The lack of access to necessary medicines and vaccines creates a vacuum often filled by falsified and substandard medical products.

Despite numerous announcements and plans to tackle antimicrobial resistance (AMR) in Africa, the basic requirements for testing for drug-resistant pathogens are unmet in most areas, according to a new study of 14 countries.

Only 1.3% of the 50,000 medical laboratories in the participating countries are conducting routine bacteriological testing to definitively identify the type of infection presenting in symptomatic patients, according to the study. Of those, only a fraction are able to handle the scientific processes needed to evaluate if a bacteria is drug-resistant, and if so, to which drugs, so that more appropriate treatment could be administered.  

Even where laboratories were testing for AMR, only five out of the 15 antibiotic-resistant pathogens designated by the World Health Organization (WHO) as priority pathogens are being consistently tested, and there was high resistance to all five.

The study reviewed about 820,000 AMR records from over 200 laboratories in Burkina Faso, Ghana, Nigeria, Senegal, Sierra Leone, Kenya, Tanzania, Uganda, Malawi, Eswatini, Zambia, Zimbabwe, Gabon, and Cameroon from 2016 to 2019. 

Data from 327 hospital and community pharmacies and 16 national level datasets was also included in the study, which was carried out by the Mapping Antimicrobial Resistance and Antimicrobial use Partnership (MAAP). MAAP is spearheaded by the African Society for Laboratory Medicine (ASLM), with partners including the Africa Center for Disease Control and Prevention (Africa CDC) and the One Health Trust.

No patient information

Out of almost 187,000 samples tested for AMR, around 88% had no information on patients’ clinical profile, including a diagnosis of the possible origin of infection. The remaining 12% had incomplete information. 

“The disconnect between patient data and antimicrobial resistance results, coupled with the extreme antimicrobial resistance burden, makes it incredibly difficult to provide accurate guidelines for patient care and wider public health policies,” said Dr Yewande Alimi, Africa CDC’s AMR programme coordinator. 

“Hence, collecting and connecting laboratory, pharmacy and clinical data will be essential to provide a baseline and a reference for public health actions.”

The research also found that only four drugs comprised more than two-thirds (67%) of all the antibiotics used in healthcare settings. Stronger medicines to treat more resistant infections such as severe pneumonia, sepsis, and complicated intra-abdominal infections were not available.

 

Deaths attributable to and associated with bacterial antimicrobial resistance (2019).

 Lack of access to antibiotics

“Collectively, the data highlights a dual problem of limited access to antibiotics, and irrational use of those that are available,” said Deepak Batra, from IQVIA, a clinical research company that is part of MAAP. 

“As a result, people don’t get the right treatment for severe infections, and irrational use of antibiotics drives antimicrobial resistance for existing available treatment options. Routine monitoring of antimicrobial consumption could help monitor the limited access and irrational use.”

The WHO has described antimicrobial resistance (AMR) as one of the top ten global public health threats facing humanity this century, threatening the effectiveness of the current panel of antibiotic drugs. 

Pascale Ondoa, Director of Science and New Initiatives at ASLM, noted that Africa’s struggle to fight drug-resistant pathogens is being compounded by the lack of information about how AMR is impacting Africans and the continent’s health systems. 

“This study shines much-needed light on the crisis within the crisis,” Ondoa said.

A role for African Medicines Agency?

Dr Ramanan Laxminarayan, Director and President of One Health Trust noted that the future of modern medicine and the world’s ability to treat infectious diseases reliably hinges on the ability to control AMR. 

“This study is an important step forward for Africa’s health systems and the health of people across the continent. I hope MAAP inspires more investment in essential data collection and desperately needed resources,” Laxminarayan said.

The newly formed Africa Medicines Agency (AMA) could become the lead in fighting AMR, considering that this is what its counterparts elsewhere do, including the European Medicines Agency.

But prior to the ratification of its treaty and announcement of Rwanda as the host country for the AMA headquarters, the Africa CDC in 2018 introduced a Framework for Antimicrobial Resistance Control in Africa that did not mention the AMA. 

Instead, it proposed the establishment of the Anti-Microbial Resistance Surveillance Network (AMRSNET) – a network of public health institutions and leaders from human and animal health sectors who will collaborate to measure, prevent, and mitigate harm from AMR organisms.

AMR occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to antimicrobials, which include antibiotics, antivirals, antifungals, and antiparasitics. This makes infections harder to treat and increases the risk of disease spread, severe illness and death. 

Given the urgency of the threat of the rise of resistant organisms, the World Health Assembly at its 68th assembly in May 2015, adopted the Global Action Plan on antimicrobial resistance and established the Global Antimicrobial Resistance Surveillance System. 

In February 2020, African Union (AU) Heads of State and Government committed to addressing the threat of AMR across multiple sectors, especially human health, animal health and agriculture.

Image Credits: WHO, The Lancet.

fossil fuel
Calls are growing for fossil fuels to be phased out.

Nearly 200 health organizations and more than 1,400 health professionals have signed  a letter published on Wednesday calling on governments to negotiate a legally binding international treaty that would phase out fossil fuels, which they blame for “severe threats to human and planetary health.”

Among the treaty’s supporters is the World Health Organization (WHO), a significant step and an indicator of how urgent the climate question has become.

“The modern addiction to fossil fuels is not just an act of environmental vandalism. From the health perspective, it is an act of self-sabotage”, said Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization.

Initiated by the Global Climate and Health Alliance and Physicians for Social Responsibility, the treaty would be modelled on the WHO’s Framework Convention on Tobacco Control (FCTC), the first global public health treaty. It took effect in 2005 in response to decades of concern over the increasing death toll from tobacco use.

