AU AMA Special Representative D Michel Sidibe and AMATA moderator Kawaldip Sehmi

Africa’s most powerful countries need to ratify the African Medicines Agency (AMA) to ensure its credibility – and civil society organisations can lobby them to do so , said Dr Michel Sidibe, the African Union’s (AU) Special Representative on the AMA.

“It is important to have countries like South Africa, Nigeria, Kenya, Ethiopia, the DRC, and other countries on the continent ratifying the treaty. It is important to continue for the credibility of the AMA to drive the ratification agenda, and it is very important to not lose momentum,” Sidibe told a webinar organised by the African Medicines Agency Treaty Alliance (AMATA), a civil society network that supports AMA’s formation.

“We don’t have another way to do it except making sure that we maintain we sustained our advocacy and we mobilise political leaders,” he added, commending AMATA for its advocacy work in support of AMA.

The aim of AMA is to harmonise the regulatory system for medical products across the continent’s 55 nations to enable faster approval processes and to support local pharmaceutical production.

But its establishment has been slow, first starting back in 2009. In February 2019, the  AU adopted a treaty to establish the agency but it took until November of that year before the bare minimum of 15 member state had ratified the treaty, enabling the AU to move ahead to set it up.

In July this year, the AU selected Rwanda as the host for AMA, and Sidibe said that he was confident the process of operationalising the agency would move fast in the hands of Rwanda’s President Paul Kagame.

World Health Organization (WHO) Director General Dr Tedros Adhanom Ghebreyesus met Kagame on the sidelines of the UN General Assembly in New York last week to offer WHO’s support for AMA.

“Our continent cannot be always the second in line when we have a crisis. When I was UNAIDS Executive Director, we waited for seven years before getting the [antiretroviral] drugs to the poor people,” said Sidibe. 

“Global health security will not happen without making sure that we can provide our poor people with quality medicine that is affordable. Almost 95% of our medicines are coming from abroad when India is importing a maximum of 15% and China 5% for the same level of population.”

Sidibe has been lobbying African countries extensively himself to ensure their ratification of AMA, and so far 22 countries have done so “after intensive engagement and interaction”, he said. 

Processes to make AMA functional

Sidibe said that he expected the AMA office in Rwanda to become operational “soon”, but outlined six processes to ensure that the agency is fully functional:

  • Ensuring its ratification by all countries, particularly Africa’s largest and wealthiest countries
  • Articulate the AMA strategy and plan widely to ensure it has the support of the continent
  • Develop a funding strategy and roadmap for fundraising
  • Start to build the skeleton of the organisation, including identifying its major functions and leaders
  • Build AMA partnerships and coalitions. 
  • Identify and deliver three to five major impacts for AMA in order to establish its credibility.

Stressing that these six points were his personal views, Sidibe called for the launch of “the first replenishment for an African-based health institution” to secure money for AMA’s future.

“The ratification process has highlighted the importance of critical stakeholders – regulators, researchers, academic institutions, private industry and passionate civil society organisations,” said Sidibe.

“AMA should not be just replacing national regulatory authorities or regional harmonisation processes. I think it will be a huge mistake and it will not work. AMA will just come in complement of those and a strong AMA will depend on strong national capacities,” stressed Sidibe, appealing to academics and civil society to help strengthen ethics committees and the implementation capacity of weaker countries.

Panel members discuss innovative financing

Budgetary efficiency and innovative ways to finance health emerged as key solutions to the problems plaguing the European health systems, according to a panel at the European Health Forum in Bad Gastein on Tuesday. 

Europe’s healthcare system is faced with several bottlenecks, said panelists. The COVID-19 pandemic has exacerbated problems such as a lack of adequate workforce and increased out-of-pocket spending on healthcare for citizens of the European Union (EU). 

The need to ensure equitable healthcare, cope with inflation and muster the political will are also issues undermining the health system. 

Is lack of money the problem? 

Money is hardly the problem. The European Commission EU’s long-term budget, coupled with the NextGenerationEU (NGEU) stimulus to boost post-COVID recovery, is channeling over €2-trillion to its member states to address the most important challenges before Europe and support those in need. 

Its EU4Health programme has a €5.3 billion budget for the 2021-27 period to “build stronger, more resilient and more accessible health systems” that are better able to withstand pandemics.

In the aftermath of Russia’s aggression on Ukraine, the EU budget was mobilised to provide emergency assistance and support in Ukraine and in the EU countries, and to alleviate the humanitarian consequences of the war.

“Different needs are best when addressed at their appropriate levels. We have all painfully realised that viruses do not stop at borders. Highly communicable diseases can only be tackled at the international level,” said Nathalie Berger, the director for support to member states’ reforms at the European Commission. 

Other key messages at the session revolved around improving efficiencies and stimulating innovation.

Efficiency

Tamás Evetovits, head of Health Systems Financing at the WHO Barcelona Office, stressed the need for efficient use of funds to bolster up the healthcare system. 

He urged member state to restrict their citizens’ out-of-pocket spending on health care to no more than 15%, which would avoid “catastrophic expenditure” by households. 

According to 2019 EU data on unmet health needs, around 3.1% of the EU population aged 16 and above reported that they have unmet medical examination or treatment needs. This number varied from 0.3% of the population in Spain to 17.6% in Estonia. ‘Unmet needs’ health care needs that are not met due to reasons like cost, distance or long waiting list to access the care service. 

Innovation – now and beyond

In pursuit of universal health coverage and access, Europe should not sacrifice the quality and affordability of healthcare services, said Anca Toma, executive director of the European Patients Forum. “Equity is really important and we want to make sure that health system reform is really centred around protecting the most vulnerable.”

While the COVID-19 pandemic tested Europe’s socio-economic safety net and health systems capacity, the war in Ukraine and with that, inflation and the food and energy crisis, have worsened matters. 

“The situation is tight as we know and the money will become tighter,” said Francesca Colombo, the head of the health division of the Organisation for Economic Co-operation and Development (OECD). “There is a question of who will absorb the pressure on price increases. Is it going to be the government? Is it going to be households? Is it going to be providers?” 

Post-pandemic, money is being channelled towards sectors other than health to rebuild. However, Colombo said that “countries need to invest 1.4% of their GDP across the OECD countries in health systems, targeted at things like workforce, information systems, prevention etc.” 

Members of the audience had a few innovative solutions to finance health systems. Ricardo Leite, a Member of Parliament from Portugal said countries could ask fast food companies to fund public health as they “are taking away health from our societies”.

He added that empowering health ministers to be part of the highest decision-making body of governments could also bring in more funds to the system. 

“I don’t know any minister of health that doesn’t say I want to do better…and they are always seen as the person bringing costs to the government,” he added.

