antibiotics
Unsupervised use of antibiotics threatens the global fight against antimicrobial resistance.

A new survey of citizens in 14 WHO member states in the Balkans, Caucasus and Central Asia found that one third of respondents questioned said that their last course of antibiotics was obtained with a medical prescription.

This is at least three times more than that reported from a similar survey of 30 European Union and European Economic Area member states, in a recent survey of citizens by the European Commission, said WHO’s European Regional Office in a report of the findings issued on Monday, which marks the start of World Antimicrobial Awareness Week.

The findings were part of a wider survey of knowledge, attitudes and behaviour around antimicrobial resistance, (AMR), conducted for the first time ever in the eastern part of the WHO European Region, including the Caucasus and Central Asia.

The countries surveyed included: Albania, Armenia, Azerbaijan, Belarus, Bosnia and Herzegovina, Georgia, Kazakhstan, Kyrgyzstan, Montenegro, North Macedonia, the Republic of Moldova, Tajikistan, Turkiye and Uzbekistan.

The findings highlight the wide gap that exists not only worldwide, but within WHO’s sprawling European Region, regarding the use of antibiotics and awareness about growing antimicrobial resistance to common drugs.

WHO’s European Region includes some 53 member states, representing a wide spectrum of economic development levels – also reflective of global development gaps more broadly.  It includes all of the EU/EEA member states as well as member states of the former Soviet Union and other former eastern bloc countries, which are not EU members.

In the WHO survey, one in three respondents said that in their last antibiotics course, they either used leftover antibiotics from a previous prescription or obtained them without a prescription over the counter from a pharmacy or elsewhere, according to the preliminary survey findings.

In addition, 50% of those surveyed across participating countries reported having used antibiotics in the last year, which is more than double that reported for EU/EEA countries for the same period.

Central and Eastern Europe and Central Asia among AMR hotspots worldwide

Number of all-age MRSA deaths attributable to AMR.

At least 1.27 million deaths per year are directly attributable to superbug resistance to common antibiotics, according to global AMR estimates released earlier this year by the Seattle, USA-based Institute for Health Metrics Evaluation (IHME) and the Global Research on Antimicrobial Resistance (GRAM) Project partners.

The deadliest pathogen-drug combination globally was methicillin-resistant Staphylococcus aureus (MRSA), which caused more than 100,000 deaths attributable to AMR in 2019, according to the IHME report. On the GBD super-region level, the number of all-age MRSA deaths attributable to AMR is largest in the Southeast Asia, East Asia, and Oceania super-region and is smallest in the Central Europe, Eastern Europe, and Central Asia super-region.

Deaths from all-age MRSA attributable to AMR are, however, largest in Southeast Asia, East Asia, and the Oceania super-region, the IHME study found, while they are proportionately smallest in Central Europe, Eastern Europe, and Central Asia super-region – where access to health care is still more robust.  Even so, according to WHO, some 35,000 people die from AMR-related infections in the EU/EEA region which represents Europe’s most developed economies.

Slow tsunami on the horizon

WHO Press Technical Briefing 11 July 2022.

“When antibiotic drugs are used too much, for too long or when they are not necessary, bacteria can become resistant to them,” said Dr Danilo Lo Fo Wong, WHO European Regional Adviser for the Control of Antimicrobial Resistance. “Without collective action, we can expect a future in which otherwise treatable illnesses, such as urinary tract infections, could once again become untreatable and procedures such as surgeries or chemotherapy too dangerous to perform.”

In the survey of 61% of respondents were also unaware that antibiotics do not work against viruses, while over half believed, incorrectly, that they were effective against colds. In the EU/EEA region, about 50% of those surveyed mistakenly believed that antibiotics kill viruses.

However, two thirds of respondents said that they understood that unnecessary use of antibiotics made them ineffective.

“Antibiotics cannot cure the common cold. A common cold is caused by a virus, against which antibiotics do not work,” stressed Dr Danilo Lo Fo Wong. “Though antibiotics will not help you, their use may lead to the development of antibiotic resistance and become a problem for you and for someone else.”

WHO Regional Director for Europe, Dr Hans Kluge, called AMR “the slow tsunami building up on the horizon.  We can take steps to make sure that people are informed about their medicines,”

See this link for more about World Antimicrobial Awareness Week events.  Link here for more WHO Resources and a joint campaign of the Quadripartite – including the global agencies dealing with animal health, agriculture and the environment.

Image Credits: Emily Brown, Healthdata.org.

Negotiations on a ‘pandemic treaty’ are starting in earnest within weeks as the World Health Organization (WHO) distributed the first ‘zero-sum’ conceptual draft of the agreement to member states on Friday – but one of the biggest conundrums is how to pay to mitigate the next pandemic. 

The COVID-19 pandemic has had a significant impact on economies, and 143 of the WHO’s 192 member states are to adopt “austerity measures’ including public spending cuts next year, while Russia’s war in Ukraine and climate crises are further challenging country budgets.

The Pandemic Fund, recently set by the World Bank, has an annual “funding gap” of $10 billion, the G20 leaders acknowledged at the conclusion of their meeting in Bali on Wednesday.

But this week the Geneva Global Health Hub (G2H2) described the Fund as an “outdated funding model dependent on colonial charity” at the launch of its report, “Financial Justice for Pandemic Prevention, Preparedness and Response”.

“There is certainly no shortage of money in this world, but redirecting it to advance health after the pandemic requires bold action. The international community instead continues to pursue outdated and opaque models, as is the case of the recently established Pandemic Fund,” said Wemos’s Mariska Meurs, co-author of the report. 

The G2H2 report proposes a number of options to fund stronger health systems to fend off pandemics, one being debt cancellation.

Several emerging and developing countries were in a dire debt crisis well ahead of the COVID-19 pandemic, while many more countries have emerged from the pandemic with higher and more unsustainable debts.

“In low-income countries, debt has increased from 58 to 65% between 2019 and 2021. Thirty nations in sub-Saharan Africa have seen a debt-to-GDP ratio exceeding 50% in 2021,” according to the report.

“Research conducted on 41 countries shows that those with the highest debt payments will spend an average of 3% less on essential public services in 2023 than in 2019,” according to the G2H2 report.

In addition, between 75 million and 95 million people would be pushed into extreme poverty by the end of 2022, according to the World Bank.

Debt cancellation and climate reparations

Nicoletta Dentico, G2H2 co-chair and report co-author.

“If the G20 had cancelled all payments due in 2020 from the 76 most indebted countries, this would have liberated $40 billion towards a pandemic response. If the cancellation had included 2021, the amount would have been $300 billion. Debt is a virus, and debt cancellation is the vaccine the world needs before the debt crisis explodes,” said Nicoletta Dentico, G2H2 co-chair and report co-author.

Debt cancellation is not such an outlandish idea in light of the “loss and damages” reparations that wealthy industrialized countries owe to developing countries for the devastations caused by their greenhouses gases emissions, the report argues.

While the World Bank keeps talking about the “debt crisis”, it is the northern countries that are indebted as “it is their ecological debt that needs to be paid”, said Dentico.

Global warming caused $6 trillion in global economic losses between 1990 and 2014, and it was time for “financial justice”, she added.

Health cuts in the name of ‘austerity’

Isabel Ortiz, Director of the Global Social Justice Program at Joseph Stiglitz’s Initiative for Policy Dialogue at Columbia University, said that there was a “tsunami of austerity cuts” ahead – yet these had always resulted in cuts to the health sector which set countries back.

