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

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

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

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

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

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

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

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

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

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

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

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

A decimal can make all the difference

 

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

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

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

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

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

For millions, the climate crisis is already here

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

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

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

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

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

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

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

Financial hurdles present big challenges

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

A disproportionate burden

CFR

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

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

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

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

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

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

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

Total systemic change is a big ask

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

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

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

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

In this context, any progress will be welcomed.

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

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

UNEP roadmap for a sustainable transition outlined in the report.

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

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

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

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

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

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

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

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

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

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

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

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

Image Credits: PNAS, OXFAM.

Shelves stand empty in a Wuhan supermarket in an earlier lockdown.

China administered the world’s first oral aerosol COVID-19 vaccine boosters in Shanghai on Wednesday, as new lockdown measures were imposed on Wuhan, the supposed birthplace of the pandemic.

Chinese vaccine manufacturer CanSino Biologics said in a media statement that the inclusion of its vaccine in Shanghai’s booster vaccination program marked “the start of the rollout of the world’s first inhaled COVID-19 vaccine, Convidecia Air”.

The inhaler, approved as a booster for adults last month by the National Medical Products Administration of China, “provides a non-invasive option that uses a nebulizer to change liquid into an aerosol for inhalation through the mouth”, according to the company.

“Convidecia Air is needle-free and can effectively induce comprehensive immune protection in response to SARS-CoV-2 after just one breath,” it added. The aerosol vaccine is based on Sinovac (marketed as CoronaVac).

The Chinese-developed Sinovac uses a modified version of an adenovirus to deliver inactive parts of SARS CoV2 to a person’s immune system to prime it recognise and attack the virus when it becomes infected. This is followed by a second vaccine to boost the immune system a few weeks later.

Results from a clinical trial that compared the oral aerosol vaccine to an injectable version of Sinovac, published in The Lancet in August, found that the aerosol elicited 6.7 to 10.7 more neutralising antibodies than the injection after two to four weeks.

However, Sinovac is less efficacious against COVID-19 than mRNA vaccines, and there are some early indications that it offers very little protection against the latest variants.

Nasal sprays

Meanwhile, there are other clinical trials of SARS-CoV-2 vaccines delivered through the mucosa, but these are all nasal sprays.

Researchers at Yale University in the US recently published a pre-print paper reporting early success in mice using a vaccine booster strategy, “prime and spike”.

Noting that protection offered by mRNA vaccines weakens fairly fast, particularly in the nasal mucosa and respiratory tract, in those already vaccinated (“primed”), they tested an intranasal “spike” to “elicit mucosal immune memory within the respiratory tract”. 

Their trial found that “prime and spike” induced a robust immune response in animals that protected against SARS-CoV-2 infection. 

Indian company Bharat has also developed an intranasal vaccine for Covaxin, which it says has been successful in animal studies although it has not yet submitted results for peer review.

Wuhan locks down

Meanwhile, China has locked down Wuhan’s central Hanyang district after COVID cases were found, as China persists with a zero-tolerance approach almost three years after the virus was first reported in the city, and about 900,000 residents were told to stay at home, according to Bloomberg.

This follows the re-election of Chinese President Xi Jinping – the architect of the “zero-COVID” strategy – for a third five-year term as leader of the country’s ruling communist party.

China’s zero-COVID strategy has resulted in lockdowns of entire cities. People living in districts where COVID-19 cases are detected are obliged to stay indoors for seven days and take a daily test.

The lockdowns have had a negative effect on the country’s economy, with a 1.7% contraction in sales last month largely as a result of quarantines in various parts of the country.

Meanwhile, a 14-year-old girl teenager, Guo Jingjing, died in a quarantine facility earlier this month, according to the BBC.

She apparently developed a fever two days after being taken to a facility in Ruzhou, and her family posted videos on social media of her shaking and convulsing on a bed. Her father, Guo Lele, said in a video on Douyin (Chinese TikTok) that the facility had not provided her with any help.

However, the videos and most references to the incident have since been removed.

Image Credits: Studio Incendo.

Testing for antimicrobial resistance at the Liverpool School of Tropical Science.

The World Health Organization (WHO) has raised the alarm over drug-resistant fungi as it released its first-ever priority list of fungal pathogens at risk from antimicrobial resistance (AMR). Nineteen species of fungi have been identified by the global health agency as representing “the greatest threat to public health” due to their growing drug resistance.  

Meanwhile,  a new report by a civil society coalition warned that unmitigated use of anti-fungal and antibacterial drugs on crop and animal production is fueling the fires of AMR – with too little action by countries and the UN system.

Speaking to media Tuesday, Dr Haileyesus Getahun, the director of AMR Global Coordination at WHO, said that WHO had compiled a list of piority fungal pathogens to put the issue on the public agenda and identify the areas for further research and development on fungal diseases.

Underlining the need for more documentation and surveillance on the fungal infections and diseases, Dr Getahun said, “ “We want the documentation of what’s happening currently … to dictate or to guide, while waiting for the evidence to be complete, what public health actions can be taken, particularly in raising awareness around these fungal infections.” 

Of the 19 species of fungi identified as priority pathogens, four pathogens were labelled as having “critical priority”. Those include Aspergillus fumigates, which causes respiratory infections in humans.  Others are Cryptococcus neoformans, Candida auris, which can cause bloodstream infections, wound infections and ear infections, and Candida albicans (thrush).  

Dr Haileyesus Getahun, the director of AMR Global Coordination at WHO, explaining the risk posed by drug-resistant fungi
Dr Haileyesus Getahun, the director of AMR Global Coordination at WHO, at the virtual press briefing on Tuesday.

The WHO report highlights how common fungal infections are becoming increasingly resistant to available treatments, raising risks particularly for people with low immunity. “Populations at greatest risk of invasive fungal infections include those with cancer, HIV/AIDS, organ transplants, chronic respiratory disease, and post-primary tuberculosis infection,” the report stated. During the Covid-19 pandemic, many health agencies also reported spikes in drug-resistant bacteria in samples collected from patients. 

While bacterial antimicrobial resistance (bacterial AMR) has received increasing attention from researchers and health ministries, information and data on fungal AMR is nowhere close. This is reflected in the fact that currently there are only four classes of antifungal medicines available to treat pathogenic fungal diseases. With few more treatment candidates in the clinical pipeline, WHO has warned that drug-resistant fungal pathogens are spreading far and wide across the globe due to many factors including unchecked use of antifungal agents in agriculture and aquaculture and climate change. 

