Open Access 240 Compound Collection Launched in Fight Against Infectious and Mosquito-Borne Illnesses for World Mosquito Day 22/08/2022 Raisa Santos Aedes aegypti mosquito can spread Zika fever, dengue, and other diseases. To mark World Mosquito Day, 20 August, the Global Health Priority Box has been launched to provide free access to 240 compounds to stimulate research into new drugs and insecticides. The initiative, launched by the Medicines for Malaria Venture (MMV) and the Innovative Vector Control Consortium (IVCC), provides scientists with starting points to advance the development of tools that can tackle several priorities set out by the WHO in late 2021, including drug resistance and communicable diseases. Every year vector-borne diseases such as malaria cause the loss of more than 700,000 lives annually, predominantly in regions with tropical climates in low- and middle-income countries. Major vector-borne diseases account for 17% of the global burden of communicable diseases. Recent studies have shown that climate change has the potential to shift the regions in which disease-carrying mosquitoes breed, introducing new pathogens to previously unaffected areas. For example, the spread of malaria, caused by a parasite that spreads to humans and other animals through the bites of infected female mosquitoes, increases in temperatures of around 25ºC. Coupled with the increasing prevalence of drug-resistant superbugs and insecticide resistance, it is clear that new tools are needed to fight against vector-borne diseases. “Efforts to end infectious diseases will only succeed if we have the tools to treat and prevent them,” said Dr Timothy Wells, MMV’s Chief Scientific Officer. Collection of compounds for malaria, neglected and zoonotic diseases, and more The collection features 240 compounds that can be used against drug-resistant malaria, neglected and zoonotic diseases, and other diseases at risk of drug resistance. This includes: 80 compounds with confirmed activity against drug-resistant malaria. 80 compounds for screening against neglected and zoonotic diseases, and diseases at risk of drug resistance. 80 compounds that have been tested for activity against various vector species. Priority Box’s ‘open approach’ emphasizes international collaboration The Global Health Priority Box’s builds on the reaction of the scientific community to the COVID-19 pandemic, which demonstrated that international collaboration accelerates the development of new tools, diagnostics and vaccines. Its open approach invites scientists to make screening results publicly available and to publish findings in an open access journal within two years following data generation. Such an approach allows for researchers around the world to build on one another’s work, saving time and resources. “Open innovation is one of the keys to unlocking drug discovery because it allows us to tap into existing knowledge and expertise and build on it collaboratively,” said Wells. Dr Nick Hamon, CEO of IVCC, noted the need for innovation in vector control due to the increased prevalence of insecticide resistance, “which is undermining the efficacy of bed nets and indoor residual sprays, the cornerstone of malaria prevention since the turn of the century.” “Open access to new chemistry will encourage greater collaboration across the scientific community, bringing new innovators into public health and potentially more rapid development of new vector control solutions,” he said. Image Credits: Sanofi Pasteur/Flickr. WHO Recommends Two Monoclonal Antibodies for Ebola Treatment; Calls to Expand Access in Developing Countries 19/08/2022 John Heilprin A health worker dresses in protective clothing to enter the treatment unit for a suspected Ebola case at western Uganda’s Bwera General Hospital in August 2019 – during the 2018-2020 Ebola outbreak in the neighboring Democratic Republic of Congo. In its first guidelines ever for Ebola treatment, the World Health Organization (WHO) advises using two monoclonal antibodies — mAb114 (Ansuvimab®, also known as Ebanga®) and REGN-EB3 (Inmazeb®) — that were first approved by the US Food and Drug Administration for use against the Zaire ebolavirus species in 2020. WHO says its “strong recommendations” for the two monoclonal antibody treatments that were released on Friday are based on a systematic review and meta-analysis of randomized clinical trials examining potential therapeutics for the deadly disease. The two therapies demonstrated “clear benefits and therefore can be used for all patients confirmed positive for Ebola virus disease, including older people, pregnant and breastfeeding women, children and newborns born to mothers with confirmed Ebola within the first seven days after birth,” WHO says. In its launch of the recommendations, WHO also called on the global community “to increase access to these lifesaving medicines”. As relatively new therapies, monoclonal antibodies have been difficult and expensive to access in low- and middle-income countries, with 80% of their sales occuring in the US, Canada and Europe. In 2020, a consortium of research organizations, led by Wellcome Trust issued a global call to action to expand access. Yes to Ansuvimab and Inmazeb, No to ZMapp and Remdesivir Patients should receive recommended neutralizing monoclonal antibodies as soon as possible after laboratory confirmation of diagnosis, according to WHO. Its new 44-page guidelines for Ebola treatment also makes a “conditional recommendation against” the use of ZMapp and remdesivir for patients with the Ebola virus. ZMapp, a drug cocktail of antibodies developed from the tobacco plant, was the first drug to be used on an experimental basis against the Ebola virus. Initially it showed promise with rhesus monkeys, but was not fully tested on humans. During the 2014-2016 Ebola epidemic in West Africa, however, the US Food and Drug Administration (FDA) approved ZMapp’s experimental use on patients. That epidemic, the continent’s largest ever, killed more than 11,000 people out of the 28,000 people who became ill with the virus. Subsequently, ZMapp, remdesivir as well as mAb114 and REGN-EB3 were all tested against one another in a randomized controlled trial in the Democratic Republic of Congo, running in parallel to the Ebola epidemic that wracked the eastern region of the country between 2018-2020. In August 2019, however, an independent monitoring board recommended early termination of the DRC therapeutics trial due to the favorable results demonstrated by the latter two drug candidates. The board recommended that all patients be randomized to receive either REGN-EB3 or mAb114 in an extension phase. The study’s preliminary results among 499 participants showed people who got REGN-EB3 or mAb114 had a greater chance of survival than those who received ZMapp or remdesivir. Remdesivir was originally developed to treat hepatitis C before it was investigated for treating the Ebola and Marburg viruses, and then as a post-infection treatment for COVID‑19. It eventually won US and European Medicines Agency approval as a COVID-19 treatment. However, in November 2020, WHO recommended against Remdesivir use for COVID, saying there was “no evidence” it improved patient outcomes. Access remains a problem for ebola treatment In its recommendations, WHO called for greater efforts to ensure that that the drugs are “where patients need them the most: where there is an active Ebola outbreak, or where the threat of outbreaks is high or very likely.” To assist with that goal, WHO offered to support “countries, manufacturers and partners” to step up national and global efforts to increase affordability of the biotherapeutic products. “Access to these therapeutics is challenging and pricing and future supply remain unknown, especially in resource-poor areas,” WHO says in its 44-page guidelines. “Without concerted effort, access will remain limited, and it is therefore possible that this strong recommendation could exacerbate health inequity,” it says. “Therefore, given the demonstrated benefits for patients, these recommendations should act as a stimulus to engage all possible mechanisms to improve global access to these treatments.” Both Inmazeb and Ebanga were developed with significant US government support The development of both Inmazeb and Ebanga was heavily supported by the US government and other public funders. Inmazeb, which also was the first FDA-approved treatment for Ebola, is produced by the US-based Regeneron Pharmaceuticals. It was developed in response to the 2018 Ebola outbreak in the DRC with supprot from the US Biomedical Advanced Research and Development Authority (BARDA). Regeneron announced in 2020, the company will “continue to provide Inmazeb for free in response to outbreaks in the DRC through the MEURI protocol for compassionate use,” in colaboration with the WHO, the US FDA and with continuing support from BARDA. “Regeneron is actively working with nongovernmental organizations and public health agencies to ensure continued access to Inmazeb in low- and middle-income countries,” the company declared at that time. The MEURI protocol is a WHO-approved ethical framework for the use of investigational agents. Regeneron gained fame in the first year of the COVID pandemic when former President Donald Trump was treated with another antibody cocktail that it had developed against COVID, (REGEN-COV- a combination of casirivimab and imdevimab) . The cocktail was later recommended by WHO for COVID treatment. As for Ebanga, it was initially developed by the Vaccine Research Center of the US National Institute of Allergy and Infectious Diseases (NIAID), part of the US National Institutes of Health (NIH), and then licensed in 2018 by the US biotech firm, Ridgeback Biotherapeutics for further development and ultimately FDA aprpoval. “Ebanga is currently available to patients, and Ridgeback Biotherapeutics provides and distributes the treatment to patients free of charge in Ebola-stricken countries,” the company states on its website. WHO publishes invitation to drug manufacturers to share drugs for evaluation WHO says it has now published the first invitation to manufacturers of therapeutics against Ebola virus disease to share their drugs for evaluation by the WHO Prequalification Unit, a crucial step to enabling bulk procurement of new drugs by global health agencies, for communities and countries affected by Ebola. “We have seen incredible advances in both the quality and safety of clinical care during Ebola outbreaks,” said Dr Janet Diaz, lead of the clinical management unit in WHO’s Health Emergencies program. “Doing the basics well, including early diagnosis, providing optimized supportive care with the evaluation of new therapeutics under clinical trials, has transformed what is possible during Ebola outbreaks,” she said. “This is what has led to development of a new standard of care for patients. However, timely access to these lifesaving interventions has to be a priority.” WHO also says there is a need for more research and evaluation of clinical interventions because of the large number of “uncertainties” that remain including with supportive care, with our understanding and characterization of the Ebola virus disease and its longer-term consequences, with the continued inclusion of vulnerable populations such as pregnant women, newborns, children and older people in future research. Back to the DRC for More Research, Studies on Ebola treatment The clinical trials used to shape WHO’S guidelines for Ebola treatment were conducted during the Ebola outbreaks that have raged in central and west Africa over the past six years; the largest trial was conducted in the Democratic Republic of the Congo (DRC) which saw a major outbreak in 2018-2020, as well as small outbreaks since then. Ebola is a severe and too often fatal illness, and previous outbreaks and responses showed the importance of early diagnosis and treatment with optimized supportive care that includes fluid and electrolyte repletion and treatment of symptoms. “This therapeutic guide is a critical tool to fight Ebola,” said Dr Richard Kojan, co-chair of the Guideline Development Group of experts selected by WHO and President of ALIMA, The Alliance for International Medical Action. “It will help reassure the communities, health care workers and patients, that this life-threatening disease can be treated thanks to effective drugs,” said Kojan. “From now on, people infected with the Ebola virus will have a greater chance of recovering if they seek care as early as possible,” he said. “As with other infectious diseases, timeliness is key, and people should not hesitate to consult health workers as quickly as possible to ensure they receive the best care possible.” The DRC has now recorded 14 Ebola outbreaks since 1976, including six since 2018. The most recent outbreak, which began in April, was declared to be over by DRC and WHO authorities last month — with fewer cases and deaths (five) than previous episodes due to a swift response including vaccinations. Vaccinations were launched less than a week after the outbreak was declared, using an ultra-cold chain freezer in Mbandaka so vaccine doses could be stored locally and safely, and delivered effectively. That enabled 2,104 people to be vaccinated, including 1,307 frontline workers and 302 contacts. In the previous outbreak in Equateur Province from June to November 2020, 130 people were infected and 55 died. Africa’s battles with Ebola and other deadly diseases also helped prepare its health systems to deal with COVID-19. When SARS-CoV2 virus landed on the continent, the African Centres for Disease Control (CDC) reinforced its regional coordinating centers, enhanced lab capacity and unified surveillance networks. An Additional Tool for Ebola treatment Along With Clinical Care Guidance The new Ebola treatment guidelines are meant to complement clinical care guidance that outlines the optimized supportive care Ebola patients should receive including factors such as relevant tests, pain management, nutrition and co-infections. But the recommendations only apply to the Ebola virus disease caused by Ebola virus (EBOV; Zaire ebolavirus). “Advances in supportive care and therapeutics over the past decade have revolutionized the treatment of Ebola. Ebola virus disease used to be perceived as a near certain killer. However, that is no longer the case,” said Dr Robert Fowler of the University of Toronto and co-chair of the Guideline Development Group of experts selected by WHO. “Provision of best supportive medical care to patients, combined with monoclonal antibody treatment — MAb114 or REGN-EB3 — now leads to recovery for the vast majority of people,” he said. Image Credits: Photo: Anna Dubuis / DFID, WHO Therapeutics for Ebola virus disease. How Can Social Innovation Improve Life in Rural Communities? 19/08/2022 Editorial team When Dr. Magaly Blas, an Associate Professor at the Universidad Peruana Cayetano Heredia in Peru, was researching the association between the human papillomavirus that causes cervical cancer and the human T-lymphotropic virus that causes leukaemia, she found herself travelling often to the Amazon region of Ucayali, home to an indigenous community among whom the disease was prevalent. In this episode of “Global Health Matters” with host Garry Aslanyan, Blas reveals how these trips inspired her to spearhead Mamás del Río, a social innovation initiative to bring access to healthcare to remote rural communities. Luis Gabriel Cuervo from the Pan American Health Organisation (PAHO), who advises the Secretariat of the Social Innovation in Health Initiative in the Americas, also joins the podcast. “For a long time in science, attention has been paid to technical innovation, but quietly, social innovation has been blooming across Latin America,” says Aslanyan. “Communities, citizen-led organisations, and researchers have been collaborating to create new solutions to improve service delivery and strengthen health systems.” Blas started her career as a traditional researcher. However, after experiencing living in communities with no access to water, electricity, sanitation, or medical care, something began to shift. Mamás del Río Focus: Pregnant women and newborns When the study was completed and published, the scientist travelled again to the area. “When I returned to the communities, I found women who participated in my research living under the same conditions without access to any basic care,” she says. “I felt disappointed because although I was able to produce new knowledge, which is what they teach in the university, my research didn’t directly impact the health of the people with whom I worked.” As a result of the experience, Blas decided to take action, focusing on the health of pregnant women and newborn children, establishing Mamás del Río, “Mothers of the Rivers” – named after the Putumayo River that marks the border between Peru and Colombia in the Amazon. According to Cuervo, social innovation happens “when communities and partners join to find new ways of addressing pervasive problems and strengthening the health systems.” With its effort to bring healthcare to the most disadvantaged communities, Mamás del Río exactly fits the definition, and for this reason, it has received widespread recognition and support, from PAHO, the Government of Canada, and the authorities in Peru and Colombia. One of the most important principles of the organisation is empowering the communities themselves. “We believe in building capacity within the community by training community health workers,” Blas explains. “We train these community health workers who are persons from the community so that they can detect early pregnancy in their community and refer this woman to prenatal care and can also conduct home visits to pregnant women and newborns.” Mamás del Río During COVID-19 too The nonprofit was able to help also during the coronavirus pandemic. While the monthly in-person visits to the communities had to be interrupted, they were able to train the healthcare workers on how to contain the disease, as well as deploy prevention material to over 100 communities. Recently, Mamás del Río has also caught the attention of the Peruvian and Colombian governments. “They were interested in implementing the project on the border between the two countries, to now use Mothers of the River, which is called Mothers of the Border, to improve health and uniting two countries through this initiative,” Blas says. Listen to previous episodes on the Health Policy Website >> Learn more about “Global Health Matters”>> Image Credits: Courtesy of the TDR Global Health Matters Podcast, Courtesy of TDR Global Health Matters Podcast. 2nd COVID Booster Advised For Highest Risk 18/08/2022 John Heilprin The SAGE group has recommended a second COVID-19 booster for those most at risk. An expert panel of advisers to the World Health Organization (WHO) has recommended that countries consider a second COVID-19 booster dose for older, at-risk and immunocompromised people, echoing guidance provided by European and U.S. regulators months earlier. WHO’s Strategic Advisory Group of Experts (SAGE) on Immunization released its updated recommendations on Thursday, a week after it met. SAGE, created in 1999, is the main advisory group to WHO for global policies and strategies for vaccines and immunization. To cut the risk of severe disease, deaths and disruption to health services, the panel recommended a second vaccine booster dose for all elderly people – using age-specific cutoffs to be defined by each country. It also recommended a second booster for adults with comorbidities that put them at higher risk of severe disease, including pregnant women and health care workers. “There is increasing evidence on the benefits of a second booster dose of COVID-19 vaccines in terms of restoring waning vaccine effectiveness (VE). The data mainly exist for mRNA vaccines with very limited data for other COVID-19 vaccines,” the SAGE expert group concluded in their latest “Good Practice” statement on booster doses. “Evolving evidence from studies suggests that additional protection of the most vulnerable populations, at least for several months, is likely to be achieved through administration of a second booster dose, although follow-up time for these studies is limited.” Targeted Guidance for ‘Certain Populations’ SAGE chairperson Dr Alex Cravioto The guidance is similar to what has already been put forward by the European Center for Disease Prevention and Control (ECDC), the European Medicines Agency (EMA), and the US Centers for Disease Control and Prevention (CDC, which have called for second boosters to be given to people aged 60 and over and those with medical conditions. “We are now providing targeted guidance on the administration of a second booster in certain populations,” SAGE Chair Alejandro Cravioto, a professor with the Faculty of Medicine of the Universidad Nacional Autónoma de México (UNAM), told a WHO-hosted virtual press briefing. “The rationale of this recommendation is in order to avoid severe disease and death in a population at the highest risk — but does not constitute a general recommendation of vaccinating all adults after the first booster,” he said. “That means that this is selectively done, in populations that we consider are at highest risk.” On Wednesday, WHO Director General Dr Tedros Adhanom Ghebreyesus told a press briefing that people should get vaccinated or boosted before winter arrives in the northern hemisphere, a time when there is an increased risk of infection due to more time spent indoors. Selective Approach with Children Fits Panel’s ‘Roadmap’ In other recommendations, the panel said that it supports a flexible approach to homologous [e.g. the same vaccine type and brand] versus heterologous vaccination, what has also been described as mixing and matching of different vaccine types and brands, for both primary series and booster doses. Heterologous boosters should be implemented with careful consideration of current vaccine supply, vaccine supply projections, and other access considerations, it says, alongside the potential benefits and risks of the specific products being used. Cravioto said the second booster should be given “at the earliest opportunity” after six months has elapsed since the first booster. The panel did not recommend it for the general population, however, because the focus is on warding off the worst outcomes. “The principal objective continues to be the prevention of severe disease and death,” he said. The panel also updated its recommendations for the use of Pfizer-BioNTech and Moderna vaccines in children, but said it was still reviewing the data for vaccines tailored to specific variants. “In the case of both vaccines, children from six months to 17 years with comorbidities should be vaccinated to avoid a higher risk in these groups of severe disease,” he said. “We do not recommend, still, the wider use of the vaccines in younger groups, since these are not the priority groups according to our roadmap.” SAGE last updated its “roadmap” for prioritizing uses of COVID-19 vaccines in January 2022. Image Credits: Marco Verch/Flickr. Ethiopia Pursues ‘Ethnic Cleansing’ in Tigray, Tedros Says; Warns of Nuclear Threat in Ukraine 18/08/2022 John Heilprin A woman selling fruit in Adigrat, Tigray region Ethiopia’s Tigray region suffers from “the worst catastrophe on Earth” due to a devastating mix of factors such as government neglect, drought, and racism, World Health Organization Director General Dr. Tedros Adhanom Ghebreyesus told a virtual press briefing Wednesday. Tedros grew emotional at the end of the briefing as he described the humanitarian crisis facing 6 million people in the region who have been cut off from the world and insisted “it’s not because I’m from Tigray that I’m saying that.” Shifting back and forth from the crisis in Tigray, drought, and hunger throughout the Horn of Africa and also Ukraine, Tedros warned the international community may be “sleepwalking into a nuclear war” as a result of Russia’s war in Ukraine, which he called “the mother of all problems.” “But in terms of humanitarian crisis, I can tell you the humanitarian crisis is greater in Tigray,” he said. Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), at a virtual press briefing Millions of people have been displaced by the fighting between Ethiopian Prime Minister Abiy Ahmed’s government and Tigray’s regional administration. National and regional governments view one another as unlawful Abiy was awarded the Nobel Peace Prize in 2019 for defusing tensions with neighboring Eritrea, but his government has taken a hardnosed approach toward Tigray’s regional administration, which it views as unlawful – leading to the military entry to the region. Tigray’s regional administration defied the government by holding an election in September 2020. And Tigray’s regional administration saw Abiy’s government as unlawful after he postponed national elections due to the coronavirus pandemic. Tigray has now been under a virtual military siege for over a year, sparking widespread hunger as well as disease. Despite recent promises to allow the entry of desperately needed food and medical supplies, only a scattered number of relief envoys have been allowed to pass by the Ethiopian forces amassed around and inside parts of Tigray. In January, Tedros slammed Ethiopia’s “complete blockade” on health and humanitarian aid to the Tigray region, saying it has been unable to deliver life-saving medications for nearly six months in a situation that is “unprecedented” even in comparison to conflict-wracked Syria or Yemen. Eritrean refugees in Ethiopia now also fear retaliation from Eritrean forces operating in the region in an alliance with Ethiopia’s government. Almost 60,000 Ethiopian refugees have fled to eastern Sudan since the conflict began, according to the UN refugee agency. While Tedros called attention to the crisis in Ukraine, he said he hadn’t heard any head of state from the developed world talking about Tigray during the last few months. “Why? Maybe the reason is the color of the skin of the people in Tigray,” he said. “Nowhere in the world you would see this level of cruelty, where a government punishes 6 million of its people for more than 21 months.” “How can peace talks occur when people are being suffocated?” he asked, grabbing his neck by his own hands to underline the point. “The only thing we ask is, ‘Can the world come back to its senses and uphold humanity?’” UN warnings go back to November 2020 A woman brings her child to a clinic in Wajirat in Southern Tigray in Ethiopia to be checked for malnutrition in late summer. United Nations officials warned of a full-scale humanitarian crisis unfolding in Ethiopia almost two years ago. The conflict erupted after an attack on an Ethiopian government military base in Tigray. Abiy’s government sent troops in to seize control of Tigray’s governing Tigray Peoples’ Liberation Front (TPLF) party and several towns and a humanitarian base with nearly 100,000 Eritrean refugees. Humanitarian aid groups said the government forces effectively sealed off the Tigray region since July 2021, disrupting the flow of crucial food and aid supplies. But the UN Office for the Coordination of Humanitarian Affairs (OCHA) reported earlier this month that 6,105 trucks were able to bring more than 1.4 million metric tons of humanitarian supplies into Tigray since humanitarian convoys resumed in April. The overall humanitarian situation in Ethiopia has significantly deteriorated in 2022 leading to increased humanitarian needs across the country due to ongoing conflict and violence, and climatic shocks such as the prolonged drought,” OCHA said in an 5 Aug situation report. “More than 20 million people are to be targeted for humanitarian assistance and protection this year. Nearly three quarters of them are women and children.” Both sides agreed to hold talks in June after a cease-fire and the flow of aid was somewhat restored but not enough to meet the needs of the millions of people still trapped in the region. As many as 13 million people in the northern Tigray, Afar, and Amhara regions need food assistance due to conflict, according to the World Food Program, and 7.4 million people across the country face severe hunger due to drought. Ethnic cleansing – it could be even more … Tigray refugees Tedros has been at odds with Ethiopia’s government for some time. When he was confirmed for a second term as WHO chief this year, Ethiopia did not co-sponsor his nomination — the first time that an incumbent director general at the UN health agency was thus shunned by his own home country. Ethiopia’s government also wrote WHO earlier this year accusing Tedros of “misconduct” after his sharp criticism of the war and humanitarian crisis in the country. He previously had served as both Ethiopian foreign minister and health minister. That has not deterred Tedros, who spoke movingly about his experiences as a “child of war” growing up in Tigray under earlier cycles of conflict at the opening of the World Health Assembly, on 22 May, where he was elected for a second term as Director General. And on Wednesday, he was even more blunt about the situation unfolding in the region. “It’s ethnic cleansing. It could even be more? Why are people not telling the truth,” Tedros told the press briefing. “Why are we keeping quiet when 6 million people are being punished?” Image Credits: Christine Nesbitt/ UNICEF, Rod Waddington/Flickr, UNICEF/Christine Nesbitt, © UNFPA/Sufian Abdul-Mouty. Monkeypox Cases Spike 20% Weekly Worldwide 17/08/2022 John Heilprin Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), at a virtual press briefing As the first monkeypox case involving a human-to-dog transmission reported, the World Health Organization (WHO) said more than 35,000 recently confirmed cases of monkeypox were accompanied by 12 deaths in 92 nations and territories, including almost 7,500 from last week alone. That made for the second consecutive week with a 20% increase, WHO Director-General Dr Tedros Adhanom Ghebreyesus said Wednesday. Almost all of the cases are being reported from Europe and the Americas and involve men who have sex with men, Tedros told a virtual press briefing, underscoring the importance for all countries to design and deliver services and information tailored to these communities that protect health, human rights and dignity. “The primary focus for all countries,” said Tedros, “must be to ensure they are ready for monkeypox and to stop transmission using effective public health tools, including enhanced disease surveillance, careful contact tracing, tailored risk communication and community engagement and risk reduction measures.” Related to the challenge of outreach, Dr Mike Ryan, executive director of WHO’s Health Emergencies Program, said WHO would “follow up directly” with Mexico’s government – when asked by a Mexican journalist why the country has not yet mounted programmes for widespread testing or clear outreach to potentially vulnerable populations of men – despite a fourfold increase in daily reported cases over the past two weeks. Tedros said vaccines may also play an important part in controlling the outbreak, and in many countries there is high demand for vaccines from the affected communities. “However, for the moment, supplies of vaccines and data about their effectiveness are limited. Although, we are starting to receive data from some countries,” he noted. “WHO has been in close contact with the manufacturers of vaccines and with countries and organizations willing to share those. We remain concerned that the inequitable access to vaccines we saw during the COVID-19 pandemic will be repeated, and that the poorest will continue to be left behind.” Bavarian Nordic, the world’s sole manufacturer of US and European-approved monkeypox vaccines has currently closed its manufacturing plant for renovations – and does not expect to reopen until late this year. Meanwhile, a few wealthy countries, led by the United States, have snapped up all available doses. See Health Policy Watch’s exclusive report: Exclusive: Closure of World’s Only Manufacturing Plant for Monkeypox Vaccine Raises Questions About World’s Ability to Meet Rising Demand First case of human to dog transmission Pet dog in France gets monkeypox from 2 men in same household WHO officials also confirmed the first case of human-to-dog transmission in Paris, where two men went to a hospital and were confirmed to have monkeypox. Twelve days later, a 4-year-old male Italian greyhound that was allowed to sleep with them also tested positive for the virus, according to a recent Lancet article. The case already prompted the U.S. Centers for Disease Control and Prevention to issue new guidance that people with monkeypox should avoid contact with animals, including pets, domestic animals and wildlife to avoid spreading the virus. “Infected animals can spread monkeypox virus to people, and it is possible that people who are infected can spread monkeypox virus to animals through close contact, including petting, cuddling, hugging, kissing, licking, sharing sleeping areas, and sharing food,” stated the CDC guidance. Dr Sylvie Briand, director of WHO’s Epidemic and Pandemic Preparedness and Prevention department (EPP), said it is important to differentiate between the emergence and reemergence of diseases. “It’s something that we know, most of the emerging viruses are coming from animals,” she said. “This is the case for monkeypox, and they infect humans. So at the beginning, it’s only sporadic cases,” she said, referring to the fact that the virus was only discovered in 1958, and for decades after that circulated in a mostly self-limiting way between animals and human communities in central and west Africa. . But if the virus finds the right environment, Briand said, it can evolve to more effectively target humans, resulting in more localized transmission especially in conditions of “high human density, very close contact,” she said. “This is what we have seen with monkeypox. Initially it was in animals, then it went to some humans. And then we had a localized outbreak and now we have a multi-country outbreak.” In terms of disease reemergence, other factors then play out as well. “It’s often because the vaccine coverage is too low that those diseases reemerge,” she said. “And it’s very important to understand that vaccine coverage is a very, very important indicator of the protection of human beings against disease.” 2020 study predicted heightened monkeypox risk with declining smallpox immunity Monkeypox lesions Ironically, a study published in September, 2020 in the Bulletin of the WHO Health Organization, predicted that Central and West Africa’s monkeypox outbreaks could become more frequent – with eventual mutations of the virus increasing human to human transmission as well. Earlier this month, a group of global experts convened by WHO agreed that the virus’s variants will be renamed with Roman numerals. In a review of historical data on outbreaks of Clade 1 of the monkeypox virus in the Democratic Republic of Congo, the authors from Institut Pasteur contended that transmission had remained self-limiting throughout the 1960s and 1970s because most people in DRC were vaccinated against smallpox – which protects against monkeypox virus too. However, after smallpox was declared to be eradicated, and smallpox vaccination ceased in the 1980s – that herd immunity waned: “Since then, the Democratic Republic of the Congo has reported increased monkeypox human infections, and parts of the country have been declared monkeypox-endemic areas,” the report’s authors note. “In 2011–2012, the population immunity against orthopoxvirus species was only 60%… among individuals vaccinated against smallpox and 26% …among individuals unvaccinated against smallpox.” Due to declining immunity, more frequent outbreaks may occur in endemic countries, triggered initially by contact with infected animals, the authors predicted, but they added that over time monkeypox may begin to undergo more “sustained human-to-human transmission (R > 1).” “In either case, repeated circulation of monkeypox in human hosts, particularly immunocompromised hosts, favours pathogen evolution and emergence of newly human-adapted pathogens, depending on R and on the human pathogen fitness landscape.” “”This finding may explain the increasing number of monkeypox outbreak reports, resulting in endemic monkeypox in central African countries…. “Moreover, with declining immunity to orthopoxvirus species, monkeypox can pose an ever-increasing threat for health security.” A prescient conclusion indeed in light of today’s rapidly evolving global health emergency. –Elaine Ruth Fletcher contributed to this story Image Credits: Mothership.sg/Twitter , Tessa Davis/Twitter . W. Africa’s Polluted Air 2nd Only to S. Asia 17/08/2022 John Heilprin & Elaine Ruth Fletcher Downtown Lagos – new study finds it to be among the most polluted cities in Africa and the world. Some 1.7 million people in cities across the planet died from polluted air in 2019, according to the first-ever study of urban air pollution that covers virtually every city in the world over the size of 50,000 people, as per the UN definition. Conditions are the most severe in cities of South Asia, (WHO’s SouthEast Asia region). Strikingly, however, cities in West Africa, are a close follower – with average annual fine particulate (PM2.5) concentrations of 62 micrograms/cubic meter of air (µg/m3), more than 15 times above WHO guideline levels. The study by the State of Global Air Initiative, a collaboration between Boston-based Health Effects Institute (HEI) and Seattle-based Institute for Health Metrics and Evaluation’s (IHME) Global Burden of Disease project, is the largest analysis of urban air pollution to date. It examines data spanning the years 2010-2019 for 7,239 cities, home to some 2.8 billion people. It is also the first global analysis to compare trends in cities over time. The study confirms that urban residents face some of the world’s worst air quality, with 98% of people in all cities around the world breathing air that fails to meet the WHO Air Quality guideline level of 5 µg/m3 – what is considered the most key indicator of health impacts. And with 68% of the world’s population expected to live in urban areas by 2050, air pollutants loom as a major battle for many of the world’s top cities. India and Indonesian cities saw the world’s worst increases in polluted air Industrial air pollution in India – South East Asia is the hardest hit by air pollution overall. While PM2.5 exposures “decreased” in some cities between 2010 and 2919, most notably in China, in parts of South Asia, notably India and Indonesia, air pollution in fact became much worse. “Of 7,239 cities, India is home to 18 of the 20 cities with the most severe increase in PM2.5 pollution from 2010 to 2019. The other two cities are in Indonesia. Alll these cities saw an increase of more than 30 µg/m3 during that decade. Of the 50 cities with the msot severe increase in PM2.5 pollution, 41 are in India and 9 are in Indonesia,” it adds. As for the present day: “Exposures are particularly high in cities in Asia, West Sub-Saharan Africa, and Andean and Central Latin America, the report concludes. “More progress is necessary to protect the health of residents.” Only 2% of cities meet the WHO Air Quality Guidelines and 41% of cities exceed even the least stringent WHO interim Air Quality Guideline Some 86% of cities around the world also exceed WHO’s guidelines for NO2, whose dangers for asthma and lung diseases have been better recognized more recently. Strikingly, cities with excessive levels of NO2 include cities in many high- and middle-income countries where stricter regulations on vehicle and power plant emissions may have reduced PM2.5 levels – but have not sufficiently addressed NO2. Diesel vehicles, promoted by the industry over the last 30 years, emit comparatively higher levels of NO2. Estimates on polluted air combine data from ground monitoring and satellites The new analysis combines available data on air quality from ground-level monitoring stations with satellite data from thousands of cities that lack stations of their own. It provides the full data set on an interactive database. The study estimated annual average concentrations of PM2.5 and NO2 for cities across the planet by integrating available ground-level and satellite data, then dividing that information into grid cells of approximately 1×1 km at the equator. Only 117 nations have ground-level monitoring systems to track PM2.5, and only 74 nations are monitoring NO2 levels, according to the report, which draws its ground level data from an online repository maintained by the World Health Organization. Based on available ground station data, WHO in April issued estimates of average annual air pollution concentrations in 4,000 cities and settlements around the world. Those included PM2.5, and NO2 when data was available. Some of the findings about global hotspots are roughly comparable with WHO’s own recent analysis – which also found that people in South/Southeast Asia, the Middle East and parts of Africa continue to breathe some of the worst air on the planet. However, WHO did not analyse trends over time. Nor did WHO attempt to incorporate satellite data from cities where ground-level measurements are unavailable – which includes most of urban Africa. This new analysis fills in that critical gap – and in the process it reveals how serious pollution in some parts of Africa, and particularly West Africa, has become. “Since most cities around the world have no ground-based air quality monitoring in place, estimates of particulate and gas pollution levels can be used to plan air quality management approaches that ensure the air is clean and safe to breathe,” said Susan Anenberg, an associate professor at George Washington University and one of the project collaborators. West African cities – now among the world’s most polluted Average annual urban air pollution concentrations by region shows cities in South Asia folowed by cities in West Africa as the most polluted in the world. Unlike the most recent WHO study, the HEI/IHME study also estimated air pollution in terms of “population-weighted” exposures to air pollution in each city considered – rather than in terms of the city’s spatial limits only – linking the pollution concentrations in each grid cell with the number of people living within each block to produce a population-weighted annual average. Population-weighted exposures are an essential input to the estimation of mortality, per capita, from air pollution in any given area. In terms of population-weighted exposures, the data includes some surprises. Not only do people in longstanding hotspots like Delhi, Kolkata, Dhaka and Jakarta as well as Beijing, continue to breathe some of the the worst air in the world, so do people in Lima Peru; Lagos and Kano, Nigeria, and Accra, Ghana. Geographic patterns of air pollutants NO2 and PM2.5 strikingly different The study also confirms prior WHO findings that the geographic patterns of excessive exposure to PM2 and NO2 are considerably different at times. “Cities in Asia and Africa are already hotspots for PM2.5 pollution,” the study concludes. “At the same time, NO2 pollution – primarily from vehicle traffic – is high and growing in some cities and regions that are not PM2.5 hotspots.” Air pollutants responsible for 7 million deaths worldwide Air pollution is responsible for about 1-in-9 deaths worldwide, or between 6.7 to 7 million deaths a year, according to the latest estimates by both HEI/IHME and WHO. Outdoor, ambient air pollution is estimated by WHO to kill about 4.2 million people a year. There is an overlap, however, between deaths attributable to outdoor air pollution and the estimated 3.2 million deaths a year attributed to household air pollution. The latter is related largely to exposures to smoke from biomass, kerosene and coal fires used by billions of people for cooking and heating. Air pollution is a factor in illness and premature deaths particularly in older people and those with chronic respiratory and cardiovascular conditions. WHO estimates that quarter of all deaths from heart attacks and stroke, and nearly 30% of deaths from lung cancer, as well as 43% of deaths from lung disease, are attributable to air pollution. Exposure to NO2, meanwhile, exacerbates lung inflammation, contributing to asthma and other respiratory diseases, and potentially impeding children’s lung development. High NO2 exposures that lead to difficulties breathing, coughing or wheezing, may cause spikes in hospital and emergency-room admissions, according to WHO. People living near busy roads congested with lots of city traffic often are exposed to higher levels than people in rural settings. China air quality improved but air pollution related mortality still very high In terms of mortality, a significant number of Chinese cities, led by Beijing, continue to have a high proportion of deaths from air pollution. That is despite the fact that China is the country that has also seen the greatest improvements in urban quality over the past couple of decades, the report finds. This paradox is due to two factors – the comparative ageing of China’s population and the fact that exposure to air pollution, even at comparatively lower levels, can still be deadly. Recognizing this, WHO in 2018 reduced by half it’s guideline level for annual average exposure levels of PM2.5 from 10 to 5 µg/m3. WHO also halved its NO2 guideline level to 10 µg/m3. Urban air pollution hotspots by region. In South/SouthEast Asia mortality from urban air pollution also has grown significantly in the past 20 years, the report also concludes – with Jakarta and Delhi having the highest levels of mortality, per 100,000 population, from air pollution. In central Asia, hot spots included Tashkent, Uzbekistan and Almaty, Kazakhstan. Most of those cities also are areas long reliant on coal-burning for heat and power production. Compared to other parts of eastern and central Europe, Kyiv and Kharkiv in Ukraine, the Polish cities of