WHO Regional director put on indefinite leave
Dr Takeshi Kasai, WHO Regional Director for the Western Pacific, at a press conference.

The World Health Organization says it has put its regional director for the Western Pacific Region “on leave” while it carries out an investigation into him.

“The investigation is still ongoing,” the UN health agency said in a statement provided to Health Policy Watch. “WHO is not in a position to comment on matters pertaining to ongoing investigations.” 

Dr Takeshi Kasai, WHO’s director for a region that is home to almost 1.9 billion people across 37 countries and areas, “is on leave,” according to WHO.

During his absence, WHO says, WHO’s Deputy Director-General Dr Zsuzsanna Jakab will assume responsibility for the region and “ensure business continuity.”

WHO did not specify the reasons for Kasai’s indefinite removal, which was first reported by The Associated Press based on internal correspondence it obtained.

However, it comes months after an AP investigation that revealed dozens of staffers accused him of racist, abusive and unethical behavior.

The staffers said his behavior undermined WHO’s efforts to stop the coronavirus pandemic in Asia.

WHO
The WHO logo on its headquarters in Geneva, Switzerland.

WHO investigation into ‘toxic atmosphere’

The AP cited two senior WHO officials who asked not to be identified because they were not authorized to speak to the press. They said Kasai was put on extended administrative leave after internal investigators substantiated some of the misconduct complaints.

The AP previously reported that more than 30 unidentified staffers sent a confidential complaint to WHO’s senior leadership and members of its Executive Board alleging Kasai created a “toxic atmosphere” in WHO’s offices across the Western Pacific. Kasai, a Japanese doctor, has denied using racist language or acting unprofessionally.

He began his term as regional director on 1 February 2019, after more than 15 years of serving in various managerial and technical positions for WHO. He also was WHO’s representative to Vietnam from 2012 to 2014.

WHO advisory panel finds need to reform

In January, an advisory panel said WHO needs to reform lines of authority and responsibility across all aspects of its emergencies response operations in order to effectively prevent, report, and take measures against sexual exploitation and harrassment.

Those were the highlights of a final report by an Independent Oversight Advisory Committee (IOAC) of the WHO Health Emergencies Programme, examining the claims of sexual exploitation and harrassment that first emerged in connection with WHO’s 2018-2020 Ebola response in the Democratic Republic of Congo.

The report, presented in a session of the WHO Executive Board, marked another milestone in the follow-up to reports of sexual exploitation and abuse claims by some 75 Congolese women against 25 WHO workers deployed to the Democratic Republic of Congo’s 2018-2020 Ebola response.

WHO
A series of media reports have come to light in January about extensive sexual abuse scandals in DR Congo

Following the reports, WHO initiated an independent investigation, as well as initial internal reforms to improve staff training in the prevention of sexual exploitation and harrassment (PRSEH); deployment of more training staff; and new recruitment standards that also consider any exploitation and abuse issues in a candidate’s background, the IOAC report states.

But there remains “ deep, lingering frustration expressed by member and staff about the lack of transparency, delays in responding to incidents and holding perpetrators accountable, and the defensiveness with which the Organization has dealt with SEAH in the past,” states the report, presented to the EB.

And more comprehensive cultural and structural changes need to occur across WHO to reduce the risks of abuse from ever occurring in the first place, said Felicity Harvey, co-chair of the IOAC committee, in her presentation of the report to the WHO Executive Board.

Image Credits: WHO, Flickr – Guilhem Vellut, WHO.

Urban garden in Tapada da Ajuda, Lisbon

From playful elements in street architecture in Cork, Ireland, to teaching children how to grow vegetables in Lisbon, Portugal, cities across Europe are using urban design and health interventions to promote the well-being of their populations.

Europe has a unique opportunity to make city life healthier since it has relatively few mega cities; more than 70% of Europeans live in cities with less than half a million inhabitants. 

These are some of the World Health Organization’s findings in a new report, “Urban design for health: inspiration for the use of urban design to promote physical activity and healthy diets in the WHO European Region,” published Wednesday and launched at the 11th Conference of HEPA Europe on health-enhancing physical activity in Nice, France. 

Launch of the WHO Europe report “Urban design for health: inspiration for the use of urban design to promote physical activity and healthy diets in the WHO European Region” at the HEPA Europe conference on 31 August.

The report, prepared by the WHO European Office for the Prevention and Control of Noncommunicable Diseases, looks at ways to promote physical activity and healthy diets in urban settings.

Rather than simply telling people about the ‘right’ food choices and benefits of physical activity, cities can use better strategies to help people choose more wisely, the report suggests. Research has shown that design also plays a role in the health of communities around the world.

“If we want to make cities a better environment that helps people to live healthier lives, first we need to understand the people’s needs,” said Dr Kremlin Wickramasinghe, head of the WHO European Office for the Prevention and Control of Noncommunicable Diseases.

“This will give us insights to integrate healthier habits into everyday lives effectively.”

Urban environment influences health 

The report says urban design and planning influence public health and human behaviour “by limiting or providing access to healthy foods and active lifestyles, which have profound effects on people’s physical and mental health.”

For instance, in the WHO European Region, environmental risk factors are estimated to cause at least 1.4 million deaths per year, approximately half of which are linked to air pollution, a major contributor to the rise in noncommunicable diseases (NCDs). One in four cases of ischaemic heart disease and strokes, and one in five cancers are estimated to result from environmental exposure.

These risk factors can be the result of inequalities in environment and health from different aspects of home and work life, including housing conditions and access to basic services and transport. 

Traffic tends to be greater in cities’ less affluent neighbourhoods, posing a greater risk of road-related injuries and exposure to air and noise pollution, which has implications for poor health and a higher incidence of NCDs.

That is why it is crucial, the report emphasizes, to find the best approaches to address these risk factors in urban settings: “Cities are places where it all comes together.”

Building connections with communities to facilitate healthy urban planning 

Wickramasinghe emphasizes that gathering data and building connections with local communities is “essential for healthier urban planning.”

WHO’s report presents several tools to facilitate this:

  • collecting data on how people move around in a city
  • identifying local food infrastructures that can improve food security
  • estimating the economic benefits of healthier policies
  • engaging various types of stakeholders, including citizens
  • analyzing data for healthier urban planning

One such tool, called the healthy streets approach, uses an index for large-scale, long-term strategic planning to make improvements across ten indicators. 

Healthy streets are important part of urban design
These 10 healthy streets indicators can be used to engage with citizens and other stakeholders in urban planning.

The index has indicators for things such as how much clean air there is, whether the streets are easy to cross, and the degree to which everyone feels welcome.

The intent, the report says, is to make it easier for citizens to promote a healthy, safe neighborhood through “simple language that everyone can understand and relate to.”