All-age rate of deaths attributable to and associated with bacterial antimicrobial resistance by GBD
region, 2019

Role of azoles in fungal AMR

Rice fields are one type of agriculture where azoles are widely used.

Meanwhile, the new report on AMR released Monday by a civil society coalition carried an even stiffer warning abou the role of agrobusiness in spurring AMR – through rampant use of antifungal, antiboitic and antiviral agents on livestock and crops.

The report was co-authored by Nicoletta Dentico of the Society for International Development and the Geneva-based AMR Think-Do Tank.

The report, Untangling Antimicrobial Resistance, highlights, in particular, the role played by the widespread use of fungicides belonging to the azole family on agricultural crops – in the process fostering more drug resistant strains of Aspergillus fumigates, one of the pathogens on WHO’s priority list as a hazard for human health.

While antifungals may be regarded as key to food security, wanton use is increasing drug resistant mutations of fungi, and thus “selective pressure on human pathogens”, especially in regions where regulations against the on the use of fungicides are weak, the SID report added. 

Aspergillus fumigates causes an “environmentally acquired respiratory illness,” with Europe reporting the highest number of cases from the fungus. A 2021-study described how Aspergillus fumigatus has been spreading in all continents across the world, except Antarctica. 

Uncontrolled release of drug-laced effluents by industry, agriculture, households and the health sector is another pathway by which AMR resistance is growing silently, but steadily – particularly in parts of the world lacking good sewage treatment systems, the report states.

Not enough data on drug-resistant fungi

Deaths from drug resistant bacteria such as S. pneumonia and K. pneumonia have been mapped recently – but similar work is lacking for fungal agents.

Another issue faced in coming to grips with the surge of fungal AMR, is the lack of data, WHO officials said at their briefing. There are no systematic requirements for countries’ reporting on the use of antimicrobial or antifungal agents in human health or agriculture – or for reporting on AMR hotspots that emerge from overuse.  Whatever data may be collected by WHO, it is not harmonised with data collected by FAO or OIE.  Without data, it is tough to know where fungal drug resistance is growing, and what is the global burden of diseases from related deaths.

“But it doesn’t mean that it’s not a problem,” Dr Getahun pointed out. “That is why we have identified the priority pathogen list. And that is why we are actually encouraging more research, more surveillance, to understand the actual extent. Then we will be able to have appropriate estimates about global [burden].”

“Currently, fungal infections receive less than 1.5% of all infectious disease research funding. Consequently, the evidence base is weak, and most treatment guidelines are informed by limited evidence and expert opinion. Tackling the problems posed by invasive fungal disease will require increased research funding, targeted at the key priorities, new antifungal medicines and improved diagnostics,” the report added. 

While a recent Lancet study estimated that drug-resistant bacterial infections directly cause around 1.3 million deaths every year, and are associated with the deaths of some five million people every year, no such numbers are available for drug-resistant fungi. “We do need surveillance to identify the real burden and direct the public health as it is.”

Coordination between WHO, FAO, OIE and UNEP – hope or smokescreen?

Stefano Prato, top left, describes the economic model that has locked in farmers to overuse of drugs critical to human health. Nicoletta Dentico, lower left, moderates.

Recognizing the growing AMR threats from animal production and crop cultivation, WHO in April 2022 signed a Memorandum of Understanding (MoU) with Food and Agriculture Organization of the United Nations (FAO), World Organization for Animal Health (OIE) and United Nations Environment Programme (UNEP) to collaborate on so-called One Health, approaches encouraging more judicious use of available drugs and chemical agents. 

Getahun, who is also director of the Quadripartite joint secretariat, told Health Policy Watch that under the MoU, the agencies – dubbed the Quadripartite – are working more closely together to identify those antibiotics that are critical to human and veterinary health. “[This was done] in order to ensure that these antimicrobials are not prescribed without the necessary veterinary or physiotherapy, you know, indications for plants.”

However, Getahun acknowledged that this work is in its early stages.

Speaking at the launch of the civil society report on AMR at Geneva’s South Centre, SID managing director Stefano Prato criticized the Quadripartite’s work as largely “theatrical” lacking normative teeth.  Meanwhile, veterinarians and farm extension advisors often receive huge financial incentives from encouraging farmers’ over-use of antibiotics, antivirals, antifungal agents and other drugs, driving uncontrolled use of such products.

“In many countries vets are really the ones who prescribe, earn and enjoy income and profits from the prescription of antiviral or antibiotics at the farm level,” observed Prato, who is both a veterinarian and an economist by training.”

In addition, developing countries have become locked into monoculture systems of industrial crop production, which typically require large drug and chemical applications – in order to generate cash crops for export.  Shifting out of that model to more sustainable agriculture systems that can supply more nutritious foods locally, is now extremely difficult because of their foreign debt burden, Prato said.

“Many countries that are locked into that export-driven model are also exposed to significan foreign debt… That means that they need the income and the currencies that are related to their export of commodities, because they need to repay those currencies”

“And so the conflicts of interest are so entrenched, not only at the global level but also at the national and micro level,” he said.

As for the new collaborations between WHO, FAO OIE and UNEP, Prato observed: “Without a proper governance structure, there will be no solution… it will end up being some kind of policy entertainment..theatrical red carpet solutions.”

-Updated 26 October with correction to the names of the report co-authors.

Image Credits: Flickr – UK Department for International Development, WHO, The Lancet, Creative Commons Zero, E. Fletcher/Health Policy Watch.

Exercise is an essential part of health.

Most countries are failing dismally to promote physical exercise despite inactivity playing a major role in heart disease, obesity and diabetes, according to the World Health Organization (WHO).

The WHO’s newly released Global status report on physical activity 2022 measures the extent to which governments are implementing recommendations to increase physical activity across all ages and abilities. 

Data from 194 countries shows that less than half the countries have a national physical activity policy, and only 30% have physical activity guidelines for all age groups. Just over 40% of countries have roads designed to enable safer walking and cycling.  

