Patient
Patients are at risk from errors in the prescription, administration, and surveillance of medicines.

“We all know that medicines save lives, but they can also harm in cases where they are inappropriately prescribed, taken the wrong way, without proper monitoring, or are not of an adequate quality,” said World Health Organization (WHO) Deputy Director-General Dr Zsuzsanna Jakab as she opened the floor on World Patient Safety Day 2022. 

The WHO chose the theme for this year’s day, which falls on Saturday, as “Medication Without Harm”, in light of the heavy burden of preventable errors in the prescription, administration, and surveillance of medicines.

“Nobody should be harmed while seeking care,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.

Yet every year, nearly three million preventable deaths occur around the world because of medication errors, and WHO estimates the cost to healthcare systems to be up to $42 billion annually.  

“Evidence suggests that medication-related harm accounts for 50% of overall avoidable harm in medical care,” said Dr Neelam Dhingra, unit head of the Patient Safety Flagship at WHO responsible for coordinating the event.

The abundant availability of information related to medication incident reports means researchers have a deeper understanding of the reasons that medications and their use can cause harm than in many other areas of patient safety. 

This, Dhingra says, is a very good reason to believe that much more can be done: “There is a huge opportunity here for us to work on medical errors because all medication errors are avoidable.”

Progress has faltered

Since the time the Patient Safety Alliance was launched in 2004, progress in reducing medical errors has faltered.

“Of all the categories of avoidable harm and death that occur in health care, medication-related harm is the biggest single category,” said Sir Liam Donaldson, former UK Chief Medical Officer and current WHO Patient Safety Envoy.

“But over the last few decades, the trajectory of progress has been slow and faltering. There is a need to drive progress further and faster,” said Donaldson. “We have built very strong foundations, but what we now need is a major push forward on medication safety,” 

“There are five preventable deaths every single minute of every single day”, said Jeremy Hunt, former British health secretary and co-chair of the World Patient Safety Day steering committee alongside Jakab. “If we removed medication error and dealt with the patient safety issues before us today, we would be tackling one of the top 10 killers in the world.”

Hunt emphasized that the technology and medical expertise to change patients’ lives are already out there.

“This is one of the great causes of our time in medicine”, he said. “And the great thing is that lives can be saved today, just by the spreading of good practise. This is not about inventing a new cure for cancer or scientific advances – wonderful as they are – these are things that we can improve today.”

Africa carries heaviest burden

Patients in low- and middle-income countries are twice more likely to experience preventable medication harm than in high-income countries, according to the WHO. 

COVID-19, and the strain it has placed on health care systems, has made things worse.

“More than two years of the COVID-19 pandemic have caused a high-risk emergency which has exacerbated many of the circumstances that drive medication errors,” said WHO Africa Regional Director Dr Matshidiso Moeti.

 Africa also faces a uniquely acute challenge in the area of substandard and falsified medicines.

 WHO estimates that between 72,000 and 169,000 children under five-years-old die as a result of inadequate pneumonia antibiotics every year, while bad antimalarials are estimated to lead to anywhere from 31,000 to 116,000 deaths in Sub-Saharan Africa annually.

WHO
Low- and middle-income countries suffer the highest negative impacts from substandard and falsified medicines. / Credit: WHO

“While the extent of unsafe medical practices in the African region is unknown, the region accounts for the highest prevalence of substandard and falsified medicines in the world, with about 1 in 5 of all medicines being either substandard or falsified,” said Moeti. “Inefficient regulatory systems present among the biggest barriers to access to safe, effective, high-quality medical products.”

But the region has made heartening progress on this front in recent years. Ghana, Nigeria, and Tanzania have already achieved the level of efficiency in their national regulatory agencies strived for under WHO guidelines, and, Moeti says, many others are following close behind.

Opioids responsible for 70% of global drug deaths

The global opioid overdose crisis is perhaps the starkest example of what impact bad medical practise can have on the lives of patients around the world. 

“The opioid crisis will not be news to any of you, I am sure”, said Ewan Maule, Director of Medicines and Pharmacy for the Integrated Care Board of the UK’s North-East and North Cumbria region. “But perhaps the scale will be.” 