Man showing signs of workplace stress
Can flexible working arrangements help to reduce workplace stress?

Practices implemented during the COVID-19 pandemic, such as flexible working arrangements and teleworking, could help to reduce work-related mental health challenges, according to a first-ever set of Guidelines on Mental Health at Work released Wednesday by the World Health Organization (WHO).

The COVID-19 pandemic triggered a 25% increase in what was already a high percentage of people suffering from anxiety and depression worldwide, WHO has previously noted. At the same time, the pandemic accelerated the pace of transformations in the world of work, especially in remote work, e-commerce and automation – and now emerging evidence shows that more access to flexi-time and remote work arrangements have mental health benefits.

Conversely, shift work and excessively long working hours adding up to 55 hours or more a week are associated with depression, increased alcohol risk and even suicidal behaviours, the WHO Guidelines review found.

More broadly,  job insecurity as well as a lack of  “job control” also are related to higher risk of depressive symptoms and risk of suicidal behaviours, while having more authority to make decisions about your job role and performance is “protective for depressive symptoms and higher job control is associated with reduced emotional exhaustion burnout.”  A lack of “organizational justice also is associated with “subthreshhold mental health symptoms”, the WHO review found.

Work and mental health closely intertwined

Pandemic lockdowns also imposed a mental health penalty when they confined to their homes for work and socializing – but now the benefits of more flexible work schedules are being recognized in the new WHO guidelines.

Release of the detailed 135-page guidelines was accompanied by a joint WHO and International Labour Organization appeal for concrete actions to address mental health concerns amongst the working population and provided evidence-based global public health guidance on how to do so in a policy brief.

“Work and mental health are closely intertwined,” WHO and ILO wrote in their joint policy brief. “A safe and healthy working environment supports mental health, and good mental health enables people to work productively. An unsafe or unhealthy working environment can undermine mental health, and poor mental health can interfere with a person’s ability to work if left unsupported.”

“As people spend a large proportion of their lives in work – a safe and healthy working environment is critical. We need to invest to build a culture of prevention around mental health at work, reshape the work environment to stop stigma and social exclusion, and ensure employees with mental health conditions feel protected and supported,” ILO Director-General Guy Ryder said of the new advice.

The World Health Organization's guidelines on mental health at work

The WHO Guidelines, the product of a lengthy and exhaustive global review of evidence, provide guidance in the following areas: organisational interventions, manager and worker training, individual interventions for promoting positive mental health, and prevention of mental health conditions. The guidelines also include a section offering recommendations on returning to work following an absence associated with mental health conditions and how to aid people with mental health conditions to gain employment.

The guidelines meet the standards for evidence-based guidelines, although in most cases there is low or even very-low certainty of evidence given that the recommendations are based on research into highly complex psycho-social risks, as compared to randomized-controlled drug trials.

Leap in depression and anxiety

Even before COVID-19, the world of work was experiencing changes, from technological development, climate change, globalisation, and demographic shifts. The pandemic accelerated these changes and forced companies and organisations to restructure both for financial reasons and to keep workers safe.

For many employees, WHO and ILO noted, these changes created new psychosocial risks or worsened existing ones.

Before the pandemic, in 2019, around 15% of working-age adults lived with a mental disorder, WHO found in its World Mental Health Report, released in June. This included 301 million people who were living with anxiety and 280 million individuals suffering from depression.

COVID led to a 25% increase in anxiety and depression, making the situation more acute. According to the reports, 12 billion working days are lost annually due to depression and anxiety at a total loss to the global economy of $1 trillion, predominantly from lost productivity.

“It’s time to focus on the detrimental effect work can have on our mental health,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “The well-being of the individual is reason enough to act, but poor mental health can also have a debilitating impact on a person’s performance and productivity. These new guidelines can help prevent negative work situations and cultures and offer much-needed mental health protection and support for working people.”

Organisational interventions – flexible work among the many examples

Flexi-work and telework are just a few among the many examples of organisational interventions that employers can take to address psychosocial risks at work, WHO found.  Others involve  involving workers more in decisions about their jobs, and changing workloads and work schedules to enable better work-life balance.

More “participatory” organisational strategies that allow workers to have a say in their own job design, workload changes, or break schedules also have positive mental health benefits – as does better feedback on worker performance.

Additionally, improvements to the physical work environment can have a positive impact, addressing issues such as “inadequate equipment availability… lack of space, poor lighting, excessive noise.”

In all cases, there was evidence of in favour of these practices, WHO found, even if the review also classified that evidence as weak in classical terms – where randomized controlled trials of the kind used for new drugs are typically seen as the gold standard.

“The GDG [Guidelines Development Group] concluded that, despite very low certainty of the available evidence, the likely benefits of organizational interventions on reducing emotional distress and improving work-related outcomes outweighed the possible harms of implementing these interventions,” the recommendations state. “This was supported by evidence for risk factors at work which negatively affect mental health outcomes, indicating that interventions to reduce, remove or mitigate risk factors could improve these outcomes.”

Addressing mental health of people with existing conditions

On a cold winter morning these women from Raipur, India are crowded into the back of a truck on their way to work.

The WHO guidelines also include recommended measures for addressing the mental health of humanitarian and emergency workers, as well as for integrating new or returning workers with mental health conditions into the workforce.

Finally, the guidelines map out recommendations for training both employers and workers in mental health literacy – including  strengthening managers’ skills to recognise and act on mental health conditions at work, and empowering workers to seek support.

In their joint brief, WHO and ILO call for the creation of an environment with “cross-cutting actions to improve mental health at work” through seven factors they said are “critical for progress:” leadership, investment, rights, integration, participation, evidence, and compliance:

  • Leadership involves the development of a mental health plan and assigning roles based on that plan. Investment centers on allocating the financial and human resources towards implementing such plans, as well as including mental health services in any work benefits package.
  • A “‘rights” based approach calls for employers to develop and implement non-discrimination policies around mental health and take the necessary steps, such as training programs, to stop stigmas around mental health in the workplace.
  • Integration means the embedding of mental health into existing occupational safety and health strategies and participation engage workers – especially those who have lived with mental health challenges – in the decision-making process.

Walking the talk at WHO

WHO’s new headquarters in Geneva – touted architecturally for its modern design but with many staff doubling up on desks in the new atrium open-space.

Ironically, prior to the pandemic, WHO itself was the agency with some of the UN’s most restrictive policies on teleworking and flextime – until COVID which forced most of its 8,000+ workforce to abruptly begin working remotely in March 2020 – the resulting efficiencies triggered a re-evaluation of internal policies.