“We need more countries to scale up implementation of policies to support people to be more active through walking, cycling, sport, and other physical activity. The benefits are huge, not only for the physical and mental health of individuals, but also for societies, environments, and economies,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General, “We hope countries and partners will use this report to build more active, healthier, and fairer societies for all.”  

The economic burden of physical inactivity is significant and the cost of treating new cases of preventable non-communicable diseases (NCDs) will reach nearly $300 billion by 2030, according to the WHO. 

To help countries increase physical activity, WHO’s Global action plan on physical activity 2018-2030 offers 20 policy recommendations, including policies to create safer roads to encourage more active transport, provide more programmes and opportunities for physical activity in key settings, such as childcare, schools, primary health care and the workplace. 

The report calls for countries to prioritize physical activity as key to improving health and tackling NCDs, integrate physical activity into all relevant policies, and develop tools, guidance and training to improve implementation. 

“It is good for public health and makes economic sense to promote more physical activity for everyone,” said Dr Ruediger Krech, Director Department of Health

Exercise and COVID-19 vaccine

Meanwhile, a South African observational study of over 190,000 people suggests that regular physical activity may have boosted the efficacy of the Johnson & Johnson (J&J) COVID-19 vaccine. 

The study, published in the British Journal of Sports Medicine on Wednesday, was conducted by the health insurance company, Discovery Health, and its wellness programme, Vitality, in collaboration with Witwatersrand Sport and Health Research Group and the South African Medical Research Council (SAMRC).

It drew on the anonymised medical records, and recordable activity tracker data for 196,444 healthcare workers vaccinated with the J&J vaccine, who were clients of both a Discovery Health Administered Scheme and a Vitality wellness programme.

Those who were fully vaccinated and had high weekly levels of physical activity were nearly three times less likely to be admitted to hospital than those who were vaccinated but in the low physical activity category. 

“We set out to test the hypothesis that regular physical activity enhances the immune-boosting effect of COVID-19 vaccines, reducing severe outcomes in vaccinated people (measured by hospital admission),” explains Discovery Health’s analytics actuary, Shirley Collie. 

“The risk of hospital admission among fully vaccinated healthcare workers was reduced by 60% in the group who engaged in low levels of physical activity, and by 72% and 86% in the medium and high physical activity groups, respectively.” 

However, Professor Glenda Gray, President of the South African Medical Research Council, cautions that more research is needed to understand why exercise enhances the vaccine’s effects.

“For now, we suggest this may be a combination of enhanced antibody levels, improved T-cell immunosurveillance and psychosocial factors,” said Gray.

Image Credits: WHO/A. Loke.

Polio
Representatives from Rotary International and the government of the Philippines sign the agreement that starts Rotary International’s first polio project, 1979.

A historic window of opportunity to eradicate polio could be slipping away, World Health Organization (WHO) Europe leaders warned at a press conference marking World Polio Day on Monday. 

Since the 1980s, global polio cases have fallen by 99.9% and if polio were to be eradicated, it would join smallpox as only the second disease to be consigned to history.

“Polio is on the verge of becoming a story of the past,” said Dr Hans Kluge, WHO Europe Regional Director. “We stand on the cusp of eradicating the virus, but progress and the European region’s polio free status remain vulnerable.” 

The European region has been free from wild polio for two decades. But over the past year, circulation of vaccine-derived polio virus – a strain mutated from the weakened virus contained in the oral polio vaccine – has been confirmed in Israel, Ukraine, and the United Kingdom. This weakened variant can only spread in pockets of under-immunized communities, highlighting the need to reinforce vaccination efforts.

“The fight against polio has demonstrated the wonders of immunization, but this is not something we can take for granted,” Kluge said. “We are so close to the prospect of a polio free world. Choosing to leave the fight now would be a tragedy for future generations.”

Journey to eradication: from dream to reality

Polio
The 1979 agreement between Rotary International and the Philippine Ministry of Health for a joint multi-year effort to immunize children against polio

In 1979, a member of Rotary International issued a challenge to their peers in the Philippines chapter to eliminate polio from the island nation. It would take years of work, but the initiative was successful. The last case of wild polio in the Philippines was recorded in 1993. 

The challenge was then put to Rotary’s 1.4 million members globally. With representatives in over 200 countries, the goal became global eradication of the disease. Since the start of the 1979 vaccination campaign in the Philippines, Rotary International has invested $2.6 billion in the fight against polio.

“The thought was ‘if we can do it here, can we do it everywhere?‘” explained Rotary international president Jennifer Jones in her opening statement at the Monday press conference. “We started to speak with health professionals and organizations around the world, but it wasn’t seen as being a possibility at all.”

In 1988, the WHO, UNICEF and the Centers for Disease Control and Prevention, came together to form the Global Polio Eradication Initiative (GPEI). Later, the Bill and the Melinda Gates Foundation joined and GPEI became the largest international public health initiative in history.

Just last week, GPEI secured $2.6 billion in commitments at the World Health Summit, which is over half of its funding target of $4.8 billion set out in its 2022-2026 Strategy. This money is needed to provide vaccinations and essential healthcare services to over 370 million children worldwide. In total, over $19 billion has been invested into the programme since its launch.

The global effort has led to a reduction in polio cases by 99.9%.  “We are closer than we’ve ever been,” Jones said.

Endemic regions making progress

The mountains of North Waziristan, Pakistan.

Two years ago, wild polio was eradicated from endemic reservoirs in India and the African continent, and efforts in the last two endemic countries – Pakistan and Afghanistan – are trending in the right direction. But with the finish line in sight, the last mile is proving difficult.

“Pakistan has made incredible progress against polio, but recent challenges have allowed the virus to persist,” said Dr Zulfi Bhutta, professor at Aga Khan University in Pakistan. “Polio, like any virus, knows no borders; its continued transmission threatens children everywhere.”

Waziristan, a mountainous region of Pakistan on its Afghan border, faces high levels of vaccine hesitancy that have led to it becoming polios’ most resilient reservoir. The surrounding mountains – once strongholds of the Taliban – are a fitting backdrop for the disease to take its final stand.

The return of the Taliban from these very mountains to the levers of power in Afghanistan have complicated progress in reaching its unvaccinated communities. But negotiations to allow vaccinators better access to the country are underway.

Children pay the price of low-vaccination

Vaccine-derived polio strains are only a threat to the under-immunized. Too often, this means the heaviest burden falls on children.