Before the Ebola outbreaks in West Africa in 2014, the International Monetary Fund (IMF) had compelled Guinea, Liberia and Sierra Leone to adopt austerity measures, including limiting the number of health workers that they could hire and capping health workers’ wages, which then affected their response to Ebola, according to the report.

G2H2 co-chair Baba Aye, from Public Services International, said that austerity measures as part of fiscal consolidation had mostly led to “a massive deterioration of health conditions for entire populations”. 

“This economic model has enslaved global South countries to multiple financial dependencies, constricted their fiscal policy space, distorted their economic and human development and impoverished them,” said Aye.

Austerity usually went with the commercialization and privatization of public health services – yet “people suffered the most during COVID-19 where there was privatized healthcare or funding cuts”, added Aye. 

Despite this, the World Bank has rolled out its “private-first” approach – including in health – through its “maximizing finance for development strategy”, added the G2H2.

Meanwhile, the IMF, after a brief spending boost during the Covid-19 pandemic, has returned to pushing for ‘fiscal consolidation’ in country programs and loans, according to the report.

But there are better alternatives to austerity-related public spending cuts, said Ortiz, including increasing the taxation of corporations and wealthy individuals. 

“For instance, we can increase taxes on corporate profits, financial activities, wealth, property, natural resources, and digital services like Amazon,” said Ortiz.  

Argentina, Iceland, Spain have announced special taxation of the windfall profits of the energy sector, she added.

“All the human suffering caused by austerity cuts can be avoided. There are alternatives. Even in the poorest countries, governments can increase their budgets to ensure quality public services and universal social protection by looking at financing options such as fairer taxation, reducing debt and illicit financial flows,” said Ortiz.

Isabel Ortiz, Director of the Global Social Justice Program at Joseph Stiglitz’s Initiative for Policy Dialogue at Columbia University

Illicit financial flows to tax havens

Illicit Financial Flows (IFFs) are yet another drain on public resources that can only be tackled with radical action, according to the G2H2. 

Many of these flows involved the expatriation of profits from the countries where they were generated to tax havens.

The Eastern and Southern African region lost a staggering $7.6 billion in tax revenue in 2017 alone, due to “base erosion and profit shifting to tax havens”, according to the report.

At the UN General Assembly in 2022, the Africa Group tabled a draft resolution calling for negotiations towards a UN convention on tax cooperation, building on the long-standing call by G77 & China to establish an intergovernmental process at the UN to address global tax abuse. 

“This initiative should at least be receiving a strong indication of support in the context of the Intergovernmental Negotiating Body (INB) for the pandemic accord at the WHO,” said the G2H2.

E-cooking
A three-stone coal cook stove in Kisumu, Kenya.

SHARM EL SHEIKH, Egypt – Electric cooking is becoming more attainable for households in Africa, and BioLPG, a climate-neutral alternative to propane, could be a cost-effective replacement to the fossil fuel variant for household cooking in some developing countries, say experts at COP27, the global climate talks. 

The spoke at a panel session on tackling the health and climate crisis through clean cooking solutions, hosted by the World Health Organization at COP27.

The emerging potential to harness energy-efficient electric cooking technologies to clean up pollution from charcoal and wood stoves used by hundreds of millions of poor households offered one bright star in the mostly dismal news about climate trends and deadlocked negotiations, emerging out of this years UN Climate Conference.

For years, clean cooking solutions have received more lip service than cash from the energy and finance ministers who hold the purse strings of energy investment. Even in countries like Nigeria, which are rich in fossil fuels, governments have been far more intent on extracting oil and gas for export than expanding modern energy access at home. 

Despite major progress over the past decade, some 775 million people worldwide still have no access to electricity. And a whopping 2.6 billion people still cook on the most rudimentary wood, charcoal or biomass stoves that emit high levels of smoke directly into homes, said the World Health Organization’s (WHO) Heather Adair Rohani at the session on “tackling the health and climate crisis through clean cooking” solutions. 

Household smoke is both an agent of climate change and air pollution. It kills an estimated 3.2 million people annually including about 237,000 children under the age of five who are more prone to pneumonia as a result of their smoke exposure. Among older people who spend much of their day next to cooking fires, deadly cardiovascular and respiratory diseases, as well as cataracts and other complaints, are a frequent outcome, Adair Rohani explained.

Inefficient cook-stoves and heating systems are also a leading source of excessive CO2 emissions, and the black carbon emitted by wood and biomass stoves is a short-lived climate pollutant that accelerates snow and glacier melt. Finally, wood gathering and charcoal production not only contributes to deforestation but also consumes excessive time for women and girls, detracting from work and education and putting them at physical risk.

Household smoke is a longstanding health and climate issue

The WHO has long viewed household cooking emissions as a critical threat to global health.

As a key impediment to women’s and children’s health and gender equality, household smoke has been an issue that WHO has championed since the early days of its involvement in climate issues – long before the global health agency began to weigh in forcefully on more sensitive topics like fossil fuels.   

Meanwhile, some of the clean cook-stove solutions that held promise a decade ago have not proven to be long-term solutions. Some “improved” biomass cook-stoves may reduce pollution emissions, but not enough to make them safe for daily use inside homes.

And certain renewable cooking solutions, like solar cook-stoves, have been met with social and cultural resistance in some settings, limiting their potential for scale-up. In many countries, large-scale government investments in clean cooking have simply failed to pan out, leaving the work to non-profit organizations, with a mixed bag of solutions and approaches.

New horizon created by improved electricity access

Despite the still yawning access gaps, the number of people without electricity in their homes declined from over 1.3 billion people in 2012 to 754 million in 2021, before rising slightly in 2022. And renewable electricity is much more affordable than it was a decade ago.

New solutions like e-cooking, which a few years ago were accessible only in middle and high-income countries, are now within reach, said Ed Brown, who leads the UK-backed Modern Energy Cooking Services initiative (MECS).

“E-cooking is becoming more feasible around African urban centres as more people gain access to reliable electricity,” he said. More energy-efficient electric induction stoves and cooking tools like electric rice cookers, are also helping that transition.

In east African countries like Kenya and Uganda, and Asian countries like Nepal, the proportion of people with sufficient electricity access to shift to e-cooking is growing, Brown said, adding, “We´re also watching developments in Tanzania, Mozambique and Malawi.”

In Kenya, over 70% electricity access

Geothermal
Located in Hell’s Gate National Park, Kenya, the Olkaria III complex is the first geothermal power station in Africa.

In Kenya, over 70% of the population now has electricity access. In Uganda it’s over 40%, and in Nepal, over 95%. 

If just 40% of Kenya´s grid-connected homes currently using charcoal for cooking can be induced to shift to e-cooking by 2030, that could yield over $600 million in climate, health and ecosystem benefits over the first five years of electrification, for $110 million in costs. This would transition an estimated 700,000 households to clean cooking sources, Brown said. 

Through WHO’s interactive assessment tool, BARHAP, the team estimates that the upfront costs of the shift to e-cooking in terms of more efficient stoves or appliances would be paid back within 9 months. It would also save: 

  • 1,203 disability-adjusted life years (DALYs) a year avoided;
  • 191million hours/yr of women’s time saved (272hrs/per household/ year);
  • 1.9 million tonnes/yr CO2eq emissions reduced;
  • 400,000 tons a year in unsustainable wood harvest reduced;

But e-cooking is hardly a panacea: some 60% of people in sub-Saharan Africa still lack access to electricity.