“The proposed Fossil Fuel Nonproliferation Treaty would be an evidence-based international agreement to control a category of substances well-known to be harmful to human health”, the group stated.

That the term “nonproliferation” is more often used in connection with nuclear weapons is no accident. To the treaty’s supporters, the threat of nuclear war is no more existential than that of climate catastrophe. 

“The two overriding issues of our era — the climate crisis and the danger of nuclear war — are deeply intertwined,” said Dr Ira Helfand, a 1985 Nobel Peace Prize winner and immediate past president of the International Physicians for the Prevention of Nuclear War.

“The climate crisis is leading to greater international conflict and a growing risk of nuclear war, and nuclear war will cause catastrophic abrupt climate disruption. The world must come together to prevent both of these existential threats.”

But in the way of emulating the success of the FCTC — and to a lesser degree the 1970 Nuclear Nonproliferation Treaty, a cornerstone of global nonproliferation — stands a significant obstacle: climate transition funding.

Missed Funding Targets, Broken Emission Promises

COP25
The UK government is pushing for more exploration of North Sea oil and gas wells.

“Clean energy alternatives to burning fossil fuels exist, but many countries do not have the means and technical expertise to make the transition,” said Jeni Miller, executive director of the Global Climate and Health Alliance.

“High-income countries have benefited from the last hundred plus years of fossil fuel use,” Miller said. “These countries have the resources and moral responsibility not only to make the clean energy transition, but to support developing countries to do the same.”

The current roadmap for low- and middle-income countries to move straight to green energy depends on substantial investment from development banks, rich countries, and the private sector that is falling short.

Rich countries failed to close a $10 billion climate finance shortfall ahead of the last round of UN climate talks and failed to mobilize $100 billion a year in promised climate aid by 2020 to help low- and middle-income countries deal with global warming and transition to cleaner-burning energy sources.

Most of the world’s biggest greenhouse gas emitters have also yet to meet pledges to strengthen the emissions-cutting targets that they made at the COP26, the UN climate talks in Glasgow, Scotland last year. 

This schism is further exacerbated by Russia’s war in Ukraine, which in Europe has prompted a race to import as much natural gas from Africa as possible but no additional funding for projects that would allow the world’s poorest continent to burn more gas at home.

This comes despite recent IEA findings that 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%.  

fossil fuel emissions

“The whole of the West developed on the back of fossil fuels — even as we speak, some Western nations are deciding to bring coal back into their energy mix because of the war. So when the world wants to transition to zero carbon emissions, who has to do more?” Matthew Opoku Prempeh, energy minister for Ghana, told Bloomberg in July. “Is the West saying Africa should remain undeveloped?”

While low- and middle-income country leaders are keenly aware of the threats posed by climate change, the question of how to balance emissions targets with lifting people out of poverty has no easy solution.

“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 next round of UN climate talks, known as COP27, slated for November in Egypt.

“Energy use is crucial for almost every conceivable aspect of development — wealth, health, nutrition, water, infrastructure, education and life expectancy,” he said.

From COP26 to COP27: “Code red for humanity”

United Nations Climate Change
Commonwealth of Nations Secretary-General Patricia Scotland (centre) at Africa Climate Week

When African leaders from 21 countries gathered in Gabon for Africa Climate Week earlier this month to set a united agenda ahead of COP27, to be held in Egypt in November, the focus was clear: this COP is not about bold new sets of commitments. It is about achieving implementation of what’s already been committed.  

In her opening address, the Commonwealth of Nations Secretary-General, Patricia Scotland, emphasized the importance of COP27.

“We are at code red for humanity, and the window for action is rapidly closing,” she said. “Tackling climate change will require the most significant political, social, and economic effort that the world has ever seen. It is up to us to set the tone and shape the quality of that effort.”

Host country Egypt emphasizes the need for real action. “For us, what we want this COP to be about is moving from pledges to implementation,” Egypt’s minister for international cooperation, Rania Al Mashat, told the Guardian. “We want this COP to be about the practicalities: What is it that we need to do to operationalize the pledges into implementation?”

Kevin Chika Urama, chief economist at the African Development Bank, told Reuters this week that Africa faces a climate financing gap of about US$108 billion each year.

“Climate finance structure today is actually biased against climate-vulnerable countries. The more vulnerable you are, the less climate finance you receive,” he said.

For scale, the World Economic Forum estimates India’s transition to net-zero emissions will require $10 trillion in investment. It’s a staggering figure, but the anticipated payoff is even bigger.

Stanford University researchers said in a 2019 report that a global transition to 100% renewable energy sources would cost countries US$73 trillion upfront, but it would pay for itself in less than seven years and create 28.6 million more jobs.

Ruth Etzel, co-chair of the International Pediatric Association’s environmental health group, described the consequences of inaction in no uncertain terms. 

“Our message to government leaders is this,” said Etzel. ”The health of everyone alive today, and of future generations, depends on phasing out fossil fuels rapidly, justly, and completely.”

Image Credits: Gellscom/CC BY-ND 2.0..

WHO Europe panel on long COVID

TEL AVIV – When Belgian Ann Li got sick with COVID in March 2020, she did not know that the disease would follow her for years.

“Even though I’m standing here in front of you looking seemingly healthy, I still suffer the consequences of the initial infection,” she told the audience of a panel devoted to Long COVID during the 72nd session of the WHO Regional Committee for Europe, meeting in Tel Aviv, Israel.