“The occurrence of vaccine-derived polio around the globe clearly indicates one thing: we have left our children behind by not getting them vaccinated,” said Dr Siddhartha Datta, WHO Europe’s Regional Immunization Advisor. “It is extremely important that every child gets the vaccine doses which are part of the national vaccination schedule.”

Hundreds of children have already been paralyzed this year due to the spread of a vaccine derived strain amongst non-immune people in parts of Africa, Asia and Europe.

“Children deserve to live in a polio-free world, but as we have seen this year with painful clarity, until we reach every community and vaccinate every child, the threat of polio will persist,” said UNICEF Executive Director Catherine Russell. 

Polio anywhere is a threat everywhere

The re-emergence of polio in non-endemic regions highlights the difficulties of eradicating diseases in an increasingly interconnected world.  

“Polio is still a plane ride away,” Carol Pandak, the Chicago-based director of Rotary’s PolioPlus program told Bloomberg. “We’re sticking with the fight until we finish the job and keep our promise to the children of the world.”

But while cases in non-endemic countries are cause for anxiety, there is no need to panic, Jones explained.

“Seeing cases outside of the endemic areas is concerning, but we don’t need to fear-monger,” she said. “We should utilize the opportunity to raise awareness of what polio is and why it’s important to eradicate.”

COVID-19 has also taken a toll on polio immunization programmes. Across the WHO’s European region, coverage of the third dose of polio vaccine fell by 1% between 2019 and 2020. In 2021, only 25 out of 53 of the region’s countries had reached the 95% polio vaccination coverage rate recommended by the WHO.

“It is paramount that we ensure high vaccination coverage in all population groups,” said Kluge. “Until polio is eradicated, every country will remain at risk.”

COVID remains a threat, and forecasting is shaky

WHO Europe Director Hans Kluge at a press conference marking World Polio Day.

Last week marked 1000 days since the first cases of COVID-19 arrived in Europe. Entering the third pandemic winter, the continued evolution of the virus driven by a range of sub-lineages of the Omicron variant remains a concern.

An autumn surge has led to a tripling of cases in the European region since early September. In the second week of October, the region accounted for nearly 60% of new global cases and 42% of deaths.

“We are much better prepared, and the surge has not led to previous ICU admission or severe disease levels,” Kluge noted. “But the virus has surprised us more than once, and forecasting is tricky.”

WHO Senior Emergency Officer Dr Catherine Smallwood echoed the difficulty of projecting how the disease will develop through the winter.

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

Image Credits: Rotary International, Rizwan Ullah Wazir.

IFPMA Director-General Thomas Cueni

The Biotechnology Innovation Organization (BIO) and Developing Countries Vaccine Manufacturers’ Network (DCVMN) have thrown their weight behind the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) proposal to improve access to vaccines in future pandemics.

The proposal, known as the Berlin Declaration, outlines how the pharmaceutical industry would reserve an allocation of real-time production of vaccines for priority populations in lower-income countries in future global pandemics.

In exchange, the industry wants their intellectual property protected, and for governments to “guarantee the immediate and unhindered sharing of emerging pathogens and their associated data to all researchers”, as well as committing to unrestricted trade, no export bans, and expedited processes for import and export during a pandemic.

The three pharma associations –  representing vaccines innovators as well as manufacturers – announced their agreement on Monday following a meeting in India hosted by DCVMN.  They called upon the G20, G7 and multilateral organizations to implement their part of the proposed bargain, etched out by the Berlin Declaration. 

“By supporting the vision for equitable access in pandemics, vaccine innovators and manufacturers acknowledge that while innovation, business-to-business voluntary collaboration and manufacturing scaling up succeeded in an unprecedented way during COVID-19, efforts to achieve equitable access were not fully realised,” the three bodies acknowledged.

“The three trade bodies invite the G7, G20, as well as multilateral organizations and other decision-makers to accept this practical solution and include it in their future pandemic preparedness response plans, whilst impressing upon governments that for the proposal to succeed the health systems in lower-income countries need to be better prepared to absorb and deliver vaccines and treatments, while high-income countries need to provide the necessary political and financial support,” according to the statement.

Industry ‘power-grab’?

Manufacturing COVID-19 vaccine at a Pfizer facility.

However, the People’s Vaccine Alliance once again denounced the industry’s offer.  A policy brief on the Berlin Declaration, issued by the alliance last week described it as “a continuation of a consistent ‘third way’ campaign by the biopharmaceutical industry to maintain exclusive intellectual property (IP) protections and monopoly control over the medical technologies needed to defeat the pandemic”.

The alliance, which is made up of over 100 civil society organisations, has taken issue with a number of clauses including the declaration’s insistence on IP protection, pointing out that  “decades of publicly funded research” was behind the development of mRNA vaccines.

​​“Waiting for pharmaceutical companies to voluntarily supply life-saving medicines and vaccines to people in developing countries has not worked in the AIDS pandemic, it has not worked in the COVID-19 pandemic, and it will not work in future pandemics,” said Winnie Byanyima, executive director of UNAIDS and co-chair of the People’s Vaccine Alliance, in a media release.

“Governments negotiating a pandemic treaty need to resist the siren calls of industry. The profiteers of this pandemic must not set the rules that govern the preparations for the next pandemic. The world needs an international agreement that guarantees fair and equitable access to medical products for everyone, everywhere, not a power grab by big pharma,” she added.

The World Health Organization (WHO)’s intergovernmental negotiating body (INB), established to guide member state discussions on developing a pandemic accord for future pandemics, is currently refining the current working draft of the initial agreement, referred to as document A/INB/2/3. This will be presented as a “conceptual zero draft of the accord” at the INB’s third meeting in December.  Framing of equity and medicines access in the zero draft will set the stage for how member states negotiate over these charged issues in their attempts to reach a binding international accord.  

The INB will submit a progress report to the Seventy-sixth World Health Assembly in 2023 and the final accord is expected to be presented for consideration at the Seventy-seventh World Health Assembly in 2024.

Vaccine price hikes

People’s Vaccine Alliance co-chair, UNAIDS Executive Director Winnie Byanyima.