The drive to electrify Africa is gaining momentum as part of the Climate and UN Sustainable Energy for All agenda and initiatives by the countries themselves. 

Despite the push by many African leaders – backed by powerful oil and gas interests – to expand their fossil fuel production, green electrification is now much cheaper over the long term, at about two cents a kilowatt hour, Brown said. In some countries, it is also cheaper than charcoal, a resource often harvested unsustainably. 

Even Kenya and Uganda, which have invested far more heavily in fossil fuels than solar power, have put significant sums towards hydroelectric and geothermal electricity power generation. Renewables are now the backbone of their domestic electricity grids, generating 71% of Kenya´s power and 92% of Uganda’s. 

First ever e-cooking strategy in Kenya

Ed Brown, leader of the UK-backed Modern Energy Cooking Services initiative (MECS), speaking at COP27.

Supporting a shift to e-cooking requires a mix of measures. These range from subsidies to households for the purchase of more efficient stoves or portable cookers, to governments reducing household electricity tariffs to a level where e-cooking is more affordable than alternatives, particularly charcoal. 

“In Uganda, the government has introduced a reduced tariff for cooking. Up to a certain usage level, the price is heavily subsidized, and they’ve raised the ceiling on that,” Brown said. In Kenya, the UK-backed MECS initiative is supporting the government in the development of its first-ever e-cooking strategy.

In nearby Malawi, a new Global Green Grid Initiative, launched at last year’s COP26 in Glasgow, appears set to finance the development of Africa’s first national electric grid to be powered primarily by solar energy. The project, announced last month by the Global Alliance for Energy and the Planet – backed by Rockefeller and IKEA foundations – aims to scale up electricity access from a meagre 18% to 100% by 2030 by developing mega and mini-solar grids.

“It is true there is still significant investment in fossil fuels,” Brown concedes, reflecting on Africa’s ‘dash for gas’ that has been the talk of this year’s COP27.  “There are discussions and moves afoot for changing that. I think that as we emerge out of the energy crisis [brought on by the invasion of Ukraine], electrification will continue to get greener rather than browner.”

BioLPG – the green version of a popular fossil fuel

MECS has also been looking at how biogas production could be industrially scaled up in a number of flagship African countries with investment into bioLPG (Liquefied petroleum fuel), a chemically altered version of biogas that is the equivalent of propane. 

An assessment by the Global LPG Alliance, produced in collaboration with MECS and published before last year’s COP26, estimated that some 1.65 million households in Rwanda, Ghana and Kenya could be supplied with bioLPG for their cooking needs, cost-effectively, through the development of just five large scale municipal and farm waste to gas projects. 

Multiple health and climate benefits

The health and climate implications of this shift go well beyond the production of cleaner and greener cooking fuel. 

From a health standpoint, both municipal waste and manure are sources of dangerous pathogens and disease, particularly in fast-developing cities where waste management is weak. and these pathogens are rendered harmless during the process of anaerobic digestion that produces biogas, leaving only a slurry bi-product that is also a rich fertilizer and thus useful for food production. 

Municipal waste is also the third most potent source of global methane emissions from human activity, after oil and gas extraction and agriculture/livestock. Together, municipal waste and agro waste generate some 45% of methane emissions from human activities. Methane has 20 times the climate warming potential of CO2 over the first 20 years of its lifecycle – as well as being a precursor of ozone – which reduces crop growth and is yet another air pollution risk.  

While biogas is carbon neutral, bioLPG undergoes a stage of chemical processing that enables it to be pressurized, bottled and transported, like propane. Its carbon footprint is slightly higher than that of biogas, but its climate impact is still a fraction of LPG made out of fossil fuels. 

Waste to bioLPG and bioLNG is already happening in the global north

A year after Glasgow, MECS is now in the initial stages of making a more refined estimate of the economic, political and logistical feasibility for two of the five pilot bioLPG projects assessed earlier in Kenya and Uganda. 

Across Europe and North America, a movement to convert biogas generated from municipal waste and manure into commercial products of value to consumers is already well underway.

In North America, the efforts are largely focused on transforming raw biogas into renewable natural gas (rNG), the chemical equivalent of fossil fuel, which can be integrated into the continent’s extensive natural gas infrastructure used in heating, electricity production and vehicles. Case studies from Toronto and Minneapolis, Minnesota, among other cities, were showcased at a biogas panel session Thursday, at COP27, by the World Biogas Association. 

In Europe, where LPG is more common, fuel distributors are shifting to bioLPG in line with European Union goals. Brown noted that leading UK LPG distributors aim to convert their infrastructure fully to bioLPG. 

Tools to assess choices in light of health and climate benefits  

One of the key innovations that WHO has created for policymakers is an interactive tool that supports a cost-benefit analysis of different household energy scale-up options by policymakers and practitioners in order to quantify the trade-offs in hard numbers. 

That tool, known as BARHAP, is what allowed Brown and his team to estimate both the payback period of investment in e-cooking in Kenya, and the savings in excess morbidity and mortality, women’s labour, and climate emissions. 

“The interactive tool, which is available online, accounts for the household expenditure, the government expenditures for cleanup, looking at different interventions, the climate impacts, the time loss [in fuel gathering], etc.” said Rohani. “It helps countries to see what the different interventions are, and what can you expect in terms of that cost-benefit from a different set of different solutions.”

That tool is just one part of a Clean Household Energy Solutions Toolkit (CHEST) developed by WHO over the past several years. The toolkit contains six modules in total, including resources for local stakeholder mapping, engaging the community, monitoring evaluation, standards and testing, and communications.

The toolkit aims to support policymakers and practitioners in reaching Sustainable Development Goal 7: access to “clean, affordable, reliable, sustainable and modern energy for all” by 2030, which includes access to clean household fuels and technologies.

Assessing solutions in context

E-cooking
Replacing outdated stoves could improve the lives of millions.

“The toolkit allows policymakers to assess solutions that may be best suited to their geography, economies, culture and communities while yielding optimal reductions in air pollution and health benefits,” said Adair-Rohani.

The WHO has long championed the health benefits of clean cooking in terms of reduced air pollution exposures for women and children as well as savings in women and girls’ labour, and the “new narrative” of clean cooking is also building more on the economic benefits of “modernizing” – something that may appeal more to finance and energy ministers as well as to consumers, says Brown. 

“While progress was being made on ‘access to modern energy’ [in the form of electricity], the separation of cooking was perpetuating problems,” he said. 

Health advocates are shifting their pitch around clean cookstoves to capitalize on the “aspiration for modernisation, cleanliness and convenience”  which resonates among energy ministers and consumers to sell solutions that ultimately improve public health:

“Now we need to go to the folks that are putting money into electrification, and make sure that every electrification grid extension program that they still have is a clean cooking component.”

Image Credits: World Bank, IEA 2022 , IRENA.

The COVID-19 pandemic has been marred by uneven access to vaccines and other life-saving products.

Regional production of vaccines and other pandemic-related products – and sharing the technical know-how to enable this – features strongly in the much-anticipated first draft of the global pandemic treaty proposed by the World Health Organization (WHO) to guide future pandemics.

WHO member states will be briefed on the conceptual “zero-sum” draft on Friday in preparation for the Intergovernmental Negotiating Body’s (INB) meeting from 5-7 December, which will kick off formal negotiations.