Until today, most the WHO workforce in its Geneva headquarters is still working off-site much or most of the time – as a massive building renovation project coinciding with the pandemic reduced office space and forced workers to double up on desks – unless they are high-level directors.

More recently, a new WHO policy calling for workers to return to the office for at least one day a week may have been met with relief among some staff happy to reconvene with colleagues again, but resistance among others who say that office work policies need to be fine-tuned in light of workers’ individual status and needs.

In particular, WHO’s new building design, chosen after painstaking review, has received complaints among from critics who say that the modern, open-plan offices reduced privacy and net desk space, leaving almost no room for consultants.  Even some of the regular staff have to double up on desks in a windowless “atrium” area, taking everything home at night.  More private office spaces, featuring windows, run along the sides of the new building, but these are largely taken up by higher-level officials.

WHO’s “atrium offices” in the new building headquarters – windowless cubicles crowded together.

Observed one senior WHO staff member who asked not to be named: “I think that days in the office should be decided upon based on the benefit that can be derived from going to the office relative to the risks/disadvantages.

“For instance, effects on work-life balance would be negative for me, since I would have to waste between 1 hour and around 2 hours of my day on commuting.

“Additionally, some 95% of my work is with people outside Geneva, not to mention that I have a great teleworking set up at home – whereas in the office I have a small desk area with ‘blinders on three sides’ in a hallway (which they euphemistically call ‘atrium’) that I would have to clear every evening since it will be used by somebody else on another day. This is not what I consider a productivity environment.”

Asked for comment, Aiysha Malik, WHO’s lead coordinator of the new guidelines from the Department of Mental Health and Substance Use said: “These first ever guidelines from WHO …mean that employers, and the people responsible for the health and wellbeing of workers, can now be assured in what works for mental health. Like all organizations, WHO will review the recommendations and ensure that this guidance forms part of its way of working.”

–Elaine Ruth Fletcher contributed to this report.

Image Credits: Ciphr Connect, Neil Moralee/flickr , World Health Organization, Prem Kumar Marni/Flickr, Geneve Internationale/WHO and BBK Architekten, Health Policy Watch .

WHO Europe Director Dr Hans Kluge pitches his “moonshot”.

European finance ministers need to recognise that the “permacrisis” of the pandemic, climate change and the war in Ukraine pose as big a danger as a nuclear threat, and double their investment in the health workforce, according to World Health Organization (WHO) Europe director Dr Hans Kluge.

This, added Kluge, was his “moonshot” for a truly European health union – the theme of the European Health Forum in Gastein that he was addressing on Tuesday.

“According to some reports, nine out of 10 nurses would like to quit their job, 80% of the nurses had psychological distress, and 40% of the medical doctors in our region are close to retirement age,” Kluge told the forum.

In addition, health workers were migrating from poorer countries to in the east to the wealthier west.

“We have medical deserts, where you have rural areas where you don’t find any doctors or nurses, and this is a big challenge,” said Kluge.

Resilience and stronger health systems

Stella Kyriakides, the European Commissioner for Health and Food Safety

Stella Kyriakides, the European Commissioner for Health and Food Safety, said that both the COVID-19 pandemic and the war in Ukraine had shown the region that it needed to focus on “resilience and stronger health systems”.

“EU Member States and other countries are supporting Ukraine with emergency assistance to a level that I believe we haven’t seen before. We’re delivering medicines, personal protective equipment, ambulances, food and shelter,” said Kyriakides, adding the EU had also set up a medical evacuation system that had enabled 1,300 patients to get special treatment outside of Ukraine.

“Wars have huge consequences at all levels and so much human suffering. But we are, as an EU, in there for the long haul to support Ukraine, and we need to be prepared for more difficult autumn and winter months,” said Kyriakides.  “We must never forget the backbone of health systems which is a health workforce.”

The European Commission’s Nathalie Berger, who is Director for Support to Member States’ Reforms, said that 17 member states were being supported to reduce their dependence on Russian fossil fuels and identify and develop renewable energy sources. 

Getting through winter

Daniels Pavluts, Minister for Health in Latvia

Government ministers from Austria and Latvia were simply and immediately focused on regional co-operation to survive the winter without gas from Russia.

Latvian Health Miniser Daniels Pavluts, outlined his two priorities: to help Ukraine win the war and second, to get through the winter. 

Latvia, Estonia and Lithuania have been “among the leading countries providing bilateral help to Ukraine”, said Pavluts, adding that his country had provided treatment and rehabilitation for Ukrainian soldiers and other victims of hostilities, and taken in about 40,000 refugees. 

“We have shared borders with Belarus and Russia and we can easily imagine ourselves being in the place of Ukraine. It is our duty to help Ukraine win this war,” said Pavluts.

Latvian health officials were travelling to Ukraine, to learn “how they operate in these conditions of war” and also how to prepare for nuclear threats, he added.

Breaking dependence on fossil fuels

Leonore Gewessler, Austria’s Minister for Climate Action, Environment and Energy,

Leonore Gewessler, Austria’s Minister for Climate Action, Environment, Energy, Mobility, Innovation and Technology, said that the multiple crises had made government officials break out of their silos.

“You have a minister of health on this panel who speaks as much about war and foreign policy as health. And you now a minister of climate action and energy who speaks as much on social effects of climate policy and health effects of the climate crisis,” said Gewessler.

She was particularly challenged by “the war in Ukraine, and its effects it has both in Ukraine and on Europe’s insecurity of energy supply and the social aspects of the price hikes that we see”.

She was also trying to help people affected by the climate crisis, including “young people who are becoming increasingly anxious about a very existential threat to their well-being”.

“The root of the problem is our dependency on fossil fuels, especially our dependency on Russian fossil fuels,” she added.

In the short-term, “I will need every kilowatt hour that I can get to make sure that I can heat homes as Vladimir Putin does  now uses gas supply as a weapon”, she said.

“In the long term, the only solution is to go renewable and as independent as we can to produce as much of our energy ourselves as much as we can. And this means from every way ,we get rid of our dependency on fossil fuels – solar panel by solar panel, by heat pumps, windmill to windmill.”

Medtronics’ Betteh Life project in Sierra Leone

Infectious diseases like HIV, tuberculosis and malaria have long been the biggest public health challenges in low- and middle-income countries (LMICs) but over the past decade, non-communicable diseases (NCDs) have risen at an alarming rate.

While every country faces a growing NCD burden, low- and middle-income countries are seeing the fastest increase. This epidemiological shift is largely due to increases in exposure to risk factors – urbanization, tobacco, alcohol, ultra-processed food, air pollution and a lack of physical activity – and is exacerbated by more fragile health systems.

