INB co-chairs Roland Driece and Precious Matsoso

The African region of the World Health Organization (WHO) has condemned the weakening of equity clauses in latest draft of the pandemic accord and called for this week’s negotiations to focus on principles and key areas of concern rather than the detailed text.

The 47 WHO Africa group countries made their submission at the resumption of the Intergovernmental Negotiation Body (INB) meeting in Geneva on Monday. 

“The African member states recognise the hard position that the bureau finds itself in trying to keep everyone at the negotiating table,” said Ethiopia on behalf of Africa.

“However, it is unfortunate that, in that process, the core of what this instrument is supposed to address, namely equity, has been presented in a weakened or reduced format, especially in those articles that would result in a meaningful realisation of equity.”

Ethiopia representing the African region.

It described the draft (being referred to as WHO CA+) as “going backwards” on equity from the zero-draft. A key criticism of the current draft is that it does not propose any legal obligations to ensure that all countries have equitable access to pandemic-related products such as vaccines, tests and therapeutics.

Africa wants legally binding commitments on the transfer of technologies, know-how and intellectual property rights; capacity-building for local manufacturing to address pandemics; technical and financial support, and the establishment of a “comprehensive access and benefit sharing (ABS) mechanism” for pandemic pathogens.

In its statement in support of Africa’s call for stronger equity clauses, South Africa added “rebuilding or strengthening health systems” and “the use of IP rights and TRIPS waivers” to strengthen countries’ pandemic prevention, preparedness and response.

A new alliance of countries calling itself the Group on Equity stressed the need for “concrete provisions that effectively operationalise equity”.

Presented by the Philippines, the group cuts across WHO regions and includes China, India, Brazil, South Africa, Bangladesh, Colombia, Indonesia, Malaysia, Mexico, Pakistan and Thailand.

A group of Latin American countries represented by Colombia also supported Africa and the Equity Group’s call for strengthened equity clauses, declaring the need for “a practical and relevant instrument not simply a document filled with good intentions”.

Meanwhile, Brazil said that it is “essential that any measure related to sharing of pathogens be accompanied by the benefits that arise from their use in a unified system”, and warned that the inclusion of “so many measures” related to One Health might dilute the focus.

“It is urgent to have a fully agreed upon definition of pandemic and the method for declaring it, with clearly stated criteria, in order to be able to better grasp the scope of the instrument,” added Brazil.

Rising INB tension 

The INB Bureau has recommended that the current negotiations, in closed sessions until 16 June, should focus on “substantive issues” at this stage as the parties are still too far apart for text-based negotiations.

This approach had wide support, including from the European Union, which stressed that an “increased level of mutual understanding will be the best way to enable us to assess where we may concur and where we can move closer to each other”.

The EU called for a focus on “Chapter Two provisions and, of course, on equity issues”. Chapter Two is the guts of the draft and is home to virtually all the contentious clauses related to equity, covering all the key issues flagged by the Africa group.

Opening Monday’s INB meeting, co-chair Roland Driece said that tension was growing in the body, which he described as a “sign of maturity” as issues of conflicts became more evident.

With only 10 months left to fulfil its mandate, “time is pressing, and the text on the table is getting more concrete all the time,” said Driece, adding that six INB meetings remained in this time.

“We can feel that the tension is rising. I can feel it, where in the beginning everybody was kind and positive and you feel that people are now asking questions….  I take that as a sign of maturity, maturity in our process, and maturity of what we are doing. And it is only normal that we enter a stage where we are more critical of what we write down, more critical of what we might agree upon.”

Echoing Driece, co-chair Precious Matsoso added: “We have the best of our times laughing but it seems we’re getting now into the most difficult part where our strength will be tested.” 

Matsoso also explained to member states the gruelling process that the Bureau had gone through to formulate the latest draft, distilling all member state suggestions – amounting to 208 pages – into the 43-page draft.

After the open session of the INB, member states have moved into “drafting group” closed sessions until 16 June. 

The closed sessions continue to distress civil society organisations, which believe negotiations should be open.

Expressing concerns about participation and transparency, Health Action International said that the “secret meetings” sent the “wrong message”.

“We have serious reservations on how some topics are being addressed or, rather, discarded in these discussions; most notably the issue of health-oriented IP management as a substantive part of improving access to health technologies and contribute to a robust human rights-based approach that will harness international efforts for the attainment of universal equitable access,” added HAI’s Jaume Vidal during the session in which non-state actors were able to make their contributions.

somalia
Worried families gather outside the beachfront hotel in the Somali capital Mogadishu awaiting the return of their relatives.

A staff member of the World Health Organization (WHO) in Somalia was among the 16 civilians killed in a terrorist attack on a hotel in the capital Mogadishu on Friday night, the WHO confirmed.

The attack by al-Qaeda affiliate al-Shabaab targeted the Pearl Beach Hotel and Restaurant, an upscale location on Lido beach often frequented by high-ranking government officials and foreign diplomats.

The militants’ siege lasted over 10 hours before local security forces regained control of the hotel, killing seven attackers. Ten civilians were injured while 84 were successfully evacuated during the attack, according to a statement by Mogadishu police.