Katowice and Warsaw, as well as Budapest Hungary and Bucharest, Romania, also had high pollution-related death rates. Conversely, African cities don’t rank as prominently in terms of global air pollution-related mortality – largely because the residents of African cities are much younger on average and thus not as likely to die – yet – from air pollution related diseases. Taking action against air pollutants Cycling in Fortaleza, Brazil – the city has won worldwide recognition for its sustainable transport planning that contributes to healthy physical activity and reduces air pollution. The good news, the study concludes, is that there are a wide range of cost-effective solutions already available to reduce pollution from many key pollution sources. Those include the promotion of green and sustainable transportation, expanded access to clean energy for households and a shift to clean and efficient energy production based on renewable energy sources and not fossil fuels. The report also cites some of the urban solutions have yielded results, including stricter vehicle and power plant emissions limits and urban planning solutions that reduce the need to travel. In Europe, for instance, more than 300 cities created low-emission zones (LEZs) for vehicles that reduced traffic-related air pollution by banning the entry of high-polluting vehicles and encouraging more walking, cycling and use of public transportion. In China’s capital Beijing, new measures such as tighter controls over coal-fired power plants, more stringent vehicle emission and fuel quality standards, and additional air monitoring stations contributed to a 36% decline in the city’s annual average PM2.5 level over five years. But those successes remain exceptions to the rule for many, or even most, of the world’s low and middle income cities – which have not yet come to grips with air pollution as a deadly health threat. “As cities around the world rapidly grow,” said Pallavi Pant, a senior scientist with HEI who oversaw the study, “the impacts of air pollution on residents’ health are also expected to increase, underscoring the importance of early interventions to reduce exposures and protect public health.” Image Credits: Flickr/US 6th Fleet photostream, Uncommonthought.com, Air Quality and Health in Cities, State of Global Air Report , Urban Air Quality and Health – State of Global Air , Air Quality and Health in Cities, State of Global Air,, Air Quality and Health In Cities, State of Global Air , City of Fortaleza. Climate Change is a Double Blow for People with Disabilities 16/08/2022 Kavitha Yarlagadda Pratyush Nalam, a software professional in Hyderabad, India HYDERABAD – Pratyush Nalam, a software professional in this south-central Indian city that has become a global tech outpost for Silicon Valley, moves around his house in his wheelchair. He has spinal muscular atrophy and cannot walk, so his family members help him. Though the monsoon season in Hyderabad brings lots of precipitation from the end of June to early October, scientists say the rains are getting even heavier due to climate change. And that, says Nalam, is making life tougher for people than summer heat or winter’s chills. “Getting to a dry place quickly is a challenge,” Nalam says of the growing challenge he faces in just getting around. “Bus stops don’t have shelters and are far to get to – and accessible transport is not available in most cases.” The combined detrimental effects from a lack of inclusive planning or early warning systems, less information and transportation options, and overall discriminatory attitudes has driven the global mortality rate for people with disabilities who experience natural disasters up to four times higher than it is for people without disabilities, according to a Lancet report. Nalam said that during heavy rains “we cannot see the bumps on the roads or sidewalks, which make it riskier to drive our wheelchairs.” Hotter and hotter norms Summer in India has temperatures that regularly climb into the high 30C. Europe has suffered wildfires, evacuations and heat-related deaths this summer, as heat waves force temperatures above 40 degrees C in places like Portugal and France – only slightly hotter than the warmest season in Hyderabad, where temperatures regularly climb into the high 30s C during the pre-monsoon summer from late March to early June. Still, a devastating heat wave that scientists say was made more likely by climate change has baked India and Pakistan in recent months, with some cities in the two neighboring countries reaching around 45 to 50 C. Across Europe and Asia, record temperatures have challenged daily lives, posing serious health risks to families, students, businesspeople and travelers. As with most other natural and manmade disasters, the people that suffer the most often are those that are the most marginalized. “Extreme heat is the root cause of all of the catastrophic events that we are experiencing, from wildfires to drought, hurricanes, storm surges, and flooding,” said Wendy Nystrom, an environmental and pollution risk management consultant in Los Angeles. Among those most affected by climate change Aunia Kahn Persons with disabilities are frequently among the worst affected by climate change, similar to the disproportionately higher rates of morbidity and mortality they suffer in emergencies while also being among the least able to get emergency assistance. “It feels that I am always living in a bubble. I am allergic to heat and cold and this makes me very vulnerable to climate change,” said Aunia Kahn, a disabled U.S. business owner in Eugene, Oregon, who struggles with rare chronic illnesses such as Ehlers Danlos Syndrome, Mast Cell Activation Syndrome, and Dysautonomia. Certain conditions of disability are disproportionately affected by global warming. For example, people with spinal cord injuries cannot cool themselves during excessive heat while people with multiple sclerosis feel more pain and fatigue during hot weather conditions. Some 15% of the world’s population have a disability, the World Bank reported. Many people with them also live in extreme poverty, exacerbating their vulnerability to climate change due to a general lack of proper sanitation, health care, nutrition or safe drinking water. “Earth is warming and global warming is the main reason for the extreme heat waves. Heat intensity is increasing and reducing the quality of our lives,” said Dr. Roxy Mathew Koll of the Indian Institute of Tropical Meteorology in Pune, India. “The vulnerable are the ones who are the most impacted.” Dr Roxy Mathew Koll An increasing human rights issue But the right to a clean, healthy and sustainable environment should be the same for all irrespective of differences such as caste and creed, the UN General Assembly determined in a landmark resolution approved in late July. The assembly’s 161-0 vote with eight abstentions by Belarus, Cambodia, China, Ethiopia, Iran, Kyrgyzstan, Russia and Syria gives momentum to the work of activists and citizens seeking greater legal and regulatory protections. It followed a 43-0 vote on a similar resolution last October in the 47-nation UN Human Rights Council – with China, India, Japan and Russia abstaining. Lack of mobility in emergencies is life-threatening People with disabilities and women and children in South Asia and Africa are more vulnerable to severe weather events like heat waves, floods, cyclones and storm surges, according to experts. This is because they have less access to information on climate adaptation, rarely benefit from government aid and have fewer economic privileges than men. And extreme weather events like cyclones and floods are intensifying in a very short time, giving disabled people little time to move to safety, according to Koll. “People with disabilities, particularly with mobility issues, have limited capacity to respond to emergency situations during an extreme weather event,” he said. But only 10% of people with disabilities believe their local government has emergency, disaster management, or risk reduction plans that address their access and functional needs, according to a UN report. And just 20.6% said they could self-evacuate without difficulty in the event of a sudden disaster, a UN Office for Disaster Risk Reduction online survey found. A hot day in Hyderabad For the old and young, climate change presents difficulties. Vishnu Kumar, a 75 year old man from Hyderabad, suffered a paralytic stroke three years ago and has been confined to a bed and wheelchair since then. As with many elderly, the excessive heat zaps his energy and the frequent power cuts only increase his discomfort, adding to friction in his family. And for student Rohit Reddy, eczema and allergies worsened during summers in the coastal city of Mumbai, costing him time needed for his studies. “I had to shift to Hyderabad because of the flare ups due to extreme humidity, now I may lose an academic year,” Reddy said. -Updated 16.08.2022 with correction to the name of Pratyush Nalam’s condition as spinal muscular atrophy, not muscular dystrophy. Image Credits: Skymet , Pratyush Nalam, Aunia Kahn, Roxy Koll, Gulf News. Monkeypox Variants Get New Names 12/08/2022 Editorial team While the process of renaming monkeypox is still underway, a group of global experts convened by the World Health Organization (WHO) has agreed that the virus’s variants will be renamed with Roman numerals. This follows a meeting convened by the WHO this week to enable virologists and public health experts to reach consensus on new terminology, the global body announced on Friday. Experts in pox virology, evolutionary biology and representatives of research institutes from across the globe reached consensus that the former Congo Basin (Central African) clade will be referred to as Clade one (I) and the former West African clade as Clade two (II). The group also agreed that Clade II consists of two subclades, which will be referred to as Clade IIa and Clade IIb. Assigning new names to existing diseases is the responsibility of WHO under the International Classification of Diseases and the WHO is holding an open consultation for a new name for monkeypox. Anyone wishing to propose new names can do so here. The naming of virus species is the responsibility of the International Committee on the Taxonomy of Viruses (ICTV), which also has a process underway for the name of the monkeypox virus. Image Credits: TRT World Now/Twitter . India is Trying to Reduce Maternal Mortality Without Addressing a Key Contributor: Suicide 12/08/2022 Disha Shetty Suicide is one of the leading causes of death among women of childbearing age in India. Pregnancy is most often a cause for celebration of a new life and a new addition to the family. But for the women who walk into Garima Malik’s clinic in New Delhi, it is a very different story. Some cry. Others appear angry, irritable or frustrated. Usually, the cause is domestic violence – pregnancy is a particularly vulnerable time and as an experienced counsellor, Malik is trained to spot the signs. “They talk about suicide,” she says. “Then they calm down. We talk about risk management and safety planning and counselling. So somehow, they cope.” Malik says many of those who come to the clinic, run by the medical charity Medecins Sans Frontieres (MSF), have experienced physical and emotional violence during pregnancy. Sometimes this is because they are unwilling to be intimate with a partner in the early part of the pregnancy or immediately after the birth. Other times it is because they have given birth to a girl, seen by some as less desirable. “This can cause loneliness in women and they feel frustrated and they feel like he [the husband] needed the child, the family needed the child, and I am the one suffering,” she says. Malik says they are the lucky ones — most Indian women who experience suicidal thoughts in the period during or after their pregnancy will not seek or receive any help. Yet suicide is one of the leading causes of death among women of child-bearing age in India. According to one recent study published in The Lancet medical journal, the suicide rate among Indian women and girls is twice the global average. Women may experience suicidal thoughts during or after pregnancy. India has made enormous strides since the turn of the century in reducing overall maternal mortality, reducing deaths by more than half. In 2019, 103 mothers were dying per 100,000 live births, down from 254 in 2004. The United Nations has set the goal of reducing maternal mortality globally to 70 deaths per 100,000 by 2030. But that success has exposed a phenomenon that had previously gone largely unnoticed in India: high rates of suicides in the perinatal period, defined as during and immediately after pregnancy. A 2016 study of 462 low-income women in early pregnancy in south India found 7.6% were at risk of suicide compared to roughly 0.4% in the United States. Health experts say the government has done little to address this problem, and a suicide prevention action plan devised in 2018 has never been implemented. India is losing young women “in enormous numbers,” says Lakshmi Vijayakumar, a psychiatrist and a member of the World Health Organization (WHO)’s International Network for Suicide Research and Prevention. “And we don’t have any effective mechanism or plan or strategy to address this issue.” The Indian government did not respond to a request for comment. Data on this is limited. India compiles national maternal death statistics by extrapolating from a representative sample survey, but does not separate the data into causes of death. Police keep data on reported suicides, but do not record whether the person was pregnant, and anyway, suicides are underreported. Perinatal suicides are often linked to a history of psychiatric illness, but Lakshmi* says this does not seem to be the case in India. Instead, social factors such as early marriage, intimate partner violence, pressure to give birth to a son and women’s lack of financial autonomy are drivers. Reducing maternal deaths — a revealing success story When it comes to the physical causes of maternal deaths, India’s success has been marked and is largely due to an increase in deliveries at free public health facilities rather than at home. In-facility deliveries rose from 31.1% in 2005-06 to 88.6% in 2019-21, according to government figures, driven by awareness campaigns and offering small financial incentives to pregnant women and grassroots health workers. The southern Indian state of Kerala has been among the most successful in reducing maternal deaths. With 43 per 100,000 live births, it is the safest place in the country to give birth. It is also the only state to have looked into perinatal suicide data, analyzing the 1,076 maternal deaths registered between 2010 and 2020. During that period, mortality dropped from 66 to 43, but the share of suicides increased from about 2.6% in 2010 to 6.6% five years later, and to 18.6% in 2019–20. But that data should be treated with some caution – Kerala’s relatively low rates of maternal mortality were based on a small sample but, combined with the 2016 study in south India, it indicates a trend, says Soumitra Pathare, psychiatrist and director of the Centre for Mental Health Law and Policy. “It is important for various reasons – we now have systematic data to show that suicides are a significant problem in young women, especially young women who are pregnant or have just delivered a child,” he says. “Maternal mortality has gone down substantially because that’s something that has had an intervention done for it. So what this actually shows is that we’ve not done any intervention for suicide prevention.” He cautioned that the data capture only some of the problem. For every person who dies by suicide, an estimated four to 20 times more people attempt it. “So the number of attempted suicides [in India] is anywhere between 0.6 million to 6 million,” said Pathare. “We don’t even collect data on it. ” Early intervention is key Nearly a third of Indian women between the ages of 15 and 49 who have been married, have experienced intimate partner violence. There has been little research into the drivers of perinatal suicide in India, though the Kerala review identified psychiatric illness, young age, unmarried status and domestic violence as risk factors. Nearly one in every three Indian women between the ages of 15-49 who has ever been married has experienced intimate partner violence, according to government figures. Around 3.1% of women in this category said they experienced physical violence during pregnancy. Marital rape is not legally recognized, although this is being challenged in the courts. Nayreen Daruwalla, head of a program on the prevention of violence against women and children at the Mumbai-based non-profit SNEHA, says suicide during pregnancy often falls into one of two categories. “One is pregnant women who are married and in whose cases the family insists on having a boy,” she said. “Unwed mothers are a huge category of cases especially given the lack of social support and sometimes the lack of support from the partner who might be reluctant to wed on finding out the woman is pregnant.” Experts say early intervention is key to preventing perinatal suicides, and that India already has the systems in place to do this. Shaji KS, dean of research at the Kerala University of Health Sciences and part of the team that reviewed perinatal suicides in Kerala, cites India’s network of grassroots health workers, through whom every pregnant person in the country can be reached. Adding a psychiatric component to support their mental health would help prevent many deaths, he said. MSF’s Malik sees a need for more vocational training to enable Indian women to become financially independent, making it easier for them to escape abusive situations. Research in Australia has found this to be effective in reducing suicides. In India, women’s labour force participation has steadily declined from around 30.4% in 2000 to 19% in 2021. “When we talk to such patients, when we talk about leaving husbands and leaving such [a] toxic environment and getting out of this kind of relationship, they want to,” she said. “They cannot because they are not financially independent.” Studies also show restricting access to pesticides, used in many suicides in India, might prevent some of the deaths. Lakshmi, the psychiatrist and WHO advisor, was part of a task force set up by the Indian government in 2018 to suggest ways to reduce overall suicides, whose recommendations have not been implemented. Asked about funding for suicide prevention, the government said in February that funds had been allocated and announced plans for a national telemedicine program for mental health. But it did not commit to adopting the task force’s recommendations. “We have submitted the plan” said Lakshmi. “It is still lying there. I hope that one day it will see the light of day.” * The use of a given name used on second reference is common practice in parts of south India If you or someone you know is struggling with mental health or suicidal thoughts, help is available at iCALL run by TISS at 9152987821 [India] or the National Suicide Prevention Lifeline at 1-800-273-8255 [US]. This article was first published in The Fuller Project. Image Credits: Children's Investment Fund/Flickr , UN Photo/Kibae Park/Flickr, Yogendra Singh/ Unsplash. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... 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WHO Recommends Two Monoclonal Antibodies for Ebola Treatment; Calls to Expand Access in Developing Countries 19/08/2022 John Heilprin A health worker dresses in protective clothing to enter the treatment unit for a suspected Ebola case at western Uganda’s Bwera General Hospital in August 2019 – during the 2018-2020 Ebola outbreak in the neighboring Democratic Republic of Congo. In its first guidelines ever for Ebola treatment, the World Health Organization (WHO) advises using two monoclonal antibodies — mAb114 (Ansuvimab®, also known as Ebanga®) and REGN-EB3 (Inmazeb®) — that were first approved by the US Food and Drug Administration for use against the Zaire ebolavirus species in 2020. WHO says its “strong recommendations” for the two monoclonal antibody treatments that were released on Friday are based on a systematic review and meta-analysis of randomized clinical trials examining potential therapeutics for the deadly disease. The two therapies demonstrated “clear benefits and therefore can be used for all patients confirmed positive for Ebola virus disease, including older people, pregnant and breastfeeding women, children and newborns born to mothers with confirmed Ebola within the first seven days after birth,” WHO says. In its launch of the recommendations, WHO also called on the global community “to increase access to these lifesaving medicines”. As relatively new therapies, monoclonal antibodies have been difficult and expensive to access in low- and middle-income countries, with 80% of their sales occuring in the US, Canada and Europe. In 2020, a consortium of research organizations, led by Wellcome Trust issued a global call to action to expand access. Yes to Ansuvimab and Inmazeb, No to ZMapp and Remdesivir Patients should receive recommended neutralizing monoclonal antibodies as soon as possible after laboratory confirmation of diagnosis, according to WHO. Its new 44-page guidelines for Ebola treatment also makes a “conditional recommendation against” the use of ZMapp and remdesivir for patients with the Ebola virus. ZMapp, a drug cocktail of antibodies developed from the tobacco plant, was the first drug to be used on an experimental basis against the Ebola virus. Initially it showed promise with rhesus monkeys, but was not fully tested on humans. During the 2014-2016 Ebola epidemic in West Africa, however, the US Food and Drug Administration (FDA) approved ZMapp’s experimental use on patients. That epidemic, the continent’s largest ever, killed more than 11,000 people out of the 28,000 people who became ill with the virus. Subsequently, ZMapp, remdesivir as well as mAb114 and REGN-EB3 were all tested against one another in a randomized controlled trial in the Democratic Republic of Congo, running in parallel to the Ebola epidemic that wracked the eastern region of the country between 2018-2020. In August 2019, however, an independent monitoring board recommended early termination of the DRC therapeutics trial due to the favorable results demonstrated by the latter two drug candidates. The board recommended that all patients be randomized to receive either REGN-EB3 or mAb114 in an extension phase. The study’s preliminary results among 499 participants showed people who got REGN-EB3 or mAb114 had a greater chance of survival than those who received ZMapp or remdesivir. Remdesivir was originally developed to treat hepatitis C before it was investigated for treating the Ebola and Marburg viruses, and then as a post-infection treatment for COVID‑19. It eventually won US and European Medicines Agency approval as a COVID-19 treatment. However, in November 2020, WHO recommended against Remdesivir use for COVID, saying there was “no evidence” it improved patient outcomes. Access remains a problem for ebola treatment In its recommendations, WHO called for greater efforts to ensure that that the drugs are “where patients need them the most: where there is an active Ebola outbreak, or where the threat of outbreaks is high or very likely.” To assist with that goal, WHO offered to support “countries, manufacturers and partners” to step up national and global efforts to increase affordability of the biotherapeutic products. “Access to these therapeutics is challenging and pricing and future supply remain unknown, especially in resource-poor areas,” WHO says in its 44-page guidelines. “Without concerted effort, access will remain limited, and it is therefore possible that this strong recommendation could exacerbate health inequity,” it says. “Therefore, given the demonstrated benefits for patients, these recommendations should act as a stimulus to engage all possible mechanisms to improve global access to these treatments.” Both Inmazeb and Ebanga were developed with significant US government support The development of both Inmazeb and Ebanga was heavily supported by the US government and other public funders. Inmazeb, which also was the first FDA-approved treatment for Ebola, is produced by the US-based Regeneron Pharmaceuticals. It was developed in response to the 2018 Ebola outbreak in the DRC with supprot from the US Biomedical Advanced Research and Development Authority (BARDA). Regeneron announced in 2020, the company will “continue to provide Inmazeb for free in response to outbreaks in the DRC through the MEURI protocol for compassionate use,” in colaboration with the WHO, the US FDA and with continuing support from BARDA. “Regeneron is actively working with nongovernmental organizations and public health agencies to ensure continued access to Inmazeb in low- and middle-income countries,” the company declared at that time. The MEURI protocol is a WHO-approved ethical framework for the use of investigational agents. Regeneron gained fame in the first year of the COVID pandemic when former President Donald Trump was treated with another antibody cocktail that it had developed against COVID, (REGEN-COV- a combination of casirivimab and imdevimab) . The cocktail was later recommended by WHO for COVID treatment. As for Ebanga, it was initially developed by the Vaccine Research Center of the US National Institute of Allergy and Infectious Diseases (NIAID), part of the US National Institutes of Health (NIH), and then licensed in 2018 by the US biotech firm, Ridgeback Biotherapeutics for further development and ultimately FDA aprpoval. “Ebanga is currently available to patients, and Ridgeback Biotherapeutics provides and distributes the treatment to patients free of charge in Ebola-stricken countries,” the company states on its website. WHO publishes invitation to drug manufacturers to share drugs for evaluation WHO says it has now published the first invitation to manufacturers of therapeutics against Ebola virus disease to share their drugs for evaluation by the WHO Prequalification Unit, a crucial step to enabling bulk procurement of new drugs by global health agencies, for communities and countries affected by Ebola. “We have seen incredible advances in both the quality and safety of clinical care during Ebola outbreaks,” said Dr Janet Diaz, lead of the clinical management unit in WHO’s Health Emergencies program. “Doing the basics well, including early diagnosis, providing optimized supportive care with the evaluation of new therapeutics under clinical trials, has transformed what is possible during Ebola outbreaks,” she said. “This is what has led to development of a new standard of care for patients. However, timely access to these lifesaving interventions has to be a priority.” WHO also says there is a need for more research and evaluation of clinical interventions because of the large number of “uncertainties” that remain including with supportive care, with our understanding and characterization of the Ebola virus disease and its longer-term consequences, with the continued inclusion of vulnerable populations such as pregnant women, newborns, children and older people in future research. Back to the DRC for More Research, Studies on Ebola treatment The clinical trials used to shape WHO’S guidelines for Ebola treatment were conducted during the Ebola outbreaks that have raged in central and west Africa over the past six years; the largest trial was conducted in the Democratic Republic of the Congo (DRC) which saw a major outbreak in 2018-2020, as well as small outbreaks since then. Ebola is a severe and too often fatal illness, and previous outbreaks and responses showed the importance of early diagnosis and treatment with optimized supportive care that includes fluid and electrolyte repletion and treatment of symptoms. “This therapeutic guide is a critical tool to fight Ebola,” said Dr Richard Kojan, co-chair of the Guideline Development Group of experts selected by WHO and President of ALIMA, The Alliance for International Medical Action. “It will help reassure the communities, health care workers and patients, that this life-threatening disease can be treated thanks to effective drugs,” said Kojan. “From now on, people infected with the Ebola virus will have a greater chance of recovering if they seek care as early as possible,” he said. “As with other infectious diseases, timeliness is key, and people should not hesitate to consult health workers as quickly as possible to ensure they receive the best care possible.” The DRC has now recorded 14 Ebola outbreaks since 1976, including six since 2018. The most recent outbreak, which began in April, was declared to be over by DRC and WHO authorities last month — with fewer cases and deaths (five) than previous episodes due to a swift response including vaccinations. Vaccinations were launched less than a week after the outbreak was declared, using an ultra-cold chain freezer in Mbandaka so vaccine doses could be stored locally and safely, and delivered effectively. That enabled 2,104 people to be vaccinated, including 1,307 frontline workers and 302 contacts. In the previous outbreak in Equateur Province from June to November 2020, 130 people were infected and 55 died. Africa’s battles with Ebola and other deadly diseases also helped prepare its health systems to deal with COVID-19. When SARS-CoV2 virus landed on the continent, the African Centres for Disease Control (CDC) reinforced its regional coordinating centers, enhanced lab capacity and unified surveillance networks. An Additional Tool for Ebola treatment Along With Clinical Care Guidance The new Ebola treatment guidelines are meant to complement clinical care guidance that outlines the optimized supportive care Ebola patients should receive including factors such as relevant tests, pain management, nutrition and co-infections. But the recommendations only apply to the Ebola virus disease caused by Ebola virus (EBOV; Zaire ebolavirus). “Advances in supportive care and therapeutics over the past decade have revolutionized the treatment of Ebola. Ebola virus disease used to be perceived as a near certain killer. However, that is no longer the case,” said Dr Robert Fowler of the University of Toronto and co-chair of the Guideline Development Group of experts selected by WHO. “Provision of best supportive medical care to patients, combined with monoclonal antibody treatment — MAb114 or REGN-EB3 — now leads to recovery for the vast majority of people,” he said. Image Credits: Photo: Anna Dubuis / DFID, WHO Therapeutics for Ebola virus disease. How Can Social Innovation Improve Life in Rural Communities? 19/08/2022 Editorial team When Dr. Magaly Blas, an Associate Professor at the Universidad Peruana Cayetano Heredia in Peru, was researching the association between the human papillomavirus that causes cervical cancer and the human T-lymphotropic virus that causes leukaemia, she found herself travelling often to the Amazon region of Ucayali, home to an indigenous community among whom the disease was prevalent. In this episode of “Global Health Matters” with host Garry Aslanyan, Blas reveals how these trips inspired her to spearhead Mamás del Río, a social innovation initiative to bring access to healthcare to remote rural communities. Luis Gabriel Cuervo from the Pan American Health Organisation (PAHO), who advises the Secretariat of the Social Innovation in Health Initiative in the Americas, also joins the podcast. “For a long time in science, attention has been paid to technical innovation, but quietly, social innovation has been blooming across Latin America,” says Aslanyan. “Communities, citizen-led organisations, and researchers have been collaborating to create new solutions to improve service delivery and strengthen health systems.” Blas started her career as a traditional researcher. However, after experiencing living in communities with no access to water, electricity, sanitation, or medical care, something began to shift. Mamás del Río Focus: Pregnant women and newborns When the study was completed and published, the scientist travelled again to the area. “When I returned to the communities, I found women who participated in my research living under the same conditions without access to any basic care,” she says. “I felt disappointed because although I was able to produce new knowledge, which is what they teach in the university, my research didn’t directly impact the health of the people with whom I worked.” As a result of the experience, Blas decided to take action, focusing on the health of pregnant women and newborn children, establishing Mamás del Río, “Mothers of the Rivers” – named after the Putumayo River that marks the border between Peru and Colombia in the Amazon. According to Cuervo, social innovation happens “when communities and partners join to find new ways of addressing pervasive problems and strengthening the health systems.” With its effort to bring healthcare to the most disadvantaged communities, Mamás del Río exactly fits the definition, and for this reason, it has received widespread recognition and support, from PAHO, the Government of Canada, and the authorities in Peru and Colombia. One of the most important principles of the organisation is empowering the communities themselves. “We believe in building capacity within the community by training community health workers,” Blas explains. “We train these community health workers who are persons from the community so that they can detect early pregnancy in their community and refer this woman to prenatal care and can also conduct home visits to pregnant women and newborns.” Mamás del Río During COVID-19 too The nonprofit was able to help also during the coronavirus pandemic. While the monthly in-person visits to the communities had to be interrupted, they were able to train the healthcare workers on how to contain the disease, as well as deploy prevention material to over 100 communities. Recently, Mamás del Río has also caught the attention of the Peruvian and Colombian governments. “They were interested in implementing the project on the border between the two countries, to now use Mothers of the River, which is called Mothers of the Border, to improve health and uniting two countries through this initiative,” Blas says. Listen to previous episodes on the Health Policy Website >> Learn more about “Global Health Matters”>> Image Credits: Courtesy of the TDR Global Health Matters Podcast, Courtesy of TDR Global Health Matters Podcast. 2nd COVID Booster Advised For Highest Risk 18/08/2022 John Heilprin The SAGE group has recommended a second COVID-19 booster for those most at risk. An expert panel of advisers to the World Health Organization (WHO) has recommended that countries consider a second COVID-19 booster dose for older, at-risk and immunocompromised people, echoing guidance provided by European and U.S. regulators months earlier. WHO’s Strategic Advisory Group of Experts (SAGE) on Immunization released its updated recommendations on Thursday, a week after it met. SAGE, created in 1999, is the main advisory group to WHO for global policies and strategies for vaccines and immunization. To cut the risk of severe disease, deaths and disruption to health services, the panel recommended a second vaccine booster dose for all elderly people – using age-specific cutoffs to be defined by each country. It also recommended a second booster for adults with comorbidities that put them at higher risk of severe disease, including pregnant women and health care workers. “There is increasing evidence on the benefits of a second booster dose of COVID-19 vaccines in terms of restoring waning vaccine effectiveness (VE). The data mainly exist for mRNA vaccines with very limited data for other COVID-19 vaccines,” the SAGE expert group concluded in their latest “Good Practice” statement on booster doses. “Evolving evidence from studies suggests that additional protection of the most vulnerable populations, at least for several months, is likely to be achieved through administration of a second booster dose, although follow-up time for these studies is limited.” Targeted Guidance for ‘Certain Populations’ SAGE chairperson Dr Alex Cravioto The guidance is similar to what has already been put forward by the European Center for Disease Prevention and Control (ECDC), the European Medicines Agency (EMA), and the US Centers for Disease Control and Prevention (CDC, which have called for second boosters to be given to people aged 60 and over and those with medical conditions. “We are now providing targeted guidance on the administration of a second booster in certain populations,” SAGE Chair Alejandro Cravioto, a professor with the Faculty of Medicine of the Universidad Nacional Autónoma de México (UNAM), told a WHO-hosted virtual press briefing. “The rationale of this recommendation is in order to avoid severe disease and death in a population at the highest risk — but does not constitute a general recommendation of vaccinating all adults after the first booster,” he said. “That means that this is selectively done, in populations that we consider are at highest risk.” On Wednesday, WHO Director General Dr Tedros Adhanom Ghebreyesus told a press briefing that people should get vaccinated or boosted before winter arrives in the northern hemisphere, a time when there is an increased risk of infection due to more time spent indoors. Selective Approach with Children Fits Panel’s ‘Roadmap’ In other recommendations, the panel said that it supports a flexible approach to homologous [e.g. the same vaccine type and brand] versus heterologous vaccination, what has also been described as mixing and matching of different vaccine types and brands, for both primary series and booster doses. Heterologous boosters should be implemented with careful consideration of current vaccine supply, vaccine supply projections, and other access considerations, it says, alongside the potential benefits and risks of the specific products being used. Cravioto said the second booster should be given “at the earliest opportunity” after six months has elapsed since the first booster. The panel did not recommend it for the general population, however, because the focus is on warding off the worst outcomes. “The principal objective continues to be the prevention of severe disease and death,” he said. The panel also updated its recommendations for the use of Pfizer-BioNTech and Moderna vaccines in children, but said it was still reviewing the data for vaccines tailored to specific variants. “In the case of both vaccines, children from six months to 17 years with comorbidities should be vaccinated to avoid a higher risk in these groups of severe disease,” he said. “We do not recommend, still, the wider use of the vaccines in younger groups, since these are not the priority groups according to our roadmap.” SAGE last updated its “roadmap” for prioritizing uses of COVID-19 vaccines in January 2022. Image Credits: Marco Verch/Flickr. Ethiopia Pursues ‘Ethnic Cleansing’ in Tigray, Tedros Says; Warns of Nuclear Threat in Ukraine 18/08/2022 John Heilprin A woman selling fruit in Adigrat, Tigray region Ethiopia’s Tigray region suffers from “the worst catastrophe on Earth” due to a devastating mix of factors such as government neglect, drought, and racism, World Health Organization Director General Dr. Tedros Adhanom Ghebreyesus told a virtual press briefing Wednesday. Tedros grew emotional at the end of the briefing as he described the humanitarian crisis facing 6 million people in the region who have been cut off from the world and insisted “it’s not because I’m from Tigray that I’m saying that.” Shifting back and forth from the crisis in Tigray, drought, and hunger throughout the Horn of Africa and also Ukraine, Tedros warned the international community may be “sleepwalking into a nuclear war” as a result of Russia’s war in Ukraine, which he called “the mother of all problems.” “But in terms of humanitarian crisis, I can tell you the humanitarian crisis is greater in Tigray,” he said. Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), at a virtual press briefing Millions of people have been displaced by the fighting between Ethiopian Prime Minister Abiy Ahmed’s government and Tigray’s regional administration. National and regional governments view one another as unlawful Abiy was awarded the Nobel Peace Prize in 2019 for defusing tensions with neighboring Eritrea, but his government has taken a hardnosed approach toward Tigray’s regional administration, which it views as unlawful – leading to the military entry to the region. Tigray’s regional administration defied the government by holding an election in September 2020. And Tigray’s regional administration saw Abiy’s government as unlawful after he postponed national elections due to the coronavirus pandemic. Tigray has now been under a virtual military siege for over a year, sparking widespread hunger as well as disease. Despite recent promises to allow the entry of desperately needed food and medical supplies, only a scattered number of relief envoys have been allowed to pass by the Ethiopian forces amassed around and inside parts of Tigray. In January, Tedros slammed Ethiopia’s “complete blockade” on health and humanitarian aid to the Tigray region, saying it has been unable to deliver life-saving medications for nearly six months in a situation that is “unprecedented” even in comparison to conflict-wracked Syria or Yemen. Eritrean refugees in Ethiopia now also fear retaliation from Eritrean forces operating in the region in an alliance with Ethiopia’s government. Almost 60,000 Ethiopian refugees have fled to eastern Sudan since the conflict began, according to the UN refugee agency. While Tedros called attention to the crisis in Ukraine, he said he hadn’t heard any head of state from the developed world talking about Tigray during the last few months. “Why? Maybe the reason is the color of the skin of the people in Tigray,” he said. “Nowhere in the world you would see this level of cruelty, where a government punishes 6 million of its people for more than 21 months.” “How can peace talks occur when people are being suffocated?” he asked, grabbing his neck by his own hands to underline the point. “The only thing we ask is, ‘Can the world come back to its senses and uphold humanity?’” UN warnings go back to November 2020 A woman brings her child to a clinic in Wajirat in Southern Tigray in Ethiopia to be checked for malnutrition in late summer. United Nations officials warned of a full-scale humanitarian crisis unfolding in Ethiopia almost two years ago. The conflict erupted after an attack on an Ethiopian government military base in Tigray. Abiy’s government sent troops in to seize control of Tigray’s governing Tigray Peoples’ Liberation Front (TPLF) party and several towns and a humanitarian base with nearly 100,000 Eritrean refugees. Humanitarian aid groups said the government forces effectively sealed off the Tigray region since July 2021, disrupting the flow of crucial food and aid supplies. But the UN Office for the Coordination of Humanitarian Affairs (OCHA) reported earlier this month that 6,105 trucks were able to bring more than 1.4 million metric tons of humanitarian supplies into Tigray since humanitarian convoys resumed in April. The overall humanitarian situation in Ethiopia has significantly deteriorated in 2022 leading to increased humanitarian needs across the country due to ongoing conflict and violence, and climatic shocks such as the prolonged drought,” OCHA said in an 5 Aug situation report. “More than 20 million people are to be targeted for humanitarian assistance and protection this year. Nearly three quarters of them are women and children.” Both sides agreed to hold talks in June after a cease-fire and the flow of aid was somewhat restored but not enough to meet the needs of the millions of people still trapped in the region. As many as 13 million people in the northern Tigray, Afar, and Amhara regions need food assistance due to conflict, according to the World Food Program, and 7.4 million people across the country face severe hunger due to drought. Ethnic cleansing – it could be even more … Tigray refugees Tedros has been at odds with Ethiopia’s government for some time. When he was confirmed for a second term as WHO chief this year, Ethiopia did not co-sponsor his nomination — the first time that an incumbent director general at the UN health agency was thus shunned by his own home country. Ethiopia’s government also wrote WHO earlier this year accusing Tedros of “misconduct” after his sharp criticism of the war and humanitarian crisis in the country. He previously had served as both Ethiopian foreign minister and health minister. That has not deterred Tedros, who spoke movingly about his experiences as a “child of war” growing up in Tigray under earlier cycles of conflict at the opening of the World Health Assembly, on 22 May, where he was elected for a second term as Director General. And on Wednesday, he was even more blunt about the situation unfolding in the region. “It’s ethnic cleansing. It could even be more? Why are people not telling the truth,” Tedros told the press briefing. “Why are we keeping quiet when 6 million people are being punished?” Image Credits: Christine Nesbitt/ UNICEF, Rod Waddington/Flickr, UNICEF/Christine Nesbitt, © UNFPA/Sufian Abdul-Mouty. Monkeypox Cases Spike 20% Weekly Worldwide 17/08/2022 John Heilprin Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), at a virtual press briefing As the first monkeypox case involving a human-to-dog transmission reported, the World Health Organization (WHO) said more than 35,000 recently confirmed cases of monkeypox were accompanied by 12 deaths in 92 nations and territories, including almost 7,500 from last week alone. That made for the second consecutive week with a 20% increase, WHO Director-General Dr Tedros Adhanom Ghebreyesus said Wednesday. Almost all of the cases are being reported from Europe and the Americas and involve men who have sex with men, Tedros told a virtual press briefing, underscoring the importance for all countries to design and deliver services and information tailored to these communities that protect health, human rights and dignity. “The primary focus for all countries,” said Tedros, “must be to ensure they are ready for monkeypox and to stop transmission using effective public health tools, including enhanced disease surveillance, careful contact tracing, tailored risk communication and community engagement and risk reduction measures.” Related to the challenge of outreach, Dr Mike Ryan, executive director of WHO’s Health Emergencies Program, said WHO would “follow up directly” with Mexico’s government – when asked by a Mexican journalist why the country has not yet mounted programmes for widespread testing or clear outreach to potentially vulnerable populations of men – despite a fourfold increase in daily reported cases over the past two weeks. Tedros said vaccines may also play an important part in controlling the outbreak, and in many countries there is high demand for vaccines from the affected communities. “However, for the moment, supplies of vaccines and data about their effectiveness are limited. Although, we are starting to receive data from some countries,” he noted. “WHO has been in close contact with the manufacturers of vaccines and with countries and organizations willing to share those. We remain concerned that the inequitable access to vaccines we saw during the COVID-19 pandemic will be repeated, and that the poorest will continue to be left behind.” Bavarian Nordic, the world’s sole manufacturer of US and European-approved monkeypox vaccines has currently closed its manufacturing plant for renovations – and does not expect to reopen until late this year. Meanwhile, a few wealthy countries, led by the United States, have snapped up all available doses. See Health Policy Watch’s exclusive report: Exclusive: Closure of World’s Only Manufacturing Plant for Monkeypox Vaccine Raises Questions About World’s Ability to Meet Rising Demand First case of human to dog transmission Pet dog in France gets monkeypox from 2 men in same household WHO officials also confirmed the first case of human-to-dog transmission in Paris, where two men went to a hospital and were confirmed to have monkeypox. Twelve days later, a 4-year-old male Italian greyhound that was allowed to sleep with them also tested positive for the virus, according to a recent Lancet article. The case already prompted the U.S. Centers for Disease Control and Prevention to issue new guidance that people with monkeypox should avoid contact with animals, including pets, domestic animals and wildlife to avoid spreading the virus. “Infected animals can spread monkeypox virus to people, and it is possible that people who are infected can spread monkeypox virus to animals through close contact, including petting, cuddling, hugging, kissing, licking, sharing sleeping areas, and sharing food,” stated the CDC guidance. Dr Sylvie Briand, director of WHO’s Epidemic and Pandemic Preparedness and Prevention department (EPP), said it is important to differentiate between the emergence and reemergence of diseases. “It’s something that we know, most of the emerging viruses are coming from animals,” she said. “This is the case for monkeypox, and they infect humans. So at the beginning, it’s only sporadic cases,” she said, referring to the fact that the virus was only discovered in 1958, and for decades after that circulated in a mostly self-limiting way between animals and human communities in central and west Africa. . But if the virus finds the right environment, Briand said, it can evolve to more effectively target humans, resulting in more localized transmission especially in conditions of “high human density, very close contact,” she said. “This is what we have seen with monkeypox. Initially it was in animals, then it went to some humans. And then we had a localized outbreak and now we have a multi-country outbreak.” In terms of disease reemergence, other factors then play out as well. “It’s often because the vaccine coverage is too low that those diseases reemerge,” she said. “And it’s very important to understand that vaccine coverage is a very, very important indicator of the protection of human beings against disease.” 