Worldwide, there are about half a million deaths every year attributable to drug use, both prescribed and illicit, and more than 70% of that is caused by opioids.

“Opioid addiction touches every family unit, every demographic, and every single one of us in some way,” Maule said. “This is something that will be an issue regardless of where you are in the world.”

In North Cumbria, thanks to a campaign directed by Maule and his agency, the last few years have seen a 30% drop in overall opioid use, and a 50% reduction in high-dose opioid use.

The foundational pillar to this success, he says, has been patient education. 

“One of the things we heard from our clinicians was that one of the biggest barriers to reducing the risk of high, long-term opioid use was the percentage of patients that did not have an understanding of the relative benefits of opioid use for pain management”, Maule said.

While clinical best practice no longer supports the use of opioids for chronic pain, the UK Royal College of Anesthetists found “little evidence that they are helpful for long term pain” and can present “substantial risk of harm”, patient education has not yet caught up. 

The normalisation of this use of opioids over the previous decades, Maule explained, has meant many patients are not in a position to make informed decisions about their care. 

“They vastly underestimate the size of the risk they are exposing themselves to.”

Addressing opioid overdose is “a difficult thing to do”, Maule said. “But not only can we do it, but we should also do it. And I believe that for the patients, we must do it.”

Nurse Victor Kaphaso advises 14-year-old Wiliyamu Kerefasi about his insulin at Lisungwi Community Hospital in Neno District, Malawi

Children with type 1 diabetes living in rural parts of the world’s poorest countries often struggle to get life-saving insulin as programmes addressing non-communicable diseases (NCDs) tend to be urban-based and adult-focused.

But an initiative to address life-threatening NCDs affecting children and young adults – particularly type 1 diabetes, rheumatic and congenital heart disease, and sickle cell disease – is being extended to rural parts of a number of African and Southeast Asian countries.

Called PEN-Plus, the initiative is based on the World Health Organization’s (WHO) Package of Essential NCD Interventions (WHO PEN), which encourages the decentralisation of NCD services to the primary care level. The “plus” indicates the inclusion of these more severe NCDs that mostly affect young people.

“When we think of non-communicable diseases, we think of a problem that’s becoming epidemic that is associated with ageing, lifestyle diseases and urbanisation,” Dr Gene Bukhman, co-chair of the NCDI Poverty Network, told a meeting on Thursday to announce the extension of PEN-Plus to a further 10 countries.

“But what’s lost in that narrative is the particular features of the burden of non-communicable diseases among the very poorest people in the world who live in largely in rural sub-Saharan Africa and South Asia,” he added.

“There was a particular gap in treatment for a diverse set of diseases that were killing and incapacitating those under age 40,” said Bukhman, whose network is dedicated to addressing the gaps in universal health coverage for the world’s poorest one billion people.

Pioneered in Rwanda

PEN-Plus was first pioneered by the Rwandan Health Ministry together with the international NGO, Partners in Health, and has since been extended to 22 countries.

Ten of these countries were announced this week at a meeting hosted by NCDI Poverty Network, Helmsley Charitable Trust, UNICEF, and WHO AFRO.

At last month’s WHO Regional Committee for Africa, the 47 member states also adopted PEN-Plus, committing to achieve high levels of coverage by 2030. 

“The strategy supports building the capacity of district hospitals and other first-level referral facilities to diagnose and manage severe noncommunicable diseases early, resulting in fewer deaths,” according to WHO Africa.

In Rwanda, primary health nurses were trained to manage insulin, heart medications and echocardiography, services that previously had only been available in referral centres in the capital city.

“This integrated approach allowed Rwanda to quickly decentralise the services down to intermediate care facilities, such as district hospitals, and to better support primary care,” said Bukhman.

As a result, he added, the number of people receiving care for example, for type 1 diabetes increased by a factor of 10 between 2000 and 2015, reaching 202,000 patients by 2015. 

Haiti, Sierra Leone, Liberia, Cameroon, Nigeria, Burkina Faso, Benin, Ghana, the Democratic Republic of Congo, Rwanda, Uganda, Kenya, Tanzania, Ethiopia, Malawi, Zambia, Zimbabwe, Mozambique, Nepal, Chattisgarh state in India, Cambodia and, most recently, Bangladesh are all rolling out PEN-Plus programmes.