Getting NCDs under control in LMICs requires new approaches to securing funds, through innovative partnerships that can creatively leverage resources and technology for efficient and effective service delivery.

‘Betteh Lyfe’ in Sierra Leone

In Africa, the Betteh Lyfe programme – a collaboration between Medtronic LABS, the Christian Health Association of Sierra Leone, and Sanofi Global Health – was launched in Sierra Leone this year. 

Medtronic LABS supports end-to-end care with their digital health platform, SPICE, and their team on the ground. It begins with community health workers who carry out screening for diabetes and hypertension close to people’s homes – even those living in remote areas – and referral to health facilities to begin a treatment programme.

Follow-up and monitoring are community-based or via tele-counselling, making it easier for patients to adhere to treatment. This also generates real-time data that is valuable for clinical, programmatic and policy decision-making. Private sector funding helped to catalyse the programme while collaboration with the existing faith-based network made it possible to build connections with remote and marginalized communities to bring NCD diagnosis and care to their doorsteps.

The total number of people living with diabetes in Africa is predicted to more than double to 55 million by 2045. Hypertension, cardiovascular diseases, cancers and mental health disorders are all on similarly steep upward trajectories.

Today, 74% of all deaths are due to NCDs – with the heaviest and fastest rising burden in LMICs – and yet only 1-2% of global health funding supports NCD care. This number has stagnated since NCDs made it onto the global health agenda two decades ago.

Medtronic LAB has helped to check people for hypertension in Sierra Leone.

 Kenya’s public-private partnership

Aside from funding, the response on the ground will need to adapt to the evolving epidemiology. It requires ‘all-of-society’ partnerships, that bring together the private sector, public sector, civil society, donors, and most importantly patients themselves in designing and delivering solutions.

Such partnerships are essential if we are to overcome numerous barriers to better health in LMICs, like inadequate funding, hard-to-reach services, poor adherence to treatment, and insufficient data to make informed health policy decisions. We’ve seen their effectiveness proven on the ground.

A similar approach has been employed in Kenya for the last three years in a landmark public-private partnership with Medtronic LABS, the Ministry of Health, the County Government of Makueni, PATH, Novo Nordisk and Kenya Defeat Diabetes Association. 

This multi-sectoral model has focused on public health system strengthening. So far, it has screened 114,000 people, enrolled over 21,000 patients in Makueni County alone, and will extend to all 47 counties in Kenya by 2026. 

Its ethos is based on both reaching and retaining patients. Like the Betteh Lyfe program, community health workers visit people in remote areas for education, screening, follow-up, and blood pressure and blood glucose monitoring while physicians track the readings remotely through the digital health platform. Patients are kept engaged with health services as they do not have to travel prohibitively long distances to access care and begin to see improved outcomes within a year.

Digitizing the health information system

The program has also digitized the national diabetes and hypertension health information system from data collection all the way to aggregation into District Health Information Software (DHIS2), ensuring consistent availability of data for decision-making. As part of the commitment to work within and sustainably transform health systems for scale, the full ownership of the model, including the digital health component is being transitioned to the Ministry of Health.         

These examples highlight how a robust multi-sectoral partnership framework can improve access to essential NCD services, ensure optimal and efficient use of scarce resources and leverage the expertise, capacity and experience of the different partners to mount a more coordinated NCD response. 

Programme leadership from national and sub-national governments and aligning strategies around government priorities whilst engaging faith-based networks and other community groups can ensure sustainable, bespoke and person-centered chronic care.

Rwanda’s Universal Health Coverage

Rwanda is a good example of this approach. Its government has taken a strong lead in the enactment of Universal Health Coverage (UHC), which integrates NCD prevention and care whilst constructively engaging partners, civil society and the community.

Here, 91% of the population is covered by health insurance, primarily the Rwanda Community Based Health Insurance (CBHI) which covers 90% of all health costs at all levels of care. This kind of financial protection, plus ambitious community screening and education programmes, helped increase the use of health services from 30.7% in 2003 to 85% in 2008.

These programmes offer many translatable lessons for other countries looking to improve their health systems through multi-sectoral partnerships: the importance of government leadership, working with community organizations, leveraging community health workers to deliver NCD care, and the role of digital innovations to reach remote or marginalized populations. 

Building experience and evidence from bold partnerships like these will be an important contribution to supporting LMICs as they make gains towards reducing the health and economic burden of NCDs.

 

Alison Cox

 

 

Alison Cox is the Policy and Advocacy Director of the NCD Alliance.

 

 

Megha Kumar

 

 

Megha Kumar is Head of Global Partnerships at Medtronic LABS.

 

 

Anne Stake

 

 

Anne Stake is Chief Strategy & Product Officer at Medtronic LABS

 

Image Credits: Medtronics.

Aam Admi Party leaders Bhagwant Mann (centre), the Punjab chief minister, and Arvind Kejrwal (left), chief minister of Delhi.

NEW DELHI – When India’s Aam Admi Party (AAP) won elections in the northern state of Punjab in March, decisively wresting power away from the Indian National Congress (INC) and defeating the nationalist Bharatiya Janata Party, clean air advocates and activists were optimistic that the burning of crop stubble by Punjab farmers – the biggest contributor to Delhi’s recurring autumn and winter air pollution spikes – would finally be tackled and a real solution found.

There were two primary reasons for this optimism. First, of all Indian political parties, the AAP, which came into power in Delhi in 2013, was one of the earliest to acknowledge the health harm of air pollution and speak out most openly about the need to reduce this environmental toxin.

It even experimented with implementing an odd-even road-sharing plan for vehicles in the high pollution season in early 2016. Even though this scheme failed to deliver – some research showed pollution actually increased during this period – the AAP succeeded in raising awareness about air pollution and making it a mainstream issue.

But it was the second reason that gave activists cause for optimism this season. For years, the AAP has loudly, aggressively and publicly blamed the INC for the winter pollution peaks in Delhi and northern India, saying that the Congress-ruled Punjab government has been  unable to control fires set by farmers to prepare their fields for winter sowing. 

Satellite image of northern India on 26 October 2020 shows the Delhi region with “very poor” to “severe” air quality, largely as a result of of crop burning in Punjab, whose capital is Chandigarh.

Now that the AAP had taken control of Punjab with a sweeping majority, the party had all the power to stop farm fires – whose toxic drifts southward towards Delhi in early and mid-winter, setting off choking pollution crises in the city for more than a decade.

But the AAP’s proposal that the central government, the Punjab state government and the Delhi state government jointly pay farmers a cash incentive of Rs 2500 per acre – not to burn crop residue appears to have already fallen through. The party has been unable to explain why – although it’s likley attributable to the deep political rivalries that exist between the centre-left AAP, now controlling Punjab state and Prime Minister Narendra Modi’s Hindu nationalist Bharatiya Janata Party (BJP), which controls the government today.