2020 study predicted heightened monkeypox risk with declining smallpox immunity Monkeypox lesions Ironically, a study published in September, 2020 in the Bulletin of the WHO Health Organization, predicted that Central and West Africa’s monkeypox outbreaks could become more frequent – with eventual mutations of the virus increasing human to human transmission as well. Earlier this month, a group of global experts convened by WHO agreed that the virus’s variants will be renamed with Roman numerals. In a review of historical data on outbreaks of Clade 1 of the monkeypox virus in the Democratic Republic of Congo, the authors from Institut Pasteur contended that transmission had remained self-limiting throughout the 1960s and 1970s because most people in DRC were vaccinated against smallpox – which protects against monkeypox virus too. However, after smallpox was declared to be eradicated, and smallpox vaccination ceased in the 1980s – that herd immunity waned: “Since then, the Democratic Republic of the Congo has reported increased monkeypox human infections, and parts of the country have been declared monkeypox-endemic areas,” the report’s authors note. “In 2011–2012, the population immunity against orthopoxvirus species was only 60%… among individuals vaccinated against smallpox and 26% …among individuals unvaccinated against smallpox.” Due to declining immunity, more frequent outbreaks may occur in endemic countries, triggered initially by contact with infected animals, the authors predicted, but they added that over time monkeypox may begin to undergo more “sustained human-to-human transmission (R > 1).” “In either case, repeated circulation of monkeypox in human hosts, particularly immunocompromised hosts, favours pathogen evolution and emergence of newly human-adapted pathogens, depending on R and on the human pathogen fitness landscape.” “”This finding may explain the increasing number of monkeypox outbreak reports, resulting in endemic monkeypox in central African countries…. “Moreover, with declining immunity to orthopoxvirus species, monkeypox can pose an ever-increasing threat for health security.” A prescient conclusion indeed in light of today’s rapidly evolving global health emergency. –Elaine Ruth Fletcher contributed to this story Image Credits: Mothership.sg/Twitter , Tessa Davis/Twitter . W. Africa’s Polluted Air 2nd Only to S. Asia 17/08/2022 John Heilprin & Elaine Ruth Fletcher Downtown Lagos – new study finds it to be among the most polluted cities in Africa and the world. Some 1.7 million people in cities across the planet died from polluted air in 2019, according to the first-ever study of urban air pollution that covers virtually every city in the world over the size of 50,000 people, as per the UN definition. Conditions are the most severe in cities of South Asia, (WHO’s SouthEast Asia region). Strikingly, however, cities in West Africa, are a close follower – with average annual fine particulate (PM2.5) concentrations of 62 micrograms/cubic meter of air (µg/m3), more than 15 times above WHO guideline levels. The study by the State of Global Air Initiative, a collaboration between Boston-based Health Effects Institute (HEI) and Seattle-based Institute for Health Metrics and Evaluation’s (IHME) Global Burden of Disease project, is the largest analysis of urban air pollution to date. It examines data spanning the years 2010-2019 for 7,239 cities, home to some 2.8 billion people. It is also the first global analysis to compare trends in cities over time. The study confirms that urban residents face some of the world’s worst air quality, with 98% of people in all cities around the world breathing air that fails to meet the WHO Air Quality guideline level of 5 µg/m3 – what is considered the most key indicator of health impacts. And with 68% of the world’s population expected to live in urban areas by 2050, air pollutants loom as a major battle for many of the world’s top cities. India and Indonesian cities saw the world’s worst increases in polluted air Industrial air pollution in India – South East Asia is the hardest hit by air pollution overall. While PM2.5 exposures “decreased” in some cities between 2010 and 2919, most notably in China, in parts of South Asia, notably India and Indonesia, air pollution in fact became much worse. “Of 7,239 cities, India is home to 18 of the 20 cities with the most severe increase in PM2.5 pollution from 2010 to 2019. The other two cities are in Indonesia. Alll these cities saw an increase of more than 30 µg/m3 during that decade. Of the 50 cities with the msot severe increase in PM2.5 pollution, 41 are in India and 9 are in Indonesia,” it adds. As for the present day: “Exposures are particularly high in cities in Asia, West Sub-Saharan Africa, and Andean and Central Latin America, the report concludes. “More progress is necessary to protect the health of residents.” Only 2% of cities meet the WHO Air Quality Guidelines and 41% of cities exceed even the least stringent WHO interim Air Quality Guideline Some 86% of cities around the world also exceed WHO’s guidelines for NO2, whose dangers for asthma and lung diseases have been better recognized more recently. Strikingly, cities with excessive levels of NO2 include cities in many high- and middle-income countries where stricter regulations on vehicle and power plant emissions may have reduced PM2.5 levels – but have not sufficiently addressed NO2. Diesel vehicles, promoted by the industry over the last 30 years, emit comparatively higher levels of NO2. Estimates on polluted air combine data from ground monitoring and satellites The new analysis combines available data on air quality from ground-level monitoring stations with satellite data from thousands of cities that lack stations of their own. It provides the full data set on an interactive database. The study estimated annual average concentrations of PM2.5 and NO2 for cities across the planet by integrating available ground-level and satellite data, then dividing that information into grid cells of approximately 1×1 km at the equator. Only 117 nations have ground-level monitoring systems to track PM2.5, and only 74 nations are monitoring NO2 levels, according to the report, which draws its ground level data from an online repository maintained by the World Health Organization. Based on available ground station data, WHO in April issued estimates of average annual air pollution concentrations in 4,000 cities and settlements around the world. Those included PM2.5, and NO2 when data was available. Some of the findings about global hotspots are roughly comparable with WHO’s own recent analysis – which also found that people in South/Southeast Asia, the Middle East and parts of Africa continue to breathe some of the worst air on the planet. However, WHO did not analyse trends over time. Nor did WHO attempt to incorporate satellite data from cities where ground-level measurements are unavailable – which includes most of urban Africa. This new analysis fills in that critical gap – and in the process it reveals how serious pollution in some parts of Africa, and particularly West Africa, has become. “Since most cities around the world have no ground-based air quality monitoring in place, estimates of particulate and gas pollution levels can be used to plan air quality management approaches that ensure the air is clean and safe to breathe,” said Susan Anenberg, an associate professor at George Washington University and one of the project collaborators. West African cities – now among the world’s most polluted Average annual urban air pollution concentrations by region shows cities in South Asia folowed by cities in West Africa as the most polluted in the world. Unlike the most recent WHO study, the HEI/IHME study also estimated air pollution in terms of “population-weighted” exposures to air pollution in each city considered – rather than in terms of the city’s spatial limits only – linking the pollution concentrations in each grid cell with the number of people living within each block to produce a population-weighted annual average. Population-weighted exposures are an essential input to the estimation of mortality, per capita, from air pollution in any given area. In terms of population-weighted exposures, the data includes some surprises. Not only do people in longstanding hotspots like Delhi, Kolkata, Dhaka and Jakarta as well as Beijing, continue to breathe some of the the worst air in the world, so do people in Lima Peru; Lagos and Kano, Nigeria, and Accra, Ghana. Geographic patterns of air pollutants NO2 and PM2.5 strikingly different The study also confirms prior WHO findings that the geographic patterns of excessive exposure to PM2 and NO2 are considerably different at times. “Cities in Asia and Africa are already hotspots for PM2.5 pollution,” the study concludes. “At the same time, NO2 pollution – primarily from vehicle traffic – is high and growing in some cities and regions that are not PM2.5 hotspots.” Air pollutants responsible for 7 million deaths worldwide Air pollution is responsible for about 1-in-9 deaths worldwide, or between 6.7 to 7 million deaths a year, according to the latest estimates by both HEI/IHME and WHO. Outdoor, ambient air pollution is estimated by WHO to kill about 4.2 million people a year. There is an overlap, however, between deaths attributable to outdoor air pollution and the estimated 3.2 million deaths a year attributed to household air pollution. The latter is related largely to exposures to smoke from biomass, kerosene and coal fires used by billions of people for cooking and heating. Air pollution is a factor in illness and premature deaths particularly in older people and those with chronic respiratory and cardiovascular conditions. WHO estimates that quarter of all deaths from heart attacks and stroke, and nearly 30% of deaths from lung cancer, as well as 43% of deaths from lung disease, are attributable to air pollution. Exposure to NO2, meanwhile, exacerbates lung inflammation, contributing to asthma and other respiratory diseases, and potentially impeding children’s lung development. High NO2 exposures that lead to difficulties breathing, coughing or wheezing, may cause spikes in hospital and emergency-room admissions, according to WHO. People living near busy roads congested with lots of city traffic often are exposed to higher levels than people in rural settings. China air quality improved but air pollution related mortality still very high In terms of mortality, a significant number of Chinese cities, led by Beijing, continue to have a high proportion of deaths from air pollution. That is despite the fact that China is the country that has also seen the greatest improvements in urban quality over the past couple of decades, the report finds. This paradox is due to two factors – the comparative ageing of China’s population and the fact that exposure to air pollution, even at comparatively lower levels, can still be deadly. Recognizing this, WHO in 2018 reduced by half it’s guideline level for annual average exposure levels of PM2.5 from 10 to 5 µg/m3. WHO also halved its NO2 guideline level to 10 µg/m3. Urban air pollution hotspots by region. In South/SouthEast Asia mortality from urban air pollution also has grown significantly in the past 20 years, the report also concludes – with Jakarta and Delhi having the highest levels of mortality, per 100,000 population, from air pollution. In central Asia, hot spots included Tashkent, Uzbekistan and Almaty, Kazakhstan. Most of those cities also are areas long reliant on coal-burning for heat and power production. Compared to other parts of eastern and central Europe, Kyiv and Kharkiv in Ukraine, the Polish cities of Katowice and Warsaw, as well as Budapest Hungary and Bucharest, Romania, also had high pollution-related death rates. Conversely, African cities don’t rank as prominently in terms of global air pollution-related mortality – largely because the residents of African cities are much younger on average and thus not as likely to die – yet – from air pollution related diseases. Taking action against air pollutants Cycling in Fortaleza, Brazil – the city has won worldwide recognition for its sustainable transport planning that contributes to healthy physical activity and reduces air pollution. The good news, the study concludes, is that there are a wide range of cost-effective solutions already available to reduce pollution from many key pollution sources. Those include the promotion of green and sustainable transportation, expanded access to clean energy for households and a shift to clean and efficient energy production based on renewable energy sources and not fossil fuels. The report also cites some of the urban solutions have yielded results, including stricter vehicle and power plant emissions limits and urban planning solutions that reduce the need to travel. In Europe, for instance, more than 300 cities created low-emission zones (LEZs) for vehicles that reduced traffic-related air pollution by banning the entry of high-polluting vehicles and encouraging more walking, cycling and use of public transportion. In China’s capital Beijing, new measures such as tighter controls over coal-fired power plants, more stringent vehicle emission and fuel quality standards, and additional air monitoring stations contributed to a 36% decline in the city’s annual average PM2.5 level over five years. But those successes remain exceptions to the rule for many, or even most, of the world’s low and middle income cities – which have not yet come to grips with air pollution as a deadly health threat. “As cities around the world rapidly grow,” said Pallavi Pant, a senior scientist with HEI who oversaw the study, “the impacts of air pollution on residents’ health are also expected to increase, underscoring the importance of early interventions to reduce exposures and protect public health.” Image Credits: Flickr/US 6th Fleet photostream, Uncommonthought.com, Air Quality and Health in Cities, State of Global Air Report , Urban Air Quality and Health – State of Global Air , Air Quality and Health in Cities, State of Global Air,, Air Quality and Health In Cities, State of Global Air , City of Fortaleza. Climate Change is a Double Blow for People with Disabilities 16/08/2022 Kavitha Yarlagadda Pratyush Nalam, a software professional in Hyderabad, India HYDERABAD – Pratyush Nalam, a software professional in this south-central Indian city that has become a global tech outpost for Silicon Valley, moves around his house in his wheelchair. He has spinal muscular atrophy and cannot walk, so his family members help him. Though the monsoon season in Hyderabad brings lots of precipitation from the end of June to early October, scientists say the rains are getting even heavier due to climate change. And that, says Nalam, is making life tougher for people than summer heat or winter’s chills. “Getting to a dry place quickly is a challenge,” Nalam says of the growing challenge he faces in just getting around. “Bus stops don’t have shelters and are far to get to – and accessible transport is not available in most cases.” The combined detrimental effects from a lack of inclusive planning or early warning systems, less information and transportation options, and overall discriminatory attitudes has driven the global mortality rate for people with disabilities who experience natural disasters up to four times higher than it is for people without disabilities, according to a Lancet report. Nalam said that during heavy rains “we cannot see the bumps on the roads or sidewalks, which make it riskier to drive our wheelchairs.” Hotter and hotter norms Summer in India has temperatures that regularly climb into the high 30C. Europe has suffered wildfires, evacuations and heat-related deaths this summer, as heat waves force temperatures above 40 degrees C in places like Portugal and France – only slightly hotter than the warmest season in Hyderabad, where temperatures regularly climb into the high 30s C during the pre-monsoon summer from late March to early June. Still, a devastating heat wave that scientists say was made more likely by climate change has baked India and Pakistan in recent months, with some cities in the two neighboring countries reaching around 45 to 50 C. Across Europe and Asia, record temperatures have challenged daily lives, posing serious health risks to families, students, businesspeople and travelers. As with most other natural and manmade disasters, the people that suffer the most often are those that are the most marginalized. “Extreme heat is the root cause of all of the catastrophic events that we are experiencing, from wildfires to drought, hurricanes, storm surges, and flooding,” said Wendy Nystrom, an environmental and pollution risk management consultant in Los Angeles. Among those most affected by climate change Aunia Kahn Persons with disabilities are frequently among the worst affected by climate change, similar to the disproportionately higher rates of morbidity and mortality they suffer in emergencies while also being among the least able to get emergency assistance. “It feels that I am always living in a bubble. I am allergic to heat and cold and this makes me very vulnerable to climate change,” said Aunia Kahn, a disabled U.S. business owner in Eugene, Oregon, who struggles with rare chronic illnesses such as Ehlers Danlos Syndrome, Mast Cell Activation Syndrome, and Dysautonomia. Certain conditions of disability are disproportionately affected by global warming. For example, people with spinal cord injuries cannot cool themselves during excessive heat while people with multiple sclerosis feel more pain and fatigue during hot weather conditions. Some 15% of the world’s population have a disability, the World Bank reported. Many people with them also live in extreme poverty, exacerbating their vulnerability to climate change due to a general lack of proper sanitation, health care, nutrition or safe drinking water. “Earth is warming and global warming is the main reason for the extreme heat waves. Heat intensity is increasing and reducing the quality of our lives,” said Dr. Roxy Mathew Koll of the Indian Institute of Tropical Meteorology in Pune, India. “The vulnerable are the ones who are the most impacted.” Dr Roxy Mathew Koll An increasing human rights issue But the right to a clean, healthy and sustainable environment should be the same for all irrespective of differences such as caste and creed, the UN General Assembly determined in a landmark resolution approved in late July. The assembly’s 161-0 vote with eight abstentions by Belarus, Cambodia, China, Ethiopia, Iran, Kyrgyzstan, Russia and Syria gives momentum to the work of activists and citizens seeking greater legal and regulatory protections. It followed a 43-0 vote on a similar resolution last October in the 47-nation UN Human Rights Council – with China, India, Japan and Russia abstaining. Lack of mobility in emergencies is life-threatening People with disabilities and women and children in South Asia and Africa are more vulnerable to severe weather events like heat waves, floods, cyclones and storm surges, according to experts. This is because they have less access to information on climate adaptation, rarely benefit from government aid and have fewer economic privileges than men. And extreme weather events like cyclones and floods are intensifying in a very short time, giving disabled people little time to move to safety, according to Koll. “People with disabilities, particularly with mobility issues, have limited capacity to respond to emergency situations during an extreme weather event,” he said. But only 10% of people with disabilities believe their local government has emergency, disaster management, or risk reduction plans that address their access and functional needs, according to a UN report. And just 20.6% said they could self-evacuate without difficulty in the event of a sudden disaster, a UN Office for Disaster Risk Reduction online survey found. A hot day in Hyderabad For the old and young, climate change presents difficulties. Vishnu Kumar, a 75 year old man from Hyderabad, suffered a paralytic stroke three years ago and has been confined to a bed and wheelchair since then. As with many elderly, the excessive heat zaps his energy and the frequent power cuts only increase his discomfort, adding to friction in his family. And for student Rohit Reddy, eczema and allergies worsened during summers in the coastal city of Mumbai, costing him time needed for his studies. “I had to shift to Hyderabad because of the flare ups due to extreme humidity, now I may lose an academic year,” Reddy said. -Updated 16.08.2022 with correction to the name of Pratyush Nalam’s condition as spinal muscular atrophy, not muscular dystrophy. Image Credits: Skymet , Pratyush Nalam, Aunia Kahn, Roxy Koll, Gulf News. Monkeypox Variants Get New Names 12/08/2022 Editorial team While the process of renaming monkeypox is still underway, a group of global experts convened by the World Health Organization (WHO) has agreed that the virus’s variants will be renamed with Roman numerals. This follows a meeting convened by the WHO this week to enable virologists and public health experts to reach consensus on new terminology, the global body announced on Friday. Experts in pox virology, evolutionary biology and representatives of research institutes from across the globe reached consensus that the former Congo Basin (Central African) clade will be referred to as Clade one (I) and the former West African clade as Clade two (II). The group also agreed that Clade II consists of two subclades, which will be referred to as Clade IIa and Clade IIb. Assigning new names to existing diseases is the responsibility of WHO under the International Classification of Diseases and the WHO is holding an open consultation for a new name for monkeypox. Anyone wishing to propose new names can do so here. The naming of virus species is the responsibility of the International Committee on the Taxonomy of Viruses (ICTV), which also has a process underway for the name of the monkeypox virus. Image Credits: TRT World Now/Twitter . India is Trying to Reduce Maternal Mortality Without Addressing a Key Contributor: Suicide 12/08/2022 Disha Shetty Suicide is one of the leading causes of death among women of childbearing age in India. Pregnancy is most often a cause for celebration of a new life and a new addition to the family. But for the women who walk into Garima Malik’s clinic in New Delhi, it is a very different story. Some cry. Others appear angry, irritable or frustrated. Usually, the cause is domestic violence – pregnancy is a particularly vulnerable time and as an experienced counsellor, Malik is trained to spot the signs. “They talk about suicide,” she says. “Then they calm down. We talk about risk management and safety planning and counselling. So somehow, they cope.” Malik says many of those who come to the clinic, run by the medical charity Medecins Sans Frontieres (MSF), have experienced physical and emotional violence during pregnancy. Sometimes this is because they are unwilling to be intimate with a partner in the early part of the pregnancy or immediately after the birth. Other times it is because they have given birth to a girl, seen by some as less desirable. “This can cause loneliness in women and they feel frustrated and they feel like he [the husband] needed the child, the family needed the child, and I am the one suffering,” she says. Malik says they are the lucky ones — most Indian women who experience suicidal thoughts in the period during or after their pregnancy will not seek or receive any help. Yet suicide is one of the leading causes of death among women of child-bearing age in India. According to one recent study published in The Lancet medical journal, the suicide rate among Indian women and girls is twice the global average. Women may experience suicidal thoughts during or after pregnancy. India has made enormous strides since the turn of the century in reducing overall maternal mortality, reducing deaths by more than half. In 2019, 103 mothers were dying per 100,000 live births, down from 254 in 2004. The United Nations has set the goal of reducing maternal mortality globally to 70 deaths per 100,000 by 2030. But that success has exposed a phenomenon that had previously gone largely unnoticed in India: high rates of suicides in the perinatal period, defined as during and immediately after pregnancy. A 2016 study of 462 low-income women in early pregnancy in south India found 7.6% were at risk of suicide compared to roughly 0.4% in the United States. Health experts say the government has done little to address this problem, and a suicide prevention action plan devised in 2018 has never been implemented. India is losing young women “in enormous numbers,” says Lakshmi Vijayakumar, a psychiatrist and a member of the World Health Organization (WHO)’s International Network for Suicide Research and Prevention. “And we don’t have any effective mechanism or plan or strategy to address this issue.” The Indian government did not respond to a request for comment. Data on this is limited. India compiles national maternal death statistics by extrapolating from a representative sample survey, but does not separate the data into causes of death. Police keep data on reported suicides, but do not record whether the person was pregnant, and anyway, suicides are underreported. Perinatal suicides are often linked to a history of psychiatric illness, but Lakshmi* says this does not seem to be the case in India. Instead, social factors such as early marriage, intimate partner violence, pressure to give birth to a son and women’s lack of financial autonomy are drivers. Reducing maternal deaths — a revealing success story When it comes to the physical causes of maternal deaths, India’s success has been marked and is largely due to an increase in deliveries at free public health facilities rather than at home. In-facility deliveries rose from 31.1% in 2005-06 to 88.6% in 2019-21, according to government figures, driven by awareness campaigns and offering small financial incentives to pregnant women and grassroots health workers. The southern Indian state of Kerala has been among the most successful in reducing maternal deaths. With 43 per 100,000 live births, it is the safest place in the country to give birth. It is also the only state to have looked into perinatal suicide data, analyzing the 1,076 maternal deaths registered between 2010 and 2020. During that period, mortality dropped from 66 to 43, but the share of suicides increased from about 2.6% in 2010 to 6.6% five years later, and to 18.6% in 2019–20. But that data should be treated with some caution – Kerala’s relatively low rates of maternal mortality were based on a small sample but, combined with the 2016 study in south India, it indicates a trend, says Soumitra Pathare, psychiatrist and director of the Centre for Mental Health Law and Policy. “It is important for various reasons – we now have systematic data to show that suicides are a significant problem in young women, especially young women who are pregnant or have just delivered a child,” he says. “Maternal mortality has gone down substantially because that’s something that has had an intervention done for it. So what this actually shows is that we’ve not done any intervention for suicide prevention.” He cautioned that the data capture only some of the problem. For every person who dies by suicide, an estimated four to 20 times more people attempt it. “So the number of attempted suicides [in India] is anywhere between 0.6 million to 6 million,” said Pathare. “We don’t even collect data on it. ” Early intervention is key Nearly a third of Indian women between the ages of 15 and 49 who have been married, have experienced intimate partner violence. There has been little research into the drivers of perinatal suicide in India, though the Kerala review identified psychiatric illness, young age, unmarried status and domestic violence as risk factors. Nearly one in every three Indian women between the ages of 15-49 who has ever been married has experienced intimate partner violence, according to government figures. Around 3.1% of women in this category said they experienced physical violence during pregnancy. Marital rape is not legally recognized, although this is being challenged in the courts. Nayreen Daruwalla, head of a program on the prevention of violence against women and children at the Mumbai-based non-profit SNEHA, says suicide during pregnancy often falls into one of two categories. “One is pregnant women who are married and in whose cases the family insists on having a boy,” she said. “Unwed mothers are a huge category of cases especially given the lack of social support and sometimes the lack of support from the partner who might be reluctant to wed on finding out the woman is pregnant.” Experts say early intervention is key to preventing perinatal suicides, and that India already has the systems in place to do this. Shaji KS, dean of research at the Kerala University of Health Sciences and part of the team that reviewed perinatal suicides in Kerala, cites India’s network of grassroots health workers, through whom every pregnant person in the country can be reached. Adding a psychiatric component to support their mental health would help prevent many deaths, he said. MSF’s Malik sees a need for more vocational training to enable Indian women to become financially independent, making it easier for them to escape abusive situations. Research in Australia has found this to be effective in reducing suicides. In India, women’s labour force participation has steadily declined from around 30.4% in 2000 to 19% in 2021. “When we talk to such patients, when we talk about leaving husbands and leaving such [a] toxic environment and getting out of this kind of relationship, they want to,” she said. “They cannot because they are not financially independent.” Studies also show restricting access to pesticides, used in many suicides in India, might prevent some of the deaths. Lakshmi, the psychiatrist and WHO advisor, was part of a task force set up by the Indian government in 2018 to suggest ways to reduce overall suicides, whose recommendations have not been implemented. Asked about funding for suicide prevention, the government said in February that funds had been allocated and announced plans for a national telemedicine program for mental health. But it did not commit to adopting the task force’s recommendations. “We have submitted the plan” said Lakshmi. “It is still lying there. I hope that one day it will see the light of day.” * The use of a given name used on second reference is common practice in parts of south India If you or someone you know is struggling with mental health or suicidal thoughts, help is available at iCALL run by TISS at 9152987821 [India] or the National Suicide Prevention Lifeline at 1-800-273-8255 [US]. This article was first published in The Fuller Project. Image Credits: Children's Investment Fund/Flickr , UN Photo/Kibae Park/Flickr, Yogendra Singh/ Unsplash. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... 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How Can Social Innovation Improve Life in Rural Communities? 19/08/2022 Editorial team When Dr. Magaly Blas, an Associate Professor at the Universidad Peruana Cayetano Heredia in Peru, was researching the association between the human papillomavirus that causes cervical cancer and the human T-lymphotropic virus that causes leukaemia, she found herself travelling often to the Amazon region of Ucayali, home to an indigenous community among whom the disease was prevalent. In this episode of “Global Health Matters” with host Garry Aslanyan, Blas reveals how these trips inspired her to spearhead Mamás del Río, a social innovation initiative to bring access to healthcare to remote rural communities. Luis Gabriel Cuervo from the Pan American Health Organisation (PAHO), who advises the Secretariat of the Social Innovation in Health Initiative in the Americas, also joins the podcast. “For a long time in science, attention has been paid to technical innovation, but quietly, social innovation has been blooming across Latin America,” says Aslanyan. “Communities, citizen-led organisations, and researchers have been collaborating to create new solutions to improve service delivery and strengthen health systems.” Blas started her career as a traditional researcher. However, after experiencing living in communities with no access to water, electricity, sanitation, or medical care, something began to shift. Mamás del Río Focus: Pregnant women and newborns When the study was completed and published, the scientist travelled again to the area. “When I returned to the communities, I found women who participated in my research living under the same conditions without access to any basic care,” she says. “I felt disappointed because although I was able to produce new knowledge, which is what they teach in the university, my research didn’t directly impact the health of the people with whom I worked.” As a result of the experience, Blas decided to take action, focusing on the health of pregnant women and newborn children, establishing Mamás del Río, “Mothers of the Rivers” – named after the Putumayo River that marks the border between Peru and Colombia in the Amazon. According to Cuervo, social innovation happens “when communities and partners join to find new ways of addressing pervasive problems and strengthening the health systems.” With its effort to bring healthcare to the most disadvantaged communities, Mamás del Río exactly fits the definition, and for this reason, it has received widespread recognition and support, from PAHO, the Government of Canada, and the authorities in Peru and Colombia. One of the most important principles of the organisation is empowering the communities themselves. “We believe in building capacity within the community by training community health workers,” Blas explains. “We train these community health workers who are persons from the community so that they can detect early pregnancy in their community and refer this woman to prenatal care and can also conduct home visits to pregnant women and newborns.” Mamás del Río During COVID-19 too The nonprofit was able to help also during the coronavirus pandemic. While the monthly in-person visits to the communities had to be interrupted, they were able to train the healthcare workers on how to contain the disease, as well as deploy prevention material to over 100 communities. Recently, Mamás del Río has also caught the attention of the Peruvian and Colombian governments. “They were interested in implementing the project on the border between the two countries, to now use Mothers of the River, which is called Mothers of the Border, to improve health and uniting two countries through this initiative,” Blas says. Listen to previous episodes on the Health Policy Website >> Learn more about “Global Health Matters”>> Image Credits: Courtesy of the TDR Global Health Matters Podcast, Courtesy of TDR Global Health Matters Podcast. 2nd COVID Booster Advised For Highest Risk 18/08/2022 John Heilprin The SAGE group has recommended a second COVID-19 booster for those most at risk. An expert panel of advisers to the World Health Organization (WHO) has recommended that countries consider a second COVID-19 booster dose for older, at-risk and immunocompromised people, echoing guidance provided by European and U.S. regulators months earlier. WHO’s Strategic Advisory Group of Experts (SAGE) on Immunization released its updated recommendations on Thursday, a week after it met. SAGE, created in 1999, is the main advisory group to WHO for global policies and strategies for vaccines and immunization. To cut the risk of severe disease, deaths and disruption to health services, the panel recommended a second vaccine booster dose for all elderly people – using age-specific cutoffs to be defined by each country. It also recommended a second booster for adults with comorbidities that put them at higher risk of severe disease, including pregnant women and health care workers. “There is increasing evidence on the benefits of a second booster dose of COVID-19 vaccines in terms of restoring waning vaccine effectiveness (VE). The data mainly exist for mRNA vaccines with very limited data for other COVID-19 vaccines,” the SAGE expert group concluded in their latest “Good Practice” statement on booster doses. “Evolving evidence from studies suggests that additional protection of the most vulnerable populations, at least for several months, is likely to be achieved through administration of a second booster dose, although follow-up time for these studies is limited.” Targeted Guidance for ‘Certain Populations’ SAGE chairperson Dr Alex Cravioto The guidance is similar to what has already been put forward by the European Center for Disease Prevention and Control (ECDC), the European Medicines Agency (EMA), and the US Centers for Disease Control and Prevention (CDC, which have called for second boosters to be given to people aged 60 and over and those with medical conditions. “We are now providing targeted guidance on the administration of a second booster in certain populations,” SAGE Chair Alejandro Cravioto, a professor with the Faculty of Medicine of the Universidad Nacional Autónoma de México (UNAM), told a WHO-hosted virtual press briefing. “The rationale of this recommendation is in order to avoid severe disease and death in a population at the highest risk — but does not constitute a general recommendation of vaccinating all adults after the first booster,” he said. “That means that this is selectively done, in populations that we consider are at highest risk.” On Wednesday, WHO Director General Dr Tedros Adhanom Ghebreyesus told a press briefing that people should get vaccinated or boosted before winter arrives in the northern hemisphere, a time when there is an increased risk of infection due to more time spent indoors. Selective Approach with Children Fits Panel’s ‘Roadmap’ In other recommendations, the panel said that it supports a flexible approach to homologous [e.g. the same vaccine type and brand] versus heterologous vaccination, what has also been described as mixing and matching of different vaccine types and brands, for both primary series and booster doses. Heterologous boosters should be implemented with careful consideration of current vaccine supply, vaccine supply projections, and other access considerations, it says, alongside the potential benefits and risks of the specific products being used. Cravioto said the second booster should be given “at the earliest opportunity” after six months has elapsed since the first booster. The panel did not recommend it for the general population, however, because the focus is on warding off the worst outcomes. “The principal objective continues to be the prevention of severe disease and death,” he said. The panel also updated its recommendations for the use of Pfizer-BioNTech and Moderna vaccines in children, but said it was still reviewing the data for vaccines tailored to specific variants. “In the case of both vaccines, children from six months to 17 years with comorbidities should be vaccinated to avoid a higher risk in these groups of severe disease,” he said. “We do not recommend, still, the wider use of the vaccines in younger groups, since these are not the priority groups according to our roadmap.” SAGE last updated its “roadmap” for prioritizing uses of COVID-19 vaccines in January 2022. Image Credits: Marco Verch/Flickr. Ethiopia Pursues ‘Ethnic Cleansing’ in Tigray, Tedros Says; Warns of Nuclear Threat in Ukraine 18/08/2022 John Heilprin A woman selling fruit in Adigrat, Tigray region Ethiopia’s Tigray region suffers from “the worst catastrophe on Earth” due to a devastating mix of factors such as government neglect, drought, and racism, World Health Organization Director General Dr. Tedros Adhanom Ghebreyesus told a virtual press briefing Wednesday. Tedros grew emotional at the end of the briefing as he described the humanitarian crisis facing 6 million people in the region who have been cut off from the world and insisted “it’s not because I’m from Tigray that I’m saying that.” Shifting back and forth from the crisis in Tigray, drought, and hunger throughout the Horn of Africa and also Ukraine, Tedros warned the international community may be “sleepwalking into a nuclear war” as a result of Russia’s war in Ukraine, which he called “the mother of all problems.” “But in terms of humanitarian crisis, I can tell you the humanitarian crisis is greater in Tigray,” he said. Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), at a virtual press briefing Millions of people have been displaced by the fighting between Ethiopian Prime Minister Abiy Ahmed’s government and Tigray’s regional administration. National and regional governments view one another as unlawful Abiy was awarded the Nobel Peace Prize in 2019 for defusing tensions with neighboring Eritrea, but his government has taken a hardnosed approach toward Tigray’s regional administration, which it views as unlawful – leading to the military entry to the region. Tigray’s regional administration defied the government by holding an election in September 2020. And Tigray’s regional administration saw Abiy’s government as unlawful after he postponed national elections due to the coronavirus pandemic. Tigray has now been under a virtual military siege for over a year, sparking widespread hunger as well as disease. Despite recent promises to allow the entry of desperately needed food and medical supplies, only a scattered number of relief envoys have been allowed to pass by the Ethiopian forces amassed around and inside parts of Tigray. In January, Tedros slammed Ethiopia’s “complete blockade” on health and humanitarian aid to the Tigray region, saying it has been unable to deliver life-saving medications for nearly six months in a situation that is “unprecedented” even in comparison to conflict-wracked Syria or Yemen. Eritrean refugees in Ethiopia now also fear retaliation from Eritrean forces operating in the region in an alliance with Ethiopia’s government. Almost 60,000 Ethiopian refugees have fled to eastern Sudan since the conflict began, according to the UN refugee agency. While Tedros called attention to the crisis in Ukraine, he said he hadn’t heard any head of state from the developed world talking about Tigray during the last few months. “Why? Maybe the reason is the color of the skin of the people in Tigray,” he said. “Nowhere in the world you would see this level of cruelty, where a government punishes 6 million of its people for more than 21 months.” “How can peace talks occur when people are being suffocated?” he asked, grabbing his neck by his own hands to underline the point. “The only thing we ask is, ‘Can the world come back to its senses and uphold humanity?’” UN warnings go back to November 2020 A woman brings her child to a clinic in Wajirat in Southern Tigray in Ethiopia to be checked for malnutrition in late summer. United Nations officials warned of a full-scale humanitarian crisis unfolding in Ethiopia almost two years ago. The conflict erupted after an attack on an Ethiopian government military base in Tigray. Abiy’s government sent troops in to seize control of Tigray’s governing Tigray Peoples’ Liberation Front (TPLF) party and several towns and a humanitarian base with nearly 100,000 Eritrean refugees. Humanitarian aid groups said the government forces effectively sealed off the Tigray region since July 2021, disrupting the flow of crucial food and aid supplies. But the UN Office for the Coordination of Humanitarian Affairs (OCHA) reported earlier this month that 6,105 trucks were able to bring more than 1.4 million metric tons of humanitarian supplies into Tigray since humanitarian convoys resumed in April. The overall humanitarian situation in Ethiopia has significantly deteriorated in 2022 leading to increased humanitarian needs across the country due to ongoing conflict and violence, and climatic shocks such as the prolonged drought,” OCHA said in an 5 Aug situation report. “More than 20 million people are to be targeted for humanitarian assistance and protection this year. Nearly three quarters of them are women and children.” Both sides agreed to hold talks in June after a cease-fire and the flow of aid was somewhat restored but not enough to meet the needs of the millions of people still trapped in the region. As many as 13 million people in the northern Tigray, Afar, and Amhara regions need food assistance due to conflict, according to the World Food Program, and 7.4 million people across the country face severe hunger due to drought. Ethnic cleansing – it could be even more … Tigray refugees Tedros has been at odds with Ethiopia’s government for some time. When he was confirmed for a second term as WHO chief this year, Ethiopia did not co-sponsor his nomination — the first time that an incumbent director general at the UN health agency was thus shunned by his own home country. Ethiopia’s government also wrote WHO earlier this year accusing Tedros of “misconduct” after his sharp criticism of the war and humanitarian crisis in the country. He previously had served as both Ethiopian foreign minister and health minister. That has not deterred Tedros, who spoke movingly about his experiences as a “child of war” growing up in Tigray under earlier cycles of conflict at the opening of the World Health Assembly, on 22 May, where he was elected for a second term as Director General. And on Wednesday, he was even more blunt about the situation unfolding in the region. “It’s ethnic cleansing. It could even be more? Why are people not telling the truth,” Tedros told the press briefing. “Why are we keeping quiet when 6 million people are being punished?” Image Credits: Christine Nesbitt/ UNICEF, Rod Waddington/Flickr, UNICEF/Christine Nesbitt, © UNFPA/Sufian Abdul-Mouty. Monkeypox Cases Spike 20% Weekly Worldwide 17/08/2022 John Heilprin Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), at a virtual press briefing As the first monkeypox case involving a human-to-dog transmission reported, the World Health Organization (WHO) said more than 35,000 recently confirmed cases of monkeypox were accompanied by 12 deaths in 92 nations and territories, including almost 7,500 from last week alone. That made for the second consecutive week with a 20% increase, WHO Director-General Dr Tedros Adhanom Ghebreyesus said Wednesday. Almost all of the cases are being reported from Europe and the Americas and involve men who have sex with men, Tedros told a virtual press briefing, underscoring the importance for all countries to design and deliver services and information tailored to these communities that protect health, human rights and dignity. “The primary focus for all countries,” said Tedros, “must be to ensure they are ready for monkeypox and to stop transmission using effective public health tools, including enhanced disease surveillance, careful contact tracing, tailored risk communication and community engagement and risk reduction measures.” Related to the challenge of outreach, Dr Mike Ryan, executive director of WHO’s Health Emergencies Program, said WHO would “follow up directly” with Mexico’s government – when asked by a Mexican journalist why the country has not yet mounted programmes for widespread testing or clear outreach to potentially vulnerable populations of men – despite a fourfold increase in daily reported cases over the past two weeks. Tedros said vaccines may also play an important part in controlling the outbreak, and in many countries there is high demand for vaccines from the affected communities. “However, for the moment, supplies of vaccines and data about their effectiveness are limited. Although, we are starting to receive data from some countries,” he noted. “WHO has been in close contact with the manufacturers of vaccines and with countries and organizations willing to share those. We remain concerned that the inequitable access to vaccines we saw during the COVID-19 pandemic will be repeated, and that the poorest will continue to be left behind.” Bavarian Nordic, the world’s sole manufacturer of US and European-approved monkeypox vaccines has currently closed its manufacturing plant for renovations – and does not expect to reopen until late this year. Meanwhile, a few wealthy countries, led by the United States, have snapped up all available doses. See Health Policy Watch’s exclusive report: Exclusive: Closure of World’s Only Manufacturing Plant for Monkeypox Vaccine Raises Questions About World’s Ability to Meet Rising Demand First case of human to dog transmission Pet dog in France gets monkeypox from 2 men in same household WHO officials also confirmed the first case of human-to-dog transmission in Paris, where two men went to a hospital and were confirmed to have monkeypox. Twelve days later, a 4-year-old male Italian greyhound that was allowed to sleep with them also tested positive for the virus, according to a recent Lancet article. The case already prompted the U.S. Centers for Disease Control and Prevention to issue new guidance that people with monkeypox should avoid contact with animals, including pets, domestic animals and wildlife to avoid spreading the virus. “Infected animals can spread monkeypox virus to people, and it is possible that people who are infected can spread monkeypox virus to animals through close contact, including petting, cuddling, hugging, kissing, licking, sharing sleeping areas, and sharing food,” stated the CDC guidance. Dr Sylvie Briand, director of WHO’s Epidemic and Pandemic Preparedness and Prevention department (EPP), said it is important to differentiate between the emergence and reemergence of diseases. “It’s something that we know, most of the emerging viruses are coming from animals,” she said. “This is the case for monkeypox, and they infect humans. So at the beginning, it’s only sporadic cases,” she said, referring to the fact that the virus was only discovered in 1958, and for decades after that circulated in a mostly self-limiting way between animals and human communities in central and west Africa. . But if the virus finds the right environment, Briand said, it can evolve to more effectively target humans, resulting in more localized transmission especially in conditions of “high human density, very close contact,” she said. “This is what we have seen with monkeypox. Initially it was in animals, then it went to some humans. And then we had a localized outbreak and now we have a multi-country outbreak.” In terms of disease reemergence, other factors then play out as well. “It’s often because the vaccine coverage is too low that those diseases reemerge,” she said. “And it’s very important to understand that vaccine coverage is a very, very important indicator of the protection of human beings against disease.” 2020 study predicted heightened monkeypox risk with declining smallpox immunity Monkeypox lesions Ironically, a study published in September, 2020 in the Bulletin of the WHO Health Organization, predicted that Central and West Africa’s monkeypox outbreaks could become more frequent – with eventual mutations of the virus increasing human to human transmission as well. Earlier this month, a group of global experts convened by WHO agreed that the virus’s variants will be renamed with Roman numerals. In a review of historical data on outbreaks of Clade 1 of the monkeypox virus in the Democratic Republic of Congo, the authors from Institut Pasteur contended that transmission had remained self-limiting throughout the 1960s and 1970s because most people in DRC were vaccinated against smallpox – which protects against monkeypox virus too. However, after smallpox was declared to be eradicated, and smallpox vaccination ceased in the 1980s – that herd immunity waned: “Since then, the Democratic Republic of the Congo has reported increased monkeypox human infections, and parts of the country have been declared monkeypox-endemic areas,” the report’s authors note. “In 2011–2012, the population immunity against orthopoxvirus species was only 60%… among individuals vaccinated against smallpox and 26% …among individuals unvaccinated against smallpox.” Due to declining immunity, more frequent outbreaks may occur in endemic countries, triggered initially by contact with infected animals, the authors predicted, but they added that over time monkeypox may begin to undergo more “sustained human-to-human transmission (R > 1).” “In either case, repeated circulation of monkeypox in human hosts, particularly immunocompromised hosts, favours pathogen evolution and emergence of newly human-adapted pathogens, depending on R and on the human pathogen fitness landscape.” “”This finding may explain the increasing number of monkeypox outbreak reports, resulting in endemic monkeypox in central African countries…. “Moreover, with declining immunity to orthopoxvirus species, monkeypox can pose an ever-increasing threat for health security.” A prescient conclusion indeed in light of today’s rapidly evolving global health emergency. –Elaine Ruth Fletcher contributed to this story Image Credits: Mothership.sg/Twitter , Tessa Davis/Twitter . W. Africa’s Polluted Air 2nd Only to S. Asia 17/08/2022 John Heilprin & Elaine Ruth Fletcher Downtown Lagos – new study finds it to be among the most polluted cities in Africa and the world. Some 1.7 million people in cities across the planet died from polluted air in 2019, according to the first-ever study of urban air pollution that covers virtually every city in the world over the size of 50,000 people, as per the UN definition. Conditions are the most severe in cities of South Asia, (WHO’s SouthEast Asia region). Strikingly, however, cities in West Africa, are a close follower – with average annual fine particulate (PM2.5) concentrations of 62 micrograms/cubic meter of air (µg/m3), more than 15 times above WHO guideline levels. The study by the State of Global Air Initiative, a collaboration between Boston-based Health Effects Institute (HEI) and Seattle-based Institute for Health Metrics and Evaluation’s (IHME) Global Burden of Disease project, is the largest analysis of urban air pollution to date. It examines data spanning the years 2010-2019 for 7,239 cities, home to some 2.8 billion people. It is also the first global analysis to compare trends in cities over time. The study confirms that urban residents face some of the world’s worst air quality, with 98% of people in all cities around the world breathing air that fails to meet the WHO Air Quality guideline level of 5 µg/m3 – what is considered the most key indicator of health impacts. And with 68% of the world’s population expected to live in urban areas by 2050, air pollutants loom as a major battle for many of the world’s top cities. India and Indonesian cities saw the world’s worst increases in polluted air Industrial air pollution in India – South East Asia is the hardest hit by air pollution overall. While PM2.5 exposures “decreased” in some cities between 2010 and 2919, most notably in China, in parts of South Asia, notably India and Indonesia, air pollution in fact became much worse. “Of 7,239 cities, India is home to 18 of the 20 cities with the most severe increase in PM2.5 pollution from 2010 to 2019. The other two cities are in Indonesia. Alll these cities saw an increase of more than 30 µg/m3 during that decade. Of the 50 cities with the msot severe increase in PM2.5 pollution, 41 are in India and 9 are in Indonesia,” it adds. As for the present day: “Exposures are particularly high in cities in Asia, West Sub-Saharan Africa, and Andean and Central Latin America, the report concludes. “More progress is necessary to protect the health of residents.” Only 2% of cities meet the WHO Air Quality Guidelines and 41% of cities exceed even the least stringent WHO interim Air Quality Guideline Some 86% of cities around the world also exceed WHO’s guidelines for NO2, whose dangers for asthma and lung diseases have been better recognized more recently. Strikingly, cities with excessive levels of NO2 include cities in many high- and middle-income countries where stricter regulations on vehicle and power plant emissions may have reduced PM2.5 levels – but have not sufficiently addressed NO2. Diesel vehicles, promoted by the industry over the last 30 years, emit comparatively higher levels of NO2. Estimates on polluted air combine data from ground monitoring and satellites The new analysis combines available data on air quality from ground-level monitoring stations with satellite data from thousands of cities that lack stations of their own. It provides the full data set on an interactive database. The study estimated annual average concentrations of PM2.5 and NO2 for cities across the planet by integrating available ground-level and satellite data, then dividing that information into grid cells of approximately 1×1 km at the equator. Only 117 nations have ground-level monitoring systems to track PM2.5, and only 74 nations are monitoring NO2 levels, according to the report, which draws its ground level data from an online repository maintained by the World Health Organization. Based on available ground station data, WHO in April issued estimates of average annual air pollution concentrations in 4,000 cities and settlements around the world. Those included PM2.5, and NO2 when data was available. Some of the findings about global hotspots are roughly comparable with WHO’s own recent analysis – which also found that people in South/Southeast Asia, the Middle East and parts of Africa continue to breathe some of the worst air on the planet. However, WHO did not analyse trends over time. Nor did WHO attempt to incorporate satellite data from cities where ground-level measurements are unavailable – which includes most of urban Africa. This new analysis fills in that critical gap – and in the process it reveals how serious pollution in some parts of Africa, and particularly West Africa, has become. “Since most cities around the world have no ground-based air quality monitoring in place, estimates of particulate and gas pollution levels can be used to plan air quality management approaches that ensure the air is clean and safe to breathe,” said Susan Anenberg, an associate professor at George Washington University and one of the project collaborators. West African cities – now among the world’s most polluted Average annual urban air pollution concentrations by region shows cities in South Asia folowed by cities in West Africa as the most polluted in the world. Unlike the most recent WHO study, the HEI/IHME study also estimated air pollution in terms of “population-weighted” exposures to air pollution in each city considered – rather than in terms of the city’s spatial limits only – linking the pollution concentrations in each grid cell with the number of people living within each block to produce a population-weighted annual average. Population-weighted exposures are an essential input to the estimation of mortality, per capita, from air pollution in any given area. In terms of population-weighted exposures, the data includes some surprises. Not only do people in longstanding hotspots like Delhi, Kolkata, Dhaka and Jakarta as well as Beijing, continue to breathe some of the the worst air in the world, so do people in Lima Peru; Lagos and Kano, Nigeria, and Accra, Ghana. Geographic patterns of air pollutants NO2 and PM2.5 strikingly different The study also confirms prior WHO findings that the geographic patterns of excessive exposure to PM2 and NO2 are considerably different at times. “Cities in Asia and Africa are already hotspots for PM2.5 pollution,” the study concludes. “At the same time, NO2 pollution – primarily from vehicle traffic – is high and growing in some cities and regions that are not PM2.5 hotspots.” Air pollutants responsible for 7 million deaths worldwide Air pollution is responsible for about 1-in-9 deaths worldwide, or between 6.7 to 7 million deaths a year, according to the latest estimates by both HEI/IHME and WHO. Outdoor, ambient air pollution is estimated by WHO to kill about 4.2 million people a year. There is an overlap, however, between deaths attributable to outdoor air pollution and the estimated 3.2 million deaths a year attributed to household air pollution. The latter is related largely to exposures to smoke from biomass, kerosene and coal fires used by billions of people for cooking and heating. Air pollution is a factor in illness and premature deaths particularly in older people and those with chronic respiratory and cardiovascular conditions. WHO estimates that quarter of all deaths from heart attacks and stroke, and nearly 30% of deaths from lung cancer, as well as 43% of deaths from lung disease, are attributable to air pollution. Exposure to NO2, meanwhile, exacerbates lung inflammation, contributing to asthma and other respiratory diseases, and potentially impeding children’s lung development. High NO2 exposures that lead to difficulties breathing, coughing or wheezing, may cause spikes in hospital and emergency-room admissions, according to WHO. People living near busy roads congested with lots of city traffic often are exposed to higher levels than people in rural settings. China air quality improved but air pollution related mortality still very high In terms of mortality, a significant number of Chinese cities, led by Beijing, continue to have a high proportion of deaths from air pollution. That is despite the fact that China is the country that has also seen the greatest improvements in urban quality over the past couple of decades, the report finds. This paradox is due to two factors – the comparative ageing of China’s population and the fact that exposure to air pollution, even at comparatively lower levels, can still be deadly. Recognizing this, WHO in 2018 reduced by half it’s guideline level for annual average exposure levels of PM2.5 from 10 to 5 µg/m3. WHO also halved its NO2 guideline level to 10 µg/m3. Urban air pollution hotspots by region. In South/SouthEast Asia mortality from urban air pollution also has grown significantly in the past 20 years, the report also concludes – with Jakarta and Delhi having the highest levels of mortality, per 100,000 population, from air pollution. In central Asia, hot spots included Tashkent, Uzbekistan and Almaty, Kazakhstan. Most of those cities also are areas long reliant on coal-burning for heat and power production. Compared to other parts of eastern and central Europe, Kyiv and Kharkiv in Ukraine, the Polish cities of Katowice and Warsaw, as well as Budapest Hungary and Bucharest, Romania, also had high pollution-related death rates. Conversely, African cities don’t rank as prominently in terms of global air pollution-related mortality – largely because the residents of African cities are much younger on average and thus not as likely to die – yet – from air pollution related diseases. Taking action against air pollutants Cycling in Fortaleza, Brazil – the city has won worldwide recognition for its sustainable transport planning that contributes to healthy physical activity and reduces air pollution. The good news, the study concludes, is that there are a wide range of cost-effective solutions already available to reduce pollution from many key pollution sources. Those include the promotion of green and sustainable transportation, expanded access to clean energy for households and a shift to clean and efficient energy production based on renewable energy sources and not fossil fuels. The report also cites some of the urban solutions have yielded results, including stricter vehicle and power plant emissions limits and urban planning solutions that reduce the need to travel. In Europe, for instance, more than 300 cities created low-emission zones (LEZs) for vehicles that reduced traffic-related air pollution by banning the entry of high-polluting vehicles and encouraging more walking, cycling and use of public transportion. In China’s capital Beijing, new measures such as tighter controls over coal-fired power plants, more stringent vehicle emission and fuel quality standards, and additional air monitoring stations contributed to a 36% decline in the city’s annual average PM2.5 level over five years. But those successes remain exceptions to the rule for many, or even most, of the world’s low and middle income cities – which have not yet come to grips with air pollution as a deadly health threat. “As cities around the world rapidly grow,” said Pallavi Pant, a senior scientist with HEI who oversaw the study, “the impacts of air pollution on residents’ health are also expected to increase, underscoring the importance of early interventions to reduce exposures and protect public health.” Image Credits: Flickr/US 6th Fleet photostream, Uncommonthought.com, Air Quality and Health in Cities, State of Global Air Report , Urban Air Quality and Health – State of Global Air , Air Quality and Health in Cities, State of Global Air,, Air Quality and Health In Cities, State of Global Air , City of Fortaleza. Climate Change is a Double Blow for People with Disabilities 16/08/2022 Kavitha Yarlagadda Pratyush Nalam, a software professional in Hyderabad, India HYDERABAD – Pratyush Nalam, a software professional in this south-central Indian city that has become a global tech outpost for Silicon Valley, moves around his house in his wheelchair. He has spinal muscular atrophy and cannot walk, so his family members help him. Though the monsoon season in Hyderabad brings lots of precipitation from the end of June to early October, scientists say the rains are getting even heavier due to climate change. And that, says Nalam, is making life tougher for people than summer heat or winter’s chills. “Getting to a dry place quickly is a challenge,” Nalam says of the growing challenge he faces in just getting around. “Bus stops don’t have shelters and are far to get to – and accessible transport is not available in most cases.” The combined detrimental effects from a lack of inclusive planning or early warning systems, less information and transportation options, and overall discriminatory attitudes has driven the global mortality rate for people with disabilities who experience natural disasters up to four times higher than it is for people without disabilities, according to a Lancet report. Nalam said that during heavy rains “we cannot see the bumps on the roads or sidewalks, which make it riskier to drive our wheelchairs.” Hotter and hotter norms Summer in India has temperatures that regularly climb into the high 30C. Europe has suffered wildfires, evacuations and heat-related deaths this summer, as heat waves force temperatures above 40 degrees C in places like Portugal and France – only slightly hotter than the warmest season in Hyderabad, where temperatures regularly climb into the high 30s C during the pre-monsoon summer from late March to early June. Still, a devastating heat wave that scientists say was made more likely by climate change has baked India and Pakistan in recent months, with some cities in the two neighboring countries reaching around 45 to 50 C. Across Europe and Asia, record temperatures have challenged daily lives, posing serious health risks to families, students, businesspeople and travelers. As with most other natural and manmade disasters, the people that suffer the most often are those that are the most marginalized. “Extreme heat is the root cause of all of the catastrophic events that we are experiencing, from wildfires to drought, hurricanes, storm surges, and flooding,” said Wendy Nystrom, an environmental and pollution risk management consultant in Los Angeles. Among those most affected by climate change Aunia Kahn Persons with disabilities are frequently among the worst affected by climate change, similar to the disproportionately higher rates of morbidity and mortality they suffer in emergencies while also being among the least able to get emergency assistance. “It feels that I am always living in a bubble. I am allergic to heat and cold and this makes me very vulnerable to climate change,” said Aunia Kahn, a disabled U.S. business owner in Eugene, Oregon, who struggles with rare chronic illnesses such as Ehlers Danlos Syndrome, Mast Cell Activation Syndrome, and Dysautonomia. Certain conditions of disability are disproportionately affected by global warming. For example, people with spinal cord injuries cannot cool themselves during excessive heat while people with multiple sclerosis feel more pain and fatigue during hot weather conditions. Some 15% of the world’s population have a disability, the World Bank reported. Many people with them also live in extreme poverty, exacerbating their vulnerability to climate change due to a general lack of proper sanitation, health care, nutrition or safe drinking water. “Earth is warming and global warming is the main reason for the extreme heat waves. Heat intensity is increasing and reducing the quality of our lives,” said Dr. Roxy Mathew Koll of the Indian Institute of Tropical Meteorology in Pune, India. “The vulnerable are the ones who are the most impacted.” Dr Roxy Mathew Koll An increasing human rights issue But the right to a clean, healthy and sustainable environment should be the same for all irrespective of differences such as caste and creed, the UN General Assembly determined in a landmark resolution approved in late July. The assembly’s 161-0 vote with eight abstentions by Belarus, Cambodia, China, Ethiopia, Iran, Kyrgyzstan, Russia and Syria gives momentum to the work of activists and citizens seeking greater legal and regulatory protections. It followed a 43-0 vote on a similar resolution last October in the 47-nation UN Human Rights Council – with China, India, Japan and Russia abstaining. Lack of mobility in emergencies is life-threatening People with disabilities and women and children in South Asia and Africa are more vulnerable to severe weather events like heat waves, floods, cyclones and storm surges, according to experts. This is because they have less access to information on climate adaptation, rarely benefit from government aid and have fewer economic privileges than men. And extreme weather events like cyclones and floods are intensifying in a very short time, giving disabled people little time to move to safety, according to Koll. “People with disabilities, particularly with mobility issues, have limited capacity to respond to emergency situations during an extreme weather event,” he said. But only 10% of people with disabilities believe their local government has emergency, disaster management, or risk reduction plans that address their access and functional needs, according to a UN report. And just 20.6% said they could self-evacuate without difficulty in the event of a sudden disaster, a UN Office for Disaster Risk Reduction online survey found. A hot day in Hyderabad For the old and young, climate change presents difficulties. Vishnu Kumar, a 75 year old man from Hyderabad, suffered a paralytic stroke three years ago and has been confined to a bed and wheelchair since then. As with many elderly, the excessive heat zaps his energy and the frequent power cuts only increase his discomfort, adding to friction in his family. And for student Rohit Reddy, eczema and allergies worsened during summers in the coastal city of Mumbai, costing him time needed for his studies. “I had to shift to Hyderabad because of the flare ups due to extreme humidity, now I may lose an academic year,” Reddy said. -Updated 16.08.2022 with correction to the name of Pratyush Nalam’s condition as spinal muscular atrophy, not muscular dystrophy. Image Credits: Skymet , Pratyush Nalam, Aunia Kahn, Roxy Koll, Gulf News. Monkeypox Variants Get New Names 12/08/2022 Editorial team While the process of renaming monkeypox is still underway, a group of global experts convened by the World Health Organization (WHO) has agreed that the virus’s variants will be renamed with Roman numerals. This follows a meeting convened by the WHO this week to enable virologists and public health experts to reach consensus on new terminology, the global body announced on Friday. Experts in pox virology, evolutionary biology and representatives of research institutes from across the globe reached consensus that the former Congo Basin (Central African) clade will be referred to as Clade one (I) and the former West African clade as Clade two (II). The group also agreed that Clade II consists of two subclades, which will be referred to as Clade IIa and Clade IIb. Assigning new names to existing diseases is the responsibility of WHO under the International Classification of Diseases and the WHO is holding an open consultation for a new name for monkeypox. Anyone wishing to propose new names can do so here. The naming of virus species is the responsibility of the International Committee on the Taxonomy of Viruses (ICTV), which also has a process underway for the name of the monkeypox virus. Image Credits: TRT World Now/Twitter . India is Trying to Reduce Maternal Mortality Without Addressing a Key Contributor: Suicide 12/08/2022 Disha Shetty Suicide is one of the leading causes of death among women of childbearing age in India. Pregnancy is most often a cause for celebration of a new life and a new addition to the family. But for the women who walk into Garima Malik’s clinic in New Delhi, it is a very different story. Some cry. Others appear angry, irritable or frustrated. Usually, the cause is domestic violence – pregnancy is a particularly vulnerable time and as an experienced counsellor, Malik is trained to spot the signs. “They talk about suicide,” she says. “Then they calm down. We talk about risk management and safety planning and counselling. So somehow, they cope.” Malik says many of those who come to the clinic, run by the medical charity Medecins Sans Frontieres (MSF), have experienced physical and emotional violence during pregnancy. Sometimes this is because they are unwilling to be intimate with a partner in the early part of the pregnancy or immediately after the birth. Other times it is because they have given birth to a girl, seen by some as less desirable. “This can cause loneliness in women and they feel frustrated and they feel like he [the husband] needed the child, the family needed the child, and I am the one suffering,” she says. Malik says they are the lucky ones — most Indian women who experience suicidal thoughts in the period during or after their pregnancy will not seek or receive any help. Yet suicide is one of the leading causes of death among women of child-bearing age in India. According to one recent study published in The Lancet medical journal, the suicide rate among Indian women and girls is twice the global average. Women may experience suicidal thoughts during or after pregnancy. India has made enormous strides since the turn of the century in reducing overall maternal mortality, reducing deaths by more than half. In 2019, 103 mothers were dying per 100,000 live births, down from 254 in 2004. The United Nations has set the goal of reducing maternal mortality globally to 70 deaths per 100,000 by 2030. But that success has exposed a phenomenon that had previously gone largely unnoticed in India: high rates of suicides in the perinatal period, defined as during and immediately after pregnancy. A 2016 study of 462 low-income women in early pregnancy in south India found 7.6% were at risk of suicide compared to roughly 0.4% in the United States. Health experts say the government has done little to address this problem, and a suicide prevention action plan devised in 2018 has never been implemented. India is losing young women “in enormous numbers,” says Lakshmi Vijayakumar, a psychiatrist and a member of the World Health Organization (WHO)’s International Network for Suicide Research and Prevention. “And we don’t have any effective mechanism or plan or strategy to address this issue.” The Indian government did not respond to a request for comment. Data on this is limited. India compiles national maternal death statistics by extrapolating from a representative sample survey, but does not separate the data into causes of death. Police keep data on reported suicides, but do not record whether the person was pregnant, and anyway, suicides are underreported. Perinatal suicides are often linked to a history of psychiatric illness, but Lakshmi* says this does not seem to be the case in India. Instead, social factors such as early marriage, intimate partner violence, pressure to give birth to a son and women’s lack of financial autonomy are drivers. Reducing maternal deaths — a revealing success story When it comes to the physical causes of maternal deaths, India’s success has been marked and is largely due to an increase in deliveries at free public health facilities rather than at home. In-facility deliveries rose from 31.1% in 2005-06 to 88.6% in 2019-21, according to government figures, driven by awareness campaigns and offering small financial incentives to pregnant women and grassroots health workers. The southern Indian state of Kerala has been among the most successful in reducing maternal deaths. With 43 per 100,000 live births, it is the safest place in the country to give birth. It is also the only state to have looked into perinatal suicide data, analyzing the 1,076 maternal deaths registered between 2010 and 2020. During that period, mortality dropped from 66 to 43, but the share of suicides increased from about 2.6% in 2010 to 6.6% five years later, and to 18.6% in 2019–20. But that data should be treated with some caution – Kerala’s relatively low rates of maternal mortality were based on a small sample but, combined with the 2016 study in south India, it indicates a trend, says Soumitra Pathare, psychiatrist and director of the Centre for Mental Health Law and Policy. “It is important for various reasons – we now have systematic data to show that suicides are a significant problem in young women, especially young women who are pregnant or have just delivered a child,” he says. “Maternal mortality has gone down substantially because that’s something that has had an intervention done for it. So what this actually shows is that we’ve not done any intervention for suicide prevention.” He cautioned that the data capture only some of the problem. For every person who dies by suicide, an estimated four to 20 times more people attempt it. “So the number of attempted suicides [in India] is anywhere between 0.6 million to 6 million,” said Pathare. “We don’t even collect data on it. ” Early intervention is key Nearly a third of Indian women between the ages of 15 and 49 who have been married, have experienced intimate partner violence. There has been little research into the drivers of perinatal suicide in India, though the Kerala review identified psychiatric illness, young age, unmarried status and domestic violence as risk factors. Nearly one in every three Indian women between the ages of 15-49 who has ever been married has experienced intimate partner violence, according to government figures. Around 3.1% of women in this category said they experienced physical violence during pregnancy. Marital rape is not legally recognized, although this is being challenged in the courts. Nayreen Daruwalla, head of a program on the prevention of violence against women and children at the Mumbai-based non-profit SNEHA, says suicide during pregnancy often falls into one of two categories. “One is pregnant women who are married and in whose cases the family insists on having a boy,” she said. “Unwed mothers are a huge category of cases especially given the lack of social support and sometimes the lack of support from the partner who might be reluctant to wed on finding out the woman is pregnant.” Experts say early intervention is key to preventing perinatal suicides, and that India already has the systems in place to do this. Shaji KS, dean of research at the Kerala University of Health Sciences and part of the team that reviewed perinatal suicides in Kerala, cites India’s network of grassroots health workers, through whom every pregnant person in the country can be reached. Adding a psychiatric component to support their mental health would help prevent many deaths, he said. MSF’s Malik sees a need for more vocational training to enable Indian women to become financially independent, making it easier for them to escape abusive situations. Research in Australia has found this to be effective in reducing suicides. In India, women’s labour force participation has steadily declined from around 30.4% in 2000 to 19% in 2021. “When we talk to such patients, when we talk about leaving husbands and leaving such [a] toxic environment and getting out of this kind of relationship, they want to,” she said. “They cannot because they are not financially independent.” Studies also show restricting access to pesticides, used in many suicides in India, might prevent some of the deaths. Lakshmi, the psychiatrist and WHO advisor, was part of a task force set up by the Indian government in 2018 to suggest ways to reduce overall suicides, whose recommendations have not been implemented. Asked about funding for suicide prevention, the government said in February that funds had been allocated and announced plans for a national telemedicine program for mental health. But it did not commit to adopting the task force’s recommendations. “We have submitted the plan” said Lakshmi. “It is still lying there. I hope that one day it will see the light of day.” * The use of a given name used on second reference is common practice in parts of south India If you or someone you know is struggling with mental health or suicidal thoughts, help is available at iCALL run by TISS at 9152987821 [India] or the National Suicide Prevention Lifeline at 1-800-273-8255 [US]. This article was first published in The Fuller Project. Image Credits: Children's Investment Fund/Flickr , UN Photo/Kibae Park/Flickr, Yogendra Singh/ Unsplash. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... 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2nd COVID Booster Advised For Highest Risk 18/08/2022 John Heilprin The SAGE group has recommended a second COVID-19 booster for those most at risk. An expert panel of advisers to the World Health Organization (WHO) has recommended that countries consider a second COVID-19 booster dose for older, at-risk and immunocompromised people, echoing guidance provided by European and U.S. regulators months earlier. WHO’s Strategic Advisory Group of Experts (SAGE) on Immunization released its updated recommendations on Thursday, a week after it met. SAGE, created in 1999, is the main advisory group to WHO for global policies and strategies for vaccines and immunization. To cut the risk of severe disease, deaths and disruption to health services, the panel recommended a second vaccine booster dose for all elderly people – using age-specific cutoffs to be defined by each country. It also recommended a second booster for adults with comorbidities that put them at higher risk of severe disease, including pregnant women and health care workers. “There is increasing evidence on the benefits of a second booster dose of COVID-19 vaccines in terms of restoring waning vaccine effectiveness (VE). The data mainly exist for mRNA vaccines with very limited data for other COVID-19 vaccines,” the SAGE expert group concluded in their latest “Good Practice” statement on booster doses. “Evolving evidence from studies suggests that additional protection of the most vulnerable populations, at least for several months, is likely to be achieved through administration of a second booster dose, although follow-up time for these studies is limited.” Targeted Guidance for ‘Certain Populations’ SAGE chairperson Dr Alex Cravioto The guidance is similar to what has already been put forward by the European Center for Disease Prevention and Control (ECDC), the European Medicines Agency (EMA), and the US Centers for Disease Control and Prevention (CDC, which have called for second boosters to be given to people aged 60 and over and those with medical conditions. “We are now providing targeted guidance on the administration of a second booster in certain populations,” SAGE Chair Alejandro Cravioto, a professor with the Faculty of Medicine of the Universidad Nacional Autónoma de México (UNAM), told a WHO-hosted virtual press briefing. “The rationale of this recommendation is in order to avoid severe disease and death in a population at the highest risk — but does not constitute a general recommendation of vaccinating all adults after the first booster,” he said. “That means that this is selectively done, in populations that we consider are at highest risk.” On Wednesday, WHO Director General Dr Tedros Adhanom Ghebreyesus told a press briefing that people should get vaccinated or boosted before winter arrives in the northern hemisphere, a time when there is an increased risk of infection due to more time spent indoors. Selective Approach with Children Fits Panel’s ‘Roadmap’ In other recommendations, the panel said that it supports a flexible approach to homologous [e.g. the same vaccine type and brand] versus heterologous vaccination, what has also been described as mixing and matching of different vaccine types and brands, for both primary series and booster doses. Heterologous boosters should be implemented with careful consideration of current vaccine supply, vaccine supply projections, and other access considerations, it says, alongside the potential benefits and risks of the specific products being used. Cravioto said the second booster should be given “at the earliest opportunity” after six months has elapsed since the first booster. The panel did not recommend it for the general population, however, because the focus is on warding off the worst outcomes. “The principal objective continues to be the prevention of severe disease and death,” he said. The panel also updated its recommendations for the use of Pfizer-BioNTech and Moderna vaccines in children, but said it was still reviewing the data for vaccines tailored to specific variants. “In the case of both vaccines, children from six months to 17 years with comorbidities should be vaccinated to avoid a higher risk in these groups of severe disease,” he said. “We do not recommend, still, the wider use of the vaccines in younger groups, since these are not the priority groups according to our roadmap.” SAGE last updated its “roadmap” for prioritizing uses of COVID-19 vaccines in January 2022. Image Credits: Marco Verch/Flickr. Ethiopia Pursues ‘Ethnic Cleansing’ in Tigray, Tedros Says; Warns of Nuclear Threat in Ukraine 18/08/2022 John Heilprin A woman selling fruit in Adigrat, Tigray region Ethiopia’s Tigray region suffers from “the worst catastrophe on Earth” due to a devastating mix of factors such as government neglect, drought, and racism, World Health Organization Director General Dr. Tedros Adhanom Ghebreyesus told a virtual press briefing Wednesday. Tedros grew emotional at the end of the briefing as he described the humanitarian crisis facing 6 million people in the region who have been cut off from the world and insisted “it’s not because I’m from Tigray that I’m saying that.” Shifting back and forth from the crisis in Tigray, drought, and hunger throughout the Horn of Africa and also Ukraine, Tedros warned the international community may be “sleepwalking into a nuclear war” as a result of Russia’s war in Ukraine, which he called “the mother of all problems.” “But in terms of humanitarian crisis, I can tell you the humanitarian crisis is greater in Tigray,” he said. Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), at a virtual press briefing Millions of people have been displaced by the fighting between Ethiopian Prime Minister Abiy Ahmed’s government and Tigray’s regional administration. National and regional governments view one another as unlawful Abiy was awarded the Nobel Peace Prize in 2019 for defusing tensions with neighboring Eritrea, but his government has taken a hardnosed approach toward Tigray’s regional administration, which it views as unlawful – leading to the military entry to the region. Tigray’s regional administration defied the government by holding an election in September 2020. And Tigray’s regional administration saw Abiy’s government as unlawful after he postponed national elections due to the coronavirus pandemic. Tigray has now been under a virtual military siege for over a year, sparking widespread hunger as well as disease. Despite recent promises to allow the entry of desperately needed food and medical supplies, only a scattered number of relief envoys have been allowed to pass by the Ethiopian forces amassed around and inside parts of Tigray. In January, Tedros slammed Ethiopia’s “complete blockade” on health and humanitarian aid to the Tigray region, saying it has been unable to deliver life-saving medications for nearly six months in a situation that is “unprecedented” even in comparison to conflict-wracked Syria or Yemen. Eritrean refugees in Ethiopia now also fear retaliation from Eritrean forces operating in the region in an alliance with Ethiopia’s government. Almost 60,000 Ethiopian refugees have fled to eastern Sudan since the conflict began, according to the UN refugee agency. While Tedros called attention to the crisis in Ukraine, he said he hadn’t heard any head of state from the developed world talking about Tigray during the last few months. “Why? Maybe the reason is the color of the skin of the people in Tigray,” he said. “Nowhere in the world you would see this level of cruelty, where a government punishes 6 million of its people for more than 21 months.” “How can peace talks occur when people are being suffocated?” he asked, grabbing his neck by his own hands to underline the point. “The only thing we ask is, ‘Can the world come back to its senses and uphold humanity?’” UN warnings go back to November 2020 A woman brings her child to a clinic in Wajirat in Southern Tigray in Ethiopia to be checked for malnutrition in late summer. United Nations officials warned of a full-scale humanitarian crisis unfolding in Ethiopia almost two years ago. The conflict erupted after an attack on an Ethiopian government military base in Tigray. Abiy’s government sent troops in to seize control of Tigray’s governing Tigray Peoples’ Liberation Front (TPLF) party and several towns and a humanitarian base with nearly 100,000 Eritrean refugees. Humanitarian aid groups said the government forces effectively sealed off the Tigray region since July 2021, disrupting the flow of crucial food and aid supplies. But the UN Office for the Coordination of Humanitarian Affairs (OCHA) reported earlier this month that 6,105 trucks were able to bring more than 1.4 million metric tons of humanitarian supplies into Tigray since humanitarian convoys resumed in April. The overall humanitarian situation in Ethiopia has significantly deteriorated in 2022 leading to increased humanitarian needs across the country due to ongoing conflict and violence, and climatic shocks such as the prolonged drought,” OCHA said in an 5 Aug situation report. “More than 20 million people are to be targeted for humanitarian assistance and protection this year. Nearly three quarters of them are women and children.” Both sides agreed to hold talks in June after a cease-fire and the flow of aid was somewhat restored but not enough to meet the needs of the millions of people still trapped in the region. As many as 13 million people in the northern Tigray, Afar, and Amhara regions need food assistance due to conflict, according to the World Food Program, and 7.4 million people across the country face severe hunger due to drought. Ethnic cleansing – it could be even more … Tigray refugees Tedros has been at odds with Ethiopia’s government for some time. When he was confirmed for a second term as WHO chief this year, Ethiopia did not co-sponsor his nomination — the first time that an incumbent director general at the UN health agency was thus shunned by his own home country. Ethiopia’s government also wrote WHO earlier this year accusing Tedros of “misconduct” after his sharp criticism of the war and humanitarian crisis in the country. He previously had served as both Ethiopian foreign minister and health minister. That has not deterred Tedros, who spoke movingly about his experiences as a “child of war” growing up in Tigray under earlier cycles of conflict at the opening of the World Health Assembly, on 22 May, where he was elected for a second term as Director General. And on Wednesday, he was even more blunt about the situation unfolding in the region. “It’s ethnic cleansing. It could even be more? Why are people not telling the truth,” Tedros told the press briefing. “Why are we keeping quiet when 6 million people are being punished?” Image Credits: Christine Nesbitt/ UNICEF, Rod Waddington/Flickr, UNICEF/Christine Nesbitt, © UNFPA/Sufian Abdul-Mouty. Monkeypox Cases Spike 20% Weekly Worldwide 17/08/2022 John Heilprin Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), at a virtual press briefing As the first monkeypox case involving a human-to-dog transmission reported, the World Health Organization (WHO) said more than 35,000 recently confirmed cases of monkeypox were accompanied by 12 deaths in 92 nations and territories, including almost 7,500 from last week alone. That made for the second consecutive week with a 20% increase, WHO Director-General Dr Tedros Adhanom Ghebreyesus said Wednesday. Almost all of the cases are being reported from Europe and the Americas and involve men who have sex with men, Tedros told a virtual press briefing, underscoring the importance for all countries to design and deliver services and information tailored to these communities that protect health, human rights and dignity. “The primary focus for all countries,” said Tedros, “must be to ensure they are ready for monkeypox and to stop transmission using effective public health tools, including enhanced disease surveillance, careful contact tracing, tailored risk communication and community engagement and risk reduction measures.” Related to the challenge of outreach, Dr Mike Ryan, executive director of WHO’s Health Emergencies Program, said WHO would “follow up directly” with Mexico’s government – when asked by a Mexican journalist why the country has not yet mounted programmes for widespread testing or clear outreach to potentially vulnerable populations of men – despite a fourfold increase in daily reported cases over the past two weeks. Tedros said vaccines may also play an important part in controlling the outbreak, and in many countries there is high demand for vaccines from the affected communities. “However, for the moment, supplies of vaccines and data about their effectiveness are limited. Although, we are starting to receive data from some countries,” he noted. “WHO has been in close contact with the manufacturers of vaccines and with countries and organizations willing to share those. We remain concerned that the inequitable access to vaccines we saw during the COVID-19 pandemic will be repeated, and that the poorest will continue to be left behind.” Bavarian Nordic, the world’s sole manufacturer of US and European-approved monkeypox vaccines has currently closed its manufacturing plant for renovations – and does not expect to reopen until late this year. Meanwhile, a few wealthy countries, led by the United States, have snapped up all available doses. See Health Policy Watch’s exclusive report: Exclusive: Closure of World’s Only Manufacturing Plant for Monkeypox Vaccine Raises Questions About World’s Ability to Meet Rising Demand First case of human to dog transmission Pet dog in France gets monkeypox from 2 men in same household WHO officials also confirmed the first case of human-to-dog transmission in Paris, where two men went to a hospital and were confirmed to have monkeypox. Twelve days later, a 4-year-old male Italian greyhound that was allowed to sleep with them also tested positive for the virus, according to a recent Lancet article. The case already prompted the U.S. Centers for Disease Control and Prevention to issue new guidance that people with monkeypox should avoid contact with animals, including pets, domestic animals and wildlife to avoid spreading the virus. “Infected animals can spread monkeypox virus to people, and it is possible that people who are infected can spread monkeypox virus to animals through close contact, including petting, cuddling, hugging, kissing, licking, sharing sleeping areas, and sharing food,” stated the CDC guidance. Dr Sylvie Briand, director of WHO’s Epidemic and Pandemic Preparedness and Prevention department (EPP), said it is important to differentiate between the emergence and reemergence of diseases. “It’s something that we know, most of the emerging viruses are coming from animals,” she said. “This is the case for monkeypox, and they infect humans. So at the beginning, it’s only sporadic cases,” she said, referring to the fact that the virus was only discovered in 1958, and for decades after that circulated in a mostly self-limiting way between animals and human communities in central and west Africa. . But if the virus finds the right environment, Briand said, it can evolve to more effectively target humans, resulting in more localized transmission especially in conditions of “high human density, very close contact,” she said. “This is what we have seen with monkeypox. Initially it was in animals, then it went to some humans. And then we had a localized outbreak and now we have a multi-country outbreak.” In terms of disease reemergence, other factors then play out as well. “It’s often because the vaccine coverage is too low that those diseases reemerge,” she said. “And it’s very important to understand that vaccine coverage is a very, very important indicator of the protection of human beings against disease.” 2020 study predicted heightened monkeypox risk with declining smallpox immunity Monkeypox lesions Ironically, a study published in September, 2020 in the Bulletin of the WHO Health Organization, predicted that Central and West Africa’s monkeypox outbreaks could become more frequent – with eventual mutations of the virus increasing human to human transmission as well. Earlier this month, a group of global experts convened by WHO agreed that the virus’s variants will be renamed with Roman numerals. In a review of historical data on outbreaks of Clade 1 of the monkeypox virus in the Democratic Republic of Congo, the authors from Institut Pasteur contended that transmission had remained self-limiting throughout the 1960s and 1970s because most people in DRC were vaccinated against smallpox – which protects against monkeypox virus too. However, after smallpox was declared to be eradicated, and smallpox vaccination ceased in the 1980s – that herd immunity waned: “Since then, the Democratic Republic of the Congo has reported increased monkeypox human infections, and parts of the country have been declared monkeypox-endemic areas,” the report’s authors note. “In 2011–2012, the population immunity against orthopoxvirus species was only 60%… among individuals vaccinated against smallpox and 26% …among individuals unvaccinated against smallpox.” Due to declining immunity, more frequent outbreaks may occur in endemic countries, triggered initially by contact with infected animals, the authors predicted, but they added that over time monkeypox may begin to undergo more “sustained human-to-human transmission (R > 1).” “In either case, repeated circulation of monkeypox in human hosts, particularly immunocompromised hosts, favours pathogen evolution and emergence of newly human-adapted pathogens, depending on R and on the human pathogen fitness landscape.” “”This finding may explain the increasing number of monkeypox outbreak reports, resulting in endemic monkeypox in central African countries…. “Moreover, with declining immunity to orthopoxvirus species, monkeypox can pose an ever-increasing threat for health security.” A prescient conclusion indeed in light of today’s rapidly evolving global health emergency. –Elaine Ruth Fletcher contributed to this story Image Credits: Mothership.sg/Twitter , Tessa Davis/Twitter . W. Africa’s Polluted Air 2nd Only to S. Asia 17/08/2022 John Heilprin & Elaine Ruth Fletcher Downtown Lagos – new study finds it to be among the most polluted cities in Africa and the world. Some 1.7 million people in cities across the planet died from polluted air in 2019, according to the first-ever study of urban air pollution that covers virtually every city in the world over the size of 50,000 people, as per the UN definition. Conditions are the most severe in cities of South Asia, (WHO’s SouthEast Asia region). Strikingly, however, cities in West Africa, are a close follower – with average annual fine particulate (PM2.5) concentrations of 62 micrograms/cubic meter of air (µg/m3), more than 15 times above WHO guideline levels. The study by the State of Global Air Initiative, a collaboration between Boston-based Health Effects Institute (HEI) and Seattle-based Institute for Health Metrics and Evaluation’s (IHME) Global Burden of Disease project, is the largest analysis of urban air pollution to date. It examines data spanning the years 2010-2019 for 7,239 cities, home to some 2.8 billion people. It is also the first global analysis to compare trends in cities over time. The study confirms that urban residents face some of the world’s worst air quality, with 98% of people in all cities around the world breathing air that fails to meet the WHO Air Quality guideline level of 5 µg/m3 – what is considered the most key indicator of health impacts. And with 68% of the world’s population expected to live in urban areas by 2050, air pollutants loom as a major battle for many of the world’s top cities. India and Indonesian cities saw the world’s worst increases in polluted air Industrial air pollution in India – South East Asia is the hardest hit by air pollution overall. While PM2.5 exposures “decreased” in some cities between 2010 and 2919, most notably in China, in parts of South Asia, notably India and Indonesia, air pollution in fact became much worse. “Of 7,239 cities, India is home to 18 of the 20 cities with the most severe increase in PM2.5 pollution from 2010 to 2019. The other two cities are in Indonesia. Alll these cities saw an increase of more than 30 µg/m3 during that decade. Of the 50 cities with the msot severe increase in PM2.5 pollution, 41 are in India and 9 are in Indonesia,” it adds. As for the present day: “Exposures are particularly high in cities in Asia, West Sub-Saharan Africa, and Andean and Central Latin America, the report concludes. “More progress is necessary to protect the health of residents.” Only 2% of cities meet the WHO Air Quality Guidelines and 41% of cities exceed even the least stringent WHO interim Air Quality Guideline Some 86% of cities around the world also exceed WHO’s guidelines for NO2, whose dangers for asthma and lung diseases have been better recognized more recently. Strikingly, cities with excessive levels of NO2 include cities in many high- and middle-income countries where stricter regulations on vehicle and power plant emissions may have reduced PM2.5 levels – but have not sufficiently addressed NO2. Diesel vehicles, promoted by the industry over the last 30 years, emit comparatively higher levels of NO2. Estimates on polluted air combine data from ground monitoring and satellites The new analysis combines available data on air quality from ground-level monitoring stations with satellite data from thousands of cities that lack stations of their own. It provides the full data set on an interactive database. The study estimated annual average concentrations of PM2.5 and NO2 for cities across the planet by integrating available ground-level and satellite data, then dividing that information into grid cells of approximately 1×1 km at the equator. Only 117 nations have ground-level monitoring systems to track PM2.5, and only 74 nations are monitoring NO2 levels, according to the report, which draws its ground level data from an online repository maintained by the World Health Organization. Based on available ground station data, WHO in April issued estimates of average annual air pollution concentrations in 4,000 cities and settlements around the world. Those included PM2.5, and NO2 when data was available. Some of the findings about global hotspots are roughly comparable with WHO’s own recent analysis – which also found that people in South/Southeast Asia, the Middle East and parts of Africa continue to breathe some of the worst air on the planet. However, WHO did not analyse trends over time. Nor did WHO attempt to incorporate satellite data from cities where ground-level measurements are unavailable – which includes most of urban Africa. This new analysis fills in that critical gap – and in the process it reveals how serious pollution in some parts of Africa, and particularly West Africa, has become. “Since most cities around the world have no ground-based air quality monitoring in place, estimates of particulate and gas pollution levels can be used to plan air quality management approaches that ensure the air is clean and safe to breathe,” said Susan Anenberg, an associate professor at George Washington University and one of the project collaborators. West African cities – now among the world’s most polluted Average annual urban air pollution concentrations by region shows cities in South Asia folowed by cities in West Africa as the most polluted in the world. Unlike the most recent WHO study, the HEI/IHME study also estimated air pollution in terms of “population-weighted” exposures to air pollution in each city considered – rather than in terms of the city’s spatial limits only – linking the pollution concentrations in each grid cell with the number of people living within each block to produce a population-weighted annual average. Population-weighted exposures are an essential input to the estimation of mortality, per capita, from air pollution in any given area. In terms of population-weighted exposures, the data includes some surprises. Not only do people in longstanding hotspots like Delhi, Kolkata, Dhaka and Jakarta as well as Beijing, continue to breathe some of the the worst air in the world, so do people in Lima Peru; Lagos and Kano, Nigeria, and Accra, Ghana. Geographic patterns of air pollutants NO2 and PM2.5 strikingly different The study also confirms prior WHO findings that the geographic patterns of excessive exposure to PM2 and NO2 are considerably different at times. “Cities in Asia and Africa are already hotspots for PM2.5 pollution,” the study concludes. “At the same time, NO2 pollution – primarily from vehicle traffic – is high and growing in some cities and regions that are not PM2.5 hotspots.” Air pollutants responsible for 7 million deaths worldwide Air pollution is responsible for about 1-in-9 deaths worldwide, or between 6.7 to 7 million deaths a year, according to the latest estimates by both HEI/IHME and WHO. Outdoor, ambient air pollution is estimated by WHO to kill about 4.2 million people a year. There is an overlap, however, between deaths attributable to outdoor air pollution and the estimated 3.2 million deaths a year attributed to household air pollution. The latter is related largely to exposures to smoke from biomass, kerosene and coal fires used by billions of people for cooking and heating. Air pollution is a factor in illness and premature deaths particularly in older people and those with chronic respiratory and cardiovascular conditions. WHO estimates that quarter of all deaths from heart attacks and stroke, and nearly 30% of deaths from lung cancer, as well as 43% of deaths from lung disease, are attributable to air pollution. Exposure to NO2, meanwhile, exacerbates lung inflammation, contributing to asthma and other respiratory diseases, and potentially impeding children’s lung development. High NO2 exposures that lead to difficulties breathing, coughing or wheezing, may cause spikes in hospital and emergency-room admissions, according to WHO. People living near busy roads congested with lots of city traffic often are exposed to higher levels than people in rural settings. China air quality improved but air pollution related mortality still very high In terms of mortality, a significant number of Chinese cities, led by Beijing, continue to have a high proportion of deaths from air pollution. That is despite the fact that China is the country that has also seen the greatest improvements in urban quality over the past couple of decades, the report finds. This paradox is due to two factors – the comparative ageing of China’s population and the fact that exposure to air pollution, even at comparatively lower levels, can still be deadly. Recognizing this, WHO in 2018 reduced by half it’s guideline level for annual average exposure levels of PM2.5 from 10 to 5 µg/m3. WHO also halved its NO2 guideline level to 10 µg/m3. Urban air pollution hotspots by region. In South/SouthEast Asia mortality from urban air pollution also has grown significantly in the past 20 years, the report also concludes – with Jakarta and Delhi having the highest levels of mortality, per 100,000 population, from air pollution. In central Asia, hot spots included Tashkent, Uzbekistan and Almaty, Kazakhstan. Most of those cities also are areas long reliant on coal-burning for heat and power production. Compared to other parts of eastern and central Europe, Kyiv and Kharkiv in Ukraine, the Polish cities of Katowice and Warsaw, as well as Budapest Hungary and Bucharest, Romania, also had high pollution-related death rates. Conversely, African cities don’t rank as prominently in terms of global air pollution-related mortality – largely because the residents of African cities are much younger on average and thus not as likely to die – yet – from air pollution related diseases. Taking action against air pollutants Cycling in Fortaleza, Brazil – the city has won worldwide recognition for its sustainable transport planning that contributes to healthy physical activity and reduces air pollution. The good news, the study concludes, is that there are a wide range of cost-effective solutions already available to reduce pollution from many key pollution sources. Those include the promotion of green and sustainable transportation, expanded access to clean energy for households and a shift to clean and efficient energy production based on renewable energy sources and not fossil fuels. The report also cites some of the urban solutions have yielded results, including stricter vehicle and power plant emissions limits and urban planning solutions that reduce the need to travel. In Europe, for instance, more than 300 cities created low-emission zones (LEZs) for vehicles that reduced traffic-related air pollution by banning the entry of high-polluting vehicles and encouraging more walking, cycling and use of public transportion. In China’s capital Beijing, new measures such as tighter controls over coal-fired power plants, more stringent vehicle emission and fuel quality standards, and additional air monitoring stations contributed to a 36% decline in the city’s annual average PM2.5 level over five years. But those successes remain exceptions to the rule for many, or even most, of the world’s low and middle income cities – which have not yet come to grips with air pollution as a deadly health threat. “As cities around the world rapidly grow,” said Pallavi Pant, a senior scientist with HEI who oversaw the study, “the impacts of air pollution on residents’ health are also expected to increase, underscoring the importance of early interventions to reduce exposures and protect public health.” Image Credits: Flickr/US 6th Fleet photostream, Uncommonthought.com, Air Quality and Health in Cities, State of Global Air Report , Urban Air Quality and Health – State of Global Air , Air Quality and Health in Cities, State of Global Air,, Air Quality and Health In Cities, State of Global Air , City of Fortaleza. Climate Change is a Double Blow for People with Disabilities 16/08/2022 Kavitha Yarlagadda Pratyush Nalam, a software professional in Hyderabad, India HYDERABAD – Pratyush Nalam, a software professional in this south-central Indian city that has become a global tech outpost for Silicon Valley, moves around his house in his wheelchair. He has spinal muscular atrophy and cannot walk, so his family members help him. Though the monsoon season in Hyderabad brings lots of precipitation from the end of June to early October, scientists say the rains are getting even heavier due to climate change. And that, says Nalam, is making life tougher for people than summer heat or winter’s chills. “Getting to a dry place quickly is a challenge,” Nalam says of the growing challenge he faces in just getting around. “Bus stops don’t have shelters and are far to get to – and accessible transport is not available in most cases.” The combined detrimental effects from a lack of inclusive planning or early warning systems, less information and transportation options, and overall discriminatory attitudes has driven the global mortality rate for people with disabilities who experience natural disasters up to four times higher than it is for people without disabilities, according to a Lancet report. Nalam said that during heavy rains “we cannot see the bumps on the roads or sidewalks, which make it riskier to drive our wheelchairs.” Hotter and hotter norms Summer in India has temperatures that regularly climb into the high 30C. Europe has suffered wildfires, evacuations and heat-related deaths this summer, as heat waves force temperatures above 40 degrees C in places like Portugal and France – only slightly hotter than the warmest season in Hyderabad, where temperatures regularly climb into the high 30s C during the pre-monsoon summer from late March to early June. Still, a devastating heat wave that scientists say was made more likely by climate change has baked India and Pakistan in recent months, with some cities in the two neighboring countries reaching around 45 to 50 C. Across Europe and Asia, record temperatures have challenged daily lives, posing serious health risks to families, students, businesspeople and travelers. As with most other natural and manmade disasters, the people that suffer the most often are those that are the most marginalized. “Extreme heat is the root cause of all of the catastrophic events that we are experiencing, from wildfires to drought, hurricanes, storm surges, and flooding,” said Wendy Nystrom, an environmental and pollution risk management consultant in Los Angeles. Among those most affected by climate change Aunia Kahn Persons with disabilities are frequently among the worst affected by climate change, similar to the disproportionately higher rates of morbidity and mortality they suffer in emergencies while also being among the least able to get emergency assistance. “It feels that I am always living in a bubble. I am allergic to heat and cold and this makes me very vulnerable to climate change,” said Aunia Kahn, a disabled U.S. business owner in Eugene, Oregon, who struggles with rare chronic illnesses such as Ehlers Danlos Syndrome, Mast Cell Activation Syndrome, and Dysautonomia. Certain conditions of disability are disproportionately affected by global warming. For example, people with spinal cord injuries cannot cool themselves during excessive heat while people with multiple sclerosis feel more pain and fatigue during hot weather conditions. Some 15% of the world’s population have a disability, the World Bank reported. Many people with them also live in extreme poverty, exacerbating their vulnerability to climate change due to a general lack of proper sanitation, health care, nutrition or safe drinking water. “Earth is warming and global warming is the main reason for the extreme heat waves. Heat intensity is increasing and reducing the quality of our lives,” said Dr. Roxy Mathew Koll of the Indian Institute of Tropical Meteorology in Pune, India. “The vulnerable are the ones who are the most impacted.” Dr Roxy Mathew Koll An increasing human rights issue But the right to a clean, healthy and sustainable environment should be the same for all irrespective of differences such as caste and creed, the UN General Assembly determined in a landmark resolution approved in late July. The assembly’s 161-0 vote with eight abstentions by Belarus, Cambodia, China, Ethiopia, Iran, Kyrgyzstan, Russia and Syria gives momentum to the work of activists and citizens seeking greater legal and regulatory protections. It followed a 43-0 vote on a similar resolution last October in the 47-nation UN Human Rights Council – with China, India, Japan and Russia abstaining. Lack of mobility in emergencies is life-threatening People with disabilities and women and children in South Asia and Africa are more vulnerable to severe weather events like heat waves, floods, cyclones and storm surges, according to experts. This is because they have less access to information on climate adaptation, rarely benefit from government aid and have fewer economic privileges than men. And extreme weather events like cyclones and floods are intensifying in a very short time, giving disabled people little time to move to safety, according to Koll. “People with disabilities, particularly with mobility issues, have limited capacity to respond to emergency situations during an extreme weather event,” he said. But only 10% of people with disabilities believe their local government has emergency, disaster management, or risk reduction plans that address their access and functional needs, according to a UN report. And just 20.6% said they could self-evacuate without difficulty in the event of a sudden disaster, a UN Office for Disaster Risk Reduction online survey found. A hot day in Hyderabad For the old and young, climate change presents difficulties. Vishnu Kumar, a 75 year old man from Hyderabad, suffered a paralytic stroke three years ago and has been confined to a bed and wheelchair since then. As with many elderly, the excessive heat zaps his energy and the frequent power cuts only increase his discomfort, adding to friction in his family. And for student Rohit Reddy, eczema and allergies worsened during summers in the coastal city of Mumbai, costing him time needed for his studies. “I had to shift to Hyderabad because of the flare ups due to extreme humidity, now I may lose an academic year,” Reddy said. -Updated 16.08.2022 with correction to the name of Pratyush Nalam’s condition as spinal muscular atrophy, not muscular dystrophy. Image Credits: Skymet , Pratyush Nalam, Aunia Kahn, Roxy Koll, Gulf News. Monkeypox Variants Get New Names 12/08/2022 Editorial team While the process of renaming monkeypox is still underway, a group of global experts convened by the World Health Organization (WHO) has agreed that the virus’s variants will be renamed with Roman numerals. This follows a meeting convened by the WHO this week to enable virologists and public health experts to reach consensus on new terminology, the global body announced on Friday. Experts in pox virology, evolutionary biology and representatives of research institutes from across the globe reached consensus that the former Congo Basin (Central African) clade will be referred to as Clade one (I) and the former West African clade as Clade two (II). The group also agreed that Clade II consists of two subclades, which will be referred to as Clade IIa and Clade IIb. Assigning new names to existing diseases is the responsibility of WHO under the International Classification of Diseases and the WHO is holding an open consultation for a new name for monkeypox. Anyone wishing to propose new names can do so here. The naming of virus species is the responsibility of the International Committee on the Taxonomy of Viruses (ICTV), which also has a process underway for the name of the monkeypox virus. Image Credits: TRT World Now/Twitter . India is Trying to Reduce Maternal Mortality Without Addressing a Key Contributor: Suicide 12/08/2022 Disha Shetty Suicide is one of the leading causes of death among women of childbearing age in India. Pregnancy is most often a cause for celebration of a new life and a new addition to the family. But for the women who walk into Garima Malik’s clinic in New Delhi, it is a very different story. Some cry. Others appear angry, irritable or frustrated. Usually, the cause is domestic violence – pregnancy is a particularly vulnerable time and as an experienced counsellor, Malik is trained to spot the signs. “They talk about suicide,” she says. “Then they calm down. We talk about risk management and safety planning and counselling. So somehow, they cope.” Malik says many of those who come to the clinic, run by the medical charity Medecins Sans Frontieres (MSF), have experienced physical and emotional violence during pregnancy. Sometimes this is because they are unwilling to be intimate with a partner in the early part of the pregnancy or immediately after the birth. Other times it is because they have given birth to a girl, seen by some as less desirable. “This can cause loneliness in women and they feel frustrated and they feel like he [the husband] needed the child, the family needed the child, and I am the one suffering,” she says. Malik says they are the lucky ones — most Indian women who experience suicidal thoughts in the period during or after their pregnancy will not seek or receive any help. Yet suicide is one of the leading causes of death among women of child-bearing age in India. According to one recent study published in The Lancet medical journal, the suicide rate among Indian women and girls is twice the global average. Women may experience suicidal thoughts during or after pregnancy. India has made enormous strides since the turn of the century in reducing overall maternal mortality, reducing deaths by more than half. In 2019, 103 mothers were dying per 100,000 live births, down from 254 in 2004. The United Nations has set the goal of reducing maternal mortality globally to 70 deaths per 100,000 by 2030. But that success has exposed a phenomenon that had previously gone largely unnoticed in India: high rates of suicides in the perinatal period, defined as during and immediately after pregnancy. A 2016 study of 462 low-income women in early pregnancy in south India found 7.6% were at risk of suicide compared to roughly 0.4% in the United States. Health experts say the government has done little to address this problem, and a suicide prevention action plan devised in 2018 has never been implemented. India is losing young women “in enormous numbers,” says Lakshmi Vijayakumar, a psychiatrist and a member of the World Health Organization (WHO)’s International Network for Suicide Research and Prevention. “And we don’t have any effective mechanism or plan or strategy to address this issue.” The Indian government did not respond to a request for comment. Data on this is limited. India compiles national maternal death statistics by extrapolating from a representative sample survey, but does not separate the data into causes of death. Police keep data on reported suicides, but do not record whether the person was pregnant, and anyway, suicides are underreported. Perinatal suicides are often linked to a history of psychiatric illness, but Lakshmi* says this does not seem to be the case in India. Instead, social factors such as early marriage, intimate partner violence, pressure to give birth to a son and women’s lack of financial autonomy are drivers. Reducing maternal deaths — a revealing success story When it comes to the physical causes of maternal deaths, India’s success has been marked and is largely due to an increase in deliveries at free public health facilities rather than at home. In-facility deliveries rose from 31.1% in 2005-06 to 88.6% in 2019-21, according to government figures, driven by awareness campaigns and offering small financial incentives to pregnant women and grassroots health workers. The southern Indian state of Kerala has been among the most successful in reducing maternal deaths. With 43 per 100,000 live births, it is the safest place in the country to give birth. It is also the only state to have looked into perinatal suicide data, analyzing the 1,076 maternal deaths registered between 2010 and 2020. During that period, mortality dropped from 66 to 43, but the share of suicides increased from about 2.6% in 2010 to 6.6% five years later, and to 18.6% in 2019–20. But that data should be treated with some caution – Kerala’s relatively low rates of maternal mortality were based on a small sample but, combined with the 2016 study in south India, it indicates a trend, says Soumitra Pathare, psychiatrist and director of the Centre for Mental Health Law and Policy. “It is important for various reasons – we now have systematic data to show that suicides are a significant problem in young women, especially young women who are pregnant or have just delivered a child,” he says. “Maternal mortality has gone down substantially because that’s something that has had an intervention done for it. So what this actually shows is that we’ve not done any intervention for suicide prevention.” He cautioned that the data capture only some of the problem. For every person who dies by suicide, an estimated four to 20 times more people attempt it. “So the number of attempted suicides [in India] is anywhere between 0.6 million to 6 million,” said Pathare. “We don’t even collect data on it. ” Early intervention is key Nearly a third of Indian women between the ages of 15 and 49 who have been married, have experienced intimate partner violence. There has been little research into the drivers of perinatal suicide in India, though the Kerala review identified psychiatric illness, young age, unmarried status and domestic violence as risk factors. Nearly one in every three Indian women between the ages of 15-49 who has ever been married has experienced intimate partner violence, according to government figures. Around 3.1% of women in this category said they experienced physical violence during pregnancy. Marital rape is not legally recognized, although this is being challenged in the courts. Nayreen Daruwalla, head of a program on the prevention of violence against women and children at the Mumbai-based non-profit SNEHA, says suicide during pregnancy often falls into one of two categories. “One is pregnant women who are married and in whose cases the family insists on having a boy,” she said. “Unwed mothers are a huge category of cases especially given the lack of social support and sometimes the lack of support from the partner who might be reluctant to wed on finding out the woman is pregnant.” Experts say early intervention is key to preventing perinatal suicides, and that India already has the systems in place to do this. Shaji KS, dean of research at the Kerala University of Health Sciences and part of the team that reviewed perinatal suicides in Kerala, cites India’s network of grassroots health workers, through whom every pregnant person in the country can be reached. Adding a psychiatric component to support their mental health would help prevent many deaths, he said. MSF’s Malik sees a need for more vocational training to enable Indian women to become financially independent, making it easier for them to escape abusive situations. Research in Australia has found this to be effective in reducing suicides. In India, women’s labour force participation has steadily declined from around 30.4% in 2000 to 19% in 2021. “When we talk to such patients, when we talk about leaving husbands and leaving such [a] toxic environment and getting out of this kind of relationship, they want to,” she said. “They cannot because they are not financially independent.” Studies also show restricting access to pesticides, used in many suicides in India, might prevent some of the deaths. Lakshmi, the psychiatrist and WHO advisor, was part of a task force set up by the Indian government in 2018 to suggest ways to reduce overall suicides, whose recommendations have not been implemented. Asked about funding for suicide prevention, the government said in February that funds had been allocated and announced plans for a national telemedicine program for mental health. But it did not commit to adopting the task force’s recommendations. “We have submitted the plan” said Lakshmi. “It is still lying there. I hope that one day it will see the light of day.” * The use of a given name used on second reference is common practice in parts of south India If you or someone you know is struggling with mental health or suicidal thoughts, help is available at iCALL run by TISS at 9152987821 [India] or the National Suicide Prevention Lifeline at 1-800-273-8255 [US]. This article was first published in The Fuller Project. Image Credits: Children's Investment Fund/Flickr , UN Photo/Kibae Park/Flickr, Yogendra Singh/ Unsplash. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... 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Ethiopia Pursues ‘Ethnic Cleansing’ in Tigray, Tedros Says; Warns of Nuclear Threat in Ukraine 18/08/2022 John Heilprin A woman selling fruit in Adigrat, Tigray region Ethiopia’s Tigray region suffers from “the worst catastrophe on Earth” due to a devastating mix of factors such as government neglect, drought, and racism, World Health Organization Director General Dr. Tedros Adhanom Ghebreyesus told a virtual press briefing Wednesday. Tedros grew emotional at the end of the briefing as he described the humanitarian crisis facing 6 million people in the region who have been cut off from the world and insisted “it’s not because I’m from Tigray that I’m saying that.” Shifting back and forth from the crisis in Tigray, drought, and hunger throughout the Horn of Africa and also Ukraine, Tedros warned the international community may be “sleepwalking into a nuclear war” as a result of Russia’s war in Ukraine, which he called “the mother of all problems.” “But in terms of humanitarian crisis, I can tell you the humanitarian crisis is greater in Tigray,” he said. Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), at a virtual press briefing Millions of people have been displaced by the fighting between Ethiopian Prime Minister Abiy Ahmed’s government and Tigray’s regional administration. National and regional governments view one another as unlawful Abiy was awarded the Nobel Peace Prize in 2019 for defusing tensions with neighboring Eritrea, but his government has taken a hardnosed approach toward Tigray’s regional administration, which it views as unlawful – leading to the military entry to the region. Tigray’s regional administration defied the government by holding an election in September 2020. And Tigray’s regional administration saw Abiy’s government as unlawful after he postponed national elections due to the coronavirus pandemic. Tigray has now been under a virtual military siege for over a year, sparking widespread hunger as well as disease. Despite recent promises to allow the entry of desperately needed food and medical supplies, only a scattered number of relief envoys have been allowed to pass by the Ethiopian forces amassed around and inside parts of Tigray. In January, Tedros slammed Ethiopia’s “complete blockade” on health and humanitarian aid to the Tigray region, saying it has been unable to deliver life-saving medications for nearly six months in a situation that is “unprecedented” even in comparison to conflict-wracked Syria or Yemen. Eritrean refugees in Ethiopia now also fear retaliation from Eritrean forces operating in the region in an alliance with Ethiopia’s government. Almost 60,000 Ethiopian refugees have fled to eastern Sudan since the conflict began, according to the UN refugee agency. While Tedros called attention to the crisis in Ukraine, he said he hadn’t heard any head of state from the developed world talking about Tigray during the last few months. “Why? Maybe the reason is the color of the skin of the people in Tigray,” he said. “Nowhere in the world you would see this level of cruelty, where a government punishes 6 million of its people for more than 21 months.” “How can peace talks occur when people are being suffocated?” he asked, grabbing his neck by his own hands to underline the point. “The only thing we ask is, ‘Can the world come back to its senses and uphold humanity?’” UN warnings go back to November 2020 A woman brings her child to a clinic in Wajirat in Southern Tigray in Ethiopia to be checked for malnutrition in late summer. United Nations officials warned of a full-scale humanitarian crisis unfolding in Ethiopia almost two years ago. The conflict erupted after an attack on an Ethiopian government military base in Tigray. Abiy’s government sent troops in to seize control of Tigray’s governing Tigray Peoples’ Liberation Front (TPLF) party and several towns and a humanitarian base with nearly 100,000 Eritrean refugees. Humanitarian aid groups said the government forces effectively sealed off the Tigray region since July 2021, disrupting the flow of crucial food and aid supplies. But the UN Office for the Coordination of Humanitarian Affairs (OCHA) reported earlier this month that 6,105 trucks were able to bring more than 1.4 million metric tons of humanitarian supplies into Tigray since humanitarian convoys resumed in April. The overall humanitarian situation in Ethiopia has significantly deteriorated in 2022 leading to increased humanitarian needs across the country due to ongoing conflict and violence, and climatic shocks such as the prolonged drought,” OCHA said in an 5 Aug situation report. “More than 20 million people are to be targeted for humanitarian assistance and protection this year. Nearly three quarters of them are women and children.” Both sides agreed to hold talks in June after a cease-fire and the flow of aid was somewhat restored but not enough to meet the needs of the millions of people still trapped in the region. As many as 13 million people in the northern Tigray, Afar, and Amhara regions need food assistance due to conflict, according to the World Food Program, and 7.4 million people across the country face severe hunger due to drought. Ethnic cleansing – it could be even more … Tigray refugees Tedros has been at odds with Ethiopia’s government for some time. When he was confirmed for a second term as WHO chief this year, Ethiopia did not co-sponsor his nomination — the first time that an incumbent director general at the UN health agency was thus shunned by his own home country. Ethiopia’s government also wrote WHO earlier this year accusing Tedros of “misconduct” after his sharp criticism of the war and humanitarian crisis in the country. He previously had served as both Ethiopian foreign minister and health minister. That has not deterred Tedros, who spoke movingly about his experiences as a “child of war” growing up in Tigray under earlier cycles of conflict at the opening of the World Health Assembly, on 22 May, where he was elected for a second term as Director General. And on Wednesday, he was even more blunt about the situation unfolding in the region. “It’s ethnic cleansing. It could even be more? Why are people not telling the truth,” Tedros told the press briefing. “Why are we keeping quiet when 6 million people are being punished?” Image Credits: Christine Nesbitt/ UNICEF, Rod Waddington/Flickr, UNICEF/Christine Nesbitt, © UNFPA/Sufian Abdul-Mouty. Monkeypox Cases Spike 20% Weekly Worldwide 17/08/2022 John Heilprin Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), at a virtual press briefing As the first monkeypox case involving a human-to-dog transmission reported, the World Health Organization (WHO) said more than 35,000 recently confirmed cases of monkeypox were accompanied by 12 deaths in 92 nations and territories, including almost 7,500 from last week alone. That made for the second consecutive week with a 20% increase, WHO Director-General Dr Tedros Adhanom Ghebreyesus said Wednesday. Almost all of the cases are being reported from Europe and the Americas and involve men who have sex with men, Tedros told a virtual press briefing, underscoring the importance for all countries to design and deliver services and information tailored to these communities that protect health, human rights and dignity. “The primary focus for all countries,” said Tedros, “must be to ensure they are ready for monkeypox and to stop transmission using effective public health tools, including enhanced disease surveillance, careful contact tracing, tailored risk communication and community engagement and risk reduction measures.” Related to the challenge of outreach, Dr Mike Ryan, executive director of WHO’s Health Emergencies Program, said WHO would “follow up directly” with Mexico’s government – when asked by a Mexican journalist why the country has not yet mounted programmes for widespread testing or clear outreach to potentially vulnerable populations of men – despite a fourfold increase in daily reported cases over the past two weeks. Tedros said vaccines may also play an important part in controlling the outbreak, and in many countries there is high demand for vaccines from the affected communities. “However, for the moment, supplies of vaccines and data about their effectiveness are limited. Although, we are starting to receive data from some countries,” he noted. “WHO has been in close contact with the manufacturers of vaccines and with countries and organizations willing to share those. We remain concerned that the inequitable access to vaccines we saw during the COVID-19 pandemic will be repeated, and that the poorest will continue to be left behind.” Bavarian Nordic, the world’s sole manufacturer of US and European-approved monkeypox vaccines has currently closed its manufacturing plant for renovations – and does not expect to reopen until late this year. Meanwhile, a few wealthy countries, led by the United States, have snapped up all available doses. See Health Policy Watch’s exclusive report: Exclusive: Closure of World’s Only Manufacturing Plant for Monkeypox Vaccine Raises Questions About World’s Ability to Meet Rising Demand First case of human to dog transmission Pet dog in France gets monkeypox from 2 men in same household WHO officials also confirmed the first case of human-to-dog transmission in Paris, where two men went to a hospital and were confirmed to have monkeypox. Twelve days later, a 4-year-old male Italian greyhound that was allowed to sleep with them also tested positive for the virus, according to a recent Lancet article. The case already prompted the U.S. Centers for Disease Control and Prevention to issue new guidance that people with monkeypox should avoid contact with animals, including pets, domestic animals and wildlife to avoid spreading the virus. “Infected animals can spread monkeypox virus to people, and it is possible that people who are infected can spread monkeypox virus to animals through close contact, including petting, cuddling, hugging, kissing, licking, sharing sleeping areas, and sharing food,” stated the CDC guidance. Dr Sylvie Briand, director of WHO’s Epidemic and Pandemic Preparedness and Prevention department (EPP), said it is important to differentiate between the emergence and reemergence of diseases. “It’s something that we know, most of the emerging viruses are coming from animals,” she said. “This is the case for monkeypox, and they infect humans. So at the beginning, it’s only sporadic cases,” she said, referring to the fact that the virus was only discovered in 1958, and for decades after that circulated in a mostly self-limiting way between animals and human communities in central and west Africa. . But if the virus finds the right environment, Briand said, it can evolve to more effectively target humans, resulting in more localized transmission especially in conditions of “high human density, very close contact,” she said. “This is what we have seen with monkeypox. Initially it was in animals, then it went to some humans. And then we had a localized outbreak and now we have a multi-country outbreak.” In terms of disease reemergence, other factors then play out as well. “It’s often because the vaccine coverage is too low that those diseases reemerge,” she said. “And it’s very important to understand that vaccine coverage is a very, very important indicator of the protection of human beings against disease.” 2020 study predicted heightened monkeypox risk with declining smallpox immunity Monkeypox lesions Ironically, a study published in September, 2020 in the Bulletin of the WHO Health Organization, predicted that Central and West Africa’s monkeypox outbreaks could become more frequent – with eventual mutations of the virus increasing human to human transmission as well. Earlier this month, a group of global experts convened by WHO agreed that the virus’s variants will be renamed with Roman numerals. In a review of historical data on outbreaks of Clade 1 of the monkeypox virus in the Democratic Republic of Congo, the authors from Institut Pasteur contended that transmission had remained self-limiting throughout the 1960s and 1970s because most people in DRC were vaccinated against smallpox – which protects against monkeypox virus too. However, after smallpox was declared to be eradicated, and smallpox vaccination ceased in the 1980s – that herd immunity waned: “Since then, the Democratic Republic of the Congo has reported increased monkeypox human infections, and parts of the country have been declared monkeypox-endemic areas,” the report’s authors note. “In 2011–2012, the population immunity against orthopoxvirus species was only 60%… among individuals vaccinated against smallpox and 26% …among individuals unvaccinated against smallpox.” Due to declining immunity, more frequent outbreaks may occur in endemic countries, triggered initially by contact with infected animals, the authors predicted, but they added that over time monkeypox may begin to undergo more “sustained human-to-human transmission (R > 1).” “In either case, repeated circulation of monkeypox in human hosts, particularly immunocompromised hosts, favours pathogen evolution and emergence of newly human-adapted pathogens, depending on R and on the human pathogen fitness landscape.” “”This finding may explain the increasing number of monkeypox outbreak reports, resulting in endemic monkeypox in central African countries…. “Moreover, with declining immunity to orthopoxvirus species, monkeypox can pose an ever-increasing threat for health security.” A prescient conclusion indeed in light of today’s rapidly evolving global health emergency. –Elaine Ruth Fletcher contributed to this story Image Credits: Mothership.sg/Twitter , Tessa Davis/Twitter . W. Africa’s Polluted Air 2nd Only to S. Asia 17/08/2022 John Heilprin & Elaine Ruth Fletcher Downtown Lagos – new study finds it to be among the most polluted cities in Africa and the world. Some 1.7 million people in cities across the planet died from polluted air in 2019, according to the first-ever study of urban air pollution that covers virtually every city in the world over the size of 50,000 people, as per the UN definition. Conditions are the most severe in cities of South Asia, (WHO’s SouthEast Asia region). Strikingly, however, cities in West Africa, are a close follower – with average annual fine particulate (PM2.5) concentrations of 62 micrograms/cubic meter of air (µg/m3), more than 15 times above WHO guideline levels. The study by the State of Global Air Initiative, a collaboration between Boston-based Health Effects Institute (HEI) and Seattle-based Institute for Health Metrics and Evaluation’s (IHME) Global Burden of Disease project, is the largest analysis of urban air pollution to date. It examines data spanning the years 2010-2019 for 7,239 cities, home to some 2.8 billion people. It is also the first global analysis to compare trends in cities over time. The study confirms that urban residents face some of the world’s worst air quality, with 98% of people in all cities around the world breathing air that fails to meet the WHO Air Quality guideline level of 5 µg/m3 – what is considered the most key indicator of health impacts. And with 68% of the world’s population expected to live in urban areas by 2050, air pollutants loom as a major battle for many of the world’s top cities. India and Indonesian cities saw the world’s worst increases in polluted air Industrial air pollution in India – South East Asia is the hardest hit by air pollution overall. While PM2.5 exposures “decreased” in some cities between 2010 and 2919, most notably in China, in parts of South Asia, notably India and Indonesia, air pollution in fact became much worse. “Of 7,239 cities, India is home to 18 of the 20 cities with the most severe increase in PM2.5 pollution from 2010 to 2019. The other two cities are in Indonesia. Alll these cities saw an increase of more than 30 µg/m3 during that decade. Of the 50 cities with the msot severe increase in PM2.5 pollution, 41 are in India and 9 are in Indonesia,” it adds. As for the present day: “Exposures are particularly high in cities in Asia, West Sub-Saharan Africa, and Andean and Central Latin America, the report concludes. “More progress is necessary to protect the health of residents.” Only 2% of cities meet the WHO Air Quality Guidelines and 41% of cities exceed even the least stringent WHO interim Air Quality Guideline Some 86% of cities around the world also exceed WHO’s guidelines for NO2, whose dangers for asthma and lung diseases have been better recognized more recently. Strikingly, cities with excessive levels of NO2 include cities in many high- and middle-income countries where stricter regulations on vehicle and power plant emissions may have reduced PM2.5 levels – but have not sufficiently addressed NO2. Diesel vehicles, promoted by the industry over the last 30 years, emit comparatively higher levels of NO2. Estimates on polluted air combine data from ground monitoring and satellites The new analysis combines available data on air quality from ground-level monitoring stations with satellite data from thousands of cities that lack stations of their own. It provides the full data set on an interactive database. The study estimated annual average concentrations of PM2.5 and NO2 for cities across the planet by integrating available ground-level and satellite data, then dividing that information into grid cells of approximately 1×1 km at the equator. Only 117 nations have ground-level monitoring systems to track PM2.5, and only 74 nations are monitoring NO2 levels, according to the report, which draws its ground level data from an online repository maintained by the World Health Organization. Based on available ground station data, WHO in April issued estimates of average annual air pollution concentrations in 4,000 cities and settlements around the world. Those included PM2.5, and NO2 when data was available. Some of the findings about global hotspots are roughly comparable with WHO’s own recent analysis – which also found that people in South/Southeast Asia, the Middle East and parts of Africa continue to breathe some of the worst air on the planet. However, WHO did not analyse trends over time. Nor did WHO attempt to incorporate satellite data from cities where ground-level measurements are unavailable – which includes most of urban Africa. This new analysis fills in that critical gap – and in the process it reveals how serious pollution in some parts of Africa, and particularly West Africa, has become. “Since most cities around the world have no ground-based air quality monitoring in place, estimates of particulate and gas pollution levels can be used to plan air quality management approaches that ensure the air is clean and safe to breathe,” said Susan Anenberg, an associate professor at George Washington University and one of the project collaborators. West African cities – now among the world’s most polluted Average annual urban air pollution concentrations by region shows cities in South Asia folowed by cities in West Africa as the most polluted in the world. Unlike the most recent WHO study, the HEI/IHME study also estimated air pollution in terms of “population-weighted” exposures to air pollution in each city considered – rather than in terms of the city’s spatial limits only – linking the pollution concentrations in each grid cell with the number of people living within each block to produce a population-weighted annual average. Population-weighted exposures are an essential input to the estimation of mortality, per capita, from air pollution in any given area. In terms of population-weighted exposures, the data includes some surprises. Not only do people in longstanding hotspots like Delhi, Kolkata, Dhaka and Jakarta as well as Beijing, continue to breathe some of the the worst air in the world, so do people in Lima Peru; Lagos and Kano, Nigeria, and Accra, Ghana. Geographic patterns of air pollutants NO2 and PM2.5 strikingly different The study also confirms prior WHO findings that the geographic patterns of excessive exposure to PM2 and NO2 are considerably different at times. “Cities in Asia and Africa are already hotspots for PM2.5 pollution,” the study concludes. “At the same time, NO2 pollution – primarily from vehicle traffic – is high and growing in some cities and regions that are not PM2.5 hotspots.” Air pollutants responsible for 7 million deaths worldwide Air pollution is responsible for about 1-in-9 deaths worldwide, or between 6.7 to 7 million deaths a year, according to the latest estimates by both HEI/IHME and WHO. Outdoor, ambient air pollution is estimated by WHO to kill about 4.2 million people a year. There is an overlap, however, between deaths attributable to outdoor air pollution and the estimated 3.2 million deaths a year attributed to household air pollution. The latter is related largely to exposures to smoke from biomass, kerosene and coal fires used by billions of people for cooking and heating. Air pollution is a factor in illness and premature deaths particularly in older people and those with chronic respiratory and cardiovascular conditions. WHO estimates that quarter of all deaths from heart attacks and stroke, and nearly 30% of deaths from lung cancer, as well as 43% of deaths from lung disease, are attributable to air pollution. Exposure to NO2, meanwhile, exacerbates lung inflammation, contributing to asthma and other respiratory diseases, and potentially impeding children’s lung development. High NO2 exposures that lead to difficulties breathing, coughing or wheezing, may cause spikes in hospital and emergency-room admissions, according to WHO. People living near busy roads congested with lots of city traffic often are exposed to higher levels than people in rural settings. China air quality improved but air pollution related mortality still very high In terms of mortality, a significant number of Chinese cities, led by Beijing, continue to have a high proportion of deaths from air pollution. That is despite the fact that China is the country that has also seen the greatest improvements in urban quality over the past couple of decades, the report finds. This paradox is due to two factors – the comparative ageing of China’s population and the fact that exposure to air pollution, even at comparatively lower levels, can still be deadly. Recognizing this, WHO in 2018 reduced by half it’s guideline level for annual average exposure levels of PM2.5 from 10 to 5 µg/m3. WHO also halved its NO2 guideline level to 10 µg/m3. Urban air pollution hotspots by region. In South/SouthEast Asia mortality from urban air pollution also has grown significantly in the past 20 years, the report also concludes – with Jakarta and Delhi having the highest levels of mortality, per 100,000 population, from air pollution. In central Asia, hot spots included Tashkent, Uzbekistan and Almaty, Kazakhstan. Most of those cities also are areas long reliant on coal-burning for heat and power production. Compared to other parts of eastern and central Europe, Kyiv and Kharkiv in Ukraine, the Polish cities of Katowice and Warsaw, as well as Budapest Hungary and Bucharest, Romania, also had high pollution-related death rates. Conversely, African cities don’t rank as prominently in terms of global air pollution-related mortality – largely because the residents of African cities are much younger on average and thus not as likely to die – yet – from air pollution related diseases. Taking action against air pollutants Cycling in Fortaleza, Brazil – the city has won worldwide recognition for its sustainable transport planning that contributes to healthy physical activity and reduces air pollution. The good news, the study concludes, is that there are a wide range of cost-effective solutions already available to reduce pollution from many key pollution sources. Those include the promotion of green and sustainable transportation, expanded access to clean energy for households and a shift to clean and efficient energy production based on renewable energy sources and not fossil fuels. The report also cites some of the urban solutions have yielded results, including stricter vehicle and power plant emissions limits and urban planning solutions that reduce the need to travel. In Europe, for instance, more than 300 cities created low-emission zones (LEZs) for vehicles that reduced traffic-related air pollution by banning the entry of high-polluting vehicles and encouraging more walking, cycling and use of public transportion. In China’s capital Beijing, new measures such as tighter controls over coal-fired power plants, more stringent vehicle emission and fuel quality standards, and additional air monitoring stations contributed to a 36% decline in the city’s annual average PM2.5 level over five years. But those successes remain exceptions to the rule for many, or even most, of the world’s low and middle income cities – which have not yet come to grips with air pollution as a deadly health threat. “As cities around the world rapidly grow,” said Pallavi Pant, a senior scientist with HEI who oversaw the study, “the impacts of air pollution on residents’ health are also expected to increase, underscoring the importance of early interventions to reduce exposures and protect public health.” Image Credits: Flickr/US 6th Fleet photostream, Uncommonthought.com, Air Quality and Health in Cities, State of Global Air Report , Urban Air Quality and Health – State of Global Air , Air Quality and Health in Cities, State of Global Air,, Air Quality and Health In Cities, State of Global Air , City of Fortaleza. Climate Change is a Double Blow for People with Disabilities 16/08/2022 Kavitha Yarlagadda Pratyush Nalam, a software professional in Hyderabad, India HYDERABAD – Pratyush Nalam, a software professional in this south-central Indian city that has become a global tech outpost for Silicon Valley, moves around his house in his wheelchair. He has spinal muscular atrophy and cannot walk, so his family members help him. Though the monsoon season in Hyderabad brings lots of precipitation from the end of June to early October, scientists say the rains are getting even heavier due to climate change. And that, says Nalam, is making life tougher for people than summer heat or winter’s chills. “Getting to a dry place quickly is a challenge,” Nalam says of the growing challenge he faces in just getting around. “Bus stops don’t have shelters and are far to get to – and accessible transport is not available in most cases.” The combined detrimental effects from a lack of inclusive planning or early warning systems, less information and transportation options, and overall discriminatory attitudes has driven the global mortality rate for people with disabilities who experience natural disasters up to four times higher than it is for people without disabilities, according to a Lancet report. Nalam said that during heavy rains “we cannot see the bumps on the roads or sidewalks, which make it riskier to drive our wheelchairs.” Hotter and hotter norms Summer in India has temperatures that regularly climb into the high 30C. Europe has suffered wildfires, evacuations and heat-related deaths this summer, as heat waves force temperatures above 40 degrees C in places like Portugal and France – only slightly hotter than the warmest season in Hyderabad, where temperatures regularly climb into the high 30s C during the pre-monsoon summer from late March to early June. Still, a devastating heat wave that scientists say was made more likely by climate change has baked India and Pakistan in recent months, with some cities in the two neighboring countries reaching around 45 to 50 C. Across Europe and Asia, record temperatures have challenged daily lives, posing serious health risks to families, students, businesspeople and travelers. As with most other natural and manmade disasters, the people that suffer the most often are those that are the most marginalized. “Extreme heat is the root cause of all of the catastrophic events that we are experiencing, from wildfires to drought, hurricanes, storm surges, and flooding,” said Wendy Nystrom, an environmental and pollution risk management consultant in Los Angeles. Among those most affected by climate change Aunia Kahn Persons with disabilities are frequently among the worst affected by climate change, similar to the disproportionately higher rates of morbidity and mortality they suffer in emergencies while also being among the least able to get emergency assistance. “It feels that I am always living in a bubble. I am allergic to heat and cold and this makes me very vulnerable to climate change,” said Aunia Kahn, a disabled U.S. business owner in Eugene, Oregon, who struggles with rare chronic illnesses such as Ehlers Danlos Syndrome, Mast Cell Activation Syndrome, and Dysautonomia. Certain conditions of disability are disproportionately affected by global warming. For example, people with spinal cord injuries cannot cool themselves during excessive heat while people with multiple sclerosis feel more pain and fatigue during hot weather conditions. Some 15% of the world’s population have a disability, the World Bank reported. Many people with them also live in extreme poverty, exacerbating their vulnerability to climate change due to a general lack of proper sanitation, health care, nutrition or safe drinking water. “Earth is warming and global warming is the main reason for the extreme heat waves. Heat intensity is increasing and reducing the quality of our lives,” said Dr. Roxy Mathew Koll of the Indian Institute of Tropical Meteorology in Pune, India. “The vulnerable are the ones who are the most impacted.” Dr Roxy Mathew Koll An increasing human rights issue But the right to a clean, healthy and sustainable environment should be the same for all irrespective of differences such as caste and creed, the UN General Assembly determined in a landmark resolution approved in late July. The assembly’s 161-0 vote with eight abstentions by Belarus, Cambodia, China, Ethiopia, Iran, Kyrgyzstan, Russia and Syria gives momentum to the work of activists and citizens seeking greater legal and regulatory protections. It followed a 43-0 vote on a similar resolution last October in the 47-nation UN Human Rights Council – with China, India, Japan and Russia abstaining. Lack of mobility in emergencies is life-threatening People with disabilities and women and children in South Asia and Africa are more vulnerable to severe weather events like heat waves, floods, cyclones and storm surges, according to experts. This is because they have less access to information on climate adaptation, rarely benefit from government aid and have fewer economic privileges than men. And extreme weather events like cyclones and floods are intensifying in a very short time, giving disabled people little time to move to safety, according to Koll. “People with disabilities, particularly with mobility issues, have limited capacity to respond to emergency situations during an extreme weather event,” he said. But only 10% of people with disabilities believe their local government has emergency, disaster management, or risk reduction plans that address their access and functional needs, according to a UN report. And just 20.6% said they could self-evacuate without difficulty in the event of a sudden disaster, a UN Office for Disaster Risk Reduction online survey found. A hot day in Hyderabad For the old and young, climate change presents difficulties. Vishnu Kumar, a 75 year old man from Hyderabad, suffered a paralytic stroke three years ago and has been confined to a bed and wheelchair since then. As with many elderly, the excessive heat zaps his energy and the frequent power cuts only increase his discomfort, adding to friction in his family. And for student Rohit Reddy, eczema and allergies worsened during summers in the coastal city of Mumbai, costing him time needed for his studies. “I had to shift to Hyderabad because of the flare ups due to extreme humidity, now I may lose an academic year,” Reddy said. -Updated 16.08.2022 with correction to the name of Pratyush Nalam’s condition as spinal muscular atrophy, not muscular dystrophy. Image Credits: Skymet , Pratyush Nalam, Aunia Kahn, Roxy Koll, Gulf News. Monkeypox Variants Get New Names 12/08/2022 Editorial team While the process of renaming monkeypox is still underway, a group of global experts convened by the World Health Organization (WHO) has agreed that the virus’s variants will be renamed with Roman numerals. This follows a meeting convened by the WHO this week to enable virologists and public health experts to reach consensus on new terminology, the global body announced on Friday. Experts in pox virology, evolutionary biology and representatives of research institutes from across the globe reached consensus that the former Congo Basin (Central African) clade will be referred to as Clade one (I) and the former West African clade as Clade two (II). The group also agreed that Clade II consists of two subclades, which will be referred to as Clade IIa and Clade IIb. Assigning new names to existing diseases is the responsibility of WHO under the International Classification of Diseases and the WHO is holding an open consultation for a new name for monkeypox. Anyone wishing to propose new names can do so here. The naming of virus species is the responsibility of the International Committee on the Taxonomy of Viruses (ICTV), which also has a process underway for the name of the monkeypox virus. Image Credits: TRT World Now/Twitter . India is Trying to Reduce Maternal Mortality Without Addressing a Key Contributor: Suicide 12/08/2022 Disha Shetty Suicide is one of the leading causes of death among women of childbearing age in India. Pregnancy is most often a cause for celebration of a new life and a new addition to the family. But for the women who walk into Garima Malik’s clinic in New Delhi, it is a very different story. Some cry. Others appear angry, irritable or frustrated. Usually, the cause is domestic violence – pregnancy is a particularly vulnerable time and as an experienced counsellor, Malik is trained to spot the signs. “They talk about suicide,” she says. “Then they calm down. We talk about risk management and safety planning and counselling. So somehow, they cope.” Malik says many of those who come to the clinic, run by the medical charity Medecins Sans Frontieres (MSF), have experienced physical and emotional violence during pregnancy. Sometimes this is because they are unwilling to be intimate with a partner in the early part of the pregnancy or immediately after the birth. Other times it is because they have given birth to a girl, seen by some as less desirable. “This can cause loneliness in women and they feel frustrated and they feel like he [the husband] needed the child, the family needed the child, and I am the one suffering,” she says. Malik says they are the lucky ones — most Indian women who experience suicidal thoughts in the period during or after their pregnancy will not seek or receive any help. Yet suicide is one of the leading causes of death among women of child-bearing age in India. According to one recent study published in The Lancet medical journal, the suicide rate among Indian women and girls is twice the global average. Women may experience suicidal thoughts during or after pregnancy. India has made enormous strides since the turn of the century in reducing overall maternal mortality, reducing deaths by more than half. In 2019, 103 mothers were dying per 100,000 live births, down from 254 in 2004. The United Nations has set the goal of reducing maternal mortality globally to 70 deaths per 100,000 by 2030. But that success has exposed a phenomenon that had previously gone largely unnoticed in India: high rates of suicides in the perinatal period, defined as during and immediately after pregnancy. A 2016 study of 462 low-income women in early pregnancy in south India found 7.6% were at risk of suicide compared to roughly 0.4% in the United States. Health experts say the government has done little to address this problem, and a suicide prevention action plan devised in 2018 has never been implemented. India is losing young women “in enormous numbers,” says Lakshmi Vijayakumar, a psychiatrist and a member of the World Health Organization (WHO)’s International Network for Suicide Research and Prevention. “And we don’t have any effective mechanism or plan or strategy to address this issue.” The Indian government did not respond to a request for comment. Data on this is limited. India compiles national maternal death statistics by extrapolating from a representative sample survey, but does not separate the data into causes of death. Police keep data on reported suicides, but do not record whether the person was pregnant, and anyway, suicides are underreported. Perinatal suicides are often linked to a history of psychiatric illness, but Lakshmi* says this does not seem to be the case in India. Instead, social factors such as early marriage, intimate partner violence, pressure to give birth to a son and women’s lack of financial autonomy are drivers. Reducing maternal deaths — a revealing success story When it comes to the physical causes of maternal deaths, India’s success has been marked and is largely due to an increase in deliveries at free public health facilities rather than at home. In-facility deliveries rose from 31.1% in 2005-06 to 88.6% in 2019-21, according to government figures, driven by awareness campaigns and offering small financial incentives to pregnant women and grassroots health workers. The southern Indian state of Kerala has been among the most successful in reducing maternal deaths. With 43 per 100,000 live births, it is the safest place in the country to give birth. It is also the only state to have looked into perinatal suicide data, analyzing the 1,076 maternal deaths registered between 2010 and 2020. During that period, mortality dropped from 66 to 43, but the share of suicides increased from about 2.6% in 2010 to 6.6% five years later, and to 18.6% in 2019–20. But that data should be treated with some caution – Kerala’s relatively low rates of maternal mortality were based on a small sample but, combined with the 2016 study in south India, it indicates a trend, says Soumitra Pathare, psychiatrist and director of the Centre for Mental Health Law and Policy. “It is important for various reasons – we now have systematic data to show that suicides are a significant problem in young women, especially young women who are pregnant or have just delivered a child,” he says. “Maternal mortality has gone down substantially because that’s something that has had an intervention done for it. So what this actually shows is that we’ve not done any intervention for suicide prevention.” He cautioned that the data capture only some of the problem. For every person who dies by suicide, an estimated four to 20 times more people attempt it. “So the number of attempted suicides [in India] is anywhere between 0.6 million to 6 million,” said Pathare. “We don’t even collect data on it. ” Early intervention is key Nearly a third of Indian women between the ages of 15 and 49 who have been married, have experienced intimate partner violence. There has been little research into the drivers of perinatal suicide in India, though the Kerala review identified psychiatric illness, young age, unmarried status and domestic violence as risk factors. Nearly one in every three Indian women between the ages of 15-49 who has ever been married has experienced intimate partner violence, according to government figures. Around 3.1% of women in this category said they experienced physical violence during pregnancy. Marital rape is not legally recognized, although this is being challenged in the courts. Nayreen Daruwalla, head of a program on the prevention of violence against women and children at the Mumbai-based non-profit SNEHA, says suicide during pregnancy often falls into one of two categories. “One is pregnant women who are married and in whose cases the family insists on having a boy,” she said. “Unwed mothers are a huge category of cases especially given the lack of social support and sometimes the lack of support from the partner who might be reluctant to wed on finding out the woman is pregnant.” Experts say early intervention is key to preventing perinatal suicides, and that India already has the systems in place to do this. Shaji KS, dean of research at the Kerala University of Health Sciences and part of the team that reviewed perinatal suicides in Kerala, cites India’s network of grassroots health workers, through whom every pregnant person in the country can be reached. Adding a psychiatric component to support their mental health would help prevent many deaths, he said. MSF’s Malik sees a need for more vocational training to enable Indian women to become financially independent, making it easier for them to escape abusive situations. Research in Australia has found this to be effective in reducing suicides. In India, women’s labour force participation has steadily declined from around 30.4% in 2000 to 19% in 2021. “When we talk to such patients, when we talk about leaving husbands and leaving such [a] toxic environment and getting out of this kind of relationship, they want to,” she said. “They cannot because they are not financially independent.” Studies also show restricting access to pesticides, used in many suicides in India, might prevent some of the deaths. Lakshmi, the psychiatrist and WHO advisor, was part of a task force set up by the Indian government in 2018 to suggest ways to reduce overall suicides, whose recommendations have not been implemented. Asked about funding for suicide prevention, the government said in February that funds had been allocated and announced plans for a national telemedicine program for mental health. But it did not commit to adopting the task force’s recommendations. “We have submitted the plan” said Lakshmi. “It is still lying there. I hope that one day it will see the light of day.” * The use of a given name used on second reference is common practice in parts of south India If you or someone you know is struggling with mental health or suicidal thoughts, help is available at iCALL run by TISS at 9152987821 [India] or the National Suicide Prevention Lifeline at 1-800-273-8255 [US]. This article was first published in The Fuller Project. Image Credits: Children's Investment Fund/Flickr , UN Photo/Kibae Park/Flickr, Yogendra Singh/ Unsplash. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... 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Monkeypox Cases Spike 20% Weekly Worldwide 17/08/2022 John Heilprin Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), at a virtual press briefing As the first monkeypox case involving a human-to-dog transmission reported, the World Health Organization (WHO) said more than 35,000 recently confirmed cases of monkeypox were accompanied by 12 deaths in 92 nations and territories, including almost 7,500 from last week alone. That made for the second consecutive week with a 20% increase, WHO Director-General Dr Tedros Adhanom Ghebreyesus said Wednesday. Almost all of the cases are being reported from Europe and the Americas and involve men who have sex with men, Tedros told a virtual press briefing, underscoring the importance for all countries to design and deliver services and information tailored to these communities that protect health, human rights and dignity. “The primary focus for all countries,” said Tedros, “must be to ensure they are ready for monkeypox and to stop transmission using effective public health tools, including enhanced disease surveillance, careful contact tracing, tailored risk communication and community engagement and risk reduction measures.” Related to the challenge of outreach, Dr Mike Ryan, executive director of WHO’s Health Emergencies Program, said WHO would “follow up directly” with Mexico’s government – when asked by a Mexican journalist why the country has not yet mounted programmes for widespread testing or clear outreach to potentially vulnerable populations of men – despite a fourfold increase in daily reported cases over the past two weeks. Tedros said vaccines may also play an important part in controlling the outbreak, and in many countries there is high demand for vaccines from the affected communities. “However, for the moment, supplies of vaccines and data about their effectiveness are limited. Although, we are starting to receive data from some countries,” he noted. “WHO has been in close contact with the manufacturers of vaccines and with countries and organizations willing to share those. We remain concerned that the inequitable access to vaccines we saw during the COVID-19 pandemic will be repeated, and that the poorest will continue to be left behind.” Bavarian Nordic, the world’s sole manufacturer of US and European-approved monkeypox vaccines has currently closed its manufacturing plant for renovations – and does not expect to reopen until late this year. Meanwhile, a few wealthy countries, led by the United States, have snapped up all available doses. See Health Policy Watch’s exclusive report: Exclusive: Closure of World’s Only Manufacturing Plant for Monkeypox Vaccine Raises Questions About World’s Ability to Meet Rising Demand First case of human to dog transmission Pet dog in France gets monkeypox from 2 men in same household WHO officials also confirmed the first case of human-to-dog transmission in Paris, where two men went to a hospital and were confirmed to have monkeypox. Twelve days later, a 4-year-old male Italian greyhound that was allowed to sleep with them also tested positive for the virus, according to a recent Lancet article. The case already prompted the U.S. Centers for Disease Control and Prevention to issue new guidance that people with monkeypox should avoid contact with animals, including pets, domestic animals and wildlife to avoid spreading the virus. “Infected animals can spread monkeypox virus to people, and it is possible that people who are infected can spread monkeypox virus to animals through close contact, including petting, cuddling, hugging, kissing, licking, sharing sleeping areas, and sharing food,” stated the CDC guidance. Dr Sylvie Briand, director of WHO’s Epidemic and Pandemic Preparedness and Prevention department (EPP), said it is important to differentiate between the emergence and reemergence of diseases. “It’s something that we know, most of the emerging viruses are coming from animals,” she said. “This is the case for monkeypox, and they infect humans. So at the beginning, it’s only sporadic cases,” she said, referring to the fact that the virus was only discovered in 1958, and for decades after that circulated in a mostly self-limiting way between animals and human communities in central and west Africa. . But if the virus finds the right environment, Briand said, it can evolve to more effectively target humans, resulting in more localized transmission especially in conditions of “high human density, very close contact,” she said. “This is what we have seen with monkeypox. Initially it was in animals, then it went to some humans. And then we had a localized outbreak and now we have a multi-country outbreak.” In terms of disease reemergence, other factors then play out as well. “It’s often because the vaccine coverage is too low that those diseases reemerge,” she said. “And it’s very important to understand that vaccine coverage is a very, very important indicator of the protection of human beings against disease.” 