The draft advocates for regional and country “strategic stockpiles” of pandemic response products, particularly active pharmaceutical ingredients that could be facilitated by “multilateral and regional purchasing mechanisms”.

It also suggests “international consolidation hubs, as well as regional staging areas” to ensure the streamlined transportation of supplies.

Intellectual property hot potato

Intellectual property is the most obvious hot potato. The draft offers four proposals on IP, all of which recognise the negative impact IP protection can have on prices. 

Three proposals affirm the importance of protecting IP while the more radical fourth option simply recognises that IP poses a “threat and barriers to the full realization of the right to health and to scientific progress for all, particularly the effect on prices, which limits access options and impedes independent local production and supplies”.

Various proposals are included on the TRIPS waiver, with some recognition of the need for “time-bound waivers of the protection of intellectual property rights that are a barrier to manufacturing of pandemic response products during pandemics”.

The importance of “trilateral cooperation” between the WHO, World Trade Organization and World Intellectual Property Organization (WIPO) on IP, public health, and trade, is also highlighted.

Protestors in New York City protesting against pharmaceutical companies’ profiteering.

Public funding and price disclosures

The draft also proposes measures to “encourage, incentivize, and facilitate” the private sector’s “voluntary transfer of technology and know-how through collaborative initiatives and multilateral mechanisms”. 

But where there has been “public financing of research and development for pandemic response products”, the draft proposes that measures need to be adopted to ensure “more equitable access and affordability” of these products.

These could involve “conditions on distributed manufacturing, licensing, technology transfer and pricing policies”.

In addition, public financing of R&D could result in “measures to limit indemnity or confidentiality clauses in commercial pandemic response product contracts between countries and manufacturers”.

Secret deals were a cause for serious concern for many countries and health activists at the height of the COVID-19 pandemic when vaccines were in short supply and being sold at different prices without any transparency.

The draft also proposes that “promoters of research for pandemic response products assume part of the risk (liability) when the products or supplies are in the research phase, and that making access to such pandemic response products or supplies conditional on a waiver of such liability is discouraged”.

Pfizer and Moderna in particular made countries sign onerous indemnity clauses before they agreed to supply them with COVID-19 vaccines.

‘A shopping list,’ says IFPMA

However, the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) has already indicated that it is against the draft, saying in a statement on Friday that it “does not meet the test of preserving what worked well and it is questionable whether the proposals to address the shortcomings faced in the current pandemic would work”.

“The text, while containing elements which can form a good basis to be better prepared for future pandemics, reads as a shopping list of multiple agendas and ideas which have been brought together in one document and therefore lack coherence,” added the IFPMA.

“If the draft were implemented as written today it would most likely undermine rather than facilitate our collective ability to rapidly develop and scale up counter measures and ensure its equitable access.”

It believes that a more constructive approach would be to identify and build on what worked well during the COVID-19 pandemic, such as “the R&D ecosystem”.

“The private sector developed multiple safe and effective vaccines and treatments against COVID-19 and scaled up their production in record time,” said the IFPMA. “We need to make sure that the IP-based innovation ecosystem is not undermined.  Innovation resulting in safe and effective vaccines in record time and scaling up manufacturing to historic levels involving hundreds of voluntary partnerships leaning on the capabilities available around the globe worked, together with rapid pathogen sharing were key elements of the rapid response to the COVID-19 pandemic.”

Areas of improvement include health systems strengthening and resilience and the equitable distribution of the vaccines, “which was hampered by resourcing challenges both financial and logistical, as well as the free movement of supplies and vaccines”, added the IFPMA.

 Sharing pathogens

The draft also advocates for “early, safe, transparent and rapid sharing of samples and genetic sequence data of pathogens” – a measure supported by the pharmaceutical industry – but simultaneously calls for “the fair and equitable sharing of benefits”.

In addition to international and regional anti-pandemic measures, the draft advocates that member states increase domestic funding, particularly to support strong primary health care and universal health coverage.

Intensive process 

Since the WHO’s special health assembly resolved to negotiate a pandemic ‘instrument’ almost a year ago, the INB has engaged in an intensive consultation process.

The draft is the result of inputs from member states, regional meetings, relevant stakeholders, two public hearings that were open to anyone, informal, focused consultations and two INB meetings. 

Any areas covered by the International Health Regulations (2005) are not contained in the draft. 

Mohga Kammal Yanni

Responding to the draft text, Mohga Kammal Yanni, policy co-lead for the People’s Vaccine Alliance, said that it “shows that negotiations are at a crossroads”. 

“A treaty could break with the greed and inequality that has plagued the global response to COVID-19, HIV/AIDS and other pandemics. Or, it could tie future generations to the same disastrous outcomes,” said Yanni.

“The treaty gives world leaders a chance to prevent this inequality through increasing the pharmaceutical manufacturing capacity of developing countries and sharing of technology and know-how. It needs to mandate this sharing and commit countries to waiving intellectual property rules for relevant products in future pandemics. This would avoid the current inequitable access to essential medical products needed to deal with pandemics.”

The zero draft will be discussed at the third INB meeting in December, and an even more intensive process of negotiations will begin.

The INB will submit a progress report on its deliberations to the 76th World Health Assembly in 2023, and the final draft for consideration at the 77th World Health Assembly in 2024.

* This story was updated to include the IFPMA response.

Image Credits: Zhang Meifang/Twitter, People's Vaccine Alliance.

Pakistan flood relief 2022
Pakistan’s flood-affected families receiving relief packages from RFI. 

ISLAMABAD, Pakistan – Shujaat Ali Khan’s community in the Swat valley of Pakistan was devastated by recent flash floods, leaving thousands displaced and destroying infrastructure and crops. 

“Land in the area was completely destroyed and the community needed urgent support,” said Khan, who wanted to help his community.

He found that climate activists from the social enterprise organisation, Resilient Future International (RFI), were more responsive than the government.

“We managed food package deliveries at micro-level to the flood-affected farmers in Swat with the collaboration of RFI to help people in this difficult time,” said Khan.

In early 2022, a report from the Sixth Assessment Report of the Intergovernmental Panel on Climate Change (IPCC), described Pakistan as a climate hotspot, in the top ten climate-impacted countries in the world.

“In South Asia, extreme climatic conditions are threatening food security; thus, agro-based economies, such as those of India and Pakistan, are the most vulnerable to climate change,” the report said.

A few months later, the report’s words were borne out by floods that killed some 1400 people  and left about one-third of the country’s land under water, affecting about 33 million people from Khyber Pakhtunkhwa in the far north to Baluchistan, Punjab, and Sindh province in the far south.

Last week at the COP27 climate change talks in Egypt, Pakistan´s Prime Minister, Muhammed Shehbaz Sharif, made an urgent appeal for loss and damage funds to assist his country to recover from the August floods, pointing out that Pakistan had a tiny carbon footprint but was suffering from emissions from wealthy countries.

“Estimated damage and loss have exceeded $30 billion and this is despite our very low carbon footprint. We became a victim of something with which we had nothing to do,” said Sharif, speaking about the August flooding.

Government unprepared

Pakistan’s government was unprepared for the scale of the flood, and NGOs and social enterprises have stepped into the vacuum. 

In the case of RFI, supporting immediate disaster relief is also a means of raising more awareness about the risks of climate change and the benefits of early action. 