Real-life examples from cities

Many cities are trying to improve urban transport and mobility, as well as access to urban nature and green spaces. The new report highlights some of the positive examples.

Cork, Ireland

As Cork is dominated by cars but lacking in green spaces, air quality was found to be a problem, in addition to limited outdoor spaces for physical activity. 

urban design as per WHO
First Parklet, Douglas Street, Cork City

This city decided to introduce more playful elements into its street architecture by developing ten new “parklets” with entertainment equipment and seating. It also included a “playful culture trail” in July 2021 to encourage active, playful movement between and within the locations. 

Tbilisi, Georgia

Adam Mitskevichi Street, Tbilisi has been transformed into a pedestrian oriented street to improve physical activity.

Tblisi has a transport system that is not pedestrian-friendly and lacks buses and cycling infrastructure. Its car-dependent nature results in traffic congestion and air pollution. 

Additionally, pedestrian areas are considered possible only in tourist areas and are, therefore, not found in resident neighborhoods

To solve this problem, the city is transforming its streets to make them pedestrian-oriented. The new street design is meant to address the main challenges of Tbilisi: air quality, physical inactivity, and mental health.

Adam Mitskevichi Street, a pilot area, was closed down for a few days, to familiarize citizens with a different perception of how the street could be used. From the first hours of the street’s dedication to the public, children arrived with music and started dancing, and some people enjoyed cycling and skateboarding.

Lisbon, Portugal

Tapada da Ajuda, a green space in Lisbon, is located on hilly terrain, and its steep topography makes it difficult to ensure easy access for children. Additionally, the surrounding streets are not safe for children because cars are parked on some sidewalks.

In order to build more connections between local citizens, especially children, in the area, the city promotes healthy eating by putting local produce at the heart of its public space project, while teaching children how to grow vegetables and the importance of a healthy diet.

The tools and examples in the report highlight the types of actions that policy makers and urban planners can use for inspiration to rethink and improve their cities.

Cities in other parts of the world have also come up with other ways to promote health through urban planning and policy, including Buenos Aires, Argentina and Baku, Azerbijian, showing how urban design is crucial to long-term social and health benefits. 

“Urban design is a key determinant of physical activity and healthy diets,” the report concludes, “contributing to the prevention and control of NCDs and improving global health.”

Image Credits: WHO , WHO.

A pharmacist holds two sets of pills in her hand, showing the difference between the amount of tables a patient takes on the new antibiotic regimen (L) versus the old treatment at the Sizwe Tropical Diseases Hospital in Johannesburg, South Africa, on August 05, 2019. Credits: Michele Spatari / AFP

Researchers have significantly strengthened the safety profile of a watershed treatment course for highly drug-resistant strains of tuberculosis — a heartening breakthrough set to change the lives of millions of MDR-TB patients around the world.

The results of a randomized-controlled trial published in the New England Journal of Medicine today showed the new oral TB antibiotic regimen BPaL had half as many side effects but maintained an efficacy rate of 91% after an adjustment to the course of one of the three component antibiotics in the regimen.

The breakthrough findings have already been hailed by experts as one of the most important developments in tuberculosis research this century.

Oral treatment can now safely replace injections

In numbers: the process facing patients under old generation MDR-TB treatments Credit: TB Alliance

The findings mean the new oral regimen may safely replace the 18 to 24 months of intensive treatment via injections that was the standard of care until now — with a global success rate of just 52%.

This grueling process includes daily injections for at least 6 months, multiple daily IV infusions for up to 24 months, and 14,000 pills for a case of drug-resistant tuberculosis.

The new regimen was developed over two years by the TB Alliance, a not-for-profit product development partnership based in South Africa and the United States.

Dose of Linezolid halved in new trial to reduce side effects

KYIV, UKRAINE – DECEMBER 13: Stivlana Pasichnyk tests blood samples at NIPP on December 13, 2021 in Kyiv, Ukraine. (Photo by Brendan Hoffman/Getty Images for TB Alliance)

The trial follows upon the March 2020 Nix-TB trial findings that demonstrated for the first time the efficacy of the all-oral antibiotic regimen. The trial achieved positive outcomes in 90% of its 109 patients over a period of just six to nine months.

That regimen also led to significant side effects, however, including peripheral neuropathy — nerve damage outside the brain and spinal cord — in 81% of patients.

Some 48% of patients also developed myelosuppression, a condition in which bone marrow activity is decreased, resulting in the production of fewer red and white blood cells, and platelets.  

Both conditions were linked to Linezolid, the antibiotic denoted by the “L” in BPaL, which has well-known side effects.

Today’s study results show halving the Linezolid dosage from 1200mg to 600mg achieves a reduction in incidence of peripheral neuropathy and myelosuppression by 56% and 46%, respectively, At the same time, efficacy remained stable at 91%.

WHO recommended new regimen based on early reports of data 

tuberculosis patient
PRETORIA, SOUTH AFRICA – JUNE 18: Panganai Kapfunde (42), a participant in the ZeNix trial, with his children at his home in Pretoria, South Africa, on June 18, 2021.
Photo by: Jonathan Torgovnik/Getty Images for TB Alliance

Privy to early reports from this trial and others, the World Health Organization in May 2022 recommended that the new 6-9-month oral BPaL regime replace the old intravenous one in the treatment of most drug-resistant tuberculosis.  

In addition to early results of the ZeNix trial published today, WHO based its recommendation on early reports from two other randomized control studies, which are still ongoing, about the safety and efficacy of BPaL: TB-PRACTECAL and NExT.

“We now have more and much better treatment options for people with drug-resistant TB thanks to research generating new evidence,” Dr Tereza Kasaeva, director of WHO’s Global TB Programme, said of the new guidance.

“This is major progress compared to what was available even a few years ago,” she said, “and will be of great benefit for people struggling with TB and drug-resistant TB, resulting in better outcomes, saving lives and reducing suffering.”

Accessibility Is key to the patent holder

tuberculosis treatment
A caretaker stands stands at the entrance of Ward 16, where the drug-resistant tuberculosis patients are housed and treated, at the Sizwe Tropical Diseases Hospital in Johannesburg, South Africa, on August 05, 2019. Credits: Jonathan Torgovnik / Getty Images for TB Alliance

Dr. Mel Spigelman, CEO of TB Alliance, said his organization is dedicated to discovering, developing, and delivering new therapies.

“And our mission is not complete until improved TB medicines reach every patient who needs them,” he told Health Policy Watch. “With enhanced commitment and global collaboration, we can advance the science and one day see a world where no one dies of TB.”

As one of the foremost experts on tuberculosis and TB drug development, Spigelman also sits on the Coordinating Board of the WHO Stop TB Partnership, which worked with TB Alliance in 2019 to make BPaL based regimens available to 150 low- and middle-income countries for just $364, or $2 a day.

