expressly prohibits incitement to violence, discrimination and vilification of others or incitement to cause harm”, they said that there have been “increasing incidents of malicious online and offline comments, profiling and public demonstrations against persons who identify as intersex, gay, lesbian or non-binary, and the personal details of LGBTQ+ citizens and their family members are being openly shared and intimidated online, violating the right to privacy and human dignity”. 

Evacuation requests

“Citizens are reporting confrontations with landlords and employers. They are increasing requests for evacuation, relocation and psychotherapy, while legal and health services and officers are having to close due to safety concerns, organisations have been responding to no less than 117 homophobic cases in the last month,” they noted. 

Meanwhile, the United Nations Human Rights Office urged the Ugandan parliament to refrain from passing an anti-homosexuality bill, adding that “the  State has a duty to ensure full protection of all people from violence & discrimination, regardless of sexual orientation or gender identity”.

HIV targets far off track

In 2021, the UN adopted a Polical Declaration on HIV and AIDS that committed member states to “ensure that less than 10% of countries have punitive legal and policy environments that create barriers to accessing HIV services” by 2025.

However, this goal is far form being realised with 67 of the 134 reporting countries still criminalizing consensual same-sex sexual activity and 20 criminalizing and/or prosecuting  transgender people.

“Criminalisation drives discrimination and structural inequalities. It robs people of the prospect of healthy and fulfilling lives. And it holds back the end of AIDS,” said UNAIDS.

Image Credits: Twitter.

Russia
The World Health Organization’s 152nd Executive Board meeting in February 2023 – now set to convene again in a special closed session next week.

WHO’s Executive Board is set to meet again next week in a special closed session to consider the fate of the Regional Director of WHO’s Western Pacific Regional Office (WPRO), who has been accused of racism and harassment of staff at the Manila-based office.  

In a meeting earlier this week, WHO member states from the Asian Pacific region reportedly voted by a narrow margin to remove Dr Takeshi Kasai from his post as Regional Director, Health Policy Watch has learned. 

WHO did not comment on the report, which was corroborated by multiple sources. 

The special EB session is set to meet on the matter on 6th and 7th March in line with the mandate outlined in a memorandum circulated last month at the 152nd regular session of the WHO governing board. 

The EB memorandum stated that a special session would be convened “should such sessions be required to consider the outcome of the investigation process in respect of allegations concerning the Regional Director for the Western Pacific”.

Directors in all six WHO’s regional offices are elected by the member states of the region in which they serve and then these appointments are confirmed by the WHO Executive Board, with the regional director’s contract issued by the WHO Director General. 

Investigation of Regional Director is on agenda

In the wake of the vote by the WPRO to remove Kasai from his position as Regional Director, the EB would be almost certainly be bound by WHO rules to confirm his removal from the post. They would also have to recommend to WHO Director-General Dr Tedros Adhanom Ghebreyesus what other steps to take regarding Kasai’s future as a WHO staff member. 

The WHO investigation has corroborated at least four of the allegations that had been brought against the Kasai, according to sources.  However Japan, a major WHO donor, led the minority faction against Kasai’s removal in the regional meeting and can be expected to muster significant political pressure against further action. 

The EB memo from early February does not elaborate publicly, however on what steps might be considered, stating only that: “The procedure for considering the findings of the investigation and related decisions, reflecting the advice of the Independent Expert Oversight Advisory Committee, was set out in the confidential briefing note of 16 November 2022 ….. and was discussed at the informal briefing for members of the Board held on 29 November 2022.”

The vote by a WHO Regional Committee to remove an elected director on the basis of such allegations is unprecedented in WHO´s history.

Put on administrative leave in 2022 

Dr Takeshi Kasai, WHO Regional Director for the Western Pacific, at a press conference in 2021.

In September 2022 Kasai was put on administrative leave by WHO after the formal investigation was launched into a range of staff allegations against him. 

At the time, WHO did not specify the reasons for Kasai’s indefinite removal, stating only that: “WHO is not in a position to comment on matters pertaining to ongoing investigations.” 

The WHO region is home to almost 1.9 billion people across 37 countries crossing vast ethnic and political divides from China to Australia. 

During his absence, WHO Deputy Director-General Dr Zsuzsanna Jakab has been overseeing the administration of the Regional Office. 

‘Toxic’ atmosphere

A medical doctor, Kasai, was alleged to have been presiding over a “toxic atmosphere” at the WHO regional office in Manila,  “with a culture of systemic bullying and public ridiculing.”  The allegations first came to light in an Associated Press report, published in January 2022. 

According to AP, more than 30 unidentified staffers sent a confidential complaint to WHO’s senior leadership and members of WHO’s Executive Board. However, Kasai denied using racist language or any other wrongdoing. 

Kasai began his term as regional director on 1 February 2019 after more than 15 years in various managerial and technical positions for WHO. He also was WHO’s representative to Vietnam from 2012 to 2014.

WHO Internal justice system in spotlight 

Over the past two years, WHO’s internal management of complaints around harassment, both sexual and managerial, has been the focus of increased scrutiny in the wake of a string of scandals and media reports involving senior and mid-senior WHO officials. 