The WHO staffer killed in the attack was identified as Nasra Hassan, a 27-year-old female Somali national. Hassan joined the WHO country office in Somalia to support the agency’s drought emergency response operations in the southern region of Jubaland.

“We condemn in the strongest terms this heinous attack on a hotel that claimed so many lives, including the precious life of one of our dearest colleagues, Nasra,” Dr Malik Mamunur, WHO representative in Somalia said. “We condemn all attacks on innocent civilians and humanitarian workers and express our deepest condolences to the family members of all those who were killed in this attack.”

Around 1.1 million Somalis have been displaced by droughts since January 2021. Last year, as many as 43,000 people died as a result of the record droughts sweeping the country. Half of them were under the age of five, according to a report by the Somali government and the United Nations agencies.

The hotel attack occurred just a week after the bodies of 54 Ugandan peacekeepers were found dead at a military base 130km from the capital. The increase in al-Shabaab attacks across the country in 2022 resulted in the deadliest year for Somali civilians since 2017, UN Secretary-General Antonio Guterres told the security council in February.

Despite the unrest, WHO said it remains committed to working with the Somali government and local partners to address ongoing health needs and emergencies across Somalia.

“WHO is committed to continuing efforts to preserve health and respond to emergencies in Somalia,” the organization said in a statement, adding that the safety of WHO staff is a “paramount factor in ensuring ongoing life-saving response operations”.

Al-Shabaab held permanent positions in Mogadishu until 2011 and continues to control vast areas of rural territory across the country. While its militants have been pushed out of Somalia’s major cities and towns, they continue to mount irregular attacks on civilian and military targets.

WHO has delivered around $5 million of medical supplies in the past year. This aid is focused on essential health and nutrition care for Somalis affected by the extreme drought and food insecurity sweeping the wider Horn of Africa.

The extreme droughts in the Horn of Africa are considered a “grade 3” emergency by WHO, the organization’s highest alert level. Other “grade 3” crises include the humanitarian situation in Afghanistan and the ongoing conflicts in Ukraine, Yemen, Ethiopia and Syria.

About 3.5 million children under five were vaccinated against polio, measles, and cholera or protected against malnutrition under WHO programmes in 2021. The UN health agency has also worked with federal and state ministries of health across Somalia to establish a medical supply chain that can reach the most vulnerable people in the country.

“Being a health professional and working in a resource-starved and geographically challenged health system in a conflict zone, WHO supplies are proving to be a lifeline for millions,” Dr Yusuf Omar Mohamed, head of pharmaceuticals and supply chains at the Somali Ministry of Health said of WHO’s operations in the country. “Everyone wondered how a medical supply chain could work in Somalia, but I believe WHO has shown it to the world that if there is a resolve to serve humanity, obstacles can be turned into opportunities.”

Image Credits: Said Yusuf Warsame, AMISOM.

emerging outbreaks
From far left: Dr Nathalie Strub-Wourgaft, moderator, Dr Dimié Ogoina, Dr Jean-Jacques Muyembe, Dr Marie Jaspard, Dr Mimi Darko.

More R&D into already known emerging disease threats, from Mpox to Lassa fever would go a long way to both bolster developing countries’ preparedness as well as protecting the world, experts argue.

Member state negotiations resume next week over a draft WHO convention on pandemic prevention, preparedness and response – which is supposed to be ready by the May 2024 World Health Assembly. 

While parties prepare to debate the latest draft text published, distilled from a 208 page “compilation draft” of 34 different country and regional proposals, the lessons learned from recent or ongoing outbreaks can  provide concrete insights on how to make the world better prepared.

A group of high level experts from Africa, Europe, the Middle East and Latin America provided their insights at a recent seminar on “How Can Global Action Really Meet Local Needs in Emerging Outbreaks, hosted by the Graduate Institute’s Global Health Centre on the margins of the recent World Health Assembly.  

The event was co-sponsored by the International Geneva Global Health Platform, and PANTHER Health, an NGO dedicated to supporting rapid responses to emerging infectious diseases in Africa.

Insights from Mpox, Lassa fever are indications of preparedness 

Bernhards Ogutu, Chief Research Officer, of the Kenya Medical Research Institute (KEMRI).

Speaking at the event, Bernhards Ogutu, Chief Research Officer of the Kenya Medical Research Institute (KEMRI), said insights from current Mpox, Lassa fever and other “endemic pandemics in the south” are among the best indications of countries’ current level of preparedness for future outbreaks.

“Even when we think there are no pandemics there’s lots of them that we need to address and possibly need to see how well to do this as we get prepared for the next pandemic,” Ogutu said.

The INB text echoes the importance of research and development. Article 9 of the current draft states that: 

“The Parties shall cooperate to build, strengthen and sustain capacities and institutions for research and development for pandemic-related products, particularly in developing countries, including for related clinical trials and information-sharing through open science approaches for rapid sharing of scientific findings and research results.”

More research in endemic countries is needed

But those high notes of ambition are far from today’s reality said Jean-Jacques Muyembe-Tamfun, director of the Democratic Republic of Congo’s Institut National de la Recherche Biomédicale. He noted, for instance, that more research in endemic countries on the connection between smallpox and Mpox could have contributed to the more rapid roll out of countermeasures when the Mpox global health emergency hit countries worldwide last year. 