For countries facing high drug-resistant tuberculosis burdens, this price point is a literal lifesaver.

In numbers: the burden placed by tuberculosis on the world. Credits: TB Alliance.

Old generation treatment options for drug-resistant tuberculosis range from US$2,000–$8,000 for a full course through traditional distribution channels, and have long placed a heavy weight on the finances of health care systems on the front lines.

Through traditional market channels, BPaL-based regimens are available at US$700–$800, up to 10 times cheaper than the old generation alternatives.

The TB Alliance “will continue to innovate and fight for access until the days of lengthy and highly toxic therapies are over for every person with TB,” Spigelman said in a press release accompanying the release of the ZeNix trial’s results, 

Good news at a bad time

KYIV, UKRAINE – DECEMBER 13: Dr. Rastyslav Lyubevich at NIPP on December 13, 2021 in Kyiv, Ukraine. (Photo by Brendan Hoffman/Getty Images for TB Alliance)

The advance in treatments comes at a time when global efforts to fight tuberculosis are still reeling from the devastating impacts of COVID-19.

Two years ago marked the first year on year increase in tuberculosis deaths since 2005, with fatal cases jumping by 100,000 to an estimated 1.5 million in 2020. In the same year, 1.4 million fewer people received care — a 21% reduction globally, and as much as 28% in the top 10 most affected countries.

WHO models project that COVID related disruptions to tuberculosis care and detection could have caused an additional half a million deaths in 2021.

The precise numbers remain unknown.

Impact of the COVID-19 pandemic on TB detection and mortality in 2020. Credits: WHO

Tragically, this may not even paint the full picture.

WHO modeling for mortality in 2021 doesn’t account for exacerbations in social determinants such as extreme poverty and malnutrition that fuel the spread of tuberculosis.

The COVID-19 pandemic pushed 100 million people into poverty in 2019, and nearly 20% of global TB incidence is attributable to undernutrition.

In countries with high tuberculosis burdens, as in India, that number can be far higher, reaching more than 50% in many Indian states.

With the UN estimating that developing economies will have pandemic-related losses of $US12 trillion through 2025, undernutrition-driven tuberculosis could see a steep rise. 

An unimportant emergency

tuberculosis
Doctor Pauline Howell visits a patient known as Nxumalo currently on the NIX treatment at the Sizwe Tropical Diseases Hospital in Johannesburg, South Africa, on August 05, 2019. Credits: Michele Spatari / AFP.

The world’s response to COVID-19 has also drummed up a lot of discussion in the world of TB advocacy and treatment. 

The sheer scale of financing and pace of scientific progress observed during the COVID-19 pandemic had two opposing effects: redefining the limits and hopes for what is possible to eradicate tuberculosis, and — by contrast — laying bare the persistent levels of neglect towards tuberculosis as a serious crisis since it was declared a public health emergency in 1993.

“The global response to TB has clearly failed to reflect the ‘public health emergency,’ which it is,” Spigelman said.

“It is now second only to COVID-19 as the greatest infectious disease killer in the world,” he said, “and unfortunately looks poised to regain the dubious distinction of again becoming the greatest single infectious disease killer.”

Even modest funding for tuberculosis fight could be game changing

tuberculosis patient
SOWETO, SOUTH AFRICA – JUNE 17: Mapalwsa Thafeng (37), a participant in the ZeNix trial, and her children in their hometown of Diepkloof, Soweto, South Africa, on June 17, 2021.
Photo by: Jonathan Torgovnik/Getty Images for TB Alliance

In the first 11 months of the COVID-19 outbreak, US$104 billion was spent on research and development, resulting in more than a dozen vaccines receiving authorization within a year of the public health emergency declaration.

By contrast, US$5.5 billion has been spent on tuberculosis research and development over the last decade, and the century-old Calmette-Guérin vaccine — first approved for use in 1921  — is still used for tuberculosis.

Investments in new TB vaccines amount to US$100 million per year, and overall research and development investment reached US$900 million in 2020. That is far less than the US$2 billion funding goal — more than double current levels — set at the 2018 UN High-Level Meeting on TB Political Declaration.

A significant majority of countries that pledged to the agreement continue to fall short of their fair-share funding targets. 

Despite promises, most countries in the world continue to miss TB funding targets. Credits: StopTB.

“Given the modesty of the TB funding targets, the ongoing failure of global funders to meet even these low targets reflects the deep inequity in the global response to health challenges faced by poor communities versus wealthy ones,” says a joint report on tuberculosis research funding trends by Treatment Action Group and Stop TB Partnership, whose board includes Spigelman. 

“The result of this inequity manifests in the tools available to treat diseases,” it says, “where health systems and health care providers have an array of effective options for the management of some diseases, but must make do [for decades] with substandard or non-existent tools for others.”

tuberculosis patient
KYIV, UKRAINE – DECEMBER 13: Portraits of Maria Slavych, a TB survivor who underwent the BPaL regimen, at NIPP on December 13, 2021 in Kyiv, Ukraine. (Photo by Brendan Hoffman/Getty Images for TB Alliance)

The Global Fund, an organization responsible for providing 77% of all international tuberculosis funding, says the world is at a critical juncture and must increase investment in fighting TB — or accept it is abandoning UN goal to end the disease as a public health threat by 2030.

Spigelman said the world could dramatically improve the diagnosis, treatment and prevention of TB with far less funding than it has dedicated to COVID-19.

“In short, with adequate funding, TB could potentially be eradicated.”

Image Credits: Jonathan Torgovnik/Getty Images for TB Alliance.

Men queing for the monkeypox vaccine in Chicago in the US.

Although it is not yet entirely clear whether monkeypox is sexually transmitted, the World Health Organization (WHO) has advised those at risk to use condoms during sex as monkeypox DNA has now been detected in semen.

“There have definitely been reports of the detection of the monkeypox virus DNA in semen,” Dr Rosamund Lewis, the WHO’s lead on monkeypox, told a media briefing on Wednesday.

“Monkeypox can be transmitted through the close contact that is involved in sexual activity and there may be a contribution to infection through contact with semen itself, but we don’t fully know the answers to this question yet.”

As a result, Lewis said, the WHO recommends the use of condoms “as a precautionary measure because we don’t know how much of the infection is transmitted through semen, but it is also because it reduces skin-to-skin contact”.

“It’s preferable to avoid skin-to-skin contact altogether if someone has monkeypox, but at the very least, using a condom may reduce that risk while we do more studies to learn more,” she added. “This applies to bisexual and gay men who have sex with men and anyone who has multiple sexual partners.”

Lewis added that there had been no reports yet of monkeypox transmission through blood transfusions.