Li currently chairs Long COVID Europe, a European network of Long COVID patient associations. According to new data released during the session, she is one of some 17 million individuals in the WHO European Region who have experienced COVID symptoms for at least three months in the first two years of the coronavirus pandemic.

The study was conducted by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington’s School of Medicine on behalf of the WHO Europe. 

It found that women are twice as likely as men to suffer from long COVID. Among patients who required hospitalization, one in three women and one in five men were likely to develop long COVID.

“IHME’s research shows nearly 145 million people around the world in the first two years of the pandemic suffered from any of three symptom clusters of long COVID: fatigue with bodily pain and mood swings, cognitive problems, and shortness of breath,” according to Dr Christopher Murray, Director of IHME. 

“Knowing how many people are affected and for how long is important for health systems and government agencies to develop rehabilitative and support services,” he added.

Limited knowledge 

Discussing how to tackle the health crisis posed by the condition was one of the reasons behind the meeting, said Dr Natasha Azzopardi-Muscat, WHO Europe Director of the Division of Country Health Policies and Systems.

“Our knowledge of this condition is limited but it appears that 10 to 20% of people recovering from COVID-19 go on to develop mid and long-term symptoms,” Azzopardi-Muscat said. 

“Today we are here to discuss together what are the concrete actions that we can take on all fronts to minimize the health, social and economic consequences of this debilitating condition,” she stressed.

For the past year and a half, the European Commission’s Expert Panel on Health – which includes 15 scientists and health system experts – has been working on reviewing the state of the art and providing an analysis of the research and health system requirements on the matter. 

As Dr Dionne Kringos, vice-director of the Amsterdam Public Health Research Institute and a member of the expert panel explained, the panel has come up with several recommendations.

“First of all, we need to agree on common and global definitions for clinical use, as well as for surveys and research, which are updated periodically as evidence emerges,” she remarked. “Secondly, it’s important to agree on diagnostic and prognostic criteria for the post-COVID condition, its phenotype, and its emerging subtypes.”

Assessing the needs of patients and understanding how they can re-enter the workforce is also going to be crucial, Kringos noted. Other points mentioned in the proposed strategy include ensuring that knowledge is promptly shared and incorporated into health systems and that healthcare workers are properly trained.

Lack of research-based interventions 

The current lack of guidelines and research-based interventions to treat long COVID is a source of deep frustration, several panellists agreed.

“Despite this progress, my feeling as a clinician is prone to frustration,” said Dr Gemma Torrell, a general practitioner working at a primary care center on the outskirts of Barcelona. “In my country, regional guidelines have been published in participation with patients but implementation has been erratic. As a consequence, people with long COVID often feel disappointed because doctors are reluctant about the legal existence of the condition.”

“We face the same challenges,” echoed Dr Zachi Grossman, President of the Israel Pediatric Association. 

“There is not enough awareness both among parents and pediatricians about long COVID in children,” he said. “There is no organized guidance for teens. The whole area of diagnosis is not complete.”

New WHO initiative

WHO Europe announced a partnership with Long COVID Europe to focus on recognition of the condition and knowledge sharing, research and reporting, and rehabilitation.

“For these goals to be achieved, we need all countries in the WHO European Region to recognize that long COVID is a serious problem, with serious consequences and requires a serious response to stop the lives of those affected from getting any worse – and not just on a physical health level,” said Dr Hans Kluge, WHO Europe Regional Director.

“We are hearing stories of so many individual tragedies, of people in financial crisis, facing relationship problems, losing their jobs, and falling into depression,” he added.

“Many health workers who risked their lives on the frontlines of the pandemic now have this chronic and debilitating condition as a result of infection acquired in the workplace. They, and millions of others, need our support.”

Global Fund
24th International AIDS Conference (AIDS 2022), Montreal, Canada.

As the push for adequate funds to address HIV, tuberculosis and malaria reaches its climax with next week’s replenishment meeting of the Global Fund, the fund’s latest report reveals it has saved 50 million lives between 2002 and 2021.

The Global Fund raises money in three-year cycles and seeks $18 billion for its seventh replenishment, which culminates in a meeting on 19 September hosted by US president Joe Biden. This money would enable a further 20 million people to be saved.

Since its formation, it has supported 23.3 million people with HIV to get antiretroviral treatment, 5.3 million to get TB treatment and distributed 133 million mosquito nets in areas with a high malaria prevalence, according to the report released on Monday.

In 2010, only 23% of people who needed ART were getting it, whereas this had grown to 75% by the end of 2021. 

But COVID-19 has set back a number of global goals, particularly for TB treatment, which nosedived from 69% of all those who needed it on treatment to only 57% in 2020. In addition, TB deaths rose that year for the first time in a decade. 

Even though TB kills more people than HIV/AIDS and malaria combined, the global body will continue allocating just 18% of its overall funding to TB, while 50% goes to HIV/AIDS, and 32% for malaria for the first $12 billion of funds that are spent spent between 2023-2026.

A new split of 45% for HIV, 25% for TB, and 30% for malaria will, however, be applied as cumulative funding rises above $12 billion in that period. 

“In 2020, for the first time in our history, key programmatic results declined across all three diseases,” according to the Global Fund. “With only eight years to go, COVID-19 has knocked us further off course from the Sustainable Development Goal (SDG) target of ending the three epidemics by 2030.”

TB and HIV interventions are starting to improve with more people being tested and treated as Global Fund grantees mount “catch-up” activities to find and treat those who did not access care during the pandemic. 