With knowledge about how the smallpox vaccine provides some protection against Mpox, more adequate research a decade ago into Mpox vaccines and treatments could have informed better policy guidance on priority countermeasures and target groups for their use, during the recent emergency. This might have yielded recommendations for continued smallpox vaccination in countries where Mpox is endemic, he suggested.

Instead, when the emergency hit, it was unclear how wide a net needed to be cast with the vaccines, which turned out to be in short supply, and were rarely put to use.  As for medicines, just one small study in the Central African Republic of the new treatment, Tecovirimat (TPOXX™), was only just beginning when the virus emerged.

Aligning with the INB’s draft text on supporting research in developing countries, Muyembe argued that his country remains critical for clinical trials on Mpox, the findings of which could help in developing tools that would protect the rest of the world against the new variants of an old disease. 

“DRC is the most affected country. We will not lack cases of Mpox to continue our studies and clinical trials in the field,” he said.

‘No regrets’ funding

A look inside the drafting process of the INB.

Funding has always been a subject of debate in global health and the INB’s June negotiations are no exception. In the working document, financing was captured in Article 19 and it describes sustainable financial resources as playing an important role in achieving the objective of the instrument. It pegged financing as the primary financial responsibility of national governments in protecting and promoting the health of their populations. 

The parties, however, are yet to agree on whether to include a proposed Paragraph 6 in Article 19 on Financing, stating that funding models “would take into account national financial capacity and capabilities.” Two options are being considered, one which would elaborate the principle in detail – and one which would not reference it at all:

Option 19.A6. The Parties agree that the funding models for pandemic prevention, preparedness and response need to take into account national financial capacity and capabilities, and to this extent shall: (a) establish programmes that convert debt repayment into pandemic prevention, preparedness, response and recovery investments in health, to be attained under individually negotiated “debt swap” agreements; and (b) commit to expanding partnerships with development finance institutions for providing additional funding to developing countries, through prioritized debt relief, debt restructuring and the provision of grants rather than loans that will guarantee that programmes protect essential health and related spending from encroachment, as well as to take advantage of the economic benefits of frontloading finance for prevention and preparedness or support investments. 

Option 19.B: not to include a paragraph.

At the Graduate School event, Veronika von Messling, Director-General for Life Sciences at the German Federal Ministry of Education and Research also stressed the importance of a ‘no regrets’ funding approach that permits flexible use of both national resources and donor-based funding that allows recipients to dynamically adapt plans in times of crisis. She described this as essential to long-term capacity strengthening in low and middle income countries.

“These are central elements for a global pandemic preparedness and response,” she said. “Continuous investment in national and international initiatives even before a pandemic. underline the importance of acting not only in times of crisis, but also in between.”

The formidable INB task ahead 

Members of the drafting group preparing for the upcoming INB meeting.

The Intergovernmental Negotiating Body (INB) will resume in its fifth meeting on the draft accord next week. 

The INB is the name of the group that is drafting and negotiating the WHO “convention, agreement or other international instrument on pandemic prevention, preparedness and response,” with a view to its adoption under Article 19 of the WHO Constitution, which allows the World Health Assembly to adopt “legally binding conventions or agreements” by a two-thirds vote. It is open to all Member States and Associate Members (and regional economic integration organizations)

From 12 June, the board, starting with Member States and followed by relevant stakeholders, will provide general comments on the Bureau’s most recent draft text, published on 2 June. At the 76th World Health Assembly, the INB said it has made progress in developing a framework for the accord, although negotiations are expected to continue steadily until May 2024. 

One Health – a key principle of the accord – or not?    

Excerpt from the briefing of the INB bureau drafting notes shared with member states earlier this month.

In a briefing last week, the “Bureau” of six member states guiding the negotiations, provided a mapping of the draft text and its proposed amendments by member states, reflecting the many choices still to be made.  

Those range from semantic choices between “but” or “and”, to the critical question of whether “One Health” will be included as a fundamental principle of the accord. Other challenges include how prescriptive to be regarding tasks that parties would fulfil, particularly with regard to prevention and surveillance. For instance, word choices like “are encouraged to” suggest voluntary action while “shall” conveys a mandatory meaning. 

While there appears to be agreement on referencing the importance of strengthening R&D and information sharing about research agendas and plans in the text, changes are being proposed to the section on preparedness monitoring and functional reviews (Article 8). Some member states oppose the establishment of a peer review mechanism for monitoring preparedness in which countries would review the plans and performances of other member states.

While there appears to be agreement on references in the text to the healthcare workforce, changes are being proposed to the section on preparedness monitoring, with some member states opposing the establishment of a peer review mechanism for monitoring preparedness, whereby countries themselves would review the preparedness plans and performance of other member states. 

The review instrument, fashioned on a similar mechanism used by the Human Rights Council, is called the “Universal Health and Preparedness Review’. It has already been piloted on a voluntary basis by some member states.

For the preparedness review and about 16 other controversial provisions touch on sensitive topics from the inclusion of “One Health” as a key accord principle (Article 8) to the sharing of genetic sequence data in exchange for rights to the benefits from drugs and vaccines developed (Article 12), the bureau draft contains 2-3 options for each key paragraph to allow member states to choose a direction.