2020 study predicted heightened monkeypox risk with declining smallpox immunity Monkeypox lesions Ironically, a study published in September, 2020 in the Bulletin of the WHO Health Organization, predicted that Central and West Africa’s monkeypox outbreaks could become more frequent – with eventual mutations of the virus increasing human to human transmission as well. Earlier this month, a group of global experts convened by WHO agreed that the virus’s variants will be renamed with Roman numerals. In a review of historical data on outbreaks of Clade 1 of the monkeypox virus in the Democratic Republic of Congo, the authors from Institut Pasteur contended that transmission had remained self-limiting throughout the 1960s and 1970s because most people in DRC were vaccinated against smallpox – which protects against monkeypox virus too. However, after smallpox was declared to be eradicated, and smallpox vaccination ceased in the 1980s – that herd immunity waned: “Since then, the Democratic Republic of the Congo has reported increased monkeypox human infections, and parts of the country have been declared monkeypox-endemic areas,” the report’s authors note. “In 2011–2012, the population immunity against orthopoxvirus species was only 60%… among individuals vaccinated against smallpox and 26% …among individuals unvaccinated against smallpox.” Due to declining immunity, more frequent outbreaks may occur in endemic countries, triggered initially by contact with infected animals, the authors predicted, but they added that over time monkeypox may begin to undergo more “sustained human-to-human transmission (R > 1).” “In either case, repeated circulation of monkeypox in human hosts, particularly immunocompromised hosts, favours pathogen evolution and emergence of newly human-adapted pathogens, depending on R and on the human pathogen fitness landscape.” “”This finding may explain the increasing number of monkeypox outbreak reports, resulting in endemic monkeypox in central African countries…. “Moreover, with declining immunity to orthopoxvirus species, monkeypox can pose an ever-increasing threat for health security.” A prescient conclusion indeed in light of today’s rapidly evolving global health emergency. –Elaine Ruth Fletcher contributed to this story Image Credits: Mothership.sg/Twitter , Tessa Davis/Twitter . W. Africa’s Polluted Air 2nd Only to S. Asia 17/08/2022 John Heilprin & Elaine Ruth Fletcher Downtown Lagos – new study finds it to be among the most polluted cities in Africa and the world. Some 1.7 million people in cities across the planet died from polluted air in 2019, according to the first-ever study of urban air pollution that covers virtually every city in the world over the size of 50,000 people, as per the UN definition. Conditions are the most severe in cities of South Asia, (WHO’s SouthEast Asia region). Strikingly, however, cities in West Africa, are a close follower – with average annual fine particulate (PM2.5) concentrations of 62 micrograms/cubic meter of air (µg/m3), more than 15 times above WHO guideline levels. The study by the State of Global Air Initiative, a collaboration between Boston-based Health Effects Institute (HEI) and Seattle-based Institute for Health Metrics and Evaluation’s (IHME) Global Burden of Disease project, is the largest analysis of urban air pollution to date. It examines data spanning the years 2010-2019 for 7,239 cities, home to some 2.8 billion people. It is also the first global analysis to compare trends in cities over time. The study confirms that urban residents face some of the world’s worst air quality, with 98% of people in all cities around the world breathing air that fails to meet the WHO Air Quality guideline level of 5 µg/m3 – what is considered the most key indicator of health impacts. And with 68% of the world’s population expected to live in urban areas by 2050, air pollutants loom as a major battle for many of the world’s top cities. India and Indonesian cities saw the world’s worst increases in polluted air Industrial air pollution in India – South East Asia is the hardest hit by air pollution overall. While PM2.5 exposures “decreased” in some cities between 2010 and 2919, most notably in China, in parts of South Asia, notably India and Indonesia, air pollution in fact became much worse. “Of 7,239 cities, India is home to 18 of the 20 cities with the most severe increase in PM2.5 pollution from 2010 to 2019. The other two cities are in Indonesia. Alll these cities saw an increase of more than 30 µg/m3 during that decade. Of the 50 cities with the msot severe increase in PM2.5 pollution, 41 are in India and 9 are in Indonesia,” it adds. As for the present day: “Exposures are particularly high in cities in Asia, West Sub-Saharan Africa, and Andean and Central Latin America, the report concludes. “More progress is necessary to protect the health of residents.” Only 2% of cities meet the WHO Air Quality Guidelines and 41% of cities exceed even the least stringent WHO interim Air Quality Guideline Some 86% of cities around the world also exceed WHO’s guidelines for NO2, whose dangers for asthma and lung diseases have been better recognized more recently. Strikingly, cities with excessive levels of NO2 include cities in many high- and middle-income countries where stricter regulations on vehicle and power plant emissions may have reduced PM2.5 levels – but have not sufficiently addressed NO2. Diesel vehicles, promoted by the industry over the last 30 years, emit comparatively higher levels of NO2. Estimates on polluted air combine data from ground monitoring and satellites The new analysis combines available data on air quality from ground-level monitoring stations with satellite data from thousands of cities that lack stations of their own. It provides the full data set on an interactive database. The study estimated annual average concentrations of PM2.5 and NO2 for cities across the planet by integrating available ground-level and satellite data, then dividing that information into grid cells of approximately 1×1 km at the equator. Only 117 nations have ground-level monitoring systems to track PM2.5, and only 74 nations are monitoring NO2 levels, according to the report, which draws its ground level data from an online repository maintained by the World Health Organization. Based on available ground station data, WHO in April issued estimates of average annual air pollution concentrations in 4,000 cities and settlements around the world. Those included PM2.5, and NO2 when data was available. Some of the findings about global hotspots are roughly comparable with WHO’s own recent analysis – which also found that people in South/Southeast Asia, the Middle East and parts of Africa continue to breathe some of the worst air on the planet. However, WHO did not analyse trends over time. Nor did WHO attempt to incorporate satellite data from cities where ground-level measurements are unavailable – which includes most of urban Africa. This new analysis fills in that critical gap – and in the process it reveals how serious pollution in some parts of Africa, and particularly West Africa, has become. “Since most cities around the world have no ground-based air quality monitoring in place, estimates of particulate and gas pollution levels can be used to plan air quality management approaches that ensure the air is clean and safe to breathe,” said Susan Anenberg, an associate professor at George Washington University and one of the project collaborators. West African cities – now among the world’s most polluted Average annual urban air pollution concentrations by region shows cities in South Asia folowed by cities in West Africa as the most polluted in the world. Unlike the most recent WHO study, the HEI/IHME study also estimated air pollution in terms of “population-weighted” exposures to air pollution in each city considered – rather than in terms of the city’s spatial limits only – linking the pollution concentrations in each grid cell with the number of people living within each block to produce a population-weighted annual average. Population-weighted exposures are an essential input to the estimation of mortality, per capita, from air pollution in any given area. In terms of population-weighted exposures, the data includes some surprises. Not only do people in longstanding hotspots like Delhi, Kolkata, Dhaka and Jakarta as well as Beijing, continue to breathe some of the the worst air in the world, so do people in Lima Peru; Lagos and Kano, Nigeria, and Accra, Ghana. Geographic patterns of air pollutants NO2 and PM2.5 strikingly different The study also confirms prior WHO findings that the geographic patterns of excessive exposure to PM2 and NO2 are considerably different at times. “Cities in Asia and Africa are already hotspots for PM2.5 pollution,” the study concludes. “At the same time, NO2 pollution – primarily from vehicle traffic – is high and growing in some cities and regions that are not PM2.5 hotspots.” Air pollutants responsible for 7 million deaths worldwide Air pollution is responsible for about 1-in-9 deaths worldwide, or between 6.7 to 7 million deaths a year, according to the latest estimates by both HEI/IHME and WHO. Outdoor, ambient air pollution is estimated by WHO to kill about 4.2 million people a year. There is an overlap, however, between deaths attributable to outdoor air pollution and the estimated 3.2 million deaths a year attributed to household air pollution. The latter is related largely to exposures to smoke from biomass, kerosene and coal fires used by billions of people for cooking and heating. Air pollution is a factor in illness and premature deaths particularly in older people and those with chronic respiratory and cardiovascular conditions. WHO estimates that quarter of all deaths from heart attacks and stroke, and nearly 30% of deaths from lung cancer, as well as 43% of deaths from lung disease, are attributable to air pollution. Exposure to NO2, meanwhile, exacerbates lung inflammation, contributing to asthma and other respiratory diseases, and potentially impeding children’s lung development. High NO2 exposures that lead to difficulties breathing, coughing or wheezing, may cause spikes in hospital and emergency-room admissions, according to WHO. People living near busy roads congested with lots of city traffic often are exposed to higher levels than people in rural settings. China air quality improved but air pollution related mortality still very high In terms of mortality, a significant number of Chinese cities, led by Beijing, continue to have a high proportion of deaths from air pollution. That is despite the fact that China is the country that has also seen the greatest improvements in urban quality over the past couple of decades, the report finds. This paradox is due to two factors – the comparative ageing of China’s population and the fact that exposure to air pollution, even at comparatively lower levels, can still be deadly. Recognizing this, WHO in 2018 reduced by half it’s guideline level for annual average exposure levels of PM2.5 from 10 to 5 µg/m3. WHO also halved its NO2 guideline level to 10 µg/m3. Urban air pollution hotspots by region. In South/SouthEast Asia mortality from urban air pollution also has grown significantly in the past 20 years, the report also concludes – with Jakarta and Delhi having the highest levels of mortality, per 100,000 population, from air pollution. In central Asia, hot spots included Tashkent, Uzbekistan and Almaty, Kazakhstan. Most of those cities also are areas long reliant on coal-burning for heat and power production. Compared to other parts of eastern and central Europe, Kyiv and Kharkiv in Ukraine, the Polish cities of Katowice and Warsaw, as well as Budapest Hungary and Bucharest, Romania, also had high pollution-related death rates. Conversely, African cities don’t rank as prominently in terms of global air pollution-related mortality – largely because the residents of African cities are much younger on average and thus not as likely to die – yet – from air pollution related diseases. Taking action against air pollutants Cycling in Fortaleza, Brazil – the city has won worldwide recognition for its sustainable transport planning that contributes to healthy physical activity and reduces air pollution. The good news, the study concludes, is that there are a wide range of cost-effective solutions already available to reduce pollution from many key pollution sources. Those include the promotion of green and sustainable transportation, expanded access to clean energy for households and a shift to clean and efficient energy production based on renewable energy sources and not fossil fuels. The report also cites some of the urban solutions have yielded results, including stricter vehicle and power plant emissions limits and urban planning solutions that reduce the need to travel. In Europe, for instance, more than 300 cities created low-emission zones (LEZs) for vehicles that reduced traffic-related air pollution by banning the entry of high-polluting vehicles and encouraging more walking, cycling and use of public transportion. In China’s capital Beijing, new measures such as tighter controls over coal-fired power plants, more stringent vehicle emission and fuel quality standards, and additional air monitoring stations contributed to a 36% decline in the city’s annual average PM2.5 level over five years. But those successes remain exceptions to the rule for many, or even most, of the world’s low and middle income cities – which have not yet come to grips with air pollution as a deadly health threat. “As cities around the world rapidly grow,” said Pallavi Pant, a senior scientist with HEI who oversaw the study, “the impacts of air pollution on residents’ health are also expected to increase, underscoring the importance of early interventions to reduce exposures and protect public health.” Image Credits: Flickr/US 6th Fleet photostream, Uncommonthought.com, Air Quality and Health in Cities, State of Global Air Report , Urban Air Quality and Health – State of Global Air , Air Quality and Health in Cities, State of Global Air,, Air Quality and Health In Cities, State of Global Air , City of Fortaleza. Climate Change is a Double Blow for People with Disabilities 16/08/2022 Kavitha Yarlagadda Pratyush Nalam, a software professional in Hyderabad, India HYDERABAD – Pratyush Nalam, a software professional in this south-central Indian city that has become a global tech outpost for Silicon Valley, moves around his house in his wheelchair. He has spinal muscular atrophy and cannot walk, so his family members help him. Though the monsoon season in Hyderabad brings lots of precipitation from the end of June to early October, scientists say the rains are getting even heavier due to climate change. And that, says Nalam, is making life tougher for people than summer heat or winter’s chills. “Getting to a dry place quickly is a challenge,” Nalam says of the growing challenge he faces in just getting around. “Bus stops don’t have shelters and are far to get to – and accessible transport is not available in most cases.” The combined detrimental effects from a lack of inclusive planning or early warning systems, less information and transportation options, and overall discriminatory attitudes has driven the global mortality rate for people with disabilities who experience natural disasters up to four times higher than it is for people without disabilities, according to a Lancet report. Nalam said that during heavy rains “we cannot see the bumps on the roads or sidewalks, which make it riskier to drive our wheelchairs.” Hotter and hotter norms Summer in India has temperatures that regularly climb into the high 30C. Europe has suffered wildfires, evacuations and heat-related deaths this summer, as heat waves force temperatures above 40 degrees C in places like Portugal and France – only slightly hotter than the warmest season in Hyderabad, where temperatures regularly climb into the high 30s C during the pre-monsoon summer from late March to early June. Still, a devastating heat wave that scientists say was made more likely by climate change has baked India and Pakistan in recent months, with some cities in the two neighboring countries reaching around 45 to 50 C. Across Europe and Asia, record temperatures have challenged daily lives, posing serious health risks to families, students, businesspeople and travelers. As with most other natural and manmade disasters, the people that suffer the most often are those that are the most marginalized. “Extreme heat is the root cause of all of the catastrophic events that we are experiencing, from wildfires to drought, hurricanes, storm surges, and flooding,” said Wendy Nystrom, an environmental and pollution risk management consultant in Los Angeles. Among those most affected by climate change Aunia Kahn Persons with disabilities are frequently among the worst affected by climate change, similar to the disproportionately higher rates of morbidity and mortality they suffer in emergencies while also being among the least able to get emergency assistance. “It feels that I am always living in a bubble. I am allergic to heat and cold and this makes me very vulnerable to climate change,” said Aunia Kahn, a disabled U.S. business owner in Eugene, Oregon, who struggles with rare chronic illnesses such as Ehlers Danlos Syndrome, Mast Cell Activation Syndrome, and Dysautonomia. Certain conditions of disability are disproportionately affected by global warming. For example, people with spinal cord injuries cannot cool themselves during excessive heat while people with multiple sclerosis feel more pain and fatigue during hot weather conditions. Some 15% of the world’s population have a disability, the World Bank reported. Many people with them also live in extreme poverty, exacerbating their vulnerability to climate change due to a general lack of proper sanitation, health care, nutrition or safe drinking water. “Earth is warming and global warming is the main reason for the extreme heat waves. Heat intensity is increasing and reducing the quality of our lives,” said Dr. Roxy Mathew Koll of the Indian Institute of Tropical Meteorology in Pune, India. “The vulnerable are the ones who are the most impacted.” Dr Roxy Mathew Koll An increasing human rights issue But the right to a clean, healthy and sustainable environment should be the same for all irrespective of differences such as caste and creed, the UN General Assembly determined in a landmark resolution approved in late July. The assembly’s 161-0 vote with eight abstentions by Belarus, Cambodia, China, Ethiopia, Iran, Kyrgyzstan, Russia and Syria gives momentum to the work of activists and citizens seeking greater legal and regulatory protections. It followed a 43-0 vote on a similar resolution last October in the 47-nation UN Human Rights Council – with China, India, Japan and Russia abstaining. Lack of mobility in emergencies is life-threatening People with disabilities and women and children in South Asia and Africa are more vulnerable to severe weather events like heat waves, floods, cyclones and storm surges, according to experts. This is because they have less access to information on climate adaptation, rarely benefit from government aid and have fewer economic privileges than men. And extreme weather events like cyclones and floods are intensifying in a very short time, giving disabled people little time to move to safety, according to Koll. “People with disabilities, particularly with mobility issues, have limited capacity to respond to emergency situations during an extreme weather event,” he said. But only 10% of people with disabilities believe their local government has emergency, disaster management, or risk reduction plans that address their access and functional needs, according to a UN report. And just 20.6% said they could self-evacuate without difficulty in the event of a sudden disaster, a UN Office for Disaster Risk Reduction online survey found. A hot day in Hyderabad For the old and young, climate change presents difficulties. Vishnu Kumar, a 75 year old man from Hyderabad, suffered a paralytic stroke three years ago and has been confined to a bed and wheelchair since then. As with many elderly, the excessive heat zaps his energy and the frequent power cuts only increase his discomfort, adding to friction in his family. And for student Rohit Reddy, eczema and allergies worsened during summers in the coastal city of Mumbai, costing him time needed for his studies. “I had to shift to Hyderabad because of the flare ups due to extreme humidity, now I may lose an academic year,” Reddy said. -Updated 16.08.2022 with correction to the name of Pratyush Nalam’s condition as spinal muscular atrophy, not muscular dystrophy. Image Credits: Skymet , Pratyush Nalam, Aunia Kahn, Roxy Koll, Gulf News. Monkeypox Variants Get New Names 12/08/2022 Editorial team While the process of renaming monkeypox is still underway, a group of global experts convened by the World Health Organization (WHO) has agreed that the virus’s variants will be renamed with Roman numerals. This follows a meeting convened by the WHO this week to enable virologists and public health experts to reach consensus on new terminology, the global body announced on Friday. Experts in pox virology, evolutionary biology and representatives of research institutes from across the globe reached consensus that the former Congo Basin (Central African) clade will be referred to as Clade one (I) and the former West African clade as Clade two (II). The group also agreed that Clade II consists of two subclades, which will be referred to as Clade IIa and Clade IIb. Assigning new names to existing diseases is the responsibility of WHO under the International Classification of Diseases and the WHO is holding an open consultation for a new name for monkeypox. Anyone wishing to propose new names can do so here. The naming of virus species is the responsibility of the International Committee on the Taxonomy of Viruses (ICTV), which also has a process underway for the name of the monkeypox virus. Image Credits: TRT World Now/Twitter . India is Trying to Reduce Maternal Mortality Without Addressing a Key Contributor: Suicide 12/08/2022 Disha Shetty Suicide is one of the leading causes of death among women of childbearing age in India. Pregnancy is most often a cause for celebration of a new life and a new addition to the family. But for the women who walk into Garima Malik’s clinic in New Delhi, it is a very different story. Some cry. Others appear angry, irritable or frustrated. Usually, the cause is domestic violence – pregnancy is a particularly vulnerable time and as an experienced counsellor, Malik is trained to spot the signs. “They talk about suicide,” she says. “Then they calm down. We talk about risk management and safety planning and counselling. So somehow, they cope.” Malik says many of those who come to the clinic, run by the medical charity Medecins Sans Frontieres (MSF), have experienced physical and emotional violence during pregnancy. Sometimes this is because they are unwilling to be intimate with a partner in the early part of the pregnancy or immediately after the birth. Other times it is because they have given birth to a girl, seen by some as less desirable. “This can cause loneliness in women and they feel frustrated and they feel like he [the husband] needed the child, the family needed the child, and I am the one suffering,” she says. Malik says they are the lucky ones — most Indian women who experience suicidal thoughts in the period during or after their pregnancy will not seek or receive any help. Yet suicide is one of the leading causes of death among women of child-bearing age in India. According to one recent study published in The Lancet medical journal, the suicide rate among Indian women and girls is twice the global average. Women may experience suicidal thoughts during or after pregnancy. India has made enormous strides since the turn of the century in reducing overall maternal mortality, reducing deaths by more than half. In 2019, 103 mothers were dying per 100,000 live births, down from 254 in 2004. The United Nations has set the goal of reducing maternal mortality globally to 70 deaths per 100,000 by 2030. But that success has exposed a phenomenon that had previously gone largely unnoticed in India: high rates of suicides in the perinatal period, defined as during and immediately after pregnancy. A 2016 study of 462 low-income women in early pregnancy in south India found 7.6% were at risk of suicide compared to roughly 0.4% in the United States. Health experts say the government has done little to address this problem, and a suicide prevention action plan devised in 2018 has never been implemented. India is losing young women “in enormous numbers,” says Lakshmi Vijayakumar, a psychiatrist and a member of the World Health Organization (WHO)’s International Network for Suicide Research and Prevention. “And we don’t have any effective mechanism or plan or strategy to address this issue.” The Indian government did not respond to a request for comment. Data on this is limited. India compiles national maternal death statistics by extrapolating from a representative sample survey, but does not separate the data into causes of death. Police keep data on reported suicides, but do not record whether the person was pregnant, and anyway, suicides are underreported. Perinatal suicides are often linked to a history of psychiatric illness, but Lakshmi* says this does not seem to be the case in India. Instead, social factors such as early marriage, intimate partner violence, pressure to give birth to a son and women’s lack of financial autonomy are drivers. Reducing maternal deaths — a revealing success story When it comes to the physical causes of maternal deaths, India’s success has been marked and is largely due to an increase in deliveries at free public health facilities rather than at home. In-facility deliveries rose from 31.1% in 2005-06 to 88.6% in 2019-21, according to government figures, driven by awareness campaigns and offering small financial incentives to pregnant women and grassroots health workers. The southern Indian state of Kerala has been among the most successful in reducing maternal deaths. With 43 per 100,000 live births, it is the safest place in the country to give birth. It is also the only state to have looked into perinatal suicide data, analyzing the 1,076 maternal deaths registered between 2010 and 2020. During that period, mortality dropped from 66 to 43, but the share of suicides increased from about 2.6% in 2010 to 6.6% five years later, and to 18.6% in 2019–20. But that data should be treated with some caution – Kerala’s relatively low rates of maternal mortality were based on a small sample but, combined with the 2016 study in south India, it indicates a trend, says Soumitra Pathare, psychiatrist and director of the Centre for Mental Health Law and Policy. “It is important for various reasons – we now have systematic data to show that suicides are a significant problem in young women, especially young women who are pregnant or have just delivered a child,” he says. “Maternal mortality has gone down substantially because that’s something that has had an intervention done for it. So what this actually shows is that we’ve not done any intervention for suicide prevention.” He cautioned that the data capture only some of the problem. For every person who dies by suicide, an estimated four to 20 times more people attempt it. “So the number of attempted suicides [in India] is anywhere between 0.6 million to 6 million,” said Pathare. “We don’t even collect data on it. ” Early intervention is key Nearly a third of Indian women between the ages of 15 and 49 who have been married, have experienced intimate partner violence. There has been little research into the drivers of perinatal suicide in India, though the Kerala review identified psychiatric illness, young age, unmarried status and domestic violence as risk factors. Nearly one in every three Indian women between the ages of 15-49 who has ever been married has experienced intimate partner violence, according to government figures. Around 3.1% of women in this category said they experienced physical violence during pregnancy. Marital rape is not legally recognized, although this is being challenged in the courts. Nayreen Daruwalla, head of a program on the prevention of violence against women and children at the Mumbai-based non-profit SNEHA, says suicide during pregnancy often falls into one of two categories. “One is pregnant women who are married and in whose cases the family insists on having a boy,” she said. “Unwed mothers are a huge category of cases especially given the lack of social support and sometimes the lack of support from the partner who might be reluctant to wed on finding out the woman is pregnant.” Experts say early intervention is key to preventing perinatal suicides, and that India already has the systems in place to do this. Shaji KS, dean of research at the Kerala University of Health Sciences and part of the team that reviewed perinatal suicides in Kerala, cites India’s network of grassroots health workers, through whom every pregnant person in the country can be reached. Adding a psychiatric component to support their mental health would help prevent many deaths, he said. MSF’s Malik sees a need for more vocational training to enable Indian women to become financially independent, making it easier for them to escape abusive situations. Research in Australia has found this to be effective in reducing suicides. In India, women’s labour force participation has steadily declined from around 30.4% in 2000 to 19% in 2021. “When we talk to such patients, when we talk about leaving husbands and leaving such [a] toxic environment and getting out of this kind of relationship, they want to,” she said. “They cannot because they are not financially independent.” Studies also show restricting access to pesticides, used in many suicides in India, might prevent some of the deaths. Lakshmi, the psychiatrist and WHO advisor, was part of a task force set up by the Indian government in 2018 to suggest ways to reduce overall suicides, whose recommendations have not been implemented. Asked about funding for suicide prevention, the government said in February that funds had been allocated and announced plans for a national telemedicine program for mental health. But it did not commit to adopting the task force’s recommendations. “We have submitted the plan” said Lakshmi. “It is still lying there. I hope that one day it will see the light of day.” * The use of a given name used on second reference is common practice in parts of south India If you or someone you know is struggling with mental health or suicidal thoughts, help is available at iCALL run by TISS at 9152987821 [India] or the National Suicide Prevention Lifeline at 1-800-273-8255 [US]. This article was first published in The Fuller Project. Image Credits: Children's Investment Fund/Flickr , UN Photo/Kibae Park/Flickr, Yogendra Singh/ Unsplash. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... 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W. Africa’s Polluted Air 2nd Only to S. Asia 17/08/2022 John Heilprin & Elaine Ruth Fletcher Downtown Lagos – new study finds it to be among the most polluted cities in Africa and the world. Some 1.7 million people in cities across the planet died from polluted air in 2019, according to the first-ever study of urban air pollution that covers virtually every city in the world over the size of 50,000 people, as per the UN definition. Conditions are the most severe in cities of South Asia, (WHO’s SouthEast Asia region). Strikingly, however, cities in West Africa, are a close follower – with average annual fine particulate (PM2.5) concentrations of 62 micrograms/cubic meter of air (µg/m3), more than 15 times above WHO guideline levels. The study by the State of Global Air Initiative, a collaboration between Boston-based Health Effects Institute (HEI) and Seattle-based Institute for Health Metrics and Evaluation’s (IHME) Global Burden of Disease project, is the largest analysis of urban air pollution to date. It examines data spanning the years 2010-2019 for 7,239 cities, home to some 2.8 billion people. It is also the first global analysis to compare trends in cities over time. The study confirms that urban residents face some of the world’s worst air quality, with 98% of people in all cities around the world breathing air that fails to meet the WHO Air Quality guideline level of 5 µg/m3 – what is considered the most key indicator of health impacts. And with 68% of the world’s population expected to live in urban areas by 2050, air pollutants loom as a major battle for many of the world’s top cities. India and Indonesian cities saw the world’s worst increases in polluted air Industrial air pollution in India – South East Asia is the hardest hit by air pollution overall. While PM2.5 exposures “decreased” in some cities between 2010 and 2919, most notably in China, in parts of South Asia, notably India and Indonesia, air pollution in fact became much worse. “Of 7,239 cities, India is home to 18 of the 20 cities with the most severe increase in PM2.5 pollution from 2010 to 2019. The other two cities are in Indonesia. Alll these cities saw an increase of more than 30 µg/m3 during that decade. Of the 50 cities with the msot severe increase in PM2.5 pollution, 41 are in India and 9 are in Indonesia,” it adds. As for the present day: “Exposures are particularly high in cities in Asia, West Sub-Saharan Africa, and Andean and Central Latin America, the report concludes. “More progress is necessary to protect the health of residents.” Only 2% of cities meet the WHO Air Quality Guidelines and 41% of cities exceed even the least stringent WHO interim Air Quality Guideline Some 86% of cities around the world also exceed WHO’s guidelines for NO2, whose dangers for asthma and lung diseases have been better recognized more recently. Strikingly, cities with excessive levels of NO2 include cities in many high- and middle-income countries where stricter regulations on vehicle and power plant emissions may have reduced PM2.5 levels – but have not sufficiently addressed NO2. Diesel vehicles, promoted by the industry over the last 30 years, emit comparatively higher levels of NO2. Estimates on polluted air combine data from ground monitoring and satellites The new analysis combines available data on air quality from ground-level monitoring stations with satellite data from thousands of cities that lack stations of their own. It provides the full data set on an interactive database. The study estimated annual average concentrations of PM2.5 and NO2 for cities across the planet by integrating available ground-level and satellite data, then dividing that information into grid cells of approximately 1×1 km at the equator. Only 117 nations have ground-level monitoring systems to track PM2.5, and only 74 nations are monitoring NO2 levels, according to the report, which draws its ground level data from an online repository maintained by the World Health Organization. Based on available ground station data, WHO in April issued estimates of average annual air pollution concentrations in 4,000 cities and settlements around the world. Those included PM2.5, and NO2 when data was available. Some of the findings about global hotspots are roughly comparable with WHO’s own recent analysis – which also found that people in South/Southeast Asia, the Middle East and parts of Africa continue to breathe some of the worst air on the planet. However, WHO did not analyse trends over time. Nor did WHO attempt to incorporate satellite data from cities where ground-level measurements are unavailable – which includes most of urban Africa. This new analysis fills in that critical gap – and in the process it reveals how serious pollution in some parts of Africa, and particularly West Africa, has become. “Since most cities around the world have no ground-based air quality monitoring in place, estimates of particulate and gas pollution levels can be used to plan air quality management approaches that ensure the air is clean and safe to breathe,” said Susan Anenberg, an associate professor at George Washington University and one of the project collaborators. West African cities – now among the world’s most polluted Average annual urban air pollution concentrations by region shows cities in South Asia folowed by cities in West Africa as the most polluted in the world. Unlike the most recent WHO study, the HEI/IHME study also estimated air pollution in terms of “population-weighted” exposures to air pollution in each city considered – rather than in terms of the city’s spatial limits only – linking the pollution concentrations in each grid cell with the number of people living within each block to produce a population-weighted annual average. Population-weighted exposures are an essential input to the estimation of mortality, per capita, from air pollution in any given area. In terms of population-weighted exposures, the data includes some surprises. Not only do people in longstanding hotspots like Delhi, Kolkata, Dhaka and Jakarta as well as Beijing, continue to breathe some of the the worst air in the world, so do people in Lima Peru; Lagos and Kano, Nigeria, and Accra, Ghana. Geographic patterns of air pollutants NO2 and PM2.5 strikingly different The study also confirms prior WHO findings that the geographic patterns of excessive exposure to PM2 and NO2 are considerably different at times. “Cities in Asia and Africa are already hotspots for PM2.5 pollution,” the study concludes. “At the same time, NO2 pollution – primarily from vehicle traffic – is high and growing in some cities and regions that are not PM2.5 hotspots.” Air pollutants responsible for 7 million deaths worldwide Air pollution is responsible for about 1-in-9 deaths worldwide, or between 6.7 to 7 million deaths a year, according to the latest estimates by both HEI/IHME and WHO. Outdoor, ambient air pollution is estimated by WHO to kill about 4.2 million people a year. There is an overlap, however, between deaths attributable to outdoor air pollution and the estimated 3.2 million deaths a year attributed to household air pollution. The latter is related largely to exposures to smoke from biomass, kerosene and coal fires used by billions of people for cooking and heating. Air pollution is a factor in illness and premature deaths particularly in older people and those with chronic respiratory and cardiovascular conditions. WHO estimates that quarter of all deaths from heart attacks and stroke, and nearly 30% of deaths from lung cancer, as well as 43% of deaths from lung disease, are attributable to air pollution. Exposure to NO2, meanwhile, exacerbates lung inflammation, contributing to asthma and other respiratory diseases, and potentially impeding children’s lung development. High NO2 exposures that lead to difficulties breathing, coughing or wheezing, may cause spikes in hospital and emergency-room admissions, according to WHO. People living near busy roads congested with lots of city traffic often are exposed to higher levels than people in rural settings. China air quality improved but air pollution related mortality still very high In terms of mortality, a significant number of Chinese cities, led by Beijing, continue to have a high proportion of deaths from air pollution. That is despite the fact that China is the country that has also seen the greatest improvements in urban quality over the past couple of decades, the report finds. This paradox is due to two factors – the comparative ageing of China’s population and the fact that exposure to air pollution, even at comparatively lower levels, can still be deadly. Recognizing this, WHO in 2018 reduced by half it’s guideline level for annual average exposure levels of PM2.5 from 10 to 5 µg/m3. WHO also halved its NO2 guideline level to 10 µg/m3. Urban air pollution hotspots by region. In South/SouthEast Asia mortality from urban air pollution also has grown significantly in the past 20 years, the report also concludes – with Jakarta and Delhi having the highest levels of mortality, per 100,000 population, from air pollution. In central Asia, hot spots included Tashkent, Uzbekistan and Almaty, Kazakhstan. Most of those cities also are areas long reliant on coal-burning for heat and power production. Compared to other parts of eastern and central Europe, Kyiv and Kharkiv in Ukraine, the Polish cities of Katowice and Warsaw, as well as Budapest Hungary and Bucharest, Romania, also had high pollution-related death rates. Conversely, African cities don’t rank as prominently in terms of global air pollution-related mortality – largely because the residents of African cities are much younger on average and thus not as likely to die – yet – from air pollution related diseases. Taking action against air pollutants Cycling in Fortaleza, Brazil – the city has won worldwide recognition for its sustainable transport planning that contributes to healthy physical activity and reduces air pollution. The good news, the study concludes, is that there are a wide range of cost-effective solutions already available to reduce pollution from many key pollution sources. Those include the promotion of green and sustainable transportation, expanded access to clean energy for households and a shift to clean and efficient energy production based on renewable energy sources and not fossil fuels. The report also cites some of the urban solutions have yielded results, including stricter vehicle and power plant emissions limits and urban planning solutions that reduce the need to travel. In Europe, for instance, more than 300 cities created low-emission zones (LEZs) for vehicles that reduced traffic-related air pollution by banning the entry of high-polluting vehicles and encouraging more walking, cycling and use of public transportion. In China’s capital Beijing, new measures such as tighter controls over coal-fired power plants, more stringent vehicle emission and fuel quality standards, and additional air monitoring stations contributed to a 36% decline in the city’s annual average PM2.5 level over five years. But those successes remain exceptions to the rule for many, or even most, of the world’s low and middle income cities – which have not yet come to grips with air pollution as a deadly health threat. “As cities around the world rapidly grow,” said Pallavi Pant, a senior scientist with HEI who oversaw the study, “the impacts of air pollution on residents’ health are also expected to increase, underscoring the importance of early interventions to reduce exposures and protect public health.” Image Credits: Flickr/US 6th Fleet photostream, Uncommonthought.com, Air Quality and Health in Cities, State of Global Air Report , Urban Air Quality and Health – State of Global Air , Air Quality and Health in Cities, State of Global Air,, Air Quality and Health In Cities, State of Global Air , City of Fortaleza. Climate Change is a Double Blow for People with Disabilities 16/08/2022 Kavitha Yarlagadda Pratyush Nalam, a software professional in Hyderabad, India HYDERABAD – Pratyush Nalam, a software professional in this south-central Indian city that has become a global tech outpost for Silicon Valley, moves around his house in his wheelchair. He has spinal muscular atrophy and cannot walk, so his family members help him. Though the monsoon season in Hyderabad brings lots of precipitation from the end of June to early October, scientists say the rains are getting even heavier due to climate change. And that, says Nalam, is making life tougher for people than summer heat or winter’s chills. “Getting to a dry place quickly is a challenge,” Nalam says of the growing challenge he faces in just getting around. “Bus stops don’t have shelters and are far to get to – and accessible transport is not available in most cases.” The combined detrimental effects from a lack of inclusive planning or early warning systems, less information and transportation options, and overall discriminatory attitudes has driven the global mortality rate for people with disabilities who experience natural disasters up to four times higher than it is for people without disabilities, according to a Lancet report. Nalam said that during heavy rains “we cannot see the bumps on the roads or sidewalks, which make it riskier to drive our wheelchairs.” Hotter and hotter norms Summer in India has temperatures that regularly climb into the high 30C. Europe has suffered wildfires, evacuations and heat-related deaths this summer, as heat waves force temperatures above 40 degrees C in places like Portugal and France – only slightly hotter than the warmest season in Hyderabad, where temperatures regularly climb into the high 30s C during the pre-monsoon summer from late March to early June. Still, a devastating heat wave that scientists say was made more likely by climate change has baked India and Pakistan in recent months, with some cities in the two neighboring countries reaching around 45 to 50 C. Across Europe and Asia, record temperatures have challenged daily lives, posing serious health risks to families, students, businesspeople and travelers. As with most other natural and manmade disasters, the people that suffer the most often are those that are the most marginalized. “Extreme heat is the root cause of all of the catastrophic events that we are experiencing, from wildfires to drought, hurricanes, storm surges, and flooding,” said Wendy Nystrom, an environmental and pollution risk management consultant in Los Angeles. Among those most affected by climate change Aunia Kahn Persons with disabilities are frequently among the worst affected by climate change, similar to the disproportionately higher rates of morbidity and mortality they suffer in emergencies while also being among the least able to get emergency assistance. “It feels that I am always living in a bubble. I am allergic to heat and cold and this makes me very vulnerable to climate change,” said Aunia Kahn, a disabled U.S. business owner in Eugene, Oregon, who struggles with rare chronic illnesses such as Ehlers Danlos Syndrome, Mast Cell Activation Syndrome, and Dysautonomia. Certain conditions of disability are disproportionately affected by global warming. For example, people with spinal cord injuries cannot cool themselves during excessive heat while people with multiple sclerosis feel more pain and fatigue during hot weather conditions. Some 15% of the world’s population have a disability, the World Bank reported. Many people with them also live in extreme poverty, exacerbating their vulnerability to climate change due to a general lack of proper sanitation, health care, nutrition or safe drinking water. “Earth is warming and global warming is the main reason for the extreme heat waves. Heat intensity is increasing and reducing the quality of our lives,” said Dr. Roxy Mathew Koll of the Indian Institute of Tropical Meteorology in Pune, India. “The vulnerable are the ones who are the most impacted.” Dr Roxy Mathew Koll An increasing human rights issue But the right to a clean, healthy and sustainable environment should be the same for all irrespective of differences such as caste and creed, the UN General Assembly determined in a landmark resolution approved in late July. The assembly’s 161-0 vote with eight abstentions by Belarus, Cambodia, China, Ethiopia, Iran, Kyrgyzstan, Russia and Syria gives momentum to the work of activists and citizens seeking greater legal and regulatory protections. It followed a 43-0 vote on a similar resolution last October in the 47-nation UN Human Rights Council – with China, India, Japan and Russia abstaining. Lack of mobility in emergencies is life-threatening People with disabilities and women and children in South Asia and Africa are more vulnerable to severe weather events like heat waves, floods, cyclones and storm surges, according to experts. This is because they have less access to information on climate adaptation, rarely benefit from government aid and have fewer economic privileges than men. And extreme weather events like cyclones and floods are intensifying in a very short time, giving disabled people little time to move to safety, according to Koll. “People with disabilities, particularly with mobility issues, have limited capacity to respond to emergency situations during an extreme weather event,” he said. But only 10% of people with disabilities believe their local government has emergency, disaster management, or risk reduction plans that address their access and functional needs, according to a UN report. And just 20.6% said they could self-evacuate without difficulty in the event of a sudden disaster, a UN Office for Disaster Risk Reduction online survey found. A hot day in Hyderabad For the old and young, climate change presents difficulties. Vishnu Kumar, a 75 year old man from Hyderabad, suffered a paralytic stroke three years ago and has been confined to a bed and wheelchair since then. As with many elderly, the excessive heat zaps his energy and the frequent power cuts only increase his discomfort, adding to friction in his family. And for student Rohit Reddy, eczema and allergies worsened during summers in the coastal city of Mumbai, costing him time needed for his studies. “I had to shift to Hyderabad because of the flare ups due to extreme humidity, now I may lose an academic year,” Reddy said. -Updated 16.08.2022 with correction to the name of Pratyush Nalam’s condition as spinal muscular atrophy, not muscular dystrophy. Image Credits: Skymet , Pratyush Nalam, Aunia Kahn, Roxy Koll, Gulf News. Monkeypox Variants Get New Names 12/08/2022 Editorial team While the process of renaming monkeypox is still underway, a group of global experts convened by the World Health Organization (WHO) has agreed that the virus’s variants will be renamed with Roman numerals. This follows a meeting convened by the WHO this week to enable virologists and public health