Pharma support for the Global Fund

Meanwhile, the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA)  reaffirmed its “longstanding commitment” to support the Global Fund on Tuesday.

“Without further delay, we should re-commit to the remarkable and proven vision of the Global Fund, combining human ingenuity, strategic investments, and cross-sectoral partnerships as the recipe to achieve progress toward our goals to eliminate and control three of the deadliest diseases in the world – HIV, TB, and malaria,” said IFPMA Director General Thomas Cueni.

“From the introduction of novel classes of ART to the development of new TB diagnostics, to the first-ever malaria vaccine launched in 2021, the biopharmaceutical industry has played a key role in advancing progress in the fight against HIV, TB, and malaria,” he added. “Pharmaceutical companies continue to advance R&D and are now exploring how vaccine breakthroughs made during COVID-19, such as mRNA technology, could bring new hope for responding to disease.” 

Describing the fund as “an exemplary model of public-private partnership”, the IFPMA has produced a report that “underscores the role of innovative partnerships for R&D, capacity building, public awareness, and community engagement to improve global health outcomes related to the three diseases while beating back the consequences triggered by COVID-19”.

Germany pledges 30% more for the Global Fund

Last week, German Development Minister Svenja Schulze announced Germany’s commitment of €1.3 billion to the fund.

“Every year, these diseases infect and kill countless people,” said Schulze. “The good news is that there are ways of treating and preventing the diseases. We can end these epidemics if we act in solidarity. And that is precisely what we have committed to do.”

Germany’s major pledge represents a 30% increase compared to the previous three-year period,

The Children’s Investment Fund Foundation (CIFF) pledged $33 million to the fund last week, which also raises its committment by 30% more than before.

 

Image Credits: Jordi Ruiz Cirera/IAS.

World Health Organization’s Director-General Dr Tedros Adhanom Ghebreyesus at the opening of the WHO 72nd meeting of the Regional Committee for Europe 

TEL AVIV – Russia’s invasion of Ukraine will likely have long-lasting impacts on public health in Europe, both directly and in terms of global challenges related to food security and climate.

That was among the key messages from the World Health Organization’s Director-General Dr Tedros Adhanom Ghebreyesus and Regional Director for Europe Hans Kluge at the opening of WHO’s 72nd meeting of the Regional Committee for Europe, taking place for the first time in Israel. 

Tedros warned of steep spikes in COVID-19 cases in Ukraine that could push hospitals to the limit and cause oxygen shortages as winter approaches. He said WHO also is deeply concerned about the potential for the international spread of polio due to gaps in immunization coverage and mass population movement linked to the war.” 

The meeting brought together representatives of 53 countries in WHO’s European Region to set health policies for the coming year. It included delegates from Russia, Ukraine and other former Soviet Union republics in Eastern Europe and Central Asia that are part of the WHO region.  

“COVID-19 and monkeypox are both threats that have arisen from our relationship with nature. This year another threat has cast a shadow over the region which is entirely of human origin: the pall of war,” Tedros told health ministers, referring to the grinding war that has deeply damaged Ukraine’s health infrastructure.

“The Russian Federation’s invasion of Ukraine is having a devastating impact on the physical and mental health of Ukraine’s people, with consequences that will reverberate for many years to come,” said Tedros.

“We are now seeing an increase in cases of COVID-19 in Ukraine,” he said. “We project that transmission could peak in early October, and hospitals could approach their capacity threshold. Oxygen shortages are predicted because major supply sources are in occupied parts of the country.”

Setbacks for refugees, food security and climate 

Regional Director for Europe Hans Kluge at the opening of the WHO 72nd meeting of the Regional Committee for Europe 

More than 7.1 million Ukrainians have been recorded across Europe, according to the UN refugee agency.

Another 7 million people have been displaced internally within Ukraine, the refugee agency says, and some 13 million people are estimated to be stranded or unable to leave due to heightened security risks, destruction of bridges and roads, or a lack of resources or information on where to find safety and accommodation.

Kluge said the war is exacerbating already severe global challenges.

“Efforts to push back and to deal with the global climate emergency have been set back because of the revival of burning coal due to gas supply shortages,” he said. “The war in Ukraine has worsened, in fact, global food insecurity.”

As one of the world’s biggest exporters of wheat, sunflower oil and corn, Ukraine has about US$10 billion in grain ready to be exported including 20 million metric tons from last year’s harvest. But Russia’s war there has blocked not only millions of metric tons of Ukrainian grain but also Russian exports of grain and fertilizer.

That has factored into the dire situation the World Food Program is trying to address in the Horn of Africa, where levels of hunger are soaring after back-to-back droughts and the threat of famine looms. “Since the start of the year,” WFP says, “nine million more people have slipped into severe food insecurity across Ethiopia, Kenya and Somalia, leaving 22 million people struggling to find enough food to eat.”

Looking toward winter

ukraine
A refugee family with 11 children entered Romania at the Isaccea border crossing. They are from Ismail, nearby Odessa, and they left the country imediately, by bus, and they took the ferry to arrive in Romania.

Russia’s invasion of Ukraine is having a devastating impact on the physical and mental health of Ukraine’s people, with consequences that will reverberate for many years to come, Tedros said.

“No health system can deliver optimum health to its people under the stress of war,” Tedros said.

“WHO continues to support the Ministry of Health of Ukraine to restore disrupted services, displaced health workers and destroyed infrastructure,” he said, “which is essential not only for the health of Ukraine’s people, but for the country’s resilience and recovery.” 