The RFI was founded in October 2017 by Aftab Alam Khan, who has over 20 years’ experience in developing climate resilient and people-centric solutions in Asia, Africa, Latin America. 

Khan, a graduate from the University of Wales Swansea in the United Kingdom, has advised the governments of Pakistan, Indonesia, South Africa, as well as the G-20 and G-77 on sustainable and pro-poor policies.

RFI provides research, training and consultancy services on climate-resilient, people-centric solutions. Khan is also currently designing two academic courses on tackling climate change.

In an interview with Health Policy Watch, Khan said his enterprise aims to develop the capacity of the communities, media, and entrepreneurs to face the challenges of climate change through initiatives in research, training, monitoring and evaluation. 

 “I have worked globally on climate resilience for the past 20 years, but I realized that limited or no work on crucial areas needed for climate resilient future in Pakistan has been done,” he said.

A major focus, he adds, is building youth capacity, including the integration of climate change into the university curriculum through short courses, internships, and online sessions – as well as media engagement. 

Building local networks

During the flood emergency, however, RFI also swung into action, mobilizing its platform and student network to respond to the most immediate needs of the crisis – the distribution of relief packages of food and other essential goods.

The RFI provided relief support in Swat with TechMark Agro Volunteers and extended its support to local activists in fundraising and connecting national and international relief organizations with potential fundraising opportunities.

While many organizations were focused on distributing mosquito repellents to flood-affected people, RFI provided early and indigenous solutions and suggested local people also use inexpensive local herbal oil to save them from mosquito bites. 

And at the same time, says Khan, RFI used its platform to assist local activists on how to highlight their local needs and issues.

He said RFI has brought climate to a practical level by various means by promoting climate resilient agriculture, mentoring youth on importance of learning, conducting research about climate challenges, and also training journalists to play role in building mass awareness on climate issues and the like.

Flood Affected farmers of Swat, Khyber Pakthunkhwa describing their damages to standing crops to relief activists

Fostering student climate research  

Over the past five years, the organization has also helped students to frame and develop research on local climate-related issues that have been understudied until now. 

Lahore environmental sciences student Meharwar Uppal says that she got inspiration and guidance from the RFI website, which offers Urdu translations of the IPCC findings as well as analyses of the government’s National Climate Change Policy.

Uppal says that this helped her shape her final year research project on heat waves in Pakistan at Lahore College Women’s University.

Despite such efforts, there is still a long way to go before Pakistani educators and decision-makers become more engaged in the climate challenge, says Khan. 

Too many leaders and top officials in education and government prefer to stick to their day-to-day routine, rather than taking on more strategic challenges in an area that still seems futuristic to many.  

“I hope the current floods will change that trend,” said Khan.

In the wake of the 2022 floods, RFI is launching a series of seminars with university students, which it aims to lead to the drafting of a public letter to the planned UNFCCC Loss and Damage Finance Facility, demanding aid. 

Dr Iqra Ashfaq, RFI’s youth ambassador, said that she didn’t realize the importance of climate change until she joined the organization.  

“I learned what climate change actually is and the impacts it’s causing on our planet. I learned how climate change is a whole cycle of events initiated and accelerated due to our actions and behavior,” said Iqra, who recently qualified as a medical doctor.

She said engagement with climate resilient organizations is helping youth to learn the magnitude of effects caused by excessive carbon emissions into the atmosphere and what are the ways by which such effects could be managed and tackled through mitigation and adaption.

“After realizing the seriousness of climate threat, I am looking forward to conduct research correlating climate change and health care in order to find out solutions for common people,” said Ashfaq.

Image Credits: Resilient Future International.

vaccine trials
Three Ebola vaccine candidates will be tested in Uganda soon.

Clinical trials on three Ebola vaccine candidates for the Sudan strain of the virus are due to start soon in Uganda, according to the World Health Organization (WHO).

“I’m pleased to announce that a WHO committee of external experts has evaluated three candidate vaccines and agreed that all three should be included in the planned trial in Uganda. WHO and Uganda’s Minister of Health have considered and accepted the committee’s recommendation,” WHO Director-General Dr Tedros Adhanom Ghebreyesus told a media briefing on Wednesday.

Doses of the vaccine candidates are set to arrive in Uganda next week. 

Uganda has been reeling from an Ebola outbreak, with 163 confirmed and probable cases and 77 confirmed and probable deaths. 

Tedros expressed appreciation for the Ugandan government’s efforts in containing the outbreak: “The government’s efforts to respond to the outbreak have slowed transmission in most districts, and two districts have not reported any case for 42 days, indicating the virus is no longer present in those districts.”

Too late for trials?

However, with the outbreak in decline, it might mean that it will be hard to test the vaccines.

The clinical trials will be conducted by a group of organisations including the WHO, Uganda’s Makerere University, the Coalition for Epidemic Preparedness Innovation (CEPI) and Gavi, the global vaccine alliance.

In a joint statement earlier this month, the WHO said that while the vaccines were developed by the Lung Institute at Makerere University, WHO, CEPI and GAVI will ensure that sufficient doses are available for the clinical trials. 

“We can confirm that we have received written confirmation from the developers that a sufficient number of doses will be available for the clinical trial and beyond if necessary,” Dr Ana Maria Henao-Restrepo, the co-lead of R&D blueprint for epidemics at WHO. 

While Uganda’s outbreak appears to be largely contained and its caseload is declining, Henao-Restrepo said that it is difficult to predict the evolution of an outbreak. 

She pointed out that when the Ça Suffit (French for Ebola) trial on Ebola was conducted in Guinea, researchers were also unsure about whether enough evidence would be generated and if it was too late to conduct trials. 

“It’s better for us to work towards generating the evidence and put all our efforts on that rather than trying to second guess the evolution of the outbreak,” said Henao-Restrepo.

Dr Mike Ryan, the executive director of WHO’s health emergencies programme, said that there was no time for “if onlys”. 

“We’re making these investments, and if we don’t get to the required numbers, we’ve built the collaboration, we’ve built the platform to do this,” he stressed, adding that the Ça Suffit trial in Guinea had also helped to build the necessary infrastructure to prevent future outbreaks and increase protection. 

Apart from the three vaccine candidates, a separate group of experts have also chosen two therapeutics for clinical trials, which are under review. 

India’s Covaxin still suspended by WHO

Controversy over Covaxin is unresolved.

The WHO has still not resumed supplies of Covaxin, India’s indigenous vaccine against COVID-19, the global body confirmed. 

In March, the WHO inspected the manufacturing site of Bharat Biotech, which produces Covaxin and found serious irregularities in the Good Manufacturing Practices (GMP) at the site. 

This resulted in the global health agency suspending the supply of the vaccine through UN’s procurement agencies in April, stating the company had altered the GMP after it received the Emergency Use Licence (EUL) from WHO. 

India’s journalists have consistently questioned the discrepancies in the Covaxin clinical trial data since it was released in 2020. However, these questions have always been met with silence from the manufacturer and the Indian Council of Medical Research.

There were several irregularities in Covaxin’s clinical trials and that the country’s drug regulator did not clamp down on the discrepancies, according to a recent investigation by Stat News. 

The report also quoted company executives acknowledging their mistakes. “They also argued they faced “political” pressure to get a vaccine out of the laboratory door as quickly as possible, but denied taking any shortcuts. And they insisted the steps taken to speed the trial were vetted during discussions with regulators,” the report added. 