Meanwhile, the People’s Vaccine Alliance also condemned the announcement by Pfizer that it will increase the price of its COVID-19 vaccine fourfold, to around $110-$130 after the US government’s federally-sponsored purchase programme for the vaccine expires at the end of this year.  Currently, the vaccine is sold for $30 a dose to the US government and provided for free.  As of 2023, the vaccine will be provided through the usual US public and private insurance channels, Pfizer said, in a statement that justified its price-hike to weakened demand for the vaccine. 

However, in a statement to Health Policy Watch, a Pfizer spokesperson said that the “company comments made regarding potential future vaccine pricing were specific to the United States.”

The spokesperson added: “We have government contracts in many developed markets outside the US, valid through 2023. And as such, have agreed prices for those markets.  During the pandemic, we priced our vaccine and oral treatment to ensure equitable global access for all countries, regardless of income levels… This tiered pricing, which provides to low and middle-income countries at cost, remains in effect.”

A People’s Vaccine Alliance spokesperson said that at its current US sale price, the vaccine already is priced nearly 30 times above its manufacturing cost – even at current US rates: “Experts have estimated that Pfizer’s vaccine costs just $1.18 per dose to make. Charging $130 per dose would represent a markup of more than 10,000%. This is daylight robbery. Governments must not stand by while companies like Pfizer hold the world to ransom in a global pandemic,” said alliance policy advisor Julia Kosgei.

Cost price estimates, she said. are based on Oxfam analysis of studies of mRNA production techniques, carried out by Public Citizen with engineers at Imperial College. Public Citizen and Imperial College’s analysis suggests that it could cost $9.4 billion to produce 8 billion doses of the Pfizer/BioNTech vaccine ―$1.18 per vaccine.

“While health workers and the vulnerable continue to go unvaccinated in developing countries, Pfizer is shamelessly fleecing the public for ever-greater sums of money. This latest obscene price hike is truly a mask-off moment for one of the great profiteers of this pandemic,” said Kosgei.

Not just about vaccines

Mapping of the MPP-brokered licenses awarded for the manufacture of a generic version of Paxlovid

“This isn’t just about vaccines. Right now, people in developing countries are dying without access to Paxlovid, an antiviral COVID-19 treatment for which Pfizer is charging hundreds of dollars per course. But there is a proposal at the World Trade Organization that would make it easier for poorer countries to produce generic doses. It’s time for governments to stand up to pandemic profiteers and support it.”

With regard to Paxlovid, the Pfizer spokesperson said that the company had established “a comprehensive strategy with governments, international global health leaders and global manufacturers to optimize overall supply and access to all parts of the world. ”

That, the spokesperson said, includes: a voluntary license agreement with the Medicines Patent Pool to allow generic production of the treatment, sublicensed to 38 manufacturers in 13 different countries; agreements with the Global Fund and UNICEF to supply some 10 million treatment courses through their channels; and collaborations with WHO and its partners to enable supply to reach “more vulnerable populations.

In a separate channel, World Trade Organization members are still negotiating over a proposal to extend a limited intellectual property waiver on vaccine manufacture, approved by the WTO in June, to treatments as well. The 17 June agreement calls for a WTO decision on whether to extend the waiver to diagnostics and treatments “no later than six months from the date of this decision.”

Image Credits: Pfizer, Medicines Patent Pool .

Affordable, healthy food options are key to good health.

“The bottom line is that our food environment is deeply unhealthy. And unless we change that, millions of people will suffer from avoidable illness and die early from preventable death,” Dr Tom Frieden, CEO of Resolve to Save Lives, told the World Health Summit in Berlin.

“Voluntary changes are much less likely to result in sustainable positive healthy development than a predictable regulatory framework,” said Frieden, speaking at a session on ‘Transforming Food Systems for Healthy and Sustainable Diets. 

He pointed to five areas that needed targeted action to address malnutrition – micronutrient deficiencies, artificial transfat, excessive sodium, excessive sugar and the higher cost of healthier foods.

“Let’s be clear that simply encouraging people to eat better and exercise more will not only fail, but is essentially a form of blaming the victim.

According to the WHO, 1.9 billion adults in the world are obese and 462 million are underweight. Almost 233 million children under the age of five suffer from some form of malnutrition and around 45% of deaths among children in that age group is linked to undernutrition. 


In 2019, The Lancet Commission on obesity, undernutrition and climate change identified these three issues as the biggest threats to the world, and called for significant funding to address them, including but not limited to agriculture, food production and policy, land use and environment. 

The United Nations Food Systems Summit in New York in 2021 also called for sustainable food systems and healthy diets for all, and Tuesday’s session was aimed at addressing the various commercial determinants involved in achieving this goal. 

Some countries are already reforming their food systems to deliver healthier options to their populations using measures such as investment in agriculture, tax subsidies for companies that produce healthier foods to make them more affordable and regulations ensure processed food adheres to strict health standards. 

More regulation

Government regulation of companies that manufacture processed and unhealthy foods and their marketing strategies can help the cause, according to Frieden.

“We’re not absolving individuals from responsibility. But we’re not absolving society from the responsibility of establishing the structure to make the healthy choice the easier choice either,” added Frieden, explaining that measures like front-of-the-pack warnings, increasing the price of unhealthy food and reducing the price of healthy food have helped. 

Commercial determinants of obesity and chronic diseases are very well-documented and so is the power wielded by influential processed food corporations across the world, said Dr Marion Nestle, professor of nutrition, food studies, and public health at New York University.

Prof Dr Marion Nestle
Dr Marion Nestle speaking at the World Health Summit 2022.

She pointed to the Lancet Commission’s report and stated that big food companies are not social service agencies with public health as the goal: “They’re businesses with stockholders to please. They have to put profits to stockholders as their first priority, no matter what the people in the companies think they would like to do about hunger, malnutrition, chronic disease and climate change,” she said, calling for a regulatory framework that puts all food companies on the same level playing field.

Keep companies out of public policy

One of the Lancet Commission’s recommendations was the reduction in the influence of large commercial interests in public policy development to “enable governments to implement policies in the public interest to benefit the health of current and future generations, the environment, and the planet”.

Explaining the complicated relationship many governments have with processed food companies, Nestle said that this is a difficult situation. “It’s one that public health advocates have to figure out how to deal with, which means increasing advocacy in civil society,” she said. 

“We ought to be doing what the Lancet Commission suggested, which is keeping food companies out of public policy decisions. They should not be at the table when public health policy is being discussed. They need to be regulated in terms of marketing, and in terms of what the formulation of their products is.”