For the more controversial provisions of the accord, which touch on sensitive topics ranging from the sharing of genetic sequence data to notification requirements during emergencies, the “Bureau” draft contains 2-3 options for each of about 16 key paragraphs – so that member states can concretely choose a direction.

Two options are presented for principle 8. Option 8.A: One Health – Multisectoral and transdisciplinary actions should recognize the interconnection between people, animals, plants and their shared environment, for which a coherent, integrated and unifying approach should be strengthened and applied with the aim of sustainably balancing and optimizing the health of people, animals and ecosystems, including through, but not limited to, by giving attention to the prevention of epidemics due to pathogens that are resistant to antimicrobial agents and zoonotic diseases. 

Option 8.B: not to include as a principle.

The journey ahead

Following the June meeting, the INB will host its sixth meeting in July 2023. Further meetings or drafting group sessions could be held in September, November, and December. The board is expected to submit its outcome for consideration by the 77th World Health Assembly in May 2024.

The six members of the INB Bureau include Ms Precious Matsoso (South Africa), former Director General of the National Health Department of South Africa and INB Bureau co-chair, representing Africa and Mr Roland Driece (Netherlands) Director of International Affairs at the Ministry of Health, Welfare and Sport, and INB Bureau co-chair, representing Europe. 

Other members are Ambassador Tovar da Silva Nunes (Brazil) Permanent Representative of Brazil to the UN in Geneva, representing the Americas; Dr Viroj Tangcharoensathien (Thailand) Advisor to the Ministry of Public Health, representing South-East Asia; Mr Ahmed Salama Soliman (Egypt) representing the Eastern Mediterranean region; and Mr Kazuho Taguchi (Japan) representing the Western Pacific region.

The full panel on how global action can meet local needs in emerging outbreaks can be viewed here.

  • Additional reporting by Elaine Fletcher.
CARE staff assist after the collapse of the wall of the Kakhovka Dam in Ukraine

Hours after the Kakhovka dam in Ukraine was destroyed, causing widespread floods, the World Health Organization (WHO) said that cholera and other waterborne diseases posed a risk, while the humanitarian agency CARE warned of landmine explosions.

The Kakhovka dam is located on river Dnipro in the city of Nova Kakhovka, in the Kherson region of Ukraine. Russian troops occupy the left bank of the river, while the right bank is under Ukrainian control. 

The wall of the dam collapsed early on Tuesday resulting in the flooding of tens of villages and parts of Kherson as well as the total destruction of the hydro-electric station providing electricity to the region. 

While the exact cause of the collapse is unknown, Russia and Ukraine have blamed each other for the destruction while some speculate that the dam could have been weakened in previous attacks. However, Norwegian seismic monitoring group Norsar registered seismic activity on the night of the collapse of the dam wall which indicates there was an explosion at the dam.

Since the dam collapse, thousands of people have been evacuated on both sides of the river and tens of thousands of hectares of agricultural land has been flooded. The authorities have not yet announced the official death toll following the dam collapse. 

“The impact of the region’s water supply, sanitation systems, and public health services cannot be underestimated,” Dr Tedros Adhanom Ghebreyesus, the WHO Director-General, said during a media briefing on Thursday.

“The exact information and the exact extent of the impact is yet to be seen because water continues to come downstream… figures at the moment show that initially 16,000 people were immediately at risk of flooding, on the river banks. Thousands have been evacuated,” Dr Teresa Zakaria, technical lead at WHO’s health emergencies program, told the briefing.

Ukraine
Dr Teresa Zakaria, WHO technical lead on health emergencies.

“The reservoir serves around 700,000 people downstream and there are over 30 settlements that are at a risk of flooding.” 

Zakaria added that while no cases of cholera have been reported in Ukraine since the war started in 2022, environmental samples show that the pathogens still exist in the region and  “that constitutes a risk”. 

Ukraine’s health ministry has also warned of water contamination caused by thousands of fish dying in the shallow water.

 

Landmines and oil

Meanwhile, Fabrice Martin, Country Director of humanitarian organisation CARE Ukraine, warned that “the area where the Kakhovka dam was, is full of landmines, which are now floating in the water and are posing a huge risk”. 

“We are very worried about the catastrophic consequences this explosion could have on the environment”, said Martin. “At least 150 tons of oil have been released into the Dnipro River with the risk of further leakage of more than 300 tons. This may lead to the Nyzhniodniprovskyi National Nature Park to disappear, which is more than 80 000 hectares of protected land.”

Ukraine’s president, Vladimir Zelensky, has accused Russian soldiers of firing on rescuers attempting to evacuate civilians affected by the flooding.

The dam also supplies cooling water to the Zaporizhzhia nuclear power plant around 160 kilometers away. The plant is currently under Russian control and the International Atomic Energy Agency (IAEA) has stated that there is no immediate danger to the plant and that it is monitoring the situation. 

The flooding has heightened the risk of water-borne diseases and food insecurity due to the destruction of agricultural lands. 

Ukraine’s agriculture ministry warned of a massive impact on farming, saying 94% of irrigation systems in the Kherson province, nearly 75% in Zaporizhzhia and about 30% in Dnipropetrovsk have been left without a water source. “Fields in the south of Ukraine next year can turn into deserts,” the ministry said, as reported in USA Today.