Struggle for insulin

Malawian clinician Dr Bright Mailosi (centre)

Dr Emily Wroe, who has assisted Malawi to roll out PEN-Plus, said that treatment gaps manifested as patients showing up in hospitals with conditions that should have been managed at outpatients level: “A 16-year-old coming in with diabetic ketoacidosis (DKA), very sick. A small child with pneumonia non-attrition that we would find has sickle cell disease. A 28-year-old pregnant woman with heart failure because of severe mitral stenosis who had somehow had walked seven hours to see us.”

“The gap was the fact they were in the hospital in first place, but also what was the discharge plan?” asked Wroe. “These were patients needed more than the primary care system. They needed labs, follow-up ultrasounds. They often needed food packages or school fees, and they needed to be back in school.”

Malawian clinician Dr Bright Mailosi, who works full-time on implementing PEN-Plus in his country, mostly by training healthcare workers from rural facilities, says that his typical day can be summed up by one patient:

“This 13-year-old girl has been two days in this ward. She’s a known type 1 diabetic. I realise she is in DKA because she had stayed for nearly a week without her insulin because her family cannot afford to get the insulin. Her guardian doesn’t have an idea of what to do. Even to get insulin from within the hospital takes like forever.

“So my typical day, is trying to answer this question: How do we support this 13-year-old girl not to stay like for a week without insulin?”

Resource shortages

Mozambican physician Dr Ana Mocumbi, the other co-chair of the NCDI Poverty Network, says that the 10 new countries are each establishing two PEN-Plus training sites inand plan to enrol 500 to 1000 patients per siteto start with.

“PEN-Plus providers, typically mid-level nurses and clinical officers, can be effectively trained within three to six months, with most of the focus being on mentored clinical practice, while master trainers need about a year.”

The mentorship and supervision often involve specialists such as endocrinologists, cardiologists, diabetologists and haematologists “because PEN plus providers are dealing with risky conditions, and risky medications where the difference between too much and too little can mean a difference between life and death”, adds Mocumbi.

“So we are also focused on efforts increasing the production of these types of specialists and supporting them to strengthen care at district hospitals in poor rural areas and not just in urban practises.”

By 2025, the NCDI Poverty network could be ready to grow from 22 to 30 countries – with a total price tag of around $30 million annually. 

“This may not seem a lot of money,” said Mocumbi. “But we have found that even with very optimistic projections regarding economic growth, taxation in domestic investments in healthcare, low-income countries will simply be unable to finance their most basic services without external support for the next decade.”

Image Credits: KSchermbrucker/PiH.

WHO Europe panel on health worker shortage 2022

TEL AVIV – Ageing doctors and overworked staff are just two of the consequences of the severe shortage of health care workers, even in the comparatively wealthy Europe region of the World Health Organization (WHO).

“In one out of three countries in the region, more than 40% of the doctors are older than 55 years of age,” Tomas Zapata, Unit Head at the WHO Europe Health Workforce and Service Delivery, told the WHO Europe regional committee meeting, which took place in Tel Aviv, Israel this week.

“This means that in those countries more than 40% of the doctors will retire in the next 10 years. This is a crisis. This is a ticking time bomb. If we don’t take action now, we’ll have huge shortages in 10 years in addition to those that we have now,” added Zapata, the author of a report on the issue that was launched at the meeting. 

COVID-19 toll on health workers

Some 50,000 healthcare workers in Europe have died as a result of COVID-19, and health worker absences in the European Region increased by 62% during the first wave of the pandemic in 2020, according to WHO.

The pandemic also took a severe toll on the mental health of the workers. In some countries, over 80% of nurses reported some form of psychological distress caused by the pandemic and as many as 9 out of 10 nurses planned to quit their jobs. 

“I often work shifts without even the possibility to go to the toilet, without breaks or time to eat,” German midwife Annika Schröder told a panel devoted to the health workforce in the European Region. “The doorbell and the phones ring while we rush from one room to the other. On average, I take care of two women in labour at a time. 

“This is not how I imagined my profession or my everyday working life to be. I am often exhausted and tired. The shortage of midwives makes births unsafe. And since the pandemic things have got even worse.”