 Dr Mariangela Simao, WHO assistant director-general for drug access, vaccines and pharmaceuticals, said that the WHO is yet to receive a corrective and prevention action plan (CAPA) from Bharat Biotech. Once they received and reviewed the CAPA, further steps would be taken on the suspension. 

Image Credits: Photo by Diana Polekhina on Unsplash.

Modern hospitals consume a huge amount of energy.

The healthcare sector is responsible for over 5% of global carbon emissions, double the amount of the aviation sector. But there is a way for healthcare actors to reduce this while at the same maintaining the quality of care in developed countries and expanding access to healthcare in developing countries. 

This is according to panellists at a recent event on “Healthcare and climate change: Victim or perpetrator hosted by the  Graduate Institute’s Global Heath Center.   

Sonia Roschnik, executive director at the Geneva Sustainability Centre, said that how the planet is faring is inherent to people’s health. The centre, which opened this year, has put greening healthcare delivery for better health and a healthier climate at the core of its agenda.  

“We can’t have healthy people on a sick planet, but of course, we also can’t have a healthy planet with sick people,” Roschnik said, adding that reducing the environmental impacts of health care will contribute to reducing the burden of disease and social inequities.

Sonia Roschnik, executive director of the Geneva Sustainability Centre, Bruno Jochum, executive director of the Climate Action Accelerator and Suerie Moon, co-director of the Global Health Centre at the Geneva Graduate Institute.

Reducing emissions by smarter drug procurement

“There are some things that are healthcare specific that if the healthcare sector doesn’t do nobody else is going to do,” Roschnik added.

“For instance, one that is often quoted is anaesthetic gases. Some of those gases are 100 times more potent than carbon dioxide, and actually, there are other ways of delivering that care.” 

One of these is nitrous oxide, which has a climate warming effect 300 times that of CO2, but new technologies have recently been put developed to safely capture and reuse such anaesthetic gases, including a Newcastle, UK hospital  last year.  

Bruno Jochum, founder and executive director of The Climate Action Accelerator, said that mid-level health facilities can do a lot to help decarbonize. He described his group’s work as an initiative “getting organizations to really adopt by themselves science-based targets without waiting for policy change.”

“Often hospitals are the first employer of any territory,” he noted. “They see patients, they see families, they have suppliers, they talk to authorities. They really have the space to make things move.”

According to Jochum, lowering emissions, between now and 2030 is “absolutely feasible and achievable.” 

Healthcare is vulnerable to climate extremes 

Sharing the experience of the Philippines, one of the top 10 most climate vulnerable countries, was physician Renzo R Guinto, of St Luke’s Medical Center in Manila and the Sunway Centre for Planetary Health in Malaysia.

“We’ve witnessed firsthand the confluence between two crises, the climate crisis on one hand and the COVID-19 crisis on the other,” he said. “Imagine you are a poor Filipino, confronting the dilemma: do I stay in the house to protect myself from the unseen coronavirus only for the roof of the house to be blown away by the strong wind?”

Guinto also emphasized that climate change does not only affect physical health, but also mental health.

“In a recent survey, it was found out that the Filipino young people are the most climate anxious in the world,” he pointed out. “At least 90% of the young Filipinos surveyed are moderately to extremely worried about their climate and stable future.”

But the Philippines is already leading the way in the fight to make health facilities more climate resilient, he added. The country´s Ministry of Health put in place a framework to adapt the health system to climate change beginning two decades ago. 

Echoing the climate change and health message at COP27

Maria Neira, the director of the World Health Organization’s Department of Environment, Climate Change and Health joined the panel from the COP27 Climate conference in Sharm El Sheikh, Egypt, where WHO has hosted a series of events on health and climate themes every day at a WHO pavilion – including sessions on greening health facilities.

Dr Maria Neira speaking at the event.

“We hope that we will be not only able to convince everyone that climate change is already affecting our health in a very negative way, but also to present the policy arguments and the reasons why we need to do much more to tackle the causes of climate change and air pollution, because the health benefits will be enormous,” said Neira.

The panellists agreed that decarbonizing should not come at the expense of ensuring access to healthcare in developing countries, where often facilities lack access to electricity, let alone green energy.

Solar panels provide electricity to Mulalika health clinic in Zambia.

However, they pointed out that there are opportunities to build systems in low-resourced settings and solar energy.

While there are health systems around the world that need to decarbonize “others are wanting of support and resources in order to enhance resilience and to adapt to the impacts of climate change that are already being experienced now,” said Guinto. 

“In fact, these health systems, which have nothing to do with the climate crisis, in terms of emissions are also doing their share by adopting solar or embracing sustainable healthcare waste management practices,” he added.

For this reason, the physician emphasized, it is not possible to adopt a “one size fits all approach.” 

“Instead, we need to be coming up with solutions that are tailored to the different contexts and to the different situations,” he concluded.

The event was co-organized by the Institute of Global Health of the University of Geneva and the Geneva Health Forum. The panel was introduced by Jelena Milenkovic, Director of Operations at the Geneva Health Forum and moderated by Suerie Moon, Co-Director of the Global Health Centre.

Image Credits: Richard Catabay/ Unsplash, Twitter: @GVAGrad_GHC, Twitter: @GVAGrad_GHC, UNDP/Karin Schermbrucker for Slingshot .

preterm baby
Preterm baby in incubator

The World Health Organization (WHO) has strongly recommended that babies born before 37 weeks of gestation (preterm) or with low birth weight should be provided immediate skin to skin contact with a caregiver, which in turn increases their chances of survival. 

This recommendation by the global health agency is a significant change from the previous guideline which stated that preterm babies and babies born with low birth weight should be first stabilised in an incubator before any other interventions. 

The WHO released the new guidelines for care of preterm or low birth weight infants days before World Prematurity Day, 17 November, which is promoting skin to skin contact as the theme of this year.  

The change in the existing guidelines comes in light of strong evidence of survival in babies born before a gestational period of 37 weeks or with a birth weight of under 2.5kgs. The new guidelines consist of 25 recommendations, of which 11 are described by WHO as “strong” recommendations based on robust evidence, and 14 are conditional recommendations, based on emerging evidence. 

“The first embrace with a parent is not only emotionally important, but also absolutely critical for improving chances of survival and health outcomes for small and premature babies,” Dr Karen Edmond, Medical Officer for Newborn Health at WHO said, in a press release. She added that separating babies from their mothers at childbirth is catastrophic to the health of these babies, as seen during Covid-19. “These new guidelines stress the need to provide care for families and preterm babies together as a unit, and ensure parents get the best possible support through what is often a uniquely stressful and anxious time.”

The latest guidelines also include a good practice statement on the need for parental leaves and entitlements for parents and other primary caregivers of preterm or low birth weight babies. 

Immediate Kangaroo-mother-care 

Every year, 15 million babies across the world are born before reaching a gestational age of 37 weeks. This is over 10% of the total births annually. Prematurity is the leading cause of deaths in children under the age of five. 

Skin to skin contact, also known as Kangaroo-mother care (KMC), between the infant and the caregiver immediately after birth has shown to reduce infections, hypothermia and improve feeding. 

In making its recommendations, WHO analysed 27 randomised controlled trials conducted from 1994 to 2021, which involved 11,956 infants, that studied the differences in outcomes between later KMC of preterm and low birth weight infants and infants provided with KMC immediately. These studies were conducted in high-income, upper-middle income, lower-middle income and lower income countries. 