Support for Ukraine and Russia?

While emphasising that the WHO’s priority is to offer assistance and monitor health risks equally to all affected parties during a war, Dr Mike Ryan, WHO Executive Director of Health Emergencies, said that Ukrainians were in more need since Russia’s invasion. 

“Since the Russian invasion of Ukraine, we have focused on being able to support the people to whom we have the greatest access, and that has been people on the Ukrainian side of the conflict,” said Ryan.

“ We continue to engage with, coordinate with and receive information on a regular basis from the Russian authorities regarding the health situation of the people in occupied territories,” he added. 

The WHO does not have a permanent presence on the Russia-controlled bank of the river but that before the war, the agency had access to both sides of the river, Ryan added.

“We would be delighted to be able to access those areas and monitor health as we would in most situations. But again, it will be for the authorities of Ukraine and Russia to agree on how that could be achieved.”

“We have more presence at the moment and more visibility on needs [of the people] on the side of the river that is under Ukrainian control,” Zakaria added. 

“However, we are monitoring, especially through the leadership of our regional office in Europe, to make sure that all information coming from the other side of the river [controlled by Russia] is also monitored”. 

Marburg over in Equatorial Guinea

Forty two days since the last patient affected with Marburg Virus Disease (MVD) was discharged from treatment, Equatorial Guinea declared the outbreak as over, the WHO announced at the media briefing.

The announcement comes days after Tanzania announced that the MVD outbreak in the country was over. 

Equatorial Guinea reported its first three cases of MVD in February and subsequent cases in March. Seventeen people were confirmed to have contracted MVD, of which 12 died. In addition to this, 23 probable cases were reported and all of them died.  

United Nations Headquarters in New York.

Member states have been given nine days to comment on the ‘Zero draft of the Political Declaration on Pandemic Preparedness and Response, due to be adopted at the United Nations (UN) High-Level Meeting (HLM) on 20 September – with insiders describing the draft as “underwhelming”.

The HLM is essential for boosting waning political commitment to pandemic preparedness and response amid a myriad of urgent post-COVID recovery issues vying for politicians’ attention and financing.

The 14-page “zero-draft”, sent to member states on Monday with a comments deadline of 14 June, is deferential to the two ongoing negotiations on the pandemic accord and International Health Regulations (IHR)  amendments being conducted by the World Health Organization (WHO). These will only conclude in May 2024.

However, it also contains clauses that encapsulate the same red flags as in the two WHO pandemic negotiations – including how to ensure more accountability over public funds invested in the research and development (R&D) of vaccines, medicines and other tools; intellectual property constraints and technology transfer to low- and middle-income countries.

Alternative R&D funding mechanisms

While recognising the importance of the private sector in pandemics, the draft encourages the appropriate use of “alternative financing mechanisms” for R&D. This includes support for “voluntary initiatives and incentive mechanisms” that can separate R&D cost from “the price and volume of sales” and “facilitate equitable and affordable access to new tools” such as vaccines and therapeutics.

The draft encourages member states to investigate “innovative incentives and financing mechanisms” for public-health-driven R&D, such as stronger and transparent public-private partnerships and partnerships with academia.

However, the draft also asserts that “domestic public resources” are the “main source of financing for pandemic prevention preparedness and response”. To maximise these, member states are encouraged to pool resources, identify new revenue sources and improve public financial management.

“There should be language on the need to internationalise the rights to use government-funded inventions and know-how, either as global public good or to pool on a share and share alike basis,” said Jamie Love, director of Knowledge Ecology International (KEI),

He added that the inclusion of reference to TRIPS flexibilities was good “but suffer from the flaws of only reaffirming the right to use them, but not dealing with the many failures to do so”.

Seventeen equity clauses

There are 17 clauses devoted to equity, along with the acknowledgement of the need to “build trust” after COVID-19, when wealthy nations bought up and hoarded vaccines when supply was scarce – at the expense of low- and middle-income countries.

Support for the development of local and regional “manufacturing, regulation and procurement” also features, alongside a commitment to promote the transfer of technology to enable this.

However, Love said that reference to benefit sharing is limited to pathogens of pandemic potential, “which KEI sees as a weak basis for equity provisions, and we are disappointed there are no incentives to open source other inputs to countermeasures, such as data, inventions, know-how or cell lines, even though these are inadequately supplied”.

The draft also affirms the importance of universal health coverage based on primary healthcare, and the need to protect and train health workers – but steers clear of addressing the ongoing poaching of LMIC health workers by wealthier nations.

Role of WHO?

pandemic
Former Liberian President Ellen Johnson Sirleaf (left) and Former New Zealand Prime Minister Helen Clark (right), co-chairs of The Independent Panel.

The draft also affirms the centrality of WHO as the “directing and coordinating authority on international health work”  in relation to pandemic prevention, preparedness and response.

However, the Independent Panel for Pandemic Preparedness and Response has recommended the formation of a Global Health Threats Council by a UN General Assembly resolution that comprises the heads of state from each of the UN’s regional groupings and is independent of the WHO. 