Secy General IFBA
Rocco Renaldi, secretary-general of the International Food and Beverage Alliance.

However, companies that manufacture and market processed foods play a crucial role in the eco-system and should not be ignored, argued Rocco Renaldi, the secretary-general of the International Food and Beverage Alliance (IFBA).

“We made a commitment on (reducing) sodium…to achieve a global set of sodium targets for our products by 2025, and 2030. These are minimum global targets, you can go further at national level,” he said. 

He was referring to the Nutrition for Growth Summit held in Tokyo in 2021, where the member states of the WHO agreed to a 30% reduction in the global salt intake by 2025. 

While reformulation of products to reduce salt and sugar was important, demonising processed foods is not the answer, he said. “The real answer is how to rebalance the system so that different types of food occupy the right space within that system,” Renaldi argued.

Food financing

Like many other public health challenges, money is a crucial bottleneck in addressing the issue of malnutrition across the world. 

Food financing needs to be envisioned in a different way to achieve these goals, said Dr Geeta Sethi, an advisor at the World Bank. She added that the private sector has deep pockets that will help fund these goals but are deterred by perceived risks. 

“For some reason, we in the food sector have not been able to price risk in a way that allows private finance to come in. This is urgently needed.. the change agents have to be the private finance,” she added. 

“In a nutshell, food systems do not lack financing…the public support for agriculture and food is $700billion a year,” she stated, adding that if food subsidies were a country, they would be the 19th largest economy in the world. “And this is not even considering the massive spending of the private sector, which is around $2 trillion.”

Sustainable food systems

While countries like Indonesia and Bhutan are actively redesigning their food systems and production pathways, countries like Germany, Sweden and Fiji have been successful in creating sustainable food systems that are healthy for their populations. 

“We would like to establish a framework that will be tracking institutional things that are happening in the governments, but also the behavioural change that’s happening in the stakeholders and in the private sector,” Dr Stefanos Fotiou, the director of the UN Food Systems Coordination Hub said. 

The need for political will to address these challenges also came up repeatedly as various ministers shared their experiences in designing and implementing policies around the issue. 

Speaking about her experience in Germany, Dr Doris Heberle, from the federal ministry of food and agriculture said that reducing the intake of salt is not an easy task since it impacts trade-related issues like the shelf-life of food products. 

“But we are going to have more scientific advice and scientific evidence to get better targets for reduction patterns and also to attune those to the target groups which are the most vulnerable,” she added. 

Dr Ifereimi Waqainabete
Dr Ifereimi Waqainabete, Fiji’s Health Minister, at the World Health Summit 2022.

Taking public health decisions when trade is a huge factor in the economy is difficult, said Dr Ifereimi Waqainabete, Fiji’s health minister. He added that small countries like Fiji are pushed to choose between nutritious food that is expensive and cheap food that is less nutritious. 

Waqainabete added that his government had distributed seeds and plants to people during the COVID-19 lockdown to encourage local food production and the regeneration of agriculture.

“We also regenerated our ocean area by bringing back the village system and the tribal system where you have your own ‘parish’ where you fish traditionally and stop fishing at a particular time. And we found that by doing that we’re able to regenerate our ocean,” said Waqainabete.

Sweden’s Ambassador for Global Health, Dr Anders Nordström said his government only procured healthy food for the education and healthcare sectors and this ensured that the most vulnerable received the healthiest options. 

“This has been a policy for a long time… we serve about three million meals every day and this has had a dramatic positive impact. What is interesting is that (the government) has been also putting into those policies that those meals should not just be healthy, they should be affordable.”

Image Credits: Scott Warman/ Unsplash, Megha Kaveri/Health Policy Watch.

For “Nundy,” a mother of two living in South Africa’s Khayelitsha township, going to the doctor more than once a year is not an option.

She would have to pay 50% of her total household income in a month in order to see a doctor, so she saves up all of her medical questions and then makes one appointment, at which she tries to collect as much information as possible to take care of her 18-year-old son, two-year-old daughter and ailing mother.

In the meantime, she buys over-the-counter health products and tries to treat her families ailments herself.

“She told us a story of having many products and she told us all the ways she used them. And she was not sure what their expiry date was or exactly what they were for … but she knew she had to do something,” said Manoj Raghunandanan, global president of self-care and consumer experience at Johnson & Johnson.

He met Nundy a few years ago during a visit to the area.

Manoj Raghunandanan, Global President of Self-Care and Consumer Experience at J&J
Manoj Raghunandanan, Global President of Self-Care and Consumer Experience at J&J

Raghunandanan was speaking Wednesday at the launch of the Global Self-Care Readiness Index (SCRI) 2.0, the kick-off session of the Global Self-Care Federation World Congress 2022, which runs until Thursday.

“She was a consumer that deserved better,” Raghunandanan said, “someone that deserved access, affordability and the right to take care of herself, her family and her loved ones in a responsible way.”

How to improve self-care health policies and practices for people like Nundy was the topic of the congress and the focus of the SCRI report, which is published by the Global Self-Care Federation (GSCF).

The index is 89 pages long and covers 10 additional countries, which supplements the original set of countries examined in the 2021 edition and covers at least one from each of the World Health Organization’s (WHO) six regions: Africa, the Americas, Southeast Asia, Europe, the Eastern Mediterranean, and Western Pacific.

The index is supported by the WHO and forms part of the working plan between itself and GSCF. It aims to arm healthcare decision-makers and professionals with the data they need to increase self-care in their own countries and around the world.

Judy Stenmark, Director General of the Global Self-Care Federation (GSCF), speaks at the launch of the Self-Care Readiness Index 2.0 on Wednesday, October 19, 2022
Judy Stenmark, director-general of the Global Self-Care Federation (GSCF), speaks at the launch of the Self-Care Readiness Index 2.0.

Regulatory environment

The self-care industry has sometimes come under fire for making far-fetched claims about products to encourage people to spend money on things that don’t work, but GSCF director-general Judy Stenmark said that is something her organization is working to fix.

“Consumers become aware of the products or activities mainly through marketing and advertising, especially online,” she told Health Policy Watch. “We must ensure that we continue with our self-care literacy education efforts, especially in the digital sphere, including product guidance and e-labelling.”