The new normal

Keynote speakers and delegates agreed the war and COVID-19 pandemic have drastically changed things in the region, prompting Kluge to suggest a “new normal” mindset for all 53 member countries.

“The new normal is a dual track,” he said. “It means that all countries should be able to maintain constant readiness and alert, but without breaking routine disease prevention and control.”

To that end WHO can play a pivotal role, said Sandra Gallina, the European Commission’s director general for health and food safety.

“Working together on common health issues is the only way forward,” she said. “The multilateral approach with the [World Trade Organization] at its core, it’s really crucial. All of us know that we face daunting challenges. The EU will play its part.” 

Monkeypox emergency 

Kluge said there has been a recent decline in new monkeypox cases over the past week in the European region.

“On monkeypox, it seems that we are on a good trajectory, but we have to follow it very closely,” Kluge said.

Tedros said the region accounted for the majority of cases at the beginning of the outbreak, so now “it’s very pleasing to see a sustained decline in most European member states.”

But, he added, “as with COVID-19, a downward trend can be the most dangerous time, if it opens the door to complacency.”

Both WHO officials warned about the new polio outbreak.

“The cases in New York are genetically linked to cases in our European region, which are linked to Afghanistan and Pakistan, where polio is endemic,” Kluge said. “It reminds us that a crisis anywhere quickly becomes a crisis everywhere.”

Kluge was referring, in particular, to a recent US polio case in New York and poliovirus sewage samples in London that both appear to be linked to the first polio case seen in 30 years in Jerusalem, which was identified in March in an ultra-orthodox Jewish community.   

On Friday, New York’s governor declared a state of emergency and launched a booster vaccination campaign to halt the continued spread of the deadly virus, diagnosed in July in a young, unvaccinated Rockland County ultra-orthodox Jewish man, and since  identified in sewage water elsewhere in the state. The UK has also launched a booster campaign. 

Surveillance suggests the virus has continued to spread through parts of the ultra-orthodox Jewish communities across New York, the UK and Israel, where vaccine hesitancy is high.  

New WHO center on digital health to be established in Israel 

Israel President Isaac Herzog at the opening of the WHO 72nd meeting of the Regional Committee for Europe 

During the three day meeting, delegates at the Regional Committee meeting will discuss strategies that health ministries can adopt to better face multiple crises from war, climate and global food insecurity.  

Delegates also will discuss strategies for promoting health through behavioral and cultural insights, access to affordable medicines and ways to address health worker shortages that have become even more severe due to the pandemic, according to the agenda. Researchers are also due to present new data on long COVID in the European region.

Taking a proactive look at ways to improve healthcare and health systems – including through the uptake of new technologies – is a theme for the three-day meeting. At Monday’s conference opening, Israel’s President Isaac Herzog announced the establishment of a new WHO center in Israel focused on digital health – an arena in which Israel has proven to be a leader. 

“Israel is home to countless trailblazing med-tech and health-tech start-ups, pushing the bounds of human imagination,” Herzog said. 

“Together with European and international institutions, we can develop the breakthroughs that will enable people to live healthier and longer lives,” he said. “Israel will be working with the WHO to establish a cutting-edge center for digital health, bringing top-quality and innovative care to every corner of the world.”

Image Credits: WHO, UNICEF.

tb
Field visit at a TB clinic Karachi, Pakistan

The number of people on tuberculosis treatment rebounded to 5.3 million in 2021 and is nearing pre-pandemic levels of 5.5 million, according to a new Global Fund report.  That’s an encouraging sign of progress after treatment plummeted to just 4.5 million people in 2020, the report, released on Monday, notes. 

Overall, the new report shows the fight against HIV/AIDS and malaria, as well as tuberculosis, is rebuilding momentum since the pandemic-fueled sharp declines in diagnosis and treatment levels for the world’s three biggest infectious diseases. 

While the growth in HIV coverage levels remains steady, TB and malaria coverage have both declined in recent years. Declines in TB coverage are mostly due to disruptions caused by the COVID-19 pandemic, and declines in malaria coverage in sub-Saharan Africa may partly reflect better targeting of mosquito nets.

HIV program disruption ‘less than initially feared’ 

The world missed every single global HIV target for 2020, including that of reducing deaths to fewer than 500,000 per year. But the report states that this “could have been much worse.”

As a result of the Global Fund’s COVID-19 response mechanism (C19RM) for HIV programs, disruption to antiretroviral therapy was less than initially feared, the report states. 

The Global Fund C19RM’s prevented acute disruption to HIV/AIDS programs.

Some 23.3 million people received antiretroviral therapy for HIV in 2021, continuing the trend of a rising number of people on treatment for the virus.

The HIV prevention services helped 12.5 million people, including 5.8 million from populations most at risk and 6.1 million young people. The helped to recovered the ground lost in 2020 when prevention services dropped.

Globally, AIDS-related deaths fell 50% since 2010, down to 650,000 people in 2021. On prevention, progress in reducing new HIV infections remains slow: a 32% reduction since 2010, with 1.5 million people newly infected with the virus in 2021, compared to 2.2 million in 2010. New infections flatlined, and in some regions they increased.

Pandemic impacts tuberculosis 

The rebound of tuberculosis treatment is particularly good news in light of the harsh impact the pandemic had on the fight against TB. Resources for COVID-19 diagnosis and treatment drained those used for TB.

As a result, TB killed an estimated 1.5 million people (including people living with HIV) in 2020. That marked the first increase in a decade, derailing efforts to cut TB deaths by 35%. Additionally, TB remains the leading cause of death for people living with HIV. 