Those have included allegations of a managerial cover-up of sexual exploitation, abuse and harassment cases involving dozens of Congolese women during the agency’s 2018-2020 Ebola response in the Democratic Republic of Congo.

Since then, several other complaints have surfaced against a number of high-profile WHO staff – including allegations by a young British doctor that she was sexually harassed by a senior WHO official at the World Health Summit in Berlin in October 2022. 

Those allegations involved WHO official Dr Temo Waqanivalu, who had reportedly been eyeing a run as a candidate to replace Kasai as the next WPRO Regional Director. 

In response to the string of allegations and reports of abuse, WHO says it has strengthened its Office of Investigative Services (OIS), and is investing more heavily into the prevention of sexual exploitation, abuse and harassment in its offices worldwide. 

But critics say that the agency’s internal justice system still lacks teeth. That has tended to leave victims intimidated and unwilling to pursue formal complaints against powerful officials whom they perceive as benefitting from protection at the top of WHO.  

Image Credits: WHO.

Obesity is growing fastest among children and adolescents – with about 10% of boys aged 5-19 either overweight or obese today.

More than half of the world’s population may be overweight or obese by 2035—with the sharpest rise expected to occur among children and adolescents, according to a new report by the the World Obesity Federation.

About 2.6 billion of the world’s 8 billion people are already overweight or obese, and COVID lockdowns likely exacerbated trends – although they also interrupted data collection. That means that the report is based on systematic global data collected up until 2016, according to the findings of the fifth edition of the World Obesity Atlas 2023, published just ahead of World Obesity Day, observed Saturday, 4 March.

Still dozens of research studies in countries across the globe have documented the effect of the pandemic in reducing physical activity and stimulating more unhealthy eating patterns, the report also added.

“The period from 2020 to 2022 was marked by extensive restrictions or ‘lockdowns’ in many countries that appear to have increased risk of weight gain by curtailing movements outside the home, exacerbating dietary and sedentary behaviours linked to weight gain, and significantly reducing access to care,” the report states.

And based on the sum of the evidence, one thing appears clear; obesity is rising fastest among children and young people.  About 10% of boys and 8% of girls aged 5-19 years were obese in 2020, the report estimates. Those proportions could double or more by 2035.

Obesity trends among boys and girls aged 5-19 years.

“A rise in obesity prevalence, which appears to have occurred especially among children, may prove hard to reverse, and suggests that a side-effect of managing the COVID-19 pandemic is a worsening of the obesity epidemic,” the report warns.

Low and middle income countries among the most vulnerable to rising obesity

Low and middle income countries also are amongst those with the fastest rising obesity rates, the report also found.

It highlighted Niger, Papua New Guinea, Somalia, Nigeria, and Central African Republic as countries that are among the least prepared to cope with the growing burden of noncommunicable diseases that typically accompany obesity, including cancer, heart disease, and hypertension.

Conversely, more affluent countries, particularly in Europe, may be the best prepared to buck obesity trends – due to food pricing policies that make healthy, fresh foods more accessible and affordable, as well as urban environmental design that foster physical activity as a part of daily life.

By 2035, the economic costs of obesity could exceed $4 trillion, the report warns — imposing a particular burden on the same low- and middle-income countries that lack policies to combat obesity.  And that is likely an underestimate since many developing countries don’t track obesity-related disability or unemployment.

The report calls upon governments to take more assertive action in arenas such as taxing fat- and sugar-laden fast foods, as well as imposing stricter limits on junk food marketing, particularly for children.

At last month’s WHO Executive Board meeting an updated package of recommendations to countries for fighting non-communicable diseases were considered. Those “best buys” include stricter taxes and more front-of-label warnings for unhealthy foods and sugary drinks.

Image Credits: Commons , World Obesity Atlast .

Vaccine
COVID-19 vaccine sales have netted Pfizer and Moderna around $100 billion in revenue.

A new study published in the BMJ has found that the United States invested at least $31.9 billion in public funds directly into the development, production and purchasing of mRNA COVID-19 vaccines through channels ranging from the National Institutes of Health to the Department of Defense. 

That vast pool of U.S. public funding was indispensable to the development of mRNA vaccines that have netted Moderna and Pfizer over $100 billion in sales revenues since their launch, an amount is 20 times greater than the budget of the World Health Organization (WHO) for 2020-21.

The study is based upon an extensive analysis of US  government research grants and procurement contracts related to mRNA vaccines or technologies issued between 1985 and March 2022. 

The study covered contracts issued by the National Institutes of Health, the Biomedical Advanced Research and Development Authority (BARDA), and the Department of Defense.  

Most funds invested in vaccine procurement

Vaccine
Researchers identified 34 NIH research grants directly related to mRNA covid-19 vaccines.

While the overwhelming majority of the $31.9 billion in funds was invested in the heat of the pandemic, at least $337 million was invested in mRNA related science before SARS-CoV2 emerged. 