Increased of cases in Americas

Over 50,000 monkeypox cases have been confirmed globally, and WHO Director-General Dr Tedros Adhanom Ghebreyesus told the briefing that the Americas account for more than half of reported cases. Cases were increasing cases in “several countries” in the region with the exception of Canada where there was “a sustained downward trend”.

“Some European countries, including Germany and the Netherlands, are also seeing a clear slowing of the outbreak demonstrating the effectiveness of public health interventions and community engagement to track infections and prevent transmission,” added Tedros. 

“With the right measures, this is an outbreak that can be stopped and in regions that do not have animal-to-human transmission, this is a virus that can be eliminated.”

“We might be living with COVID-19 for the foreseeable future. But we don’t have to live with monkeypox.”

Sexual transmission via semen?

Earlier in this month, Italian researchers reported in The Lancet that they had found monkeypox DNA in the semen of a 39-year-old patient living with HIV who self-identified as a man who has sex with men, and a sex worker. He had reported condomless sex with several male partners in the month before infection.

“Overall, our findings support that prolonged shedding of monkeypox virus DNA can occur in the semen of infected patients for weeks after symptoms onset, and show that semen collected in the acute phase of infection (day six after symptom onset) might contain a replication-competent virus and represent a potential source of infection,” according to the researchers, from the National Institute for Infectious Diseases in Italy.

“Whether infectious monkeypox virus found in semen could be associated with seminal cells or if viral replication occurs in the genital tract remains to be established,” they note.

However, they add that “the isolation of live replication-competent monkeypox virus from semen, and prolonged viral DNA shedding, even at low viral copies, might hint at a possible genital reservoir”. 

Dr Dimie Ogoina

Nigerian physician Dr Dimie Ogoina from the Niger Delta University, has previously raised the possibility of both sexual transmission of monkeypox and whether it could be transmitted by asymptomatic people.

“Monkeypox manifests in rashes. Would a person still engage in sex with these rashes? We need to look at asymptomatic transmission,” said Ogoina at a WHO meeting in June called to look at the new outbreak.

Ogoina was the first to raise the alarm about a monkeypox outbreak in Nigeria in 2017, which has been linked to the current global outbreak.

Writing about that outbreak in PlosOne, Ogoina and colleagues noted that “a substantial number of our cases who were young adults in their reproductive age presenting with genital ulcers, as well as concomitant syphilis and HIV infection”. 

Ogoina later told NPR that a sexual history assessment of patients in the 2017 outbreak found that many had multiple sexual partners and sex with sex workers.

“Although the role of sexual transmission of human monkeypox is not established, sexual transmission is plausible in some of these patients through close skin to skin contact during sexual intercourse or by transmission via genital secretions,” Ogoina and colleagues noted in the Plos One article, calling for further studies on role of genital secretions in transmission of human monkeypox. 

They also noted that HIV-infection might negatively influence the morbidity of human monkeypox “as patients with HIV had more severe skin lesions associated with genital ulcers” than HIV-negative individuals

Reducing number of sexual partners

“Protecting oneself involves the actions we’ve been talking about from the beginning, which are: reducing physical contact with anyone who has monkeypox, reducing the number of sexual partners, reducing casual sex or new partners and being more open about one’s risks and having conversations with others that may highlight mutual protection and protection of each other,” Lewis stressed. 

“This is not a disease that is limited to a specific group. What is happening is that it is being spread primarily in one risk group. We know that the majority of cases are occurring among bisexual men who are gay or bisexual. However, physical contact of any kind with anyone who has monkeypox would put someone at risk”. 

 

Image Credits: The Hill/Twitter .

Booster
If the US CDC recommends the booster, it could be available as soon as next week.

The US Food and Drug Administration (FDA) granted emergency use authorization (EUA) to two Omicron-targeting booster vaccines on Wednesday as it anticipates the potential rise of COVID-19 cases in its fall and spring.

The boosters, one by Moderna and the other by Pfizer-BioNTech, are bivalent vaccines, or “updated boosters”, that are designed to protect against both the original strain and the BA.4 and BA.5 Omicron subvariants that are dominant in the US. The FDA had previously recommended the inclusion of an Omicron component in COVID-19 booster vaccines back in June. 

Both are scheduled to be reviewed by the US Centers for Disease Control and Prevention  (CDC)Thursday. If the CDC recommends these boosters, some may even be available starting this weekend, with more to be rolled out in clinics, doctors’ offices, and pharmacies after Labor Day.

The FDA cleared the new Pfizer-BioNTech booster for people 12 and older and the Moderna shot for those 18 and up, and the CDC is expected to concur that those ages are appropriate. 

Anyone who has received the two-shot primary series of the mRNA vaccines and the single-shot Johnson & Johnson vaccine will be eligible, regardless of whether they received any booster shots. However, they should wait two months after receiving an initial vaccine or booster before receiving this new jab.

These changes would be the first since mRNA vaccines were first introduced to the US in December 2020.

“The COVID-19 vaccines, including boosters, continue to save countless lives and prevent the most serious outcomes (hospitalization and death) of COVID-19,” said FDA Commissioner Robert Califf, in a FDA news release.

“As we head into fall and begin to spend more time indoors, we strongly encourage anyone who is eligible to consider receiving a booster dose with a bivalent COVID-19 vaccine to provide better protection against currently circulating variants.”

Omicron subvariants make up more than 90% of US cases 

 While daily reported cases have consistently remained below 100,000 since mid-August, with 88,676 new cases reported as of 30 August, the country continues to average 400 to 500 deaths a day. Omicron subvariant BA.5 currently accounts for 88.7% of cases and BA.4 3.6% of cases, according to data from the US CDC. 

The Biden administration hopes that the boosters will stave off serious health outcomes.

Variant proportions in the US. Omicron subvariants account for most of the cases.

“In terms of trying to stave off serious outcomes and symptomatic disease, one needs to refresh the immune system with what is actually circulating and so it’s a benefit-risk here,” said Peter Marks, Director of the Center for Biologics Evaluation and Research (CBER) at the FDA, in an FDA virtual news conference Wednesday morning. 

“We believe that the benefits of receiving a booster now at least two months after [their primary series] are going to outweigh the risk.”

“A big difference here is we have to be a step ahead or at least we have to try to be a step ahead because if we waited for all the proof to come in, the wave will have already passed us by and the damage will have been done,” added Califf. 

Experts concerned about lack of public enthusiasm for boosters 

However, some experts have questioned whether the American public, which has been slow to accept COVID-19 vaccines and already available boosters, will have more enthusiasm for a new round of shots.

“We already have a problem with booster acceptance,” Eric Topol, a professor of molecular medicine at Scripps Research, said in The Washington Post. 

If that is exacerbated by the paucity of human data for the new shots, “I think that would be unfortunate,” he added. 