COVID-19 also harmed efforts to reduce the number of people who fall ill with TB but are not diagnosed, treated or reported. Health systems missed almost half of the people who fell ill with TB in 2020.

TB treatment coverage dropped in 2020 as a result of COVID-19 disruptions.

But in 2021, there was a sharp turnaround. Some 5.3 million people were treated for TB and 110,000 others were treated for drug-resistant TB last year.

In addition, 395,000 people who were in contact with TB patients received preventive therapy, while 283,000 HIV-positive TB patients were put on antiretroviral drugs. 

The report credits the recovery to US$159 million in funds invested in 2021 to support people with TB and to the Global Fund’s programs in 20 high-priority TB countries. 

“In the fight against TB, we are recovering from the 2020 losses,” it says.

Climate change and pandemic challenged malaria programs 

In 2020, malaria deaths rose by 12% compared with 2019, up to an estimated 627,000. Some 47,000 of the additional 69,000 deaths in 2020, or 68%, resulted from pandemic-caused service disruptions.

Climate change disrupted malaria programs by affecting the geographical distribution of plasmodium-carrying mosquitoes, which can cause malaria. 

To mitigate the impact of COVID-19, the Global Fund and its partners scaled up malaria program adaptations. They distributed mosquito nets door-to-door and made changes to the seasonal malaria chemo-prevention program for children under the age of five. They also increased community referrals and distribution of long-lasting insecticidal nets.

The Global Fund and its partners scaled up malaria programs to make up for losses during the pandemic.

As a result, 280 million suspected cases of malaria were tested in 2021, registering significant gains in efforts to ensure all people who may have malaria are diagnosed.

Health workers treated 148 million cases of malaria, continuing the recovery in efforts to ensure all people who are diagnosed with malaria are treated swiftly to prevent deaths.

Families received 133 million mosquito nets to protect from malaria. Additionally, 12.5 million pregnant women got preventive therapy for malaria to help keep them and their babies healthy.

Swift Global Fund response helped blunt pandemic impacts

The Global Fund says its swift response to COVID-19, providing more than $4.4 billion to fight the pandemic and mitigate its impact on HIV, TB, and malaria control, helped blunt COVID-19’s impact overall by helping countries put more resources into prevention campaigns and buying personal protective equipment, diagnostics, treatments and medical supplies. 

However, the Global Fund does not expect progress against the three diseases to fulfill the United Nations’ Sustainable Development Goals (SDGs) for 2030. 

“Although most countries that fight HIV, TB and malaria have started to recover from the ravages of COVID-19, we need to accelerate our efforts if we are to fully recover lost ground and get back on track towards ending these diseases by 2030,” said Peter Sands, the Global Fund’s executive director.

Global Fund to raise $18 billion to fund fight against the three diseases 

The report comes just ahead of Global Fund’s replenishment conference seeking US$18 billion for its next three-year cycle of programs and grants. 

The money is projected to save another 20 million lives between 2024 and 2026, Sands said, and strengthen health and community systems to reinforce pandemic preparedness.

Image Credits: Uzma Khan, Global Fund.

Dr Matshidiso Moeti, WHO’s regional director for Africa

A new R21/Matrix-M malaria vaccine shows 75% efficacy in a Phase2b trial – a potentially game-changing result compared to the WHO-approved RTS,S/AS01 (RTS,S) vaccine. 

The WHO has said it will continue with the rollout of its approved RTS,S vaccine, despite the promise of a new malaria vaccine candidate, the R21/Matrix-M, that shows an efficacy of 75% in a recent Phase 2b trial – nearly double that of the recently-approved RTS,S vaccine. 

At a WHO press briefing on Thursday, Dr Matshidiso Moeti, WHO’s regional director for Africa, welcomed the findings on the R21/Matrix-M vaccine, which were published on Wednesday in the Lancet, but said the rollout of the RTS,S vaccine would continue. 

The R21/Matrix M vaccine candidate still must be tested clinically against the RTS,S vaccine in a large-scale  field setting, Moeti said.

“We can look forward to – eventually once the data is finalized – the vaccine going through all the phases of clinical trials, and then a field test with the RTS,S vaccine,” she said.

The R21/Matrix M, she said, “can be an additional tool to join the vaccine that has been found to have a reasonable level of efficacy, the RTS,S vaccine, in reducing severe malaria and deaths in children.”

Only three months ago, the Gates Foundation said it was withdrawing financial support from the rollout of the RTS,S vaccine because of its low efficacy ratings, and would prioritize its investments in classical measures like insecticide treated bednets. 

The RTS,S vaccine, the first ever to be approved by WHO in October 2021, was piloted among some 800,000 infants and children, demonstrating a 40% reduction in malaria episodes and a 31% reduction in severe malaria infections in a three country pilot.

WHO later said it would spend US$160 million to roll out the vaccine more widely between now and 2025, beginning in Ghana, Kenya and Malawi.  

‘Aimed at licensing this vaccine for widespread use next year’

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Midwife treating a baby with severe malaria.

But if the results of the R21/Matrix-M hold up in a Phase 3 trial – which researchers hope will yield sufficient results for licensing by next year –  this newer vaccine could very well supercede the other vaccine, upending WHO’s original plans.  

In their findings reported in The Lancet Infectious Diseases, researchers from the University of Oxford and their partners found that a vaccine booster dose at one year following a primary three-dose regime, had an efficacy of at least 75% in preventing malaria episodes – as compared to about 40% for the WHO-approved RTS,S vaccine. 