Specific questions sent by Health Policy Watch to AAP leaders and spokespersons, including chairperson of the Delhi Assembly’s environment committee and legislative assembly member Atishi Marlena, were either ignored or given generic responses. 

One AAP spokesperson referred us back to a YouTube video of a speech made by the Punjab Chief Minister, Bhagwant Mann, in which Mann said that the state government has asked the central government for help in paying farmers the no-burn cash incentive. 

Punjab chief minister claims central government nixed farmer incentives

Mann said the proposal calls for the central government to cover Rs 1500 of the cost of the no-burn incenteive, while the Punjab and Delhi state governments would each add Rs 500 per acre – in light of the huge health impacts the stubble burning has downwind – including in New Delhi, India’s capital city, and the greater Delhi metropolitan area, India’s second largest.  

“The central government has rejected our proposal,” Mann said, speaking in the video in Punjabi. “But doesn’t matter, even if the central government doesn’t help us, we will go ahead with our contributions and also ask every one of our officers to spread awareness (about the harms from burning) and inform farmers that they should not light fires,” he added. 

However, subsequently, Punjab Agriculture minister Kuldeep Singh Dhaliwal said the plan to give cash incentives to farmers not to burn crop stubble had been shelved in its entirety. “How can we pay when the centre is not giving?” the minister asked.

Meanwhile, Mann said the Punjab government would also deploy 105,000 crop residue management machines in to grind the crop waste  – another much touted alternative to waste burning. But it remained unclear if the Punjab government intended to buy the machines or merely encourage farmers to buy them via subsidies – and what timelines were being planned. 

And he said that the government would also incentivize farmers to make wider use of an innovative new chemical composting technique, known as the Pusa decomposer, an indigenous catalyst that converts rice stalks to valuable manure, and has been successfully tested by the Delhi State government over the past two years in its own non-basmati rice-growing farmlands.  However, the stalks still take several weeks to decompose and it remains to be seen if farmers will perceive the value of the compost thus created as worth the wait. 

Early start of toxic air?

Pollution in Delhi peaks in late autumn when drifting emissions from crop burning exacerbate the usual urban household, traffic and industrial sources

With the harvest season beginning imminently, however, it is already getting late to take pre-emptive action – with some Punjabi farmers already beginning to set their fields on fire.

Like every monsoon season, August and September have seen the cleanest air, and the lowest Air Quality Index (AQI) numbers, in north India in 2022, with rains clearing smoke and fine particulates that are the most hazardous to health, and would otherwise drift hundreds of kilometers towards Delhi. 

On Friday 16 September, for instance, the AQI in Delhi was 44, putting it squarely in the “good” category (AQI under 50), due to a long period of light rain – the first “good” air day since 18 October 2021, which was the only good air day in 2021. 

There were only five good air days in 2020, mainly because of the lockdown. But there wasn’t a single good air day in 2015, 2016 and 2018.

This post-monsoon air is clean because it has been washed by rains – no political party or smog tower can claim credit for this although that hasn’t stopped politicians from trying. 

But as those who track air pollution know that this is the calm before the storm.  It is a narrow window of time after which, rice paddy straw burning during the dry season that follows begins to push PM2.5 readings up to dangerous levels – made even more hazardous by fireworks from the Hindu Diwali festival, to be celebrated this year on 24 October.  

PM2.5 is the microscopic particulate matter that bypasses human defences to settle deep into the lungs. It is absorbed by the bloodstream and carried to every organ in the human body, fueling inflammation and a host of cardiovascular and respiratory diseases, among others.

Often these can spike more than 250 times above the World Health Organization (WHO) limit of five micrograms per cubic metre on the day after Diwali. 

With the monsoon receding early, leaving a rainfall deficit of 35% in Delhi according to the India Meteorological Department, wind speeds dropping and some early signs of crop stubble burning, toxic air may make an early entry this year. 

Farmers already burning fields

There is a very brief turn-around between the autumn rice harvest and the time when farmers need to sow wheat, making rice stalk burning attractive to farmers.

According to the Punjab Remote Sensing Center, farmers have already begun lighting their fields. Last Tuesday the AQI immediately rose to 182, the highest since 25 June, when it was 230. 

Farm fires usually begin in Punjab’s Majha region and progress towards the Malwa region. Unless there is some miracle, Delhi and north India’s Gangetic plain are in for another toxic winter, as governments flounder without focus or specific plans to reduce the burning of agricultural waste, 

North India’s unique geography, topography and meteorology make controlling stubble burning critical to curbing air pollution. The geography of the Indo-Gangetic plain – with the great Himalayan range in the north acting as a physical barrier, preventing dirty air from dissipating quickly – traps pollution generated in the region for long periods. 

As the monsoons recede and the air becomes cooler and drier over the winter months, wind speeds also reduce. Seasonal temperature inversions  – when lighter, warmer air rises and traps cooler, denser air – further confines pollution to the ground level, keeping atmospheric particulate concentration high. 

Air pollution in this region is bad year round – but during autumn and winter, these geographical and meteorological misfortunes combine with stubble-burning to create the perfect storm, turning India’s northern plains into one gigantic bowl of pollution that its residents are forced to breathe for months on end.

Health costs of stubble burning

Analysis of the proportions of a) people exposed and b) land area covered by air pollution at various levels, based on data extracted by Washington University, St. Louis USA.

Stubble-burning is one of the major contributors to air pollution in South Asia. But the problem is particularly acute in north India due to the unique mix of crop cultivation patterns, the timing of harvests, and weather. In India’s Punjab and neighboring states, farmers burn their fields to quickly clear them of straw in the short window of time that they have between the end of rice-harvesting and the wheat-sowing period. These fires are so large that they can be seen from space.

Until September, densely populated urban areas like Delhi experience mixed winds, including the moisture-laden easterlies and south-easterlies. But by early October, the winds change direction, blowing in from the northwest so if paddy fields are on fire at this time, smoke from the fires move directly towards the urban areas – and the 46 million people living in the greater Delhi region who inhale the smoke with every breath they take.  

According to some estimates, farmers reportedly produce almost 50 million tonnes of straw a year in the northern states of Haryana, Punjab, Rajasthan and Uttar Pradesh, burning about four-fifths of the waste. Punjab alone produces 20 million tonnes of paddy residue.

Another, more conservative estimate of the International Wheat and Maize Improvement Center holds that farmers in North India burn around 23 million tonnes of straw from their rice harvests.  But this is still huge; if the stalks were packed into 38-cm-high bales, and piled on top of each other, they would reach the moon.  