SCRI 2.0 highlights the regulatory environment as one of the key enablers of self-care, advising countries to “focus on regulations and processes governing approval of new health products, from prescriptions to over-the-counter medications.”

Stenmark also stressed that while some people think of self-care as providing consumers with over-the-counter medicines, it is a multi-dimensional concept, which encompasses different notions, starting from self-medication to maintaining a healthy diet and raising health literacy levels.

WHO resolution by 2025

In order to help persuade policymakers of the importance of self-care, GSCF is working to have a self-care resolution adopted by WHO by 2025, something Stenmark said would provide a clear articulation of self-care and outline the value for health systems, governments and a people-centered care network.

It would also help facilitate member states’ development and effective implementation of national self-care strategies and provide them with direction on aligning resources.

“If we pass a resolution, things start to change, and then we get self-care embedded in policy,” she stressed. “That is why we want a WHO resolution. We want to build the political wheel for self-care.”

Socio-economic benefits

Currently, half the world lacks access to adequate healthcare, according to Dr Bente Mikkelsen, WHO’s director of non-communicable Diseases, who spoke at the beginning of the launch event.

According to the SCRI report, the sector could be improved by increased support and trust of self-care behaviors and products by healthcare providers, patients, consumers and regulators; increased health literacy; and policymakers’ recognition that self-care has economic value.

Low- and middle-income countries, often plagued by disease, have the highest potential to benefit from self-care policies.

Africa faces the “largest and biggest disease burden of all the regions in the world,” said Skhumbuzo Ngozwana, Chief Executive Officer of Kiara Health in South Africa. Some 90% of malaria deaths take place on the continent, tuberculous is still common and there is a “burgeoning and exploding” non-communicable disease problem,  Ngozwana said.

“Clearly Africa has a major problem,” he said. “All of this is in the context of significant infrastructure challenges, constrained budgets and that less than 3% of global healthcare workers are deployed on this continent. If people have to spend 50% of their monthly income on doctors, it makes it impossible.”

GSCF has also put out a supplementary report, Global Social and Economic Value of Self-Care,  which shows the potential socio-economic benefits of self-care around the world and specifically in sub-Saharan Africa.

If proper self-care policies were put into practice, the report showed, it would represent a $4 billion savings on annual healthcare costs in sub-Saharan Africa by 2030. Moreover, it could save individuals a collective 513 million hours in time savings and physicians 44 million hours. It would also reduce welfare spending by $31.5 billion.

Annual socio-economic benefits of self-care in Sub-Saharan Africa presented by the Global Self-Care Federation
Annual socio-economic benefits of self-care in Sub-Saharan Africa presented by the Global Self-Care Federation

Globally, the numbers are even greater: $179 billion in healthcare cost savings and $2.8 trillion in welfare spending.

“Self-care integration has significant long-term economic benefits for health budgets and health systems in general,” GSCF told Health Policy Watch. “Integrating self-care into the healthcare continuum allows for better resource allocation, alleviates burden placed on health systems, and ultimately improves the quality of care provided.”

Image Credits: The Global Social and Economic Value of Self-Care report, Screenshot.

Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization.

A shortage of cholera vaccines and a number of outbreaks have prompted the World Health Organization (WHO) to advise countries to administer single doses of the vaccine instead of the usual two doses.

So far, 29 countries have reported cholera outbreaks, with Haiti, Syria and Malawi dealing with large outbreaks. The standard preventive approach to cholera is two-dose vaccination with the second dose administered within six months of the first. The immunity of a fully vaccinated person against cholera lasts for three years. 

“The one-dose strategy has proven effective in previous outbreaks, although evidence on how long protection lasts is limited,” Dr Tedros Adhanom Ghebreyesus, the director-general of WHO told a media briefing on Wednesday. 

However, he stressed that “this is clearly less than ideal and rationing must only be a temporary solution”.

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

Stockpile depleted

Four organisations – WHO, UNICEF, Médecins sans Frontières and the International Federation of the Red Cross and Red Crescent Societies – have managed the global stockpile of cholera vaccines since 2013. 

Of the 36 million doses produced this year, 24 million doses have already been shipped to countries facing outbreaks. The International Coordination Group (ICG), a WHO group that manages and coordinates emergency vaccine supplies and antibiotics during major outbreaks, has approved eight million doses for the second round of emergency vaccination in four countries, leaving only four million doses for further outbreak management. 

This shortage has prompted the ICG to recommend that countries temporarily suspend the two-dose vaccination regime and instead follow a single-dose regime so that more people can be protected against the bacteria. 

“The one-dose strategy has proven effective in previous outbreaks, although evidence on how long protection lasts is limited,” Dr Ghebreyesus said, calling for a scale-up of vaccine production. “The best way to prevent cholera outbreaks is to ensure people have access to safe water and sanitation.”

Narrow window to prevent Tigray genocide

Tedros also called for international attention to the civil war in Tigray, Ethiopia, which has left around six million people “under siege for almost two years”.

“I’m running out of diplomatic language for the deliberate targeting of civilians in Tigray, Ethiopia,” said Tedros. “There is a very narrow window now to prevent genocide in Tigray.”

The WHO Chief quoted Antonio Guterres, the UN Secretary-General, who called for the immediate withdrawal of Eritrean armed forces from the region.

Tedros described the “indiscriminate attacks” on civilians as “war crimes”.

“There are no services for tuberculosis, HIV, diabetes, hypertension and more – those diseases, which are treatable elsewhere, are now a death sentence in Tigray…This is a health crisis for six million people, and the world is not paying enough attention,” added Tedros, who was a former health minister of Ethiopia.

“Banking, fuel, food, electricity and health care are being used as weapons of war. Media is also not allowed and destruction of civilians is done in darkness.”

Ebola and COVID-19

WHO expressed concerns about the Ebola outbreak in Uganda and added that there is a possibility that more transmission chains and contacts might be involved in the spread of the virus. 

As of Wednesday, there are 60 confirmed and 20 probable cases of Ebola in the country, with 25 recoveries and 44  deaths.

Two people with confirmed infection in Mubende district had travelled to Uganda’s capital city, Kampal,a for treatment, thus prompting fears of transmission in the capital. The Ugandan government issued lockdown orders in Mubende on 16 October. 