This higher efficacy also meets the WHO’s Malaria Vaccine Technology Roadmap goal – once considered largely aspirational. The R21/Matrix-M vaccine had previously demonstrated efficacy of 77% over the first 12 months of the randomized, controlled vaccine trial involving a total of 450 participants aged five to 17 months, recruited in the region of Nanoro, Burkina Faso. 

In the most recent study of a booster dose of the R21/Matrix-M, some 409 of the original 450 participants returned to receive the booster after a year, leading to a similar outcome. The trial is continuing for another two years to assess both potential value of additional booster vaccine doses, and longer-term safety.  

Halidou Tinto, a professor in parasitology and the trial’s principal investigator, said it is “fantastic to see such high efficacy again after a single booster dose of vaccine. We are currently part of a very large Phase III trial aimed at licensing this vaccine for widespread use next year.” 

Adrian Hill, a co-author of the paper who is a professor of vaccinology and director of the University of Oxford’s Jenner Institute, also expressed delight “to find that a standard four-dose immunization regime can now, for the first time, reach the high efficacy level over two years that has been an aspirational target for malaria vaccines for so many years.”

Mechanism of action 

Researching new anti-malarial medications

R21/Matrix-M is a pre-erythrocytic malaria vaccine candidate developed by scientists at the University of Oxford and manufactured by the Serum Institute of India.

It is produced by expressing recombinant Hepatitis surface antigen virus-like particles in Hansenula polymorpha, a microorganism that occurs naturally in some insects and food. The trial was funded by the EDCTP2 programme, supported by the European Union, Wellcome Trust and NIHR Oxford Biomedical Research Centre.

RTS,S, a recombinant protein-based malaria vaccine, aims to trigger the immune system to defend against the first stages of malaria when the Plasmodium falciparum parasite enters the human host’s bloodstream through a mosquito bite and infects liver cells. 

The vaccine is designed to prevent the parasite from infecting the liver, where it can mature, multiply, re-enter the bloodstream, and infect red blood cells, which can lead to disease symptoms. 

It resulted from 30 years of research and development by GSK and through a partnership with PATH, with support from a network of African research centres. The Bill and Melinda Gates Foundation provided catalytic funding for late-stage development of RTS,S between 2001 and 2015, according to WHO.

Image Credits: Elizabeth Poll/MMV, MMV.

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Barbados receives 33,600 doses of COVID-19 vaccines, its first shipment through the COVAX facility, in April 2021

In one of the first concrete measures to attempt to redress huge inequities exposed by the COVID-19 pandemic, the Washington-based World Bank formally established a new billion-dollar financial intermediary fund (FIF) to invest in helping the world – particularly low- and middle-income countries – strengthen defenses against pandemics and epidemics.

FIF’s governing board officially set up the new fund at a meeting in Washington, the World Health Organization announced on Friday. The new fund is hosted by the World Bank with technical leadership from Geneva-based WHO.

Its main purpose is to provide long-term financing that fills critical gaps mainly in low- and middle-income countries. It also will serve as a platform to advocate for stronger health systems. FIF plans to start soliciting its first funding proposals in November.

“COVID-19 has highlighted the pressing need for action to build stronger health systems,” said World Bank Group President David Malpass. “Investing now will save lives and resources for the years to come.”

The World Bank’s board of directors approved FIF’s creation in late June. The World Bank serves as FIF’s trustee and hosts its Secretariat, which includes technical staff from WHO.

A technical advisory panel chaired by WHO will help guide FIF’s governing board on the merits of funding proposals, ensuring linkages to the International Health Regulations (IHR), the legally binding rules among nations for responding to global health emergencies like the coronavirus pandemic.

The new fund was developed with support from some of the Group of 20 major economies, and has lined up more than US$1.4 billion in financial commitments.

The financing is intended to strengthen capacity in labs, emergency communication, zoonotic disease surveillance, pandemic coordination and management, workforce capacities and community engagement, according to WHO.

“The COVID-19 pandemic has been a seismic shock to the world, but we also know that the next pandemic is a matter of when not if,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus.

Nations that have made financial commitments to support the FIF include Australia, Canada, China, the European Commission, France, Germany, India, Indonesia, Italy, Japan, New Zealand, Norway, Singapore, South Africa,  South Korea, Spain, the United Arab Emirates, the United Kingdom and the United States.

Organizations that have promised support include the Bill and Melinda Gates Foundation, the Rockefeller Foundation and Wellcome Trust.

Pandemic suffering ‘will be in vain’ unless there are lessons learned

Tedros Adhanom Ghebreyesus, WHO Director-General

Already, the world is grappling with a repeat of some of the same challenges it has faced during the pandemic as it navigates the monkeypox public health emergency – and rich nations’ continued stronghold on access to vaccines.

And more than a month after declaring monkeypox a public health emergency of international concern (PHEIC), WHO’s Africa Region has only received 39,000 test kits for the virus while vaccines and treatments remain unavailable on the continent where the disease is endemic and often more deadly.

FIF aims to address the critical funding problems that already began to emerge a couple years ago. With COVID-19 vaccines, the multilateral COVAX financial facility was forced to the back of the line when trying to lock in advance purchases because it lacked the upfront funds to make legal commitments to drug makers.

FIF’s governing board also is supposed to include equal representation from among sovereign donors, governments, foundations and civil society organizations.

Tedros said the suffering and loss everyone has endured “will be in vain unless we learn the painful lessons from COVID-19 and put in place the measures to fill critical gaps in the world’s defences against epidemics and pandemics.”