Percentage of people with first booster dose in US. Less than half (48.5%) of those fully vaccinated received a first booster.

Already less than half of those fully vaccinated in the US – over 108 million people – have received a 1st booster dose, according to data from the CDC. And while the US has vaccinated two-thirds (67.4%) of its eligible population, this percentage is far lower than several other countries, including the United Kingdom, China, and Canada. 

 The FDA had cleared the new boosters on the “totality” of the evidence, which included human studies of earlier experimental bivalent shots, such as one against BA.1, the first omicron subvariant, and the overall record of the shots since December 2020. 

It also considered mouse data on the new booster, concluding the shots generated a strong antibody response against the variants.

But the lack of human data on the shots has raised concerns among health experts. 

“The mouse data are helpful,” said Michael Osterholm, Center for Infectious Disease Research and Policy at the University of Minnesota, “but the reason to have data for humans is to say the immune response is as good or better” as the one triggered by the original vaccine or an alternative.

“We don’t have data to support that the BA.4/BA.5 vaccine is superior.”

But Dr Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, felt that the updated boosters will be helpful even if an “out of left field” variant emerges that is different from BA.4 and BA.5.

“Any boost of immunity will have some degree of cross-reactivity even against a new variant,” Fauci said.

The FDA, in its news release, remained confident in its decision to grant an EUA.

“The FDA has extensive experience with strain changes for annual influenza vaccines. We are confident in the evidence supporting these authorizations,” said Peter Marks.

“The public can be assured that a great deal of care has been taken by the FDA to ensure that these bivalent COVID-19 vaccines meet our rigorous safety, effectiveness and manufacturing quality standards for emergency use authorization.”

Image Credits: Marco Verch/Flickr, US CDC , US CDC.

flood
Floods have affected all four provinces of Pakistan.

MAHANDRI, Pakistan – The village of Mahandri was once a scenic stopover for tourists visiting the valley of Kaghan in Pakistan’s northernmost province of Khyber Pakhtunkhwa but recent flash floods have destroyed most of its infrastructure.

The monsoon floods have killed about 14 people, washed away five restaurants, all 30 shops in the local market and destroyed health infrastructure in the village, which located on the Kunhar River. The river starts in the glaciers of the Kaghan valley, and melting ice has added to the deluge.

“The estimated cost of the commercial and domestic damage in the area is above $600,000,” said Babu Ashraf, a local councillor.

The Pakistani government has announced a national emergency amidst reports by the National Disaster Management Authority that over 1191 people have died and 33 million people have been affected from Khyber Pakhtunkhwa in the far north to Baluchistan, Punjab, and Sindh province in the far south.

One-third of the country is under water

UNOSAT image of Pakistan flood damage from 1-29 August – from Kyber Pakhtunkhwa to Punjab and the worst-affected Balochistan and Sindh provinces.

According to Pakistan’s Federal Minister for Climate Change, Senator Sherry Rehman, one-third of Pakistan is under water, with the rainfall in some parts of the country almost 400% more than average.  Some 22 million people have been exposed to flood-related risks -about 10% of the country’s population, according to United Nations estimates. 

At a briefing on Wednesday, Rehman said that Pakistan was at “ground zero of this climate catastrophe created by the greenhouse gas emissions of richer countries”.

While the country needed to improve its planning by “not building close to river beds, and better drainage”, that is not why the deluge took place, she stressed: “Make no mistake, climate change has caused this catastrophe.”

“The rains in Sindh and Balochistan have surpassed 30-year averages and have taken more than 1191 lives, with well over 33 million severely affected. More than 5000 kms of roads and 243 bridges have been destroyed, and nearly a million homes have been fully or partially damaged,” Rehman said.

“If we are to build back better, it will honestly require more than the $10 billion that is being talked about,” said Rehman, adding that temperatures in Sindh province had exceeded 53ºC which is “unlivable”.

Pakistan floods – summary of damage to date.

Glacier melt further exacerbates moonsoon floods

Earlier, Rehman noted to the Associated Press that Pakistan had the largest number of glaciers outside the polar region, and as these are melting, as well, they are exacerbating the monsoon floods. Pakistan is home to over 7,200 glaciers.

World Health Organisation (WHO) Director General Dr Tedros Adhanom Ghebreyesus told a media briefing on Wednesday that “damage to health infrastructure, shortages of health workers and limited health supplies are disrupting health services, leaving children and pregnant and lactating women at increased risk”.

“Pakistan was already facing health threats including COVID-19, cholera, typhoid, measles, leishmaniasis, HIV and polio,” said Tedros.

“Now the flooding has led to new outbreaks of dengue and skin infections, respiratory tract infections, malaria and more. In addition, the loss of crops and livestock will have a significant impact on the nutrition and health of many communities that depend on these resources. And more rain is expected.”

Government planning failures 

Pakistan floods have destroyed bridges and other infrastructure along rivers.

However, some also blame the Pakistan government for its failure to plan for climate crises and for allowing construction to alter the rivers’ natural pathways and human settlements on floodplains.

Mohammed Hanif, District Community Officer in Kaghan, said that most of the damage done in his province of Khyber Pakthunkhwa was in areas where the course of the rivers Sindh, Kabul, Swat, and Kunhar have been encroached on by commercial activities.

“People have encroached and made construction on the beds of rivers and natural streams for commercial benefits,” said Hanif.

Back in 2002, a River Act was passed by the provincial assembly, followed by a 2014 amendment to stop the illegal construction, but this had not been implementation, he pointed out.

Hanif added that Pakistan is on the list of the top ten countries vulnerable to climate change impacts and it needs a clear policy to deal with such natural disasters.

“The country even does not have the required departments to deal with such natural calamities,” he said.

Stronger climate adaptation efforts needed

People who have been displaced as a result of flooding.

Climate change activists believe that Pakistan should adopt a climate governance model to prevent such calamities. Aftab Alam Khan, CEO of Resilient Future International (RSI), a research and training social enterprise focused on climate change in Pakistan, said the country has to move towards the climate governance system because it cannot handle such calamities with ordinary governance.

“Much more seriousness is required at federal, provincial, and down to district level governments towards climate adaptability,” he said.

Khan said the government should learn from the 2010 floods, which affected 20 million people, and the 2005 earthquake,  and improve the coordination amongst all the departments.

Comparing the 2010 floods with current floods, he said this year’s floods were more devastating, affecting over 30 million people. The damage to livestock in 2010 were around $0.27 million whereas it was already around $0.7 million so far and likely to increase.

Some 45 % of crops had been lost in some areas, including devastating damage to the cotton crop upon which much of Pakistan’s GDP depends, in comparison to 11% in 2010,.

Khan said as Pakistan has been marked in the top ten countries being affected by climate change, the government has to take some emergency measures and develop a national adaptation plan.