The air pollution cost due to stubble burning is estimated at $30 billion annually in terms of health and economic disruptions such as flight and train delays and car crashes, according to National Institute of Public Finance and Policy.

Rural as well as urban populations experience the negative health impacts. An October 2021 study on the respiratory effects of crop stubble burning in the Patiala district of Punjab, undertaken by the Energy Resources Institute, found respiratory complaints and reduced lung function across all age groups – with the most reduced lung function in the lowest age groups whose developing bodies may be stunted by pollution for life. 

Exposure to stubble burning increased a person’s risk of lung cancer by 36%, the study also found, with more adverse health effects among women as compared to men.  

Stubble burning also harms soil fertility, destroying many nutrients. One report estimated the losses as follows: nitrogen (5.5kg), phosphorous (2.3 kg), potassium (25 kg) and sulphur (1.2 kg). The heat also kills beneficial bacteria and fungi, according to the report.

Alternative uses for stubble

For nearly a decade, Indian agricultural experts and air quality advocates have tried to promote alternative crop management practices including not only the incorporation of rice stubble into the soil through mechanical tilling or composting, but also other creative uses for the thick rigid stalks as inputs to: pulp and paper production; biofuel; soil-enriching biochar, or for production of cement and bricks.

Ashwini Choubey, the national government’s Minister of State for Environment, Forest and Climate Change, told the Parliament in July that Punjab aimed to bring its 20 million tonnes of stubble burning down to zero by 2024 by switching to other crops (reduction of 5.22 million tonnes), in-situ management with composting and mulching in the fields itself (10.70 million) and managing the remainder ex-situ (4.66 million tonnes).

However, a big part of this plan was the farmers’ subsidy to not burn crop waste, with the state governments of Delhi, Punjab and the central government sharing the cost of this subsidy in a 1:1:3 ratio. 

This came to nought with central government declining to share this cost, and later, the AAP itself deciding not to go ahead with this payout.

The subsidy was to be supplemented with a two-pronged system of support for crop waste management alternatives – including use of the Pusa decomposer and mechanical waste shredders. 

Shredding stubble and seeding simultaneously

In terms of mechanical methods, machines with names like the Happy Seeder and the Super Seeder have been marketed as devices that can be attached to conventional mechanized harvesters to shred crop residue while simultaneously seeding the winter wheat crop, eliminating the need for rice stalk burning.

But while the government has widely promoted their use in the last few years, uptake has still been limited.

A substantial increase in diesel fuel prices has proved to be an impediment for farmers’ uptake of the mechanical shredding technologies, as fuel-related costs account for 25% of the total operations costs.  

Farmers also remain wary about the Pusa decomposer – partly due to lack of awareness and partly because the benefits of the compost produced from the rice stalks is not yet perceived as  a benefit that outweighs the cost of the time lost in the process of waiting for the residues to rot – even at an accelerated pace. 

Rice paddies are too water-intensive.

Rice is the wrong crop- above and below ground

The more fundamental crux of the problem is that India is growing the wrong crop, experts say. Rice is water-intensive and  Punjab and Haryana, and to some extent UP and Rajasthan are short on water, including groundwater. But even so, in recent decades farmers have gradually switched over from the cultivation of traditional food crops like pearl millet (bajra), finger millet (ragi), sorghum (jowar), barley, rye and maize to rice, due to the government subsidies made available for the latter. The irony is that the legumes are healthy sources of nutrition, including iron, for local communities in a country harbors one quarter of the world’s cases of anaemia – while much of the rice is now exported.   

The air pollution impacts of the changing crop plantation patterns are evident in a mapping of smoke emitted from different farm regions during the autumn, a Council for Energy, Environment and Water (CEEW) study observes. It found higher emissions of PM2.5 from crop stubble burning in the rice paddy-intensive districts of Punjab’s Ludhiana and Sangrur, as compared to other parts of the state, such as Hoshiarpur and Pathankot, where more traditional plants and legumes remain popular.

Meanwhile, below ground, the rice cultivation had negative impacts on the stability of underground water aquifers, also vital for drinking water.  To remedy that, a Punjab Preservation of Subsoil Water Act in 2009 ordered farmers to delay the start of the rice-planting season from April until June – ensuring that the first summer monsoon rains could adequately recharge groundwater reservoirs before rice cultivation began. This, however, delayed the rice harvest, and that had knock-on effects –  shrinking the window of time farmers had to clear their fields between the rice harvest and wheat planting season.

From that point in time, Delhi’s autumn air pollution emergencies became more and more acute, studies of trends over time show.  

More than two decades later, turning the clock back remains a formidable challenge for the new government of Punjab, critics say now. If the AAP is truly to commit itself to controlling pollution, it will have to take a more integrated approach. 

This means expanding the uptake of non-burn alternatives to crop stubble use, as well as striking at the roots of the problem – literally – by encouraging farmers to shift to more diverse crops, including early-maturing rice varieties such as those now being developed by the Punjab Agricultural University. That would allow farmers to plant and harvest their summer crops earlier, before monsoon rains stop and wind direction and speeds pick up.

But that also means changing the regime of price supports so that farmers can still make a profit if they switch from water-guzzling rice paddies to high-nutrient millet and maize.

Unfortunately, until those systemic issues are addressed, toxic air pollution is likely to darken Delhi’s skies once more this autumn and winter – at least for another year.

Image Credits: @pawanpgupta, Flickr, Zubair Hussain/ Unsplash, urbanemissions.info, Jagamohan Senapati/ Unsplash.

Pollution

Infants’ brains are negatively affected by air pollution, according to a study which has documented the effects of children’s exposure to air pollution from conception to the age of eight-and-a-half years for the first time.   

Tracking 3,515 children aged 9-12, the study found an association between exposure to air pollutants in the womb and their early years of life to alterations in white matter structural connectivity in the brain.

“One of the important conclusions of this study is that the infant’s brain is particularly susceptible to the effects of air pollution not only during pregnancy, as has been shown in earlier studies, but also during childhood,” said Anne-Marie Binter, Barcelona Institute for Global Health (ISGlobal) researcher and first author of the study, which was published in the journal Environmental Pollution.

White matter is what ensures interconnectivity between different areas of the brain, making up the tissue through which messages are passed from region to region within the central nervous system.

Due to its role as a “neurological bridge”, abnormal development of white matter can play an outsized role in learning and brain functions, and has been linked with psychiatric disorders including anxiety, depressive symptoms and autism spectrum disorders. 