The new fund is one of those key measures, he said, and WHO “looks forward to fulfilling its technical leadership role in advising the FIF Board on where to make the most effective investments to protect health, especially in low- and middle-income countries.”

Image Credits: PMO Barbados.

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World Health Assembly

The submission period for the second round of public hearings to inform the development of a new international instrument on pandemic prevention, preparedness and response is now open and will

The World Health Organization (WHO) is inviting interested parties to submit a video statement in response to the question: Based on your experience with the COVID-19 pandemic, what do you believe should be addressed at the international level to better protect against future pandemics?

The statements should be up to 90 seconds long and can be submitted in any six official WHO languages (Arabic, Chinese, English, French, Russian or Spanish).

Public hearings inform the deliberations of the Interngovernmental Negotiating Body (INB) to help draft and negotiate a WHO convention, agreement, or other international instrument on pandemic prevention, preparedness, and response, as mandated by the World Health Assembly during its special session in December 2021.

Read more about the submission process here at WHO

Dr Matshidiso Moeti, director of WHO’s regional office for Africa

The COVID-19 pandemic delayed plans to vaccinate more than 50 million African children with doses of MenAfriVac, a vaccine designed for the African meningitis belt. That could undo the progress in controlling a lethal form of meningitis in Africa, the World Health Organization warns.

Until 12 years ago, meningitis type A made up 90% of the meningitis cases and deaths in Africa. One particularly deadly outbreak in 1996 infected a quarter million people, and killed 25,000.

After African health ministers pleaded for a solution, the MenAfriVac was developed through a partnership between WHO, the Bill and Melinda Gates Foundation and PATH. Starting in 2010, more than 350 million people in 24 high-risk nations received the single-dose vaccine.

The stunning result? Not a single new case of meningitis type A has been reported in Africa in the past five years, WHO reported on Thursday, and the chance of survival is now 95%, up from 50% less than a decade ago.

“The defeat of meningitis A is one of Africa’s biggest health success stories with not a single case being reported on the continent in the past five years,” says Dr Matshidiso Moeti, director of WHO’s regional office for Africa.

Now, that progress is in jeopardy because “the COVID-19 pandemic has delayed [MenAfriVac] vaccination campaigns targeting more than 50 million children” under 12 years of age in Benin, Guinea, Guinea Bissau, Nigeria and Togo, she told reporters in an online briefing.

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Meningitis A vaccination in Chad

“I think most importantly what we are learning about vaccines repeatedly – the lessons learned for the MenAfriVac vaccine, the lessons we’re learning very much for the COVID-19 vaccinations – is that it’s very important to create the demand for vaccines in the population,” said Moeti. “It’s very important that people know the value of vaccines.”

WHO officials say the pandemic severely disrupted meningitis prevention and control services by as much as 50% in 2020 compared to 2019, with disease surveillance, laboratory confirmation of cases and outbreak investigations all steeply declining. There was a slight improvement in 2021 but not enough to make much of a difference, according to Moeti.

“Meningitis is taking an enormous toll on our countries with COVID-19 threatening some of the extensive gains that have been made in the past,” she said. “Major outbreaks caused by meningitis group C have been reported in seven of the African sub-Saharan meningitis belt countries in the past nine years.”

Importance of ‘community acceptance’ in meningitis efforts

Twenty-six countries in sub-Saharan Africa are known as the ‘meningitis belt’ because of the frequency of outbreaks. The latest major outbreak in the Democratic Republic of Congo killed more than 200 people last year.

As a result, WHO says it is in a race against time to fight the heightened risk of outbreaks of meningitis type A caused by inflammation of the membranes that surround the brain and spinal cord. It can lead to death within 24 hours; children under the age of five are particularly at risk.

Four organisms are responsible for 50% of deaths: Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae and group B streptococcus.

Ahead of the start of the next meningitis season in January 2023, WHO is launching a US$1.5 billion global strategy to defeat bacterial meningitis in Africa by 2030.

One of the priorities is to roll out a next-generation vaccine that has been shown in clinical trials to be safe and effective against multiple forms, Moeti told reporters on Thursday.

“Community acceptance, which resulted in 95% coverage in affected countries for the MenAfriVac vaccine, is proof of what can be achieved,” said Moeti.

“Following this example, the new framework aims to roll out the new vaccine to all 26 meningitis belt countries between 2023 and 2030 – aiming to achieve 90% coverage,” she said. “WHO is expected to prequalify the vaccine by the first quarter of next year.”

The UN health agency wants to help countries shore up diagnosis, surveillance, care, advocacy and vaccination to eliminate outbreaks, curb deaths by 70% and halve infections, which it estimates would save more than 140,000 lives a year and significantly reduce disability.

Dr. F. Marc LaForce, the Serum Institute of India’s technical services director

Dr. F. Marc LaForce, the Serum Institute of India’s technical services director, emphasized the importance of the MenAfriVac vaccine in the fight against meningitis type A.

“The disease has disappeared in every country where campaigns have been done,” said LaForce, a former director of the Meningitis Vaccine Project, a PATH/WHO/Serum Institute of India partnership funded by the Gates Foundation.

“It is worth remembering that to this date, between 600,000 to a million cases of bacterial meningitis due to group A have been prevented. This is an enormous success and one I think we should all take great pride in,” he told the press briefing from his home in the United States.

“A new vaccine again specifically designed for the African meningitis belt will hopefully be prequalified [by WHO] later this year or early next year,” said LaForce. “But this vaccines holds the promise of finishing what MenAfriVac began, such that Africa may be the first continent to be free of meningitis epidemics.”

Image Credits: Gavi.