Health crises loom

These floods can lead to infectious and waterborne diseases in stagnant pools of water across the country.

“Floods have already started affecting the health of the people and a large number of people are facing issues of gastroenteritis, malaria, dengue, snake bites and typhoid in the flood-affected areas,’ said Khan.

Health experts also believe that the damage will not stop here and floods will bring long-term health challenges for millions of affected people.

“With the change in temperature, the whole environment is changing and even the diseases which were well under control are being unleashed again because of the temperate conditions,” warned Dr Zafar Mirza, a public health expert and Pakistan’s former health minister.

He predicted that waterborne diseases including diarrhoea, cholera, malaria, and dengue will spread in the medium term because there will be stagnant pools of water on vast areas of land across Pakistan.

Satellite images released on Wednesday show that overflow from the Indus River has turned part of Sindh Province into a 100 km-wide lake, according to CNN.

“If this is not addressed, it will cause mortality there,” Mirza said, adding that, in the longer-term, lack of food and healthcare would make people more vulnerable to many secondary infections.

Mirza said the government’s biggest challenge is putting all its relief and rescue departments in the coordination and raising funds to reach the public suffering from floods.

“Financial resources are also needed and the United Nations (UN) has flashed an appeal to help Pakistan but the amount is very small. Much more would be required,” Mirza.

WHO warning after damage to health facilities

Millions displaced by floods have been left without access to health care.

The WHO reported on Tuesday that around 888 health facilities had been damaged, of which 180 are completely destroyed, leaving millions of people without access to health care.

WHO has diverted mobile medical camps, including teams responding to COVID-19, to affected districts, delivered over one million water purifying tablets and provided sample collection kits to ensure clinical testing of samples to ensure early detection of infectious diseases.

“According to a preliminary assessment conducted by WHO and humanitarian partners, the current level of devastation is much more severe than that caused by floods in Pakistan in previous years, including those that devastated the country in 2010,” said Dr Ahmed Al-Mandhari, WHO’s Regional Director for the Eastern Mediterranean.

Ongoing disease outbreaks in Pakistan, including acute watery diarrhoea, dengue fever, malaria, polio, and COVID-19 are being further aggravated, particularly in camps and where water and sanitation facilities have been damaged

“WHO is working with health authorities to respond quickly and effectively on the ground. Our key priorities now are to ensure rapid access to essential health services to the flood-affected population strengthen and expand disease surveillance, outbreak prevention and control, and ensure robust health cluster coordination,” said Dr Palitha Mahipala, WHO Representative in Pakistan.

The spokesperson for the Ministry of National Health Services and Regulations, Sajid Hussain Shah, said these floods are testing times for the country and the ministry is taking all efforts to control the disease spread in flood-affected areas.

He said though health is a provincial matter in the country, but the federal ministry is coordinating with provinces to provide them with maximum facilities.

Shah said over 600,000 medicated mosquito nets have been distributed in 22 districts of Sindh and above $2.5 million worth of medicine has been provided to people affected.

“This is a huge calamity and the government cannot recover from it without international community help,” said Shah.

Image Credits: Rahul Rajput, UNOSAT , UNHCR .

A researcher explores samples from the wildlife trade.

Drug-resistant bacteria, influenza, Crimean-Congo haemorrhagic fever – all have the potential to be the ‘pathogen X’ that could drive the next pandemic, according to scientists sharing notes at a two-day meeting convened by the World Health Organization (WHO) R&D Blueprint.

Dr Ana Maria Restrepo, WHO head of research and development, said that while predicting the future was impossible, the body wanted to develop a common global priority list for pathogens as there was a “pandemic of lists”.

Research has shown that although the number of viral species was increasing, the number of new viral families that are infecting humans is beginning to plateau, according to Dr Barney Graham, formerly with vaccine research at the US National Institutes of Health.

“That suggests that this is a finite problem that we could prepare for in a more proactive way,” he added, pointing out that if viruses within the 27 viral families were grouped according to entry mechanisms, about 120 had the potential for increased human-to-human transmission.

“It would be possible to develop vaccines for 30 prototype viruses in phase one and generate the reagents and data on all the other 90 viruses, at least through animal testing,” said Graham, now at the Morehouse School of Medicine in Atlanta.

Dr Ana Maria Restrepo, WHO head of research and development

Graham is most worried about influenza driving the next pandemic: “Even though we’ve been dealing with influenza for almost 90 years now, I don’t think we’re really ready for the next pandemic. We have vaccine technologies that require six to seven months to scale up,” said Graham, adding that new vaccine technology needed to be applied to influenza so that billions of doses could be made within three to four months.

Drug-resistant bacteria are already killing millions

“We are also very much or considering bacteria as an important potential cause of the next pandemic,” said Restrepo. “Antimicrobial resistance comes to mind, but there is also the evolution of bacteria.” 

Dr Loice Achieng from Nairobi University in Kenya, made a convincing case for a bacterium driving the next pandemic, highlighting that many bacteria have high case fatality rates and efficient human-to-human transmissibility. 

“Looking at the mortality around antimicrobial resistance for many years, we’ve had the projection that by 2050 there would be about 10 million deaths per year from antimicrobial resistance,” said Achieng, adding that some had seen this as an exaggeration.

However, recent research published in The Lancet found that, in 2019, there were almost five million deaths associated with bacterial AMR, and about 1.3 million deaths directly attributable to bacterial AMR. 

“If you compare this to mortality from COVID-19 over the last two and a half years there have been 6.5 million deaths globally. If the estimates of AMR-related deaths are indeed true, then it means over that same period, there have been more than 10 million deaths,” said Achieng. “They’re slow. They’re undocumented, many times unrecognised and continue to kill many people.”

She cited gram-negative bacteria like E.coli and Klebsiella pneumonia and gram-positive bacteria like methicillin-resistant staph aureus (SARS) and Streptococcus as being amongst the most deadly bacteria. 

Lessons from COVID and other outbreaks 

An effective surveillance network for both animals and humans is critical to preparing for the next pandemic, said Dr Kanta Subbarao, director of the WHO Collaborating Centre for Reference and Research on Influenza, based at the Doherty Institute in Melbourne, Australia.

“Surveillance networks came to play a big part even in the response to COVID-19. And I would argue that at least in influenza, we have much more interaction with our animal health colleagues in the surveillance space,” said Subbarao.

“When outbreaks begin, we really rely on astute clinicians to pick them up and identify a cluster of unusual illnesses that they then track and say what is going on. At that point, you need diagnostic assays to identify what the pathogen is, and that means the ability to isolate the virus.”