Huge disparities between member states

The European region can in general boast a high number of healthcare workers. Data shows that the region enjoys 80 nurses, 37 doctors, 8 physiotherapists, 6.9 pharmacists, 6.7 dentists and 4.1 midwives per 10,000 people.

However, huge gaps between countries remain. The doctor-, nurse- and midwife-to-population density ranges from 54.3 per 10,000 people in Turkey to over 200 per 10,000 people in Iceland, Norway, Monaco, and Switzerland.

As highlighted by Zapata, the report also offers several action points, including aligning education with health service needs, improving health information systems and digitalization of services and raising awareness about the needs of health systems in governments. 

“We also need to improve working conditions of the health workforce and this also links to the next point, which is protecting their health and well-being,” he said. “A big lesson we learned from the COVID pandemic is how we can really make efforts to improve health and well-being of our health workers.”

Regional and national needs

 People from a range of countries shared experiences about tackling the challenges related to healthcare staff. 

In Georgia for instance, over 85% of healthcare providers are currently privately employed, said Tamar Gabunia, a Deputy Minister. 

“Many factors have led us where we stand right now, including commercial interests and market factors dictated by human resource-related developments,” she remarked.  

“Now it’s time to change the situation. Our government is really very keen to achieve universal health coverage and we all know that health systems cannot function without human resources,” she said, emphasizing that they have been working hard to solve the issues related to recruiting and retaining health personnel.

In Romania, there are 700 towns and villages without doctors, said Prof Alexandru Rafila, Bucharest’s Health Minister. 

“When we discuss inequalities we are not talking just about inequalities between countries but also inside the countries,” he said. “I think the involvement of the local authorities is crucial in order to respond to some of these issues.” 

He said that Romania is getting ready to launch a new strategic approach: “The WHO/Europe will give us the technical assistance needed for the development of human resources in the health sector and we are glad to be part of this process and to host a special meeting on the topic in March 2023.”

More support from WHO

When COVID-19 hit Israel in the early spring of 2020 its health system, as in the rest of the world, was severely strained.

“We had several new challenges,” Dr Shoshy Goldberg, head of Nursing Administration at the Israeli Ministry of Health, recalled. “We didn’t know anything about the disease at the beginning, and we had been in shortage of manpower in all the occupations in the system for more than 10 years.”

Goldberg explained that the Israeli Health Ministry was able to hire new staff and train thousands of people in a short period of time. 

According, Dr Natasha Azzopardi-Muscat, WHO Europe’s Director of Country Health Policies and Systems, the report highlights the huge diversity between the different countries in the region and the need to work with every nation to find solutions that fit their contexts.

“This is not a “one size fits all” approach,” she said. “But with the support of the Regional Director, we shall also be increasing our capacity to support countries in this area.”  

Dr Tedros Adhanom Ghebreyesus

Global COVID-19 cases have dropped to their lowest level since the start of the pandemic in March 2020, World Health Organization (WHO) Dr Tedros Adhanom Ghebreyesus told a media briefing on Wednesday.

In the past week alone (5-11 September), the number of new weekly cases decreased by 28% while new weekly deaths decreased by 22%, with just under 11 000 fatalities reported. 

“We have never been in a better position to end the pandemic. We’re not there yet, but the end is in sight,” said Tedros.

“A marathon runner does not stop when the finish line comes into view. She runs harder with all the energy she has left. So must we, as we can see the finish line.”

Tedros urged countries to vaccinate 100% of their most at-risk groups, including health workers and older people, and keep testing and sequencing the SARS-CoV2 virus to identify any possible variants.

He also said that the WHO advised member states to integrate COVID-19 surveillance and testing services with those for other respiratory diseases including influenza, and integrate care for COVID-19 into primary health care systems. 

“We are in a winning position, but now is the worst time to stop running,” said Tedros. “Now is the time to run harder and make sure we cross the line and reap the rewards of all our hard work. If we don’t take this opportunity now, we run the risk of more variants, more disruption and uncertainty.

“We can end this pandemic together, but only if all countries, manufacturers, communities and individuals step up and seize this opportunity,” he said, adding that he was “incredibly proud” of WHO’s people and what they had done during the pandemic.

