COP27
Global Young Greens protestors demanding the end of fossil fuels at COP27.

(SHARM EL-SHEIKH, Egypt via The New Humanitarian) – Climate justice played a central role at COP27, where the snail’s pace of progress on addressing the climate emergency once again stood in stark contrast to the realities on disaster front lines.

Negotiators and policymakers emerged from the annual summit in Egypt hailing a breakthrough on so-called “loss and damage” financing, agreeing to create a new fund to help countries facing the worst impacts of the crisis.

After 30 years of advocacy and pushback on the issue, arguments leaning on climate justice had a clear influence on the political agenda, with vulnerable countries and climate campaigners alike pushing similar messages.

Yeb Saño, a prominent former diplomat from the Philippines and the Southeast Asia director for Greenpeace, called it a “new dawn for climate justice”. UN Secretary-General António Guterres said it was a badly needed step “to rebuild broken trust”. Humanitarian groups branded it a “monumental win”, though the crucial details of how the fund work still need to be thrashed out in the coming months.

Yet in spite of the diplomatic negotiations and last-minute theatrics, results came up short in other key areas. “It has been a good pitch to say that it’s a COP for Africa. But the negotiations haven’t had Africa at the centre, and the needs of several millions of Africans facing starvation.”

Funds to help countries adapt to and mitigate climate change are still far short of the annual $100 billion previously pledged. Stronger wording on the phasing down of fossil fuels wasn’t included in the final negotiated text. And there were no major new promises to ratchet up emissions cuts – despite signs that country-level plans to limit temperature-rise to 1.5 degrees Celsius are significantly off target.

COP27 had been presented by its Egyptian presidency as “the implementation COP”, and as Africa’s summit, though many participants here felt that the talks disappointed on both fronts.

“It has been a good pitch to say that it’s a COP for Africa. But the negotiations haven’t had Africa at the centre, and the needs of several millions of Africans facing starvation,” Isaiah Kipyegon Toroitich, head of global advocacy at the Lutheran World Federation, told The New Humanitarian.

Frustrated by years of roadblocks by powerful countries at these summits, some civil society groups and humanitarians have concentrated their advocacy outside the negotiation rooms in an attempt to drive the needle forward. At this COP, issues like debt, gender justice, and migration emerged as hot-button concerns on the summit sidelines, if only blips on the official radar.

Here are some of the key issues that emerged – or were overlooked – during COP27, and what the next steps may include.

Loss and damage

Described as a “down payment on climate justice” by Pakistan’s climate minister, the agreement to set up a loss and damage fund must be just the start, humanitarian groups and civil society advocates say.

Farah Naureen, Pakistan director for aid group Mercy Corps, said more public funding and more innovative financing sources were needed, adding “the real work will only begin after COP27”.

While advocates view acknowledgement for loss and damage as a core part of climate justice, discussions on the new fund were only able to proceed after negotiators agreed to remove references linking funding to any form of “reparations” or “liability”, which wealthy countries worried may usher in unlimited claims.

Questions over who will pay into the fund and how the money will be distributed are still to be negotiated. European countries argued in Sharm el-Sheikh that China and oil and gas producers such as Saudi Arabia and Qatar – all considered by UN definitions as developing countries – should pay. They also want Russia to be included.

COP27
Protesters at COP27 demanding debt relief for poorer climate-vulnerable countries. (via The New Humanitarian)

A sense of who would be eligible to receive money was at least partially provided during the last sleepless night of negotiations: Negotiators agreed to a final wording that cited “developing countries that are particularly vulnerable to the adverse effects of climate change”.

“The loss and damage outcome was one that was vital for solidarity with [climate-vulnerable] countries, because it’s about the entire ecosystem that needs to happen,” Jennifer Morgan, Germany’s special climate envoy and former executive director of Greenpeace, told The New Humanitarian.

Germany and other G7 nations, along with their counterparts in the Vulnerable 20 (V20) negotiating bloc, used COP27 to announce an insurance and disaster risk finance mechanism called the Global Shield. Some critics saw it as a distraction, especially if it becomes a substitute for new funding.