Professor Madhu Pai

Pathogen X is mostly like to emerge at level of primary health care where it will not get detected, as 50% of the world primarily in LMICs lack access to essential diagnostics, and primary care is the weakest in terms of access, according to Professor Madhukar Pai from McGill University in Canada.

“Secondly, pathogen X will emerge in a world where high-income countries are repeatedly failing in terms of global solidarity, and repeatedly failing in terms of what not to do in a crisis,” said Pai.

“We should assume rich nations will again hoard vaccinations, diagnostics and supplies for the next pandemic. And low and middle-income countries be left with nothing,” he added.

Thus preparing for ‘pathogen X’ should focus on building low and middle-income countries’ manufacturing capacity, including of diagnostics, added Pai.   

“India and China produced their own COVID19 tests and did not have to wait for the trickle-down charity from high-income countries,” he said.

Graham added that emerging viral diseases are almost always recognised first in high-income countries but they almost always emerge from LMICs.

“This means that we all have we have mutual interest and should have a coordinated global effort towards addressing this problem because it’s not going to stop.”

Wildlife dangers

The most likely source of pathogen X is zoonotic diseases, said John Hopkins University epidemiologist Dr Pranab Chatterjee.

While we have learned a lot about how a new pathogen behaves once it has become capable of infecting humans, there remains a lot of unanswered questions regarding pathogens spillovers from animals to humans, added Chatterjee.

“The focus should remain on [identifying] a zoonotic source for an emerging pathogen X or a reemerging known pathogens, strengthening global governance mechanisms and supporting countries in designing and deploying One Health informed surveillance systems embedded within existing public health systems,” he added.

The EcoHealth Alliance’s Dr Willian Karesh said that global investment in pandemics had focused on health security but there was little money going to prevention and recovery.

Groups including the World Bank are starting to think about the drivers of emerging infectious diseases and pandemics, and there a tight correlation with land use change, deforestation, agricultural expansion and the wildlife trade, said Karesh.

COVID-19 has highlighted the potential risks emanating from the wildlife trade,and there were a number of possibilities to address these, he added.

While there are potentially millions of viruses in wildlife, there has been almost no research to implement and test interventions to address this risk, said Karesh, highlighting this as a “priority research area”.

​​Karesh also highlighted the danger of “spill back” of pathogens from humans to animals, where they had the potential to mutate and reinfect humans at a later stage. 

SARS CoV2 spilt into mink and white-tailed deer, and there is “a large swath of the US where Delta variants are circulating in deer,” he said.

Image Credits: Wildlife Conservation Society .

Clean Water
Hospitals and clinics without safe water and basic hygiene and sanitation services are a potential death trap for pregnant mothers, newborns, and children, according to UNICEF.

A new UN report showing that half of the world’s health care facilities fail to meet the basic standard for providing hygiene services like soap and water or an alcohol-based hand rub highlights the widespread global risk of disease spread and infections to patients and health care providers.

About two-thirds of all health care facilities provide these services at the points of care or toilets but not at both, which is the basic standard. Only 51% meet that standard by providing both, says a new report Tuesday from the World Health Organization (WHO) and UNICEF. 

The report, “Progress on WASH in health care facilities 2000-2021: Special focus on WASH and infection prevention and control (IPC)“, focuses on data from 2000 to 2021 and finds that the lack of basic hygiene puts around 3.85 billion people who use these facilities at greater risk of infection. That includes 688 million whose facilities offer no basic hygiene services at all.

global hygiene
Just 40 countries in the world kept their own national estimates for basic hygiene services last year

Hygiene ‘non-negotiable’

Health officials say the situation likely will prolong the COVID-19 pandemic, monkeypox outbreak and other health crises.

“Hygiene facilities and practices in health care settings are non-negotiable,” said Dr Maria Neira, director of WHO’s Department of Environment, Climate Change and Health. 

“Their improvement is essential to pandemic recovery, prevention and preparedness,” she said, urging nations to spend more for “basic measures, which include safe water, clean toilets, and safely managed health care waste.”

That is in line with the 194-nation World Health Assembly’s commitment in 2019 to strengthen and monitor water, sanitation and hygiene services in health care facilities.

WHO and UNICEF operate a Joint Monitoring Program that provides regional, national and global estimates of progress on drinking water, hygiene and sanitation. The latest report on hygiene covers 35% of the world’s population and 40 nations, up from 21 nations in 2020.

Low-and-middle-income countries have made significantly less progress than high-income countries in implementing hand hygiene and infection prevention programmes that can stop deadly diseases, from diarrhoea to COVID-19, according to a recent WHO survey of 88 countries.

“If health care providers don’t have access to a hygiene service, patients don’t have a health care facility,” said Kelly Ann Naylor, UNICEF’s director of Water, Sanitation and Hygiene (WASH) and Climate, Environment, Energy, and Disaster Risk Reduction (CEED).

“Hospitals and clinics without safe water and basic hygiene and sanitation services are a potential death trap for pregnant mothers, newborns, and children,” she said. “Every year, around 670,000 newborns lose their lives to sepsis. This is a travesty — even more so as their deaths are preventable.”

global hygiene
Practical steps outlined by the joint WHO-UNICEF report to improving water, sanitation, and hygiene in health care facilities, and reduce risk to patients.

In 2017, the World Health Assembly adopted a resolution to fight which is a life-threatening blood stream infection for which there is growing resistance.

The Assembly, which is WHO’s governing body, acknowledged that antimicrobial resistance is a growing health concern and underlined the urgent need for new accessible and affordable antibiotics.

The report finds the lack of basic hygiene is uneven across different regions and income groupings.

Facilities in sub-Saharan Africa are lagging; 73% in the region have alcohol-based hand rub or water and soap at points of care, but only 37% have handwashing facilities with water and soap at toilets. Among hospitals, 87% have hand hygiene facilities at points of care.

In the least developed countries, only 53% of health care facilities have access on-premises to a protected water source, the report says. That compares with 78% globally.

Many health care facilities also lack basic environmental cleaning and safe segregation and disposal of health care waste, it says.

Image Credits: WHO/UNICEF.

CEPI is helping to improve global laboratory capacity.

Recently, the Coalition for Epidemic Preparedness (CEPI) launched a $3.5 billion plan of investment in ground-breaking R&D, linked to equitable access commitments, which aims to transform the world’s ability to respond to new epidemic and pandemic threats and catalyze cooperation across a coalition of public and private sector partners.

As parliamentarians from across the European Union, we want to underscore the importance of governments’ role in actively supporting these kinds of global health preparedness plans at national level – with concrete investments and actions.

The COVID-19 pandemic has demonstrated that multilateralism and solidarity are fundamental to address any global health threat and that governments must increase global solidarity and collaboration, ensuring fair and universal access to vaccines.