“Pandemic readiness extends beyond health, and heads of state and government have no tradition of travelling to Geneva to report to the WHO Executive Board or World Health Assembly (WHA). An effective [Global Health Threats] council with adequate participation should not be solely under the mandate of the WHO; instead, it needs to operate with a strong General Assembly mandate and independence from the WHO,” Independent Panel leaders wrote in a recent article for Think GlobalHealth. 

The first reading of the zero draft for member states takes place on 12-13 June, with two other readings planned before a final draft is presented on 24-25 July.

Image Credits: John Samuel, UN Photo/Manuel Elias, @TheIndPanel.

Traditional cooking in India

The high cost of energy and negligible progress in rolling out electricity in sub-Saharan Africa since 2010 are some of the factors behind why 2.3 billion people are still reliant on cooking fuels like coal and firewood that harm their health.

Meanwhile, the transition to renewable energy has been too slow – and there has been a substantial drop in international finance available to help developing countries make this transition.

These are some of the findings of the 2023 edition of Tracking SDG 7: The Energy Progress Report  released on Tuesday, which warns that the world is far off track to meet Sustainable Development Goal (SDG) 7,  “ensuring access to affordable, reliable, sustainable and modern energy”.

The goal is broken down into access to electricity and clean cooking (7.1), a substantial increase in renewable energy (7.2) and doubling the global rate of improvement in energy efficiency by 2030 (7.3).

The report is published by the SDG 7 custodian agencies, the International Energy Agency (IEA), the International Renewable Energy Agency (IRENA), the United Nations Statistics Division (UNSD), the World Bank, and the World Health Organization (WHO).

“Attaining [SDG 7] will have a deep impact on people’s health and well-being, helping to protect them from environmental and social risks such as air pollution, and expanding access to primary health care and services,” according to the agencies in a media release.

Dirty fuel pollutes household air

According to WHO, 3.2 million people die each year from illnesses caused by the use of polluting fuels that increase household air pollution. Africa alone faces 1.1 million deaths from air pollution, second only to malnutrition.

“The use of traditional biomass also means households spend up to 40 hours a week gathering firewood and cooking, which prohibits women from pursuing employment or participating in local decision-making bodies and children from going to school,” according to the report, which adds that traditional fuel perpetuates “gender inequity, deforestation, and climate damage”.

While access to cleaner cooking fuels has improved since 2010 when 2.9 billion used dirty household energy, some 1.9 billion people would still be without access to clean cooking in 2030 – with 60% of these living in Sub-Saharan Africa – if current trends are followed. 

The economic impact of COVID-19 and soaring energy prices might also push 100 million people who recently transitioned to clean cooking to revert to using traditional biomass.

Eastern Asia, Latin America and the Caribbean were the only regions to sustain progress in access to clean cooking between 2019 and 2021. 

“Access to electricity and clean cooking still display great regional disparities and should be the focus of action to ensure that no one is left behind. Investment needs to reach the least-developed countries and sub-Saharan Africa to ensure more equitable progress toward Goal 7,” said Francesco La Camera, Director-General of IRENA.

Impressive electrification in South and Central Asia

Globally, 91% of the world’s population had access to electricity in 2021 in comparison to 84% in 2010 – an increase pf more than a billion people.

In Central and Southern Asia, 414 million people had no electricity in 2010 but this was slashed to 24 million by 2021, with Bangladesh and India singled out for their progress.

Eastern and South-eastern Asia cut those without electricity from 90 million to 35 million during the same period. 

But in Sub-Saharan Africa, over 80% of the 524 million people in rural areas are without access to electricity in 2021 – almost unchanged since 2010. Globally, around 675 million people don’t have access to electricity.

Swing to renewables is too slow but accelerating

Solar panels provide electricity to Mulalika Clinic in Zambia.

Global use of renewable electricity has grown from 26.3% in 2019 to 28.2% in 2020, the largest single-year increase since the start of tracking SDG 7 progress.

international public financial flows in support of clean energy in low- and middle-income countries have been decreasing since before the COVID-19 pandemic and funding is limited to a small number of countries.

Efforts to increase renewables’ share in heating and transport, which represent more than three-quarters of global energy consumption, remain off target to achieve 1.5oC climate objectives.

In addition, international public financial flows in support of clean energy in developing countries stand at $10.8 billion in 2021, 35% less than the 2010–2019 average. And this is financial flow is concentrated in 19 countries, which received 80% of the commitments.

The report will be presented to top decision-makers at a special launch event on 11 July at the High-Level Political Forum (HLPF) on Sustainable Development, ahead of the second SDG Summit in September 2023 in New York.

Image Credits: Nigel Bruce/WHO, Shruti Singh/ Unsplash, UNDP/Karin Schermbrucker for Slingshot .

The WHO aims to use the EU’s digital COVID-19 certificate to develop a global certificate network.

The World Health Organization (WHO) is establishing a global digital health certification network based on the European Union’s COVID-19 certificate to “facilitate global mobility and protect citizens across the world from ongoing and future health threats, including pandemics”, the body announced on Monday.

The EU’s digital COVID-19 certificate (DCC), which recorded vaccinations, tests and recovery, “facilitated safe travel for citizens, and it has also been key to support Europe’s hard-hit tourism industry”, according to the European Commission.