A study published in the New England Journal of Medicine (NEJM) in 2021, which laid the foundation for the new WHO recommendations, found  that based on the available data, initiating skin to skin contact immediately after birth has the potential to save up to 150,000 babies from dying each year. 

KMC was already known to reduce mortality by 40% when started after the infants are clinically stabilised. Starting the process immediately after birth improves the chances of survival by an additional 25%, as per the NEJM study. 

A clinical trial, which was part of the study, was conducted across five countries – India, Malawi, Nigeria, Tanzania and Ghana. 

Role of community support crucial

In the new guidelines, the WHO has also emphasised the importance that one’s family, community and local resources can have in improving the survival of preterm or low birth weight babies. 

Apart from education and counselling programmes, the agency pointed out that adequate and appropriate leave for parents and primary caregivers of such babies can go a long way in improving their outcomes. 

“Home visits by trained health workers are recommended to support families to care for their preterm or low-birth-weight infant,” the recommendations continued. 

Sperm count
A new study has mapped a massive decline in sperm count – environment primary suspect.

A worldwide decline in sperm counts of more than 50% over the past 46 years has been identified by a team of international researchers, and the decline has accelerated since the year 2000, according to an article in the journal Human Reproduction Update published on Tuesday.

The article updates a previous study published in 2017, providing strong evidence for the first time of a decline in sperm count and total sperm concentration in men from South and Central America, Asia and Africa.  A previous study showed a similar decline in North America, Europe and Australia. 

Threat to human survival?

“We have a serious problem on our hands that, if not mitigated, could threaten mankind’s survival,” said Professor Hagai Levine of the Hebrew University- Hadassah Braun School of Public Health, who led the study in collaboration with a team of scientists from Denmark, Brazil, Spain and the United States.

Levine described the findings as a “canary in the coal mine – a red flag. There is a loss of biological diversity around the world. We know that reproduction is very sensitive to the environment and it is essential for future existence.”

A mom and her newborn baby in Dhaka, Bangladesh.  Exposures to environmental toxins in the womb could be one of the reasons for reduced sperm count, researchers say.

Data from 53 countries was included in the meta-analysis, including Australia, Bangladesh, Belgium, Brazil, Canada, Chile, China, Cuba, Czech Republic, Denmark, Egypt, Estonia, Finland, France, Germany, Greece, Greenland, India, Indonesia, Iran, Iraq, Ireland, Israel, Italy, Japan, Jordan, Kenya, Latvia, Libya, Lithuania, Malaysia, Mexico, Netherlands, New Zealand, Nigeria, Norway, Pakistan, Peru, Poland, Russia, Singapore, Slovenia, South Africa, Spain, Sweden, Taiwan, Tanzania, United Republic of Thailand, Tunisia, Turkey, Ukraine, United Kingdom and the United States.

The previous study focused only on countries in North America, Europe and Australia and was based on samples collected between 1973 and 2011. The latest study includes seven additional years of sample collection. 

Levine told Health Policy Watch that the data shows a decline of around 2.5% each year in mean sperm concentration since the year 2000, which is “a clear signal that something is wrong with men’s sperm count around the world, something that cannot be explained by genetics.”

Sperm count
Dr Hagai Levine

Sperm count is the total number of sperm a man produces. Sperm concentration is the number of sperm per millilitre of semen. 

These are not the only predictors of fertility. Another predictor is total motile sperm, which looks at what percentage of sperm are able to swim and move. Infertility is generally defined as a couple’s inability to get pregnant for one year despite regular intercourse. 

Sperm concentration and count are not only good markers of men’s ability to participate in conception, but have also been linked to men’s general health, including premature mortality and morbidity risks.

In other words, men with lower sperm counts have higher chances of becoming sick or dying at a younger age, Levine said.

He noted that the worldwide decline in sperm concentration and count is consistent with other adverse trends in men’s health, including increasing rates of testicular cancer and genital birth defects.

Primary suspect: mother’s exposure to environmental toxins in pregnancy

Heavy metals, toxic gasses, urban air pollution and unhealthy lifestyles may all lower sperm count; portrayed here, air pollution in Cairo, Egypt

While the study does not aim to prove the cause of the decline in sperm count and concentration, Levine said animal research points to a connection between environmental toxins and hormonal disruptions or imbalances, which in turn impede reproductive capacity. 

Growing evidence that plasticisers, pesticides, herbicides, heavy metals, toxic gasses, air pollution and poor lifestyle choices such as sedentary behaviour, poor diet and smoking all are tied to abnormal sperm count. 

“The primary suspect is a mother’s exposure to man-made chemicals during pregnancy,” Levine told Health Policy Watch. “We also know exposure in adult life and lifestyle choices such as smoking and poor nutritional habits can be associated with poor sperm count.”

He stressed, however, that the research is neither definitive nor does it establish which chemicals specifically may be causing the decline.

Dr Ryan Smith, associate professor of urology at the University of Virginia, confirmed Levine’s assessment. After reviewing the paper, he said that “the impact of reproductive toxins on male infertility deserves further investigation and there is cause for concern”. 

Environmental toxins a threat to reproductive health

Microplastics collected from the Rhode River, Maryland, whose tributeries feed into the Chesapeake Bay.

“Environmental toxin exposure represents a clear threat to our global reproductive and general health. Increased public awareness and advocacy that leads to more careful monitoring and regulation will be critical to protect our future global health and our environment,” Smith said. 

He added that while the authors acknowledge that sperm count is an imperfect assessment of fertility and point out that a higher sperm count does not necessarily imply a higher probability of conception, “the authors should be commended for this work and their prior investigations into the decline in male reproductive health.”

The 2017 study that focused primarily on developed countries was well received. However, there were some researchers who pushed back at the report, including a team from Harvard’s GenderSci Lab led by Sarah S. Richardson, which called the previous assessment “overblown” and noted that separate research contradicted the assumption that there was a causal link between declining sperm counts and declining fertility and between exposure to certain chemicals and lower sperm counts. 

Health Policy Watch reached out to Richardson and asked her to evaluate the updated study, but Richardson could not respond by press time.

Levine said that in his own country and in the US there are a growing number of theoretically healthy couples who struggle to conceive and require assistance. “This is not something that is supposed to be,” he said. “Our species is supposed to be able to reproduce.”

New study includes meta-analysis of over 10,000 publications

To develop the analysis, Levine and team systematically reviewed all the relevant studies published until 2019 that they could find according to a strict protocol. Then, using sophisticated modelling they adjusted the data from different places and studies to get one estimate about the global trend in sperm count and concentration.

“This requires enough data, and so we screened over 10,000 publications that gave data on sperm count,” Levine explained. “We read the papers, and with a large team of researchers and according to a strict protocol, identified which studies met our criteria and then, from those studies, extracted the relevant data.”

While he said that relying on modelling was not foolproof nor a substitute for additional research of specific populations at specific points in time, Levine noted that modelling is a good way to evaluate long-term trends. 

“We are seeing the forest from the trees,” he said. “We aim to look at the overall picture.”

Urgent call for action to promote healthier environments

Healthier lifestyles and environments reduce exposure to environmental toxins.

“As clinicians, we can educate our patients and advocate for continued research and public health support,” Smith said. 

He said the topic should be given attention not only by clinicians and scientists but also from decision-makers and the general public.