But Sara Jane Ahmed, finance advisor to the V20 group, said the shield would complement a loss and damage fund. Generally, the V20 countries pushed for new loss and damage financing on top of other solutions. “We have a timing mismatch,” she said. “We need resources today; we cannot wait two to three years to get new resources to come through. We need to keep going at the same time that they find resolution working on [loss and damage].”

Adaptation finance

With much of the public focus on loss and damage, there was little progress on increasing funding for a less-controversial branch of climate finance: adaptation.

Long-standing promises of $100 billion a year have consistently been unmet. At 2021’s COP26 summit in Glasgow, countries agreed to double the funding available for adaptation – the money used to help countries prepare for and reduce the risks of climate change.

Negotiators in Sharm el-Sheikh wrangled over issues such as what baseline to use, before finally recommitting to the previous COP’s promises. They also agreed to set up a framework to track progress on adaptation.

While heads of state from traditional donor governments touted new contributions at COP27, vulnerable countries made clear it was far short of what’s needed. They have long said that adaptation funding – which could be used, for example, to make homes more storm-resistant, to restore coastlines, and to build flood defences – should be more balanced with financing available for mitigation or reducing emissions, which traditionally sees the bulk of the climate funding.

For aid agencies and NGOs, which maintained a strong presence at COP27, insufficient adaptation means climate impacts have become even more challenging to respond to.

Andrew Harper, chief climate advisor at the UN’s refugee agency, UNHCR, said high-profile crises such as the conflict in Ukraine have left less money for “forgotten” emergencies worsened by climate change.

With only 4% of climate finance directed to Africa, mostly in the form of loans instead of grants, and most of it going to mitigation, Harper said: “it is clear that the developing countries who have been doing the most to protect and support refugees, sometimes for decades, demonstrating a level of global solidarity that many in the [Global] North could learn from, are not benefitting at all from even the miniscule funding that is available.”

Reforming the global financial system

Some of the most far-reaching reform proposals weren’t found on the COP27 agenda, but became talking points throughout the summit.

Trapped in a cycle of climate-linked disasters and crushing rebuilding debt, countries like Barbados have led the push to reform the global financial system. Prime Minister Mia Mottley, has called for a range of reforms including loan conditions that would suspend payments after they are hit by disasters or pandemics. Her Bridgetown Agenda suggests that substantial funds could be unlocked through debt relief, more accessible loans, and other reform measures – allowing countries to spend on recovery and reconstruction instead of paying down debt.

Mottley and others used the COP27 stage to call for an overhaul of the global financial system that has trapped climate-vulnerable countries in a cycle of debt. She argues that the Bretton Woods institutions set up following World War II, including the International Monetary Fund and the World Bank, are not serving countries that regularly face increasingly intense and unpredictable disasters.

While loss and damage remains divisive despite progress in Egypt, there’s much greater appetite for financial reforms. Humanitarian groups and the UN’s Guterres are also pushing for debt relief. The US has echoed calls to reform multilateral lending. Even David Malpass, the head of the World Bank, has cited the need to “make progress in the debt agenda”.

Migration

Human mobility was not on the official COP agenda, but displacement – particularly from conflicts worsened by climate change – was a key concern in sideline discussions, especially those attended by the humanitarian aid sector.

Floods and storms, which are aggravated by climate change, pushed at least 21.6 million people from their homes last year, and climate change can also intensify other causes of displacement.

Some believe mobility should be viewed as a way that people adapt to climate change, and say financial support for programmes that assist displaced people should be a part of much-needed adaptation finances in the future.

The final COP27 text cited “displacement”, “relocation”, and “migration” as some of the many “gaps” that need to be tackled in the coming months as the new loss and damage financing is discussed – potentially carving out more space for mobility in coming climate negotiations.

And refugees and displaced people themselves need seats at the COP28 table in Dubai, UNHCR said.