The pandemic also has made us realize the impact that infectious diseases can have on our daily lives.  And it is now more clear than ever that it is not possible to rebuild our societies unless we control the epidemiological risk and commit to a more robust and effective global epidemic and pandemic preparedness and response architecture.

Investment in regional and international health security

As each country discusses how to strengthen its own domestic preparedness and response, it is also crucial to be certain that those efforts feed into a stronger global ecosystem. Domestic plans will be of little worth if the infectious disease threats that loom now or rise up in the future continue to hover just across our borders.  National contingency plans will only be effective if they also take into account and invest in the regional and international health security systems.

As a globally recognised organising force for R&D collaboration and innovation, CEPI is uniquely placed to coordinate an international approach to the research and development of new vaccines and other tools that significantly reduce future epidemic and pandemic risks.

CEPI offers a global focus and the agility to move quickly, extensive partnerships, and a proven track record with its rapid and effective action in response to the ongoing COVID-19 crisis. It is able to leverage its unique connecting role, being able to work with vaccine developers and manufacturers, national governments, philanthropies, civil society and global health organisations, with an extensive network to pool and deploy resources in ways that states often cannot.

CEPI is continuing to respond to the COVID-19 pandemic – optimising current vaccines and developing the next-generation of COVID-19 vaccines to respond to variants of concern.

Simultaneously, however, CEPI is also preparing for future infectious disease threats through initiating the development of a) broadly protective coronavirus vaccines, b) advancing vaccines for other known infectious disease threats and c) producing a library of prototype vaccines and other biological interventions against representative pathogens from critical viral families.

Building global capacity

CEPI is also working to establish global networks for lab capacity, assays, and preclinical models that are critical for rapid vaccine development, and to support the efforts of low- and middle-income countries to take full ownership of their national health security. Taken together, these tools will support CEPI’s ambitious aim to compress vaccine development timelines to 100 days from genetic sequence to vaccine availability. The plan is developed, but it now needs funding.

National contingency plans are only effective if they also pay attention to, and invest in, the international health security system. Investing in research and development for pandemic preparedness, both from domestic and foreign aid budgets, in an all-of-government strategy, is an efficient way to protect our future, as emerging infectious diseases require a similar kind of investment attention as other major threats, such as climate change or wars. Therefore, we need to establish a coordinated global R&D system where national and regional initiatives can complement each other, in order to avoid economic turmoil and save lives.

One of the main priorities of UNITE Members, Members of Parliament and policymakers around the world is to protect the people they represent and they are therefore fundamental in this process. We can hold governments accountable and advocate for more investment in R&D for pandemic preparedness.

We can also give political support for a strengthened future ecosystem through the work on a global accord, that secures appropriate funding for pandemic preparedness and makes sure that we put equitable access at the heart of the response.

We have the technology. Now, we need the political leadership.

UNITE Global Parliamentarians Network to End Infectious Diseases:

Petra Bayr, Member of Parliament, Austria

Jean François Mbaye, Former Member of Parliament, France

Jean-Luc Romero Michel – Deputy-Mayor of Paris and President of Local Elected Representatives against AIDS

Jean Spiri, Former Member of the Regional Council of Île-de-France

 Sara Cerdas, Member of the European Parliament, Portugal

 Juan Ignacio Echániz Salgado, Member of Parliament, Spain

Lisa Cameron, Member of Parliament, UK

Lia Quartapelle, Member of Parliament, Italy

Sirpa Pietikäinen, Member of the European Parliament, Finland

Andrew Ullmann, Member of Parliament, Germany

 

 

 

Image Credits: Novavax, Sanofi.

monkeypox

The World Health Organization’s top official in Europe says the monkeypox outbreak appears to be slowing in the region, and could be eliminated through universal effort.

“There are encouraging early signs, as evidenced in France, Germany, Portugal, Spain, the U.K., and other countries, that the outbreak may be slowing,” WHO’s Regional Director for Europe Dr Hans Kluge told an online press briefing.

“To move towards elimination in our region,” he said, “we need to urgently step up our efforts.”

Kluge reported more than 22,000 confirmed cases of monkeypox across 43 countries and areas, representing more than a third of the global tally.

His office is advising all governments and policymakers to join in efforts at controlling and eliminating monkeypox.

“All countries — whether they currently have cases or not — need to implement a set of combined interventions towards this end,” Kluge said.

“Yet we believe we can eliminate sustained human-to-human transmission of monkeypox in the region if we commit to doing so and put the needed resources towards that end,” he said.

Monkeypox trends point to importance of earlier detection, isolation

The global number of weekly new cases of monkeypox reported to WHO declined by 21% last week — the first such decline since the infection endemic to central and west Africa began to appear around the world earlier this year.

Cases continued rising sharply in the Americas, however, in contrast to recent declines in European hotspots.

But there has been a global shortage of monkeypox vaccines.

The African continent has not yet received any vaccine doses to combat the monkeypox virus, African health officials said last week. More monkeypox testing kits also are urgently needed to improve the continent’s emergency response, top health officials warned.

The rollout of MVA-BN vaccine, made by Danish company Bavarian Nordic, has been hampered by limited supplies.

In response, WHO is examining proposals to split scarce monkeypox vaccines doses to stretch supplies. The United States adopted that strategy earlier this month.

The slowdown in monkeypox outbreak may be due to better detection and earlier isolation among some communities, said WHO Europe’s incident manager, Dr Catherine Smallwood.

“We do have some pretty good anecdotal evidence that people — particularly men who have sex with men, who are in particular risk groups — are much more informed about the disease,” Smallwood said.

Holistic monkeypox approach working well

“Which really leads us to believe that a major change, at least for the moment, is contributing very significantly to them,” she said. “We need to build on that … and we firmly believe that if we continue to do that, we will be able to sustain this decline.”

In Europe there are “early signs” that “this is going in the right direction, but it’s not enough,” Kluge said of the monkeypox outbreak.

Kluge pointed to the example of Portugal, where the government’s community outreach and partnership efforts raised awareness, prompting people “to take precautions and modify their behavior, resulting in better health outcomes and helping curb the outbreak.”

Monkeypox, which was long isolated in a few countries in Africa, broke out in Europe in early May but WHO waited until 10 weeks later to declare a public health emergency.

Much like with AIDS, initially the most affected group has been gay and bisexual men. The cause of the early neglect towards monkeypox is rooted in homophobia, says Michael Weinstein, president of AIDS Healthcare Foundation (AHF), the largest global nonprofit AIDS organization.

Kluge said the current outbreak in Europe emerged among men who have sex with men, often through sex with anonymous or multiple partners, and “that’s where the outbreak remains centered.”

“And that’s where we must concentrate our prevention and response efforts — with the active collaboration and participation of the community itself, fostering an environment free of stigma and discrimination against this long-marginalized population,” he said.