But when the DCC was first introduced in mid-2021, it was viewed with suspicion by non-EU members who feared it was a measure to exclude non-Europeans and in the early days a number of EU countries did not recognise vaccines used in other countries, such Covishield, India’s generic version of the AstraZeneca vaccine.

When a ​​vaccine was not centrally authorised by the EU, “each member state has the option to recognise it,” EU spokesperson Stefan de Keersmaecker told Health Policy Watch. 

However, the DCC open-source platform became widely used by non-EU countries to issue and validate certificates. But the DCC regulation is set to expire on 30 June and the WHO hopes to step into the gap with a global solution. 

“Building on the EU’s highly successful digital certification network, WHO aims to offer all WHO member states access to an open-source digital health tool, which is based on the principles of equity, innovation, transparency and data protection and privacy,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General, on Monday.

The WHO will work in partnership with the EC to develop the global digital health certificate, guided by the EU Global Health Strategy and WHO Global strategy on digital health.

Thierry Breton, European Commissioner for Internal Market, said: “With 80 countries and territories connected to the EU Digital COVID-19 Certificate, the EU has set a global standard. The EU certificate has not only been an important tool in our fight against the pandemic, but has also facilitated international travel and tourism. I am pleased that the WHO will build on the privacy-preserving principles and cutting-edge technology of the EU certificate to create a global tool against future pandemics.”

Image Credits: Lukas/ Unsplash.

Global Health Policy Lab launch event on 24 May, 2023 in Geneva
Global Health Policy Lab launch event on 24 May, 2023 in Geneva

A new collaboration called the “Global Health Policy Lab” (GHPL) aims to develop digital tools that strengthen the available global capacity to identify, benchmark, disseminate and assess the impact of relevant health laws and policies within the field of global health.

The lab, a partnership between the Harvard Health Systems Innovation Lab and the Charité Center for Global Health was announced on the sidelines of the World Health Assembly in Geneva last month. The partners will work to make science and evidence-based policy-making a “universal reality,” they said, with the end goal of improving access and quality of care across the globe.

“Policy design is painful, but policy implementation is even more painful,” said Dr. Rifat Atun, Director of the Harvard Health Systems Innovation Lab at Harvard School of Public Health. “We are therefore committed to innovate on how these challenges are addressed: with rigorous learning and collaboration, democratization and dissemination through machine learning and AI.”

Part of the collaboration will include building an accessible “Digital Repositorium” of health laws and policies, which will be disseminated through a yearly report that includes analysis of health policy trends, challenges, opportunities and threats.

Foundational to the lab is digitalization and use of new technologies to drive better care.

Digital Health Aim of WHO Since 2020

The World Health Organization set a Global Strategy on Digital Health in 2020 at the World Health Assembly. WHO’s vision is “for digital health to be supportive of equitable and universal access to quality health services,” the organization said.

The WHO program includes three critical objectives:

1 – Supporting the implementation of digital solution to inform medical decision making.

2 – To bring together experts around the world via digital communication to share best practices and knowledge.

3 – Linking countries with the specific health innovations that best meet their needs.

Similarly, according to Ricardo Baptista Leite, founding chair of the initiative, “We will harness the power of technology to foster innovation and knowledge that ultimately provides policy makers at all levels (multilateral, national, state, regional and local) with tools and competencies capable of accelerating the translation of science-based recommendations into concrete laws, policies, awareness campaigns and other political interventions that ultimately can contribute to a healthier population at a global scale.”

He said GHPL plans to play a “differentiating and disruptive role in how data and science
effectively translate into new approaches and solutions that lead to improved health
outcomes for all.”

AI: Challenges and Opportunities

On the other hand, some doctors and scientists have identified challenges to using AI in healthcare and health policy making. A paper published this year in the peer-reviewed journal Biomed Matter Devices highlighted the drawbacks of artificial intelligence and their potential solutions in the healthcare sector. Included in the list of obstacles is data collecting, technological development, clinical application and ethical and societal concerns.

The GHPL is supported by the Virchow Foundation for Global Health by providing the legal and collaborative framework for the initiative. The World Health Summit with its conference and activity platform is also a project partner.

“The gap in the translation between scientific knowledge, on one hand, and political action,
on the other hand, is still weak and leaves a lot to do,” said Dr. Axel Pries, President of the World Health Summit. “Science is inherently global, and governments on a national level have to work together much more to address these broad challenges. We believe this initiative will highly contribute to this goal.”

Image Credits: Courtesy Global Health Policy Lab.

There is growing evidence that using e-cigarettes doubles the chance of starting to smoke cigarettes later in life for never-smoker adolescents.

Electronic cigarettes are a trap to recruit children, not part of harm reduction, said Dr Tedros Adhanom Ghebreyesus, Director General of the World Health Organization (WHO) at the global body’s weekly media conference.

“When the tobacco industry introduced electronic cigarettes and vaping, one narrative they really tried to sell is that this is part of harm reduction. It’s not true. It actually is a trap, meaning kids are being recruited at the early age of 10,11,12 to do vaping and e-cigarettes,” said Tedros in one of the sharpest rebukes of the industry yet.