Gender justice

Gender justice has for years been sidelined as a “fringe” issue at climate talks. But women activists have pushed for greater representation at the negotiating table, unique financing, and attention to the climate costs faced by women and girls.

Little of substance on gender issues was mentioned in the final COP27 text, leaving observers disappointed.

“Gender was only marginally mentioned, if at all, in the climate talks’ decisions,” Oxfam said.

Reem Alsalem, the UN special rapporteur on violence, has said that climate change represented the “most consequential threat multiplier for women and girls” and increased the risk and prevalence of violence against them.

Beverly Musili, a gender justice activist and lawyer with the Kenya Institute for Public Policy Research and Analysis, or KIPPRA, said gender still remained very much on the backburner during COP27.  “Gender was only marginally mentioned, if at all, in the climate talks’ decisions.” 

She noted that in pastoralist societies in Kenya – where gender inequalities are present – drought is exacerbating impacts on women and girls. “Due to climate change, poverty has been growing and child marriage will most likely regress,” she said.

Her organisation has been trying to educate families about the importance of girls attending school, but “with climate change come more fundamental questions of, ‘Are we going to send our children to school or are we going to look for food?’”

Indigenous women and rural women play key roles in ensuring food security for their communities, as well as in climate change adaptation efforts. In many communities, however, women are marginalised, putting them at greater risk, particularly in the face of climate change.

In spite of the distance and logistical difficulties of travelling to Egypt, Indigenous women from the Amazon were prominent at COP27. They have been leading the drive to recognise the role their communities play in protecting forests; the final text from COP recognised nature-based solutions, a mechanism that can be used to cut carbon emissions, an implicit acknowledgement of the importance of preserving natural ecosystems.

There’s still a clear gender imbalance when it comes to the COP negotiating table, as underlined by the “family shot” of heads of state taken at the summit’s opening: Only 7 of the 110 pictured were women.

In an effort to change the balance, one group, She Changes Climate, encouraged the United Arab Emirates, which will host next year’s climate talks, to appoint a woman as COP28 president: the current minister of climate change and the environment, Mariam Almheiri.

Global climate action beyond COP27

Facing slow progress at the annual UN-led climate summits, countries are finding other ways to accelerate climate action.

The campaign for debt relief and systemic financial reform is one example. The push to bring climate change and human rights to the International Court of Justice is another.

Backed by a catchy music video, the Pacific island nation of Vanuatu used COP27 to announce that its allies have almost finalised a resolution that could put the issue before the UN General Assembly and – if passed there – the UN’s top court.

Years of inaction at COP summits contributed to initial plans for legal action.

“What we have seen this week is that negotiations are not working for the most vulnerable,” said Ralph Regenvanu, Vanuatu’s minister for climate change.

Image Credits: Twitter/Global Young Greens, Paula Dupraz-Dobias/TNH.

Civil society in Geneva call for an IP waiver for COVID vaccines with UNAIDS Executive Director Winnie Byanyima earlier in the year.

Little agreement emerged from an informal World Trade Organization (WTO) meeting on Tuesday about whether an intellectual property (IP) waiver should be extended to COVID-19 therapeutics and diagnostics.

But low and middle-income countries (LMIC) that qualify for free COVID-19 anti-virals Paxlovid (nirmatrelvir) and Molnupiravir have shown so little interest in accepting donations that some question whether debating the waiver extension is a waste of time.

Singapore, Switzerland, Japan, Korea, the European Union and the United Kingdom wanted to see proof of IP barriers hampering access to therapeutics and diagnostics before they supported any waiver extension, according to a Geneva-based trade official at the WTO meeting.

Meanwhile, Switzerland and Mexico argued that the ship has already sailed as there is little demand for therapeutics.

The WTO’s TRIPS Council has until 17 December to decide on whether to extend June’s Ministerial Decision on a patent waiver on COVID-19 vaccines. 

But at Tuesday’s meeting, there was no new movement towards consensus, according to the trade official.