Lower testing levels

However, Dr Maria van Kerkhove, WHO’s technical lead on COVID-19 warned that, because of lower testing levels, cases were likely to be a lot higher than reported.

“We expect there to be future waves of infection, potentially at different time points throughout the world, caused by different sub-variants of Omicron or even different variants of concern,” she warned.

“The more this virus circulates, the more opportunities it has to change. But those future waves of infection do not need to translate into future waves of death because we have tools that can prevent infections, and critically the use of vaccines and vaccination and early use of antivirals can prevent people from developing severe disease and dying.”

The WHO published six policy briefs on Wednesday to assist countries to end COVID-19 on Wednesday, describing them as providing the basis for “an agile response as countries continue to confront the pandemic while consolidating the foundation for a stronger public health infrastructure and strengthening the global architecture for health emergency preparedness, response and resilience”.

“These policy briefs are an urgent call for governments to take a hard look at their policies, and strengthen them for COVID-19 and future pathogens with pandemic potential,” urged Tedros.

The 6 policy briefs issued by WHO cover:
* COVID-19 testing
* Clinical management of COVID-19  
* Reaching COVID-19 vaccination targets 
* Maintaining infection prevention and control measures for COVID-19 in health care facilities
* Building trust through risk communication and community engagement 
* Managing the COVID-19 infodemic.

Preparing for post-flood health emergencies in Pakistan 

Meanwhile, the WHO is assisting Pakistan to recover from its recent floods, which affected 33 million people and damaged almost 1500 health facilities.

The global body is supporting Pakistan’s Ministry of Health to prepare for, and respond to, outbreaks of measles, cholera, malaria, respiratory, skin and eye infections, typhoid and malnutrition expected in the wake of the floods.

 

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

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

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

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

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

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

No patient information

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

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

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

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

 

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

 Lack of access to antibiotics

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

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

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

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

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

A role for African Medicines Agency?

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

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

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

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

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

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

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

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

Image Credits: WHO, The Lancet.

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

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

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

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

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

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

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

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

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

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

Missed Funding Targets, Broken Emission Promises

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

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

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

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

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

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

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

This comes despite recent IEA findings that estimated the exploitation of all proven natural gas reserves in Africa would amount to an increase of just 0.5% in Africa’s global emissions burden, to 3.5% up from 3.0%.  

fossil fuel emissions

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

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

“For Africa, the problem of energy poverty is as important as our climate ambitions,” Nigerian Vice-President Yemi Osinbajo said in a video address announcing his country’s aim to raise an initial US$10 billion in funding to implement its energy transition plan ahead of the next round of UN climate talks, known as COP27, slated for November in Egypt.

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

From COP26 to COP27: “Code red for humanity”

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

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

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

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

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

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

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

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

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

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

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

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

WHO Europe panel on long COVID

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

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

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

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

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

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

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

Limited knowledge 

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

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

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

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

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

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

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

Lack of research-based interventions 

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

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

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

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

New WHO initiative

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Pharma support for the Global Fund

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

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

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

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

Germany pledges 30% more for the Global Fund

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

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

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

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

 

Image Credits: Jordi Ruiz Cirera/IAS.

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

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

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

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

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

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

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

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

Setbacks for refugees, food security and climate 

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

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

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

Kluge said the war is exacerbating already severe global challenges.

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

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

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

Looking toward winter

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

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

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

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

The new normal

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

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

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

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

Monkeypox emergency 

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

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

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

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

Both WHO officials warned about the new polio outbreak.

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

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

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

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

New WHO center on digital health to be established in Israel 

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

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

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

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

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

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

Image Credits: WHO, UNICEF.

tb
Field visit at a TB clinic Karachi, Pakistan

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

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

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

HIV program disruption ‘less than initially feared’ 

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

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

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

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

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

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

Pandemic impacts tuberculosis 

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

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

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

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

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

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

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

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

Climate change and pandemic challenged malaria programs 

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

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

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

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

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

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

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

Swift Global Fund response helped blunt pandemic impacts

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

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

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

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

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

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

Image Credits: Uzma Khan, Global Fund.