“Men need to be aware that their health and lifestyle choices can impact their reproductive health and that lifestyle changes, such as increased exercise and a healthy diet can have positive impacts,” Smith concluded. 

Added Levine “We urgently call for global action to promote healthier environments for all species and reduce exposures and behaviors that threaten our reproductive health.”

Image Credits: Photo by Nadezhda Moryak, UN Photo/Kibae Park/Flickr, Avi Hayon Hadassa, Kim Eun Yeul / World Bank, Will Parson/Chesapeake Bay Program, WHO.

Digital Health
Young people rely more on social media to get information on health.

New report highlights the impact of social media on the health of young people in middle- and low-income countries. 

The digital transformation of health offers both significant empowerment potential and significant risks for young people, according to a new study published Tuesday by the Global Health Centre of the Graduate Institute of International and Development Studies.

The report, “Digital health and human rights of young adults in Ghana, Kenya and Vietnam,” highlights young people’s increasing dependence on social networks such as Facebook, Instagram, YouTube and TikTok to access health information, and demonstrates the challenges and opportunities that arise in the realm of human right as a result. 

“We hear all this excitement around digital health and we don’t know how much is hype and how much is true,” explained Prof Sara “Meg” Davis, a senior researcher for the Digital Health and Rights Project, who led the study. “There are also concerns for people who are marginalized or vulnerable” on the digital platforms.

Davis told Health Policy Watch that the digital ethnography her team conducted was “revealing” because it confirmed just how much young people were using social media to get their health answers. It also raised concerns that the World Health Organization’s definition of digital health does not even mention social networks.

Digital health generally centers on telemedicine and the use of technology to receive care, or on tailored digital health applications, Davis said. But it leaves out mainstream social media as a source of care. Her study showed that Google searches and social networks are the primary source of health information for many young people. 

Davis and her international team have been working on the report for two years. It will be formally released during a public webinar on November 22 titled “Digital justice: How social media is transforming young people’s health and rights.” The webinar will take place from 14:00-15:30 CEST. Registration is available online.

Transnational participatory action research

The report is based on qualitative research with 174 young people and 33 experts in Ghana, Kenya and Vietnam. It specifically centers on their use of mobile phones to access information on HIV, sexual and reproductive health and COVID-19. Carried out using a transnational participatory action research (PAR) approach, teams in all three countries explored the tensions between the benefits and risks to young people’s rights to health and human rights, identified themes and patterns in the data, and helped identify areas for policy action. 

The research team included academic social scientists, staff at national community-led networks, human rights groups and civil society organizations. 

“The study represents the first transnational participatory action research project in global digital health,” Davis said. “Participatory action research empowers the community to have a voice in the design, data-gathering and analysis of the findings for action. Our study is a unique collaboration between global and national networks of social scientists and affected communities. We are excited to share both the findings and the approach, which we believe is key to creating new forms of evidence and public participation in the digital age.” 

The November 22 event will include a panel discussion, including some of the staff who took part in the study. Participants will be Stephen Agbenyo, Executive Director, Savana Signatures; Terry Gachie, Country Coordinator, Love Matters Kenya; Professor Catalina Gonzalez-Uribe, Universidad de los Andes; Tabitha Ha, Advocacy Manager, STOPAIDS; and Tigest Tamrat, Technical Officer, Sexual and Reproductive Health and Rights, WHO.

Health champions

The study documents a growing group of social media influencers and other health champions who offer health information and advice from medically sound sources in a language and level of acceptability that is comfortable for today’s young people. There are also chat rooms and social media groups that have successfully managed to recruit young people to join them and that have become safe online spaces for discussion on sensitive topics. 

Young people emphasized the importance of these “online families” for access to medicines, financial aid and psychosocial support, especially during COVID-19 lockdowns.

“[Our social media group] is more or less like a family, because we can help someone if that person is in need,” an HIV peer outreach counsellor in Ghana said. “If that person is sick and needs some help – maybe that person is in an abused case – we can step in. …The great benefit that we are getting out of it is the education that we are putting out there, and the services they are receiving.” 

Davis said that young people expressed enthusiasm for accessing health information through online channels because they believed their anonymity was protected online and they could therefore avoid some of the stigmas they might otherwise experience in clinics. 

At the same time, young people in all three countries shared serious harms linked to their use of digital health services, including verbal abuse and threats. This was especially true of young women, LGBTQ+ people and sex workers. 

“One of my friends posted on Facebook that she feels cold, has a headache, wondering what could be the problem? Just asking in the Kisumu Moms group. She was told: ‘You are pregnant, you have sugar daddies,’ and so on. People started throwing words at her until she withdrew that post,” explained a 25-year-old woman from Kenya.

Another thing the researchers found was a group of “really innovative people on social media” with significant followings in the tens of thousands or even millions in all three countries, who are serving as champions of sexual and reproductive health, David said.

“Young people have used their online access to information and social media networks to form extraordinarily powerful communities, investing little more than their own airtime and energy, and have literally saved lives by sharing medicines and information during COVID-19 lockdowns,” it says in the study. “As one young social media health champion suggested in Nairobi, they could do so much more by working together in partnership with health agencies.”

The work of some of these groups and individual influencers will be showcased during the webinar on the 22nd. Among them will be two of the organizations that participated, Love Matters Kenya with its 1.5 million Facebook followers, and Savana Signatures, which is running a hotline in 10 languages on reproductive health in Ghana. 

Misinformation 

Gachie of Love Matters Kenya said that her group has found censorship to be among the biggest challenges. Facebook, she said, often inadvertently censors content on the topic of sex, even when it is educational. The group has had many posts pulled down, marked as “escort services,” for example.

In addition, she said the government has sometimes intervened in the sharing of content, as have more conservative group members, who will report some posts. 

Another challenge is misinformation, said Pham Huyen Trang, program manager of the Vietnam Network of People living with HIV and a researcher on the study.

“There is information online that is not true, and sometimes young people access it before they realise and then they are scared,” Trang said. She noted that sometimes even untested medicines and other treatments can be offered that put people at risk. 

“Not everyone comes to learn,” said Gachie. “Some people come to sell products that are not even approved on the market. There is always a balance between being open and keeping people out who can do harm.”

Gachie added that minimal staffing is also a challenge because of the lack of understanding about how important it is to have experts working with these online groups. 

Finally, the youth need to have a better grasp of their online rights and the ability to protect their data.

“Our review also found that the use of social media, social chat and web searches for health information and peer support is generally not addressed in global health strategies and policies,” the report said. “While all three countries have data protection laws and policies, key informants in each country described implementation and enforcement as weak.

“Young people in the study generally had little knowledge of these laws or their rights,” the study continued. “Many expressed enthusiasm, nonetheless, to learn more about digital technologies and governance, and to play an active role in the digital transformation. They called for more resources and training and a voice in policy.”

The findings also demonstrated the need for governments and WHO to work together to roll out more robust regulations of social media and web platforms in the area of health. 

Trang said the interviews highlighted the need for training and noted that those interviewed said they wanted to learn to be able to take a more active role in their health. 

“Future digital health strategies should engage young people in creative thinking about ways to bridge the intersectional digital divides, empower young people with knowledge and information, and consult them in the design and governance of digital technologies,” according to the study.

A second phase of the study has been launched in Bangladesh and Colombia.

Image Credits: Photo by S O C I A L . C U T on Unsplash.