The study also found a link between specific exposure to fine particulate matter (PM2.5) and the volume of the putamen, a brain structure involved in motor function. Beyond its effects on children’s developmental health, PM2.5 is estimated to be responsible for about 4.2 million deaths annually according to researchers at McGill University.

“A larger putamen has been associated with certain psychiatric disorders like schizophrenia, autism spectrum disorders, and obsessive-compulsive spectrum disorders,” said Binter.

While previous studies have been directed at the question of the effects of air-pollutants on childhood brain development, none have been as granular in their methodology.cr

“The novel aspect of the present study is that it identified periods of susceptibility to air pollution,” Binter explained. “We measured exposure using a finer time scale by analysing the data on a month-by-month basis, unlike previous studies in which data was analysed for trimesters of pregnancy or childhood years.”

The study is the latest addition to an ever-growing mountain of evidence documenting the negative effects of air pollutants on human health.

According to the World Health Organization (WHO), 99% of all people breathe air that exceeds WHO air quality limits, and threatens their health. Earlier this year, The Lancet estimated the overall death toll of “modern” air pollution sources to be nine million, making air pollution the world’s largest environmental risk factor for disease and premature death.

 “We should follow up and continue to measure the same parameters in this cohort to investigate the possible long-term effects on the brain of exposure to air pollution,” concludes Mònica Guxens, ISGlobal researcher and last author of the study.

 

Image Credits: Vicente Zambrano González, Barcelona City Council.

A teen mother in Karongi district in Rwanda.

Seventeen-year-old South African Amanda Nkosi* is already a mother and living with HIV – thanks to what she describes as “doing things that teenagers do” without access to accurate health information or contraception.

She discovered her HIV status recently when a youth-friendly clinic opened near her home in the coastal city of Durban and offered her a test when she went to get contraception. She liked the clinic as it provided her services without making her feel judged, and now helps to educate other teens about HIV and their bodies.

South Africa has one of the highest rates of HIV in the world, and young women bear the brunt of this statistic. Meanwhile, the country’s battle against teen pregnancy was severely undermined by COVID-19 lockdowns and school closures  – with spikes in teen pregnancies experienced throughout the continent during the pandemic lockdowns in 2020 and 2021.

South Africa’s most populous province, Gauteng, reported a 60% jump in teen pregnancies between April 2020 and March 2021. More than 23,226 teenagers aged between the ages of 10 and 18 girls gave birth during this period compared to 14,577 girls in the same period a year earlier.

Nkosi told her story at a webinar convened by Clinton Health Access Initiative (CHAI) and Health Systems Trust to discuss how to address teen pregnancy in South Africa.

Describing most teenage pregnancies as “abuse”, CHAI country director Dr Yogan Pillay said that young people in southern Africa had a much higher chance of getting HIV and other sexually transmitted infections as well as mental health problems if they started having sex at an early age.

“Children are also more likely to bear babies born premature, with a lower birth weight and higher neonatal mortality,” added Pillay, former deputy director general of the country’s health department. 

“Teenage mothers experience greater rates of postpartum depression and are less likely to initiate breastfeeding. Teenage mothers are less likely to complete high school, more likely to live in poverty and have children who frequently experience health and developmental problems,” he added.

Pillay said that a systematic review of the predictors of teen pregnancies in sub-Saharan Africa found that the most common causes were sexual coercion, low or incorrect use of contraceptives, lack of parental communication and support , low socio-economic status and school dropout. 

Addressing these would assist to reduce prevent teen pregnancies, and support teen parents to avoid additional unwanted pregnancies.

Surge in lockdown pregnancies

Many African countries experienced a surge in teen pregnancies during COVID-19 lockdowns and school closures, and concerned health policymakers are struggling to implement effective strategies to curb teen pregnancies.

According to Uganda’s 2016 Demographic and Health Survey, a quarter of girls aged 15-19 years had already experienced a pregnancy. However, teen pregnancies rose by 28% during the first COVID-19 lockdown in 2020, according to the Makerere University School of Public Health. In Uganda’s eastern Busoga sub-region,  45% of deliveries were girls under the age of 17, according to the health ministry.

The Ugandan government’s approach to combatting teen pregnancy has been to promote abstinence-based education in schools. Comprehensive sexuality education has been banned in schools and abortion is illegal.

However, in light of the huge burden of teen pregnancies, some Ugandan parents are demanding more effective sex education in schools and adolescent access to contraception.

Ethiopia, Ghana, Kenya and Zambia have also reported jumps in teen pregnancy thanks to lockdowns. For example, a recent Kenyan study found that girls in Siaya County under the age of 17 who were under lockdown containment measures had double the risk of falling pregnancy and triple the risk of dropping out of school as those who were not under lockdown.

Tackling the problem

UNFPA is spearheading a four-year programme in 10 countries in east and southern Africa called 2gether 4SRHR, with the involvement of  UNAIDS UNICEF and the World Health Organization (WHO). Supported by the Swedish International Development Cooperation Agency (SIDA), it aims to improve sexual and reproductive health (SRH) services in the region. 

“This includes scaling up client-centred, quality-assured, integrated and sustainable services in SRH, HIV and sexual and gender-based violence, and empowering young people to exercise their SRH rights,” according to UNFPA.

“In many countries in the region, adolescent and young mothers have higher rates of unplanned pregnancies, lower uptake of antenatal and postnatal care, and those living with HIV have poorer adherence to treatment regimens and lower viral load suppression,” according to the UN agency.

“Each week, nearly 3,500 adolescent girls and young women in eastern and southern Africa newly acquire HIV.”

Teen mothers also tend to drop out of school and often never return.

Peer educator Rebecca holding an HIV-prevention discussion with young mothers.

No more pilots

Unlike most other African countries, young South Africans are both able to terminate unwanted pregnancies before 20 weeks and get access to contraception – and neither require their parent’s consent.

However, many teens shun clinics because of the judgemental treatment of healthworkers. For this reason, youth-friendly clinics have long been hailed as one of the solutions to teen pregnancies.

However, Dr Thato Chidarikire, acting chief director of child, youth and school health at the South African health ministry, said lack of resources was a problem.

“Not all primary health care facilities are providing youth-friendly services and have functional, dedicated clinic times for young people. There’s a high turnover of trained personnel and no dedicated resources to support the youth health-focused programmes,” she conceded.

‘Considerable evidence’ of what works

The WHO’s Dr Venkatraman Chandra-Mouli said that there is considerable evidence of successful approaches to reducing adolescent pregnancy.

“What we need are large-scale and sustained programmes. And happily, we now have experiences from a growing number of countries of such programmes,” he said. 

“All these programmes had five elements,” according to Chandra-Mouli from the sexual and reproductive health and research unit.