experts to reach consensus on new terminology, the global body announced on Friday. Experts in pox virology, evolutionary biology and representatives of research institutes from across the globe reached consensus that the former Congo Basin (Central African) clade will be referred to as Clade one (I) and the former West African clade as Clade two (II). The group also agreed that Clade II consists of two subclades, which will be referred to as Clade IIa and Clade IIb. Assigning new names to existing diseases is the responsibility of WHO under the International Classification of Diseases and the WHO is holding an open consultation for a new name for monkeypox. Anyone wishing to propose new names can do so here. The naming of virus species is the responsibility of the International Committee on the Taxonomy of Viruses (ICTV), which also has a process underway for the name of the monkeypox virus. Image Credits: TRT World Now/Twitter . India is Trying to Reduce Maternal Mortality Without Addressing a Key Contributor: Suicide 12/08/2022 Disha Shetty Suicide is one of the leading causes of death among women of childbearing age in India. Pregnancy is most often a cause for celebration of a new life and a new addition to the family. But for the women who walk into Garima Malik’s clinic in New Delhi, it is a very different story. Some cry. Others appear angry, irritable or frustrated. Usually, the cause is domestic violence – pregnancy is a particularly vulnerable time and as an experienced counsellor, Malik is trained to spot the signs. “They talk about suicide,” she says. “Then they calm down. We talk about risk management and safety planning and counselling. So somehow, they cope.” Malik says many of those who come to the clinic, run by the medical charity Medecins Sans Frontieres (MSF), have experienced physical and emotional violence during pregnancy. Sometimes this is because they are unwilling to be intimate with a partner in the early part of the pregnancy or immediately after the birth. Other times it is because they have given birth to a girl, seen by some as less desirable. “This can cause loneliness in women and they feel frustrated and they feel like he [the husband] needed the child, the family needed the child, and I am the one suffering,” she says. Malik says they are the lucky ones — most Indian women who experience suicidal thoughts in the period during or after their pregnancy will not seek or receive any help. Yet suicide is one of the leading causes of death among women of child-bearing age in India. According to one recent study published in The Lancet medical journal, the suicide rate among Indian women and girls is twice the global average. Women may experience suicidal thoughts during or after pregnancy. India has made enormous strides since the turn of the century in reducing overall maternal mortality, reducing deaths by more than half. In 2019, 103 mothers were dying per 100,000 live births, down from 254 in 2004. The United Nations has set the goal of reducing maternal mortality globally to 70 deaths per 100,000 by 2030. But that success has exposed a phenomenon that had previously gone largely unnoticed in India: high rates of suicides in the perinatal period, defined as during and immediately after pregnancy. A 2016 study of 462 low-income women in early pregnancy in south India found 7.6% were at risk of suicide compared to roughly 0.4% in the United States. Health experts say the government has done little to address this problem, and a suicide prevention action plan devised in 2018 has never been implemented. India is losing young women “in enormous numbers,” says Lakshmi Vijayakumar, a psychiatrist and a member of the World Health Organization (WHO)’s International Network for Suicide Research and Prevention. “And we don’t have any effective mechanism or plan or strategy to address this issue.” The Indian government did not respond to a request for comment. Data on this is limited. India compiles national maternal death statistics by extrapolating from a representative sample survey, but does not separate the data into causes of death. Police keep data on reported suicides, but do not record whether the person was pregnant, and anyway, suicides are underreported. Perinatal suicides are often linked to a history of psychiatric illness, but Lakshmi* says this does not seem to be the case in India. Instead, social factors such as early marriage, intimate partner violence, pressure to give birth to a son and women’s lack of financial autonomy are drivers. Reducing maternal deaths — a revealing success story When it comes to the physical causes of maternal deaths, India’s success has been marked and is largely due to an increase in deliveries at free public health facilities rather than at home. In-facility deliveries rose from 31.1% in 2005-06 to 88.6% in 2019-21, according to government figures, driven by awareness campaigns and offering small financial incentives to pregnant women and grassroots health workers. The southern Indian state of Kerala has been among the most successful in reducing maternal deaths. With 43 per 100,000 live births, it is the safest place in the country to give birth. It is also the only state to have looked into perinatal suicide data, analyzing the 1,076 maternal deaths registered between 2010 and 2020. During that period, mortality dropped from 66 to 43, but the share of suicides increased from about 2.6% in 2010 to 6.6% five years later, and to 18.6% in 2019–20. But that data should be treated with some caution – Kerala’s relatively low rates of maternal mortality were based on a small sample but, combined with the 2016 study in south India, it indicates a trend, says Soumitra Pathare, psychiatrist and director of the Centre for Mental Health Law and Policy. “It is important for various reasons – we now have systematic data to show that suicides are a significant problem in young women, especially young women who are pregnant or have just delivered a child,” he says. “Maternal mortality has gone down substantially because that’s something that has had an intervention done for it. So what this actually shows is that we’ve not done any intervention for suicide prevention.” He cautioned that the data capture only some of the problem. For every person who dies by suicide, an estimated four to 20 times more people attempt it. “So the number of attempted suicides [in India] is anywhere between 0.6 million to 6 million,” said Pathare. “We don’t even collect data on it. ” Early intervention is key Nearly a third of Indian women between the ages of 15 and 49 who have been married, have experienced intimate partner violence. There has been little research into the drivers of perinatal suicide in India, though the Kerala review identified psychiatric illness, young age, unmarried status and domestic violence as risk factors. Nearly one in every three Indian women between the ages of 15-49 who has ever been married has experienced intimate partner violence, according to government figures. Around 3.1% of women in this category said they experienced physical violence during pregnancy. Marital rape is not legally recognized, although this is being challenged in the courts. Nayreen Daruwalla, head of a program on the prevention of violence against women and children at the Mumbai-based non-profit SNEHA, says suicide during pregnancy often falls into one of two categories. “One is pregnant women who are married and in whose cases the family insists on having a boy,” she said. “Unwed mothers are a huge category of cases especially given the lack of social support and sometimes the lack of support from the partner who might be reluctant to wed on finding out the woman is pregnant.” Experts say early intervention is key to preventing perinatal suicides, and that India already has the systems in place to do this. Shaji KS, dean of research at the Kerala University of Health Sciences and part of the team that reviewed perinatal suicides in Kerala, cites India’s network of grassroots health workers, through whom every pregnant person in the country can be reached. Adding a psychiatric component to support their mental health would help prevent many deaths, he said. MSF’s Malik sees a need for more vocational training to enable Indian women to become financially independent, making it easier for them to escape abusive situations. Research in Australia has found this to be effective in reducing suicides. In India, women’s labour force participation has steadily declined from around 30.4% in 2000 to 19% in 2021. “When we talk to such patients, when we talk about leaving husbands and leaving such [a] toxic environment and getting out of this kind of relationship, they want to,” she said. “They cannot because they are not financially independent.” Studies also show restricting access to pesticides, used in many suicides in India, might prevent some of the deaths. Lakshmi, the psychiatrist and WHO advisor, was part of a task force set up by the Indian government in 2018 to suggest ways to reduce overall suicides, whose recommendations have not been implemented. Asked about funding for suicide prevention, the government said in February that funds had been allocated and announced plans for a national telemedicine program for mental health. But it did not commit to adopting the task force’s recommendations. “We have submitted the plan” said Lakshmi. “It is still lying there. I hope that one day it will see the light of day.” * The use of a given name used on second reference is common practice in parts of south India If you or someone you know is struggling with mental health or suicidal thoughts, help is available at iCALL run by TISS at 9152987821 [India] or the National Suicide Prevention Lifeline at 1-800-273-8255 [US]. This article was first published in The Fuller Project. Image Credits: Children's Investment Fund/Flickr , UN Photo/Kibae Park/Flickr, Yogendra Singh/ Unsplash. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... 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Climate Change is a Double Blow for People with Disabilities 16/08/2022 Kavitha Yarlagadda Pratyush Nalam, a software professional in Hyderabad, India HYDERABAD – Pratyush Nalam, a software professional in this south-central Indian city that has become a global tech outpost for Silicon Valley, moves around his house in his wheelchair. He has spinal muscular atrophy and cannot walk, so his family members help him. Though the monsoon season in Hyderabad brings lots of precipitation from the end of June to early October, scientists say the rains are getting even heavier due to climate change. And that, says Nalam, is making life tougher for people than summer heat or winter’s chills. “Getting to a dry place quickly is a challenge,” Nalam says of the growing challenge he faces in just getting around. “Bus stops don’t have shelters and are far to get to – and accessible transport is not available in most cases.” The combined detrimental effects from a lack of inclusive planning or early warning systems, less information and transportation options, and overall discriminatory attitudes has driven the global mortality rate for people with disabilities who experience natural disasters up to four times higher than it is for people without disabilities, according to a Lancet report. Nalam said that during heavy rains “we cannot see the bumps on the roads or sidewalks, which make it riskier to drive our wheelchairs.” Hotter and hotter norms Summer in India has temperatures that regularly climb into the high 30C. Europe has suffered wildfires, evacuations and heat-related deaths this summer, as heat waves force temperatures above 40 degrees C in places like Portugal and France – only slightly hotter than the warmest season in Hyderabad, where temperatures regularly climb into the high 30s C during the pre-monsoon summer from late March to early June. Still, a devastating heat wave that scientists say was made more likely by climate change has baked India and Pakistan in recent months, with some cities in the two neighboring countries reaching around 45 to 50 C. Across Europe and Asia, record temperatures have challenged daily lives, posing serious health risks to families, students, businesspeople and travelers. As with most other natural and manmade disasters, the people that suffer the most often are those that are the most marginalized. “Extreme heat is the root cause of all of the catastrophic events that we are experiencing, from wildfires to drought, hurricanes, storm surges, and flooding,” said Wendy Nystrom, an environmental and pollution risk management consultant in Los Angeles. Among those most affected by climate change Aunia Kahn Persons with disabilities are frequently among the worst affected by climate change, similar to the disproportionately higher rates of morbidity and mortality they suffer in emergencies while also being among the least able to get emergency assistance. “It feels that I am always living in a bubble. I am allergic to heat and cold and this makes me very vulnerable to climate change,” said Aunia Kahn, a disabled U.S. business owner in Eugene, Oregon, who struggles with rare chronic illnesses such as Ehlers Danlos Syndrome, Mast Cell Activation Syndrome, and Dysautonomia. Certain conditions of disability are disproportionately affected by global warming. For example, people with spinal cord injuries cannot cool themselves during excessive heat while people with multiple sclerosis feel more pain and fatigue during hot weather conditions. Some 15% of the world’s population have a disability, the World Bank reported. Many people with them also live in extreme poverty, exacerbating their vulnerability to climate change due to a general lack of proper sanitation, health care, nutrition or safe drinking water. “Earth is warming and global warming is the main reason for the extreme heat waves. Heat intensity is increasing and reducing the quality of our lives,” said Dr. Roxy Mathew Koll of the Indian Institute of Tropical Meteorology in Pune, India. “The vulnerable are the ones who are the most impacted.” Dr Roxy Mathew Koll An increasing human rights issue But the right to a clean, healthy and sustainable environment should be the same for all irrespective of differences such as caste and creed, the UN General Assembly determined in a landmark resolution approved in late July. The assembly’s 161-0 vote with eight abstentions by Belarus, Cambodia, China, Ethiopia, Iran, Kyrgyzstan, Russia and Syria gives momentum to the work of activists and citizens seeking greater legal and regulatory protections. It followed a 43-0 vote on a similar resolution last October in the 47-nation UN Human Rights Council – with China, India, Japan and Russia abstaining. Lack of mobility in emergencies is life-threatening People with disabilities and women and children in South Asia and Africa are more vulnerable to severe weather events like heat waves, floods, cyclones and storm surges, according to experts. This is because they have less access to information on climate adaptation, rarely benefit from government aid and have fewer economic privileges than men. And extreme weather events like cyclones and floods are intensifying in a very short time, giving disabled people little time to move to safety, according to Koll. “People with disabilities, particularly with mobility issues, have limited capacity to respond to emergency situations during an extreme weather event,” he said. But only 10% of people with disabilities believe their local government has emergency, disaster management, or risk reduction plans that address their access and functional needs, according to a UN report. And just 20.6% said they could self-evacuate without difficulty in the event of a sudden disaster, a UN Office for Disaster Risk Reduction online survey found. A hot day in Hyderabad For the old and young, climate change presents difficulties. Vishnu Kumar, a 75 year old man from Hyderabad, suffered a paralytic stroke three years ago and has been confined to a bed and wheelchair since then. As with many elderly, the excessive heat zaps his energy and the frequent power cuts only increase his discomfort, adding to friction in his family. And for student Rohit Reddy, eczema and allergies worsened during summers in the coastal city of Mumbai, costing him time needed for his studies. “I had to shift to Hyderabad because of the flare ups due to extreme humidity, now I may lose an academic year,” Reddy said. -Updated 16.08.2022 with correction to the name of Pratyush Nalam’s condition as spinal muscular atrophy, not muscular dystrophy. Image Credits: Skymet , Pratyush Nalam, Aunia Kahn, Roxy Koll, Gulf News. Monkeypox Variants Get New Names 12/08/2022 Editorial team While the process of renaming monkeypox is still underway, a group of global experts convened by the World Health Organization (WHO) has agreed that the virus’s variants will be renamed with Roman numerals. This follows a meeting convened by the WHO this week to enable virologists and public health experts to reach consensus on new terminology, the global body announced on Friday. Experts in pox virology, evolutionary biology and representatives of research institutes from across the globe reached consensus that the former Congo Basin (Central African) clade will be referred to as Clade one (I) and the former West African clade as Clade two (II). The group also agreed that Clade II consists of two subclades, which will be referred to as Clade IIa and Clade IIb. Assigning new names to existing diseases is the responsibility of WHO under the International Classification of Diseases and the WHO is holding an open consultation for a new name for monkeypox. Anyone wishing to propose new names can do so here. The naming of virus species is the responsibility of the International Committee on the Taxonomy of Viruses (ICTV), which also has a process underway for the name of the monkeypox virus. Image Credits: TRT World Now/Twitter . India is Trying to Reduce Maternal Mortality Without Addressing a Key Contributor: Suicide 12/08/2022 Disha Shetty Suicide is one of the leading causes of death among women of childbearing age in India. Pregnancy is most often a cause for celebration of a new life and a new addition to the family. But for the women who walk into Garima Malik’s clinic in New Delhi, it is a very different story. Some cry. Others appear angry, irritable or frustrated. Usually, the cause is domestic violence – pregnancy is a particularly vulnerable time and as an experienced counsellor, Malik is trained to spot the signs. “They talk about suicide,” she says. “Then they calm down. We talk about risk management and safety planning and counselling. So somehow, they cope.” Malik says many of those who come to the clinic, run by the medical charity Medecins Sans Frontieres (MSF), have experienced physical and emotional violence during pregnancy. Sometimes this is because they are unwilling to be intimate with a partner in the early part of the pregnancy or immediately after the birth. Other times it is because they have given birth to a girl, seen by some as less desirable. “This can cause loneliness in women and they feel frustrated and they feel like he [the husband] needed the child, the family needed the child, and I am the one suffering,” she says. Malik says they are the lucky ones — most Indian women who experience suicidal thoughts in the period during or after their pregnancy will not seek or receive any help. Yet suicide is one of the leading causes of death among women of child-bearing age in India. According to one recent study published in The Lancet medical journal, the suicide rate among Indian women and girls is twice the global average. Women may experience suicidal thoughts during or after pregnancy. India has made enormous strides since the turn of the century in reducing overall maternal mortality, reducing deaths by more than half. In 2019, 103 mothers were dying per 100,000 live births, down from 254 in 2004. The United Nations has set the goal of reducing maternal mortality globally to 70 deaths per 100,000 by 2030. But that success has exposed a phenomenon that had previously gone largely unnoticed in India: high rates of suicides in the perinatal period, defined as during and immediately after pregnancy. A 2016 study of 462 low-income women in early pregnancy in south India found 7.6% were at risk of suicide compared to roughly 0.4% in the United States. Health experts say the government has done little to address this problem, and a suicide prevention action plan devised in 2018 has never been implemented. India is losing young women “in enormous numbers,” says Lakshmi Vijayakumar, a psychiatrist and a member of the World Health Organization (WHO)’s International Network for Suicide Research and Prevention. “And we don’t have any effective mechanism or plan or strategy to address this issue.” The Indian government did not respond to a request for comment. Data on this is limited. India compiles national maternal death statistics by extrapolating from a representative sample survey, but does not separate the data into causes of death. Police keep data on reported suicides, but do not record whether the person was pregnant, and anyway, suicides are underreported. Perinatal suicides are often linked to a history of psychiatric illness, but Lakshmi* says this does not seem to be the case in India. Instead, social factors such as early marriage, intimate partner violence, pressure to give birth to a son and women’s lack of financial autonomy are drivers. Reducing maternal deaths — a revealing success story When it comes to the physical causes of maternal deaths, India’s success has been marked and is largely due to an increase in deliveries at free public health facilities rather than at home. In-facility deliveries rose from 31.1% in 2005-06 to 88.6% in 2019-21, according to government figures, driven by awareness campaigns and offering small financial incentives to pregnant women and grassroots health workers. The southern Indian state of Kerala has been among the most successful in reducing maternal deaths. With 43 per 100,000 live births, it is the safest place in the country to give birth. It is also the only state to have looked into perinatal suicide data, analyzing the 1,076 maternal deaths registered between 2010 and 2020. During that period, mortality dropped from 66 to 43, but the share of suicides increased from about 2.6% in 2010 to 6.6% five years later, and to 18.6% in 2019–20. But that data should be treated with some caution – Kerala’s relatively low rates of maternal mortality were based on a small sample but, combined with the 2016 study in south India, it indicates a trend, says Soumitra Pathare, psychiatrist and director of the Centre for Mental Health Law and Policy. “It is important for various reasons – we now have systematic data to show that suicides are a significant problem in young women, especially young women who are pregnant or have just delivered a child,” he says. “Maternal mortality has gone down substantially because that’s something that has had an intervention done for it. So what this actually shows is that we’ve not done any intervention for suicide prevention.” He cautioned that the data capture only some of the problem. For every person who dies by suicide, an estimated four to 20 times more people attempt it. “So the number of attempted suicides [in India] is anywhere between 0.6 million to 6 million,” said Pathare. “We don’t even collect data on it. ” Early intervention is key Nearly a third of Indian women between the ages of 15 and 49 who have been married, have experienced intimate partner violence. There has been little research into the drivers of perinatal suicide in India, though the Kerala review identified psychiatric illness, young age, unmarried status and domestic violence as risk factors. Nearly one in every three Indian women between the ages of 15-49 who has ever been married has experienced intimate partner violence, according to government figures. Around 3.1% of women in this category said they experienced physical violence during pregnancy. Marital rape is not legally recognized, although this is being challenged in the courts. Nayreen Daruwalla, head of a program on the prevention of violence against women and children at the Mumbai-based non-profit SNEHA, says suicide during pregnancy often falls into one of two categories. “One is pregnant women who are married and in whose cases the family insists on having a boy,” she said. “Unwed mothers are a huge category of cases especially given the lack of social support and sometimes the lack of support from the partner who might be reluctant to wed on finding out the woman is pregnant.” Experts say early intervention is key to preventing perinatal suicides, and that India already has the systems in place to do this. Shaji KS, dean of research at the Kerala University of Health Sciences and part of the team that reviewed perinatal suicides in Kerala, cites India’s network of grassroots health workers, through whom every pregnant person in the country can be reached. Adding a psychiatric component to support their mental health would help prevent many deaths, he said. MSF’s Malik sees a need for more vocational training to enable Indian women to become financially independent, making it easier for them to escape abusive situations. Research in Australia has found this to be effective in reducing suicides. In India, women’s labour force participation has steadily declined from around 30.4% in 2000 to 19% in 2021. “When we talk to such patients, when we talk about leaving husbands and leaving such [a] toxic environment and getting out of this kind of relationship, they want to,” she said. “They cannot because they are not financially independent.” Studies also show restricting access to pesticides, used in many suicides in India, might prevent some of the deaths. Lakshmi, the psychiatrist and WHO advisor, was part of a task force set up by the Indian government in 2018 to suggest ways to reduce overall suicides, whose recommendations have not been implemented. Asked about funding for suicide prevention, the government said in February that funds had been allocated and announced plans for a national telemedicine program for mental health. But it did not commit to adopting the task force’s recommendations. “We have submitted the plan” said Lakshmi. “It is still lying there. I hope that one day it will see the light of day.” * The use of a given name used on second reference is common practice in parts of south India If you or someone you know is struggling with mental health or suicidal thoughts, help is available at iCALL run by TISS at 9152987821 [India] or the National Suicide Prevention Lifeline at 1-800-273-8255 [US]. This article was first published in The Fuller Project. Image Credits: Children's Investment Fund/Flickr , UN Photo/Kibae Park/Flickr, Yogendra Singh/ Unsplash. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
Monkeypox Variants Get New Names 12/08/2022 Editorial team While the process of renaming monkeypox is still underway, a group of global experts convened by the World Health Organization (WHO) has agreed that the virus’s variants will be renamed with Roman numerals. This follows a meeting convened by the WHO this week to enable virologists and public health experts to reach consensus on new terminology, the global body announced on Friday. Experts in pox virology, evolutionary biology and representatives of research institutes from across the globe reached consensus that the former Congo Basin (Central African) clade will be referred to as Clade one (I) and the former West African clade as Clade two (II). The group also agreed that Clade II consists of two subclades, which will be referred to as Clade IIa and Clade IIb. Assigning new names to existing diseases is the responsibility of WHO under the International Classification of Diseases and the WHO is holding an open consultation for a new name for monkeypox. Anyone wishing to propose new names can do so here. The naming of virus species is the responsibility of the International Committee on the Taxonomy of Viruses (ICTV), which also has a process underway for the name of the monkeypox virus. Image Credits: TRT World Now/Twitter . India is Trying to Reduce Maternal Mortality Without Addressing a Key Contributor: Suicide 12/08/2022 Disha Shetty Suicide is one of the leading causes of death among women of childbearing age in India. Pregnancy is most often a cause for celebration of a new life and a new addition to the family. But for the women who walk into Garima Malik’s clinic in New Delhi, it is a very different story. Some cry. Others appear angry, irritable or frustrated. Usually, the cause is domestic violence – pregnancy is a particularly vulnerable time and as an experienced counsellor, Malik is trained to spot the signs. “They talk about suicide,” she says. “Then they calm down. We talk about risk management and safety planning and counselling. So somehow, they cope.” Malik says many of those who come to the clinic, run by the medical charity Medecins Sans Frontieres (MSF), have experienced physical and emotional violence during pregnancy. Sometimes this is because they are unwilling to be intimate with a partner in the early part of the pregnancy or immediately after the birth. Other times it is because they have given birth to a girl, seen by some as less desirable. “This can cause loneliness in women and they feel frustrated and they feel like he [the husband] needed the child, the family needed the child, and I am the one suffering,” she says. Malik says they are the lucky ones — most Indian women who experience suicidal thoughts in the period during or after their pregnancy will not seek or receive any help. Yet suicide is one of the leading causes of death among women of child-bearing age in India. According to one recent study published in The Lancet medical journal, the suicide rate among Indian women and girls is twice the global average. Women may experience suicidal thoughts during or after pregnancy. India has made enormous strides since the turn of the century in reducing overall maternal mortality, reducing deaths by more than half. In 2019, 103 mothers were dying per 100,000 live births, down from 254 in 2004. The United Nations has set the goal of reducing maternal mortality globally to 70 deaths per 100,000 by 2030. But that success has exposed a phenomenon that had previously gone largely unnoticed in India: high rates of suicides in the perinatal period, defined as during and immediately after pregnancy. A 2016 study of 462 low-income women in early pregnancy in south India found 7.6% were at risk of suicide compared to roughly 0.4% in the United States. Health experts say the government has done little to address this problem, and a suicide prevention action plan devised in 2018 has never been implemented. India is losing young women “in enormous numbers,” says Lakshmi Vijayakumar, a psychiatrist and a member of the World Health Organization (WHO)’s International Network for Suicide Research and Prevention. “And we don’t have any effective mechanism or plan or strategy to address this issue.” The Indian government did not respond to a request for comment. Data on this is limited. India compiles national maternal death statistics by extrapolating from a representative sample survey, but does not separate the data into causes of death. Police keep data on reported suicides, but do not record whether the person was pregnant, and anyway, suicides are underreported. Perinatal suicides are often linked to a history of psychiatric illness, but Lakshmi* says this does not seem to be the case in India. Instead, social factors such as early marriage, intimate partner violence, pressure to give birth to a son and women’s lack of financial autonomy are drivers. Reducing maternal deaths — a revealing success story When it comes to the physical causes of maternal deaths, India’s success has been marked and is largely due to an increase in deliveries at free public health facilities rather than at home. In-facility deliveries rose from 31.1% in 2005-06 to 88.6% in 2019-21, according to government figures, driven by awareness campaigns and offering small financial incentives to pregnant women and grassroots health workers. The southern Indian state of Kerala has been among the most successful in reducing maternal deaths. With 43 per 100,000 live births, it is the safest place in the country to give birth. It is also the only state to have looked into perinatal suicide data, analyzing the 1,076 maternal deaths registered between 2010 and 2020. During that period, mortality dropped from 66 to 43, but the share of suicides increased from about 2.6% in 2010 to 6.6% five years later, and to 18.6% in 2019–20. But that data should be treated with some caution – Kerala’s relatively low rates of maternal mortality were based on a small sample but, combined with the 2016 study in south India, it indicates a trend, says Soumitra Pathare, psychiatrist and director of the Centre for Mental Health Law and Policy. “It is important for various reasons – we now have systematic data to show that suicides are a significant problem in young women, especially young women who are pregnant or have just delivered a child,” he says. “Maternal mortality has gone down substantially because that’s something that has had an intervention done for it. So what this actually shows is that we’ve not done any intervention for suicide prevention.” He cautioned that the data capture only some of the problem. For every person who dies by suicide, an estimated four to 20 times more people attempt it. “So the number of attempted suicides [in India] is anywhere between 0.6 million to 6 million,” said Pathare. “We don’t even collect data on it. ” Early intervention is key Nearly a third of Indian women between the ages of 15 and 49 who have been married, have experienced intimate partner violence. There has been little research into the drivers of perinatal suicide in India, though the Kerala review identified psychiatric illness, young age, unmarried status and domestic violence as risk factors. Nearly one in every three Indian women between the ages of 15-49 who has ever been married has experienced intimate partner violence, according to government figures. Around 3.1% of women in this category said they experienced physical violence during pregnancy. Marital rape is not legally recognized, although this is being challenged in the courts. Nayreen Daruwalla, head of a program on the prevention of violence against women and children at the Mumbai-based non-profit SNEHA, says suicide during pregnancy often falls into one of two categories. “One is pregnant women who are married and in whose cases the family insists on having a boy,” she said. “Unwed mothers are a huge category of cases especially given the lack of social support and sometimes the lack of support from the partner who might be reluctant to wed on finding out the woman is pregnant.” Experts say early intervention is key to preventing perinatal suicides, and that India already has the systems in place to do this. Shaji KS, dean of research at the Kerala University of Health Sciences and part of the team that reviewed perinatal suicides in Kerala, cites India’s network of grassroots health workers, through whom every pregnant person in the country can be reached. Adding a psychiatric component to support their mental health would help prevent many deaths, he said. MSF’s Malik sees a need for more vocational training to enable Indian women to become financially independent, making it easier for them to escape abusive situations. Research in Australia has found this to be effective in reducing suicides. In India, women’s labour force participation has steadily declined from around 30.4% in 2000 to 19% in 2021. “When we talk to such patients, when we talk about leaving husbands and leaving such [a] toxic environment and getting out of this kind of relationship, they want to,” she said. “They cannot because they are not financially independent.” Studies also show restricting access to pesticides, used in many suicides in India, might prevent some of the deaths. Lakshmi, the psychiatrist and WHO advisor, was part of a task force set up by the Indian government in 2018 to suggest ways to reduce overall suicides, whose recommendations have not been implemented. Asked about funding for suicide prevention, the government said in February that funds had been allocated and announced plans for a national telemedicine program for mental health. But it did not commit to adopting the task force’s recommendations. “We have submitted the plan” said Lakshmi. “It is still lying there. I hope that one day it will see the light of day.” * The use of a given name used on second reference is common practice in parts of south India If you or someone you know is struggling with mental health or suicidal thoughts, help is available at iCALL run by TISS at 9152987821 [India] or the National Suicide Prevention Lifeline at 1-800-273-8255 [US]. This article was first published in The Fuller Project. Image Credits: Children's Investment Fund/Flickr , UN Photo/Kibae Park/Flickr, Yogendra Singh/ Unsplash. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy
India is Trying to Reduce Maternal Mortality Without Addressing a Key Contributor: Suicide 12/08/2022 Disha Shetty Suicide is one of the leading causes of death among women of childbearing age in India. Pregnancy is most often a cause for celebration of a new life and a new addition to the family. But for the women who walk into Garima Malik’s clinic in New Delhi, it is a very different story. Some cry. Others appear angry, irritable or frustrated. Usually, the cause is domestic violence – pregnancy is a particularly vulnerable time and as an experienced counsellor, Malik is trained to spot the signs. “They talk about suicide,” she says. “Then they calm down. We talk about risk management and safety planning and counselling. So somehow, they cope.” Malik says many of those who come to the clinic, run by the medical charity Medecins Sans Frontieres (MSF), have experienced physical and emotional violence during pregnancy. Sometimes this is because they are unwilling to be intimate with a partner in the early part of the pregnancy or immediately after the birth. Other times it is because they have given birth to a girl, seen by some as less desirable. “This can cause loneliness in women and they feel frustrated and they feel like he [the husband] needed the child, the family needed the child, and I am the one suffering,” she says. Malik says they are the lucky ones — most Indian women who experience suicidal thoughts in the period during or after their pregnancy will not seek or receive any help. Yet suicide is one of the leading causes of death among women of child-bearing age in India. According to one recent study published in The Lancet medical journal, the suicide rate among Indian women and girls is twice the global average. Women may experience suicidal thoughts during or after pregnancy. India has made enormous strides since the turn of the century in reducing overall maternal mortality, reducing deaths by more than half. In 2019, 103 mothers were dying per 100,000 live births, down from 254 in 2004. The United Nations has set the goal of reducing maternal mortality globally to 70 deaths per 100,000 by 2030. But that success has exposed a phenomenon that had previously gone largely unnoticed in India: high rates of suicides in the perinatal period, defined as during and immediately after pregnancy. A 2016 study of 462 low-income women in early pregnancy in south India found 7.6% were at risk of suicide compared to roughly 0.4% in the United States. Health experts say the government has done little to address this problem, and a suicide prevention action plan devised in 2018 has never been implemented. India is losing young women “in enormous numbers,” says Lakshmi Vijayakumar, a psychiatrist and a member of the World Health Organization (WHO)’s International Network for Suicide Research and Prevention. “And we don’t have any effective mechanism or plan or strategy to address this issue.” The Indian government did not respond to a request for comment. Data on this is limited. India compiles national maternal death statistics by extrapolating from a representative sample survey, but does not separate the data into causes of death. Police keep data on reported suicides, but do not record whether the person was pregnant, and anyway, suicides are underreported. Perinatal suicides are often linked to a history of psychiatric illness, but Lakshmi* says this does not seem to be the case in India. Instead, social factors such as early marriage, intimate partner violence, pressure to give birth to a son and women’s lack of financial autonomy are drivers. Reducing maternal deaths — a revealing success story When it comes to the physical causes of maternal deaths, India’s success has been marked and is largely due to an increase in deliveries at free public health facilities rather than at home. In-facility deliveries rose from 31.1% in 2005-06 to 88.6% in 2019-21, according to government figures, driven by awareness campaigns and offering small financial incentives to pregnant women and grassroots health workers. The southern Indian state of Kerala has been among the most successful in reducing maternal deaths. With 43 per 100,000 live births, it is the safest place in the country to give birth. It is also the only state to have looked into perinatal suicide data, analyzing the 1,076 maternal deaths registered between 2010 and 2020. During that period, mortality dropped from 66 to 43, but the share of suicides increased from about 2.6% in 2010 to 6.6% five years later, and to 18.6% in 2019–20. But that data should be treated with some caution – Kerala’s relatively low rates of maternal mortality were based on a small sample but, combined with the 2016 study in south India, it indicates a trend, says Soumitra Pathare, psychiatrist and director of the Centre for Mental Health Law and Policy. “It is important for various reasons – we now have systematic data to show that suicides are a significant problem in young women, especially young women who are pregnant or have just delivered a child,” he says. “Maternal mortality has gone down substantially because that’s something that has had an intervention done for it. So what this actually shows is that we’ve not done any intervention for suicide prevention.” He cautioned that the data capture only some of the problem. For every person who dies by suicide, an estimated four to 20 times more people attempt it. “So the number of attempted suicides [in India] is anywhere between 0.6 million to 6 million,” said Pathare. “We don’t even collect data on it. ” Early intervention is key Nearly a third of Indian women between the ages of 15 and 49 who have been married, have experienced intimate partner violence. There has been little research into the drivers of perinatal suicide in India, though the Kerala review identified psychiatric illness, young age, unmarried status and domestic violence as risk factors. Nearly one in every three Indian women between the ages of 15-49 who has ever been married has experienced intimate partner violence, according to government figures. Around 3.1% of women in this category said they experienced physical violence during pregnancy. Marital rape is not legally recognized, although this is being challenged in the courts. Nayreen Daruwalla, head of a program on the prevention of violence against women and children at the Mumbai-based non-profit SNEHA, says suicide during pregnancy often falls into one of two categories. “One is pregnant women who are married and in whose cases the family insists on having a boy,” she said. “Unwed mothers are a huge category of cases especially given the lack of social support and sometimes the lack of support from the partner who might be reluctant to wed on finding out the woman is pregnant.” Experts say early intervention is key to preventing perinatal suicides, and that India already has the systems in place to do this. Shaji KS, dean of research at the Kerala University of Health Sciences and part of the team that reviewed perinatal suicides in Kerala, cites India’s network of grassroots health workers, through whom every pregnant person in the country can be reached. Adding a psychiatric component to support their mental health would help prevent many deaths, he said. MSF’s Malik sees a need for more vocational training to enable Indian women to become financially independent, making it easier for them to escape abusive situations. Research in Australia has found this to be effective in reducing suicides. In India, women’s labour force participation has steadily declined from around 30.4% in 2000 to 19% in 2021. “When we talk to such patients, when we talk about leaving husbands and leaving such [a] toxic environment and getting out of this kind of relationship, they want to,” she said. “They cannot because they are not financially independent.” Studies also show restricting access to pesticides, used in many suicides in India, might prevent some of the deaths. Lakshmi, the psychiatrist and WHO advisor, was part of a task force set up by the Indian government in 2018 to suggest ways to reduce overall suicides, whose recommendations have not been implemented. Asked about funding for suicide prevention, the government said in February that funds had been allocated and announced plans for a national telemedicine program for mental health. But it did not commit to adopting the task force’s recommendations. “We have submitted the plan” said Lakshmi. “It is still lying there. I hope that one day it will see the light of day.” * The use of a given name used on second reference is common practice in parts of south India If you or someone you know is struggling with mental health or suicidal thoughts, help is available at iCALL run by TISS at 9152987821 [India] or the National Suicide Prevention Lifeline at 1-800-273-8255 [US]. This article was first published in The Fuller Project. 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