That research, conducted between 1985 and 2019, resulted in the discovery of indispensable precursor technologies to mRNA vaccines including lipid nanoparticles, mRNA modification and synthesis, pre-fusion spike proteins, and mRNA vaccine biotechnology.

Pre-pandemic, the NIH invested $116m (35%) in basic and translational science related to mRNA vaccine technology, and the Biomedical Advanced Research and Development Authority (BARDA) ($148m; 44%) and the Department of Defense ($72m; 21%) invested in vaccine development.  

“The pre-pandemic investments are conservative and likely much higher than $337 million,” said Dr Hussain Lalani, lead author of the study.

Altogether, the study identified 34 NIH research grants directly related to mRNA COVID-19 vaccines.  

An additional $5.9 billion in U.S. financing contributed indirectly to the development of mRNA technology. The resulting vaccines are recognized as among the most effective jabs against the SARS-CoV2 virus.

After the onset of the pandemic, $29.2bn (92%) of US public funds went to vaccine procurement, $2.2bn (7%) supported clinical trials, and $108m (<1%) supported manufacturing plus basic and translational science. 

“[This is] the largest public investment for a disease ever,” Lalani said.

Risks were socialized while financial rewards were privatized 

A network analysis of COVID-19 mRNA vaccine patents.

The speed of vaccine development in response to the COVID-19 threat is unprecedented in vaccine science. In their first year alone, COVID-19 vaccines are estimated to have prevented 20 million deaths globally, including 1.1 million in the US. 

“In making health and protection possible amid a deadly pandemic, the mRNA COVID-19 vaccines have been a remarkable achievement,” writes Victory Roy, a fellow at Yale Medical School who authored the BMJ editorial that accompanied the study. 

“However, their development also serves as a cautionary tale of a system in which the risks of pursuing innovation were socialized while the lion’s share of rewards became privatized to corporate shareholders … who risked little of their capital in the development process.”

Both Moderna and Pfizer plan to sell their vaccines at over $110 per dose in the U.S. once freed of their government contracts. Their estimated production cost is just $1-3 per dose.

Research or share buy-backs? 

A significant portion of the vaccine-derived profits, Roy points out, are not being reinvested into medical research and development. Between 2021 and 2022, Moderna has announced or executed $7 billion in share buybacks – $3 billion more than it has spent on research and development.

Pfizer, meanwhile, spent $115 billion on shareholder payouts in the decade before the pandemic, $34 billion more than it invested in its R&D division. 

“Without public investment, there would be no mRNA vaccines,” said People’s Vaccine Alliance policy co-lead Mogha Kamal-Yanni in reaction to the study. “Pharmaceutical companies have sold a false narrative to the public: that it was their investment which gave us mRNA vaccines, and that they deserve the $75 billion profit made from COVID-19 vaccines.

“As this research shows, that claim is a total myth,” she said. 

What’s the counter?

The UN World Intellectual Property Organization’s 2022 report estimates the social benefit of COVID-19 vaccines – which includes the value of lives saved, health problems avoided, and economic costs of mitigation measures – at $70.5 trillion annually, or 887 times estimated private sector revenues of $130.5 billion. 

Pharmaceutical companies also point to the significant risk that came with following the mRNA route. Now seen as a game changer, the technology was unproven heading into the pandemic. Smaller companies like BioNtech, which had accumulated over $400 million in debt since its founding in 2008, ran the risk of collapsing if its vaccine did not succeed.

And that risk was real. Of the four largest pre-pandemic vaccine companies, three of them – GSK, Sanofi and MSD – failed to produce a successful vaccine by 2021. Novavax, whose vaccine was approved for emergency use in December 2021, raised doubts this week about its ability to remain in business, highlighting the boom-or-bust nature of vaccine development. 

The medical upside of mRNA

The risk taken in pursuing mRNA technology for developing COVID-19 vaccines has also played a significant role in mainstreaming mRNA as a platform. The medical upside, some researchers believe, could be revolutionary.

“Some experts believe that we are entering a new era with mRNA technology and the promise of regenerative medicine and personalized cancer vaccines on the horizon,” the BMJ study on U.S. vaccine spending said. “Hundreds of new products incorporating this technology using mRNA synthesis and lipid nanoparticles are being tested.”

The world’s first universal mRNA influenza vaccine, for example, which would be effective against all known types of influenze, is already being tested in animals and has shown promising results. In late 2022, researchers at Moderna and Merck announced they would move forward with efforts to pursue a personalized mRNA cancer vaccine for high-risk melanoma patients.

“Today’s results are highly encouraging for the field of cancer treatment,” said Stéphane Bancel, Moderna’s Chief Executive Officer said of the December Phase 2 trial. “mRNA has been transformative for COVID-19, and now, for the first time ever, we have demonstrated the potential for mRNA to have an impact on outcomes in a randomized clinical trial in melanoma.”

Asked about Moderna’s proposed 130$ price point for its COVID-19 vaccine by the Wall Street Journal, Bancel said of the 400% price hike, “I would think this type of pricing is consistent with the value.”

Image Credits: Ajay Suresh, NIH, Nature Biotechnology.