“Firstly, they put scale-up on the national agenda. Secondly, they offered a multi-component intervention package, not just sexual and reproductive services or sexuality education. Thirdly, they put money on the table from internal sources and external sources and managed the scale-up. Fourthly, they built support for the programme and anticipated and addressed resistance when it occurred. And lastly, they worked strategically to ensure sustainability.”

*not her real name.

Image Credits: UNFPA Rwanda, UNFPA.

Women HCWs experience sexual harassment at workplace.
Two women healthcare workers caring for an infant.

A significant number of women health care workers are being driven from the professional because of sexual harassment, and Women in Global Health (WGH) collecting their testimonies.

There are no laws against sexual harassment at workplace in over 50 countries, and WGH has called for a ‘change at all levels’ of the ecosystem. 

The organisation recently announced their research project, “HealthToo”, to document testimonies of sexual exploitation, abuse and harassment (SEAH) experienced by women health care workers across the globe. 

WGH will be accepting testimonies from women healthcare workers till 30 November, and intends to publish the data and findings by December. 

The intention of the project is to address the gap in the data of SEAH across the world and draw attention to the issue that has caused several women to leave the workforce. Women constitute around 70% of the global health care workforce and that the workforce is already short-staffed. 

Dr Ann Keeling, a senior fellow at WGH, said that the lack of comparable data and consistency in the terminology used prompted this project to take shape. 

“When you try and chart this, you can’t get any consistent picture and what isn’t visible in data is easy to ignore. So there is this very widespread denial about the extent of this among policymakers,” she told Health Policy Watch. 

“This is the time now to use women’s testimonies as data and get a platform out there where we can lock these stories, so that this will no longer be invisible.”

The testimonies collected from women healthcare workers will be made public on the WGH website. 

“We are aiming to have a geographic representation of testimonies on the website,” said Dr Kalkidan Lakew, a policy associate at WGH. “We do not want to concentrate on a specific country but want to show that this happens everywhere – high income country, low income country, hospitals, organisations and NGOs,” she said. 

Pointing to the International Labour Organization (ILO)’s convention on violence and harassment, referred to as C190, the researchers said that the end goal is to get as many countries as possible to sign up to the convention. 

The convention, which has been ratified by 20 countries and is in force in eight, defines violence and harassment at the workplace and encourages countries to set up their own legislative framework to address SEAH at the workplace. 

“ILO’s C190 defines what harassment and violence is and recognises it as a human rights abuse. So, for the first time we actually have a framework that every country can sign up to,” Keeling explained, adding that a “change is needed at all levels of the ecosystem.”

Image Credits: Photo by Mufid Majnun on Unsplash.

Ebola
Surveillance for Ebola virus disease at the border between DR Congo and Uganda in 2019 Photo: WHO/Matt Taylor

In a matter of weeks, a clinical trial for an Ebola vaccine candidate that could protect against the Sudan strain of the Ebola virus could get underway in central Uganda where the number of confirmed cases in the country’s ongoing outbreak has risen to seven.

Uganda has confirmed seven cases and one death from its Ebola outbreak and is investigating seven other deaths suspected to be Ebola cases, according to ​​Dr Kyobe Henry Bbosa of Uganda’s Ministry of Health.

Bbosa told a World Health Organization (WHO) special press briefing on the Ebola outbreak on Thursday that it began earlier this month when sporadic deaths began to be recorded in small villages now considered to be at the epicenter.

On Sept. 19, he said, a 25-year-old man entered a regional hospital with symptoms after being treated earlier in several other places. “We were able to identify the Ebola Sudan virus at the Uganda Virus Research Institute,” Bbosa said.

Six more cases have since been confirmed, mainly from five sub-counties within central Uganda’s Mubende district. On Thursday however, Bbosa revealed that one case may have come from a neighboring district.

He noted the epicenter of the outbreak is close to a major highway that leads into the country’s capital city of Kampala from the Democratic Republic of Congo, and that it has busy trading places and a nearby goldmine.

Contact tracing has begun, he said, with a total of 43 contacts reached so far. Authorities have turned a former COVID-19 clinic into an Ebola treatment center and are working to boost public awareness about the risks.

This is not the first time that Uganda has dealt with an Ebola outbreak from the Sudan strain of the virus. An outbreak in 2000 led to more than 200 deaths and a subsequent one in 2012 occurred in central Uganda.

Because of those, Bbosa said, Uganda’s health authorities have developed “significant expertise to be able to respond to this current outbreak.”

WHO’s Director-General Tedros Adhanom Ghebreyesus said the world health body’s “experts are on the ground, working with Uganda’s experienced Ebola control teams to reinforce diagnosis, treatment and preventive measures.”

Along with the seven confirmed cases and one confirmed death, another seven deaths are being investigated as “probable Ebola,” he told a press briefing on Thursday, while 16 people with suspected Ebola disease are receiving care, and contact tracing is ongoing.

“We are also delivering medical supplies to support the care of patients,” he added.

Ebola
Dr Ana Maria Henao-Restrepo, head of WHO’s Research and Development Unit

The race to test new Ebola vaccines

There is no approved vaccine for the Ebola virus disease outbreak that is caused by the Sudan strain of the virus, Health Policy Watch has reported.

Dr Ana Maria Henao-Restrepo, WHO’s technical lead for the R&D blueprint for emergency response, confirmed the UN health agency has already begun talking to drug makers about vaccine candidates that could undergo clinical trials on an emergency basis.

“We have been able to initiate research very quickly during previous outbreaks in Uganda, Sierra Leone, Liberia, Guinea, Sudan and other countries,” she said. “What we are doing now is we are bringing all the stakeholders and we are sharing all the information about candidate vaccines very quickly. We will soon identify which of the candidates has sufficient data to move into a phase II/III study.”

Some of WHO’s most immediate goals are to ensure there are sufficient doses for a clinical trial to start and to approve the protocols to be used. Henao-Restrepo said there is already a core protocol — a design that includes all the critical elements needed to conduct a robust evaluation of candidate vaccines.

This protocol, she said, was developed based on experience with vaccines for Ebola and Marburg viruses, and can be updated to adapt to the situation in Uganda.

The supplies for vaccine candidates are ready to be deployed for trials, she said, and will not be delayed by a time-consuming procurement process.

“So we have three critical elements ready, moving fast,” said Henao-Restrepo.

“If we do have more cases, we could trigger a trial within a few weeks. That’s the experience from DRC, to Guinea, Sierra Leone and Liberia, and other countries,” she said. “In doing this fast, we are ensuring that we comply with the international standards, Uganda regulatory standards and the researchers’ capabilities and qualities. We are not cutting corners.”

Image Credits: WHO/Matt Taylor.