Children are attracted to e-cigarettes and vaping because think that it’s cool, and it comes in different colours and flavours, he added.

“Then they get hooked for life and most actually move into regular cigarette smoking,” said Tedros, who also stressed that e-cigarette and vaping were also harmful to health in themselves.

He appealed to WHO member states to regulate e-cigarettes and vaping to protect their citizens.

Earlier in the week, the WHO marked World No Tobacco Day by appealing to member states to assist local tobacco farmers in  to move to food crops by ending tobacco-growing subsidies.

Meanwhile, the US Food and Drug Administration issued warning letters to 30 retailers, for illegally selling unauthorized tobacco products. 

“The unauthorized products were various types of Puff and Hyde brand disposable e-cigarettes, which were two of the most commonly reported brands used by youth e-cigarette users in 2022,” according to the FDA.

“Protecting our nation’s youth from tobacco products – including disposable e-cigarettes – is a top priority for the FDA,” said FDA Commissioner Robert M. Califf, M.D. “We’re committed to holding all players in the supply chain – not just manufacturers but also retailers and distributors – accountable to the law.”

Bogus claims about pandemic treaty

Tedros also hailed the long list of resolutions adopted over the past 10 days by the World Health Assembly, the highest decision-making body of the WHO.

He described the decision to increase member states’ fees – assessed contributions – to cover 20% of the WHO’s budget and support for an investment drive as  “landmark agreements in our shared efforts towards a stronger, more effective and empowered WHO”.

However, he once again appealed for an end to disinformation that the pandemic accord and changes to the International Health Regulations currently being negotiated would threaten nations’ sovereignty.

Right-wing Swiss members of Freiheitstrychler protest against the WHO in Geneva

“This accord is a generational opportunity that we must seize. We are the generation that lived through the COVID-19 pandemic so we must be the generation that learns the lessons and makes the changes to keep future generations safer,” stressed Tedros.

“The two processes are being negotiated by member states for member states and will, if enacted, be implemented in member states in accordance with their own national laws,” said Tedros. 

“All member states will retain their own sovereignty to set their own domestic health policies. The idea that tthis accord or the amended international health regulations will cede sovereignty to WHO is simply bogus.”

Last Saturday, members of the right-wing Frieheitstrychler (“freedom bell-ringers”) held a protest outside the United Nations in Geneva in protest against the WHO and the pandemic treaty. Ringing cowbells, some of the protestors carried posters condemning the pandemic treaty and claiming that the WHO was trying to take power from member states.

Image Credits: WHO, Megha Kaveri.

Africa
Medical teams in Tanzania react to the country’s first-ever Marburg virus case.

Tanzania declared the end of its Marburg Virus Disease outbreak on Friday, two months after the outbreak was first detected in the north-western Kagera region. 

Nine cases (eight confirmed and one probable) and six deaths were recorded in the outbreak, which was declared on 21 March after laboratory analysis confirmed that the cause of deaths and illnesses that were reported earlier in the region was Marburg.

The last confirmed case tested negative for a second time on 19 April, setting off the 42-day waiting period before the end of the outbreak could be declared.

Marburg is from the same virus family as Ebola, and very virulent and causes haemorrhagic fever. Around 88% of cases dies.

Symptoms start almost immediately, with high fever, severe headache, and severe malaise. Many patients develop severe haemorrhagic symptoms within seven days.

The virus is transmitted to people from fruit bats and spreads between people through direct contact with the bodily fluids of infected people, surfaces and materials. 

There are no vaccines or antiviral treatments approved to treat the virus. However, supportive care – rehydration with oral or intravenous fluids – and treatment of specific symptoms, improve survival.

In Africa, previous outbreaks and sporadic cases have been reported in Angola, the Democratic Republic of the Congo, Ghana, Kenya, Equatorial Guinea, South Africa and Uganda.

The World Health Organization (WHO) assisted Tanzania to train responders, which had been slow to identify the disease because of a lack of laboratory facilities in the remote area where the first cases were found.

“With the investments being made to prepare for and tackle health emergencies in the region, we are responding even faster and more effectively to save lives, livelihoods and safeguard health,” said Dr Matshidiso Moeti, WHO Regional Director for Africa.

The WHO office in Tanzania also assisted the country’s efforts by deploying outbreak response experts to reinforce surveillance, testing, infection prevention and control, contact tracing, treatment and community engagement. 

Additionally, with partners, WHO shipped nearly three tons of supplies of personal protective equipment and is also working with the Ministry of Health to support survivors of the disease.

“Thanks to these efforts, Tanzania has been able to end this outbreak and limit the potentially devastating impacts of a highly infectious disease,” Dr Moeti said.

“The outbreak in Equatorial Guinea is also expected to be declared over next week if no further cases are detected,” WHO Director General Dr Tedros Adhanom Ghebreyesus told a media briefing on Friday.

Marburg was first identified in Marburg, Germany in 1967. Since then, there have been a limited number of outbreaks reported in Angola, the Democratic Republic of the Congo, Kenya, South Africa and Uganda.

In 2023, two separate Marburg outbreaks have been reported in two countries, Equatorial Guinea and the United Republic of Tanzania.

Image Credits: WHO, WHO.