“The Ministry of Health is investigating the most recent eight cases, as initial reports indicate they were not among known contacts,” Tedros said. 

Meanwhile, COVID-19 remains a public health emergency of global concern as per the Emergency Committee meeting last week. WHO urged countries to strengthen surveillance, and not reduce testing, treatment and vaccination for their populations.

“While the global situation has obviously improved since the pandemic began, the virus continues to change, and there remain many risks and uncertainties.”

Cary Adams, Bente Mikkelsen, Alejandra de Cima Aldrete, Valerie McCormack, Miriam Mutebi and Olivier Michielin address the World Cancer Congress press conference.

Common cancers that can be treated successfully when they’re detected early – breast, cervical, colorectal and prostate – are causing high mortality in low and middle-income countries (LMICs) because of a lack of screening and treatment, Dr Cary Adams, CEO of the Union for International Cancer Control (UICC), told a press conference at the start of the World Cancer Congress in Geneva on Tuesday.

“We see this inequity in childhood cancer, with 80% survival rates in high-income countries and as low as 20% in low and middle-income countries,” he added at the start of the hybrid in-person and online congress, which is being attended by some 2,000 scientists, public health officials, civil society representatives and cancer control experts from 120 countries.

A new study by members of the Bloomberg New Economy International Cancer Coalition released this week calculates that at least 1.5 million deaths, representing 20% of global cancer deaths, could be avoided each year if international regulations around patient trials were more standardized and people placed on life-saving treatment immunotherapy treatments such as Pembrolizumab (for lung cancer) and Enzalutamide (prostate cancer).

Despite the US Food and Drug Administration (FDA) approval of Pembrolizumab in 2016 and Enzalutamide in 2012, neither drug is yet available in many countries and regions of the world due to “regulatory isolationism that is preventing approval and usage of these and other much-needed oncology therapies”, according to the study.

The  Access to Oncology Medicines (ATOM) Coalition, which was formed in May, has started to engage with pharmaceutical generic and biosimilar companies “to see whether we can find ways to get their medicines into LMIC countries either by increasing donations, by tier pricing or using a voluntary licence mechanism”, said Adams. 

Dr Bente Mikkelsen, director of non-communicable diseases (NCDs) at the World Health Organization (WHO), said that the WHO had private sector dialogues every six months “where we have defined asks for most of the diseases and we call for commitments to be able to increase access to medicines and devices”. 

“On cancer, our focus is now of course on the medicines that are already on the essential medicine list, but we don’t shy away from the innovative new drugs and devices,” said Mikkelsen, adding that the dialogue was a structured and safe way to discuss access to medicine.

COVID disruptions

Mikkelsen pointed out that, in the four years since the last cancer congress, 30 million people had died of cancer – and there had been disruptions to 50-60% of cancer treatments during the COVID-19 pandemic.

“This is happening because the health system is actually too weak,” said Mikkelsen. “There is no [pandemic] preparedness without including cancer in universal health coverage. We will not be able to manage the new pandemic or for a humanitarian crisis unless we build stronger health systems.”

Mikkelsen added that over 70% of people diagnosed with cancer in LMICs “pay out of their own pocket for things that should be covered by the governments and this is very often the choice between food, care of the family or actual treatment and diagnosis”.

‘Financial toxicity’

Dr Miriam Mutebi, UICC Board Member and a breast surgical oncologist, said that “financial toxicity –  the fact that patients paid themselves for cancer treatment”, was a big reason why the majority of African patients are “still getting diagnosed with advanced disease and frequently not completing their care”. 

Women were particularly affected by a lack of finances as many were involved in the informal economy.

“Looking at the system’s challenges, we know in sub-Saharan Africa, women patients will see, on average four to six healthcare providers before a definitive diagnosis of their cancer, and this really underscores the need for increasing awareness, not just in the community but also amongst healthcare workers,” stressed Mutebi.

Mexico’s civil society makes cancer ‘law’

Mexican cancer survivor Alejandra de Cima Aldrete, Founder and President of Fundación CIMA, said that civil society in her country was in the process of drawing up cancer laws themselves.

“Every day I hear horrible stories about a massive shortages of medicine, about women that have to wait months before they get they get seen by a specialist, of woman that died because they didn’t have the money to continue their treatment,” said Aldrete.

“So my commitment today with my people in my country is to improve the lives of people living with cancer through changes in the legislation, the most meaningful, efficient and with the outmost reach being the general cancer law from Mexico that is currently being drawn up by 13 NGOs, mine included.”

“The cancer law would provide the very needed legal instrument that will allow us citizens to demand the policies that ensure quality and timely medical care for cancer patients. It will force also the government to comply to its sections which include amongst others, the national cancer plan and the National Cancer Registry,” said Aldrete.

A million maternal orphans

Over one million children lose their mothers to cancer every year, according to a congress paper that modelled maternal orphans for the first time using data from 185 countries. 

In 2020, an estimated 4.4 million women died from all types of cancer worldwide leaving behind 1.04 million new orphans (aged 18 and under), according to researcher Dr Valerie McCormack from the French International Agency for Research on Cancer (IARC).

Almost half the orphans were in Asia (49%), and over one-third were from Africa (35%). 

Their mothers died predominantly from breast (25%), cervical (18%) and upper-gastrointestinal cancers (13%). 

The mortality rate of cervical cancer should be reduced through screening for, and vaccinating against, the human papillomavirus (HPV), while early detection and quality treatment of other cancers was essential “to avoid the impact on on the next generation”, said McCormack.

“Orphans in some settings have lower educational levels and higher mortality than their peers. So it’s not only the women who die, we need to prevent their deaths,” she added.

WHO cancer survey

Meanwhile, the WHO launched the first global survey on Tuesday to better understand and address the needs of all those affected by cancer. 

Noting that nearly every family globally is affected by cancer, either directly – 1 in 5 people are diagnosed with cancer during their lifetime – or as caregivers or family members, the survey “is part of a broader campaign, designed with and intended to amplify the voices of those affected by cancer – survivors, caregivers and the bereaved – as part of WHO’s Framework for Meaningful Engagement of People Living with Noncommunicable diseases”. 

“For too long, the focus in cancer control has been on clinical care and not on the broader needs of people affected by cancer,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “Global cancer policies must be shaped by more than data and scientific research, to include the voices and insight of people impacted by the disease.”