Parties still pushing for the waiver include South Africa, India, Sri Lanka, Nepal, Nigeria and Indonesia – all part of the core group that first introduced the notion of a TRIPS waiver for all COVID-related products.

Meanwhile, China and Mexico are part of a group that supports a limited waiver on specified products.

Lack of access – or lack of interest?

Shortly before the WTO meeting, Oxfam and the People’s Vaccine Alliance (PVA) decried the fact that rich countries have secured almost three times as many courses of a World Health Organisation (WHO)-recommended COVID-19 medicine, Pfizer’s Paxlovid.

“Just a quarter of orders for the treatment will go to low- and middle-income countries (LMICs), despite the fact they make up 84% of the world’s population and have a much greater need as far fewer people are vaccinated against COVID, unlike rich nations which are largely protected,” said the two bodies in a media statement this week, warning of “the same worrying trend of inequity that we saw with COVID vaccines”. 

However, the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) disputed this, saying that “of the 105 lower-income countries eligible for COVID-19 treatments coordinated by the ACT Accelerator, very few countries have expressed an interest and barely a handful have so far placed very low volume orders.”

“The lack of demand means that, of the 38 generic companies lined up to produce Paxlovid and the 27 companies with licenses for Molnupiravir, there is currently barely a market for even a handful of companies to operate,” the IFPMA told Health Policy Watch.

The Oxfam-PVA figures were drawn from Airfinity, an independent provider of global health analytics and data.

Airfinity’s CEO, Rasmus Hansen, told Health Policy Watch that it was correct that only around 25% of purchased doses of Paxlovid were going to LMIC.

“But it’s a bit of a mistake only to look at that number without looking at some other demand indicators,” Hansen added.

One important indicator was the demand for Paxlovid doses from countries that qualified for the medication for free through the ACT Accelerator, he added.

“Only around 7% of the Paxlovid doses that are available for donation have been accepted by low-income countries. When I saw that number, I was really surprised you because that’s not a pricing issue,” said Hansen.

Meanwhile, the total demand from LMICs for both WHO-approved antivirals – Molnupiravir and Paxlovid – available free via the ACT-Accelerator had only reached 13%, and there had been zero demand for either medication in the fourth quarter of the year, said Hansen.

‘This available number of doses is not even the full 25% of doses available for donation. I think this is about 10% of the donations promised,” he added.

More complicated than availability

“The story is more complicated than doses not being available. There seems to be an issue with a country’s ability or willingness to use the medicine.”

Hansen speculated that factors influencing this could include countries’ inability to conduct systematic COVID-19 testing as antivirals have to be given early to prevent serious illness, as well as them having other health priorities.

He also said that a country might not accept a donated drug not because they didn’t need it but because they lacked the capacity to roll it out.

Hansen also said that the lack of data about hospitalizations, particularly in Africa, meant that deciding on what was needed “is a little bit like shooting in the dark because we don’t actually have factual data on how many are severely ill by COVID”. 

Image Credits: @FilesGeneva , Airfinity.

Bacteria
Bacterial infections are the secong leading cause of deaths in 2019.

Some 7.7 million people are estimated to have been killed by bacterial pathogens in 2019 according to a study published in The Lancet this week, making this the second leading cause of death globally in2019. 

Some 33 bacterial pathogens across 11 infectious syndromes were linked to 13.6% of all global deaths in 2019, according to the study, which was led by the Institute of Health Metrics and Evaluation (IHME) at the University of Washington

Almost 55% of these bacterial deaths came from just five pathogens – Staphylococcus aureus, Escherichia coli, Streptococcus pneumoniae, Klebsiella pneumoniae, and Pseudomonas aeruginosa. 

The worst impact of these bacteria is in sub-Saharan Africa, where the mortality rate is 230 deaths per 100,000 population in comparison to 52 deaths per 100,000 in high-income countries. 

“Effective antimicrobials exist for all 33 of the investigated bacteria, yet much of the disproportionately high burden in LMICs might be attributable to inadequate access to effective antimicrobials, weak health systems, and insufficient prevention programmes,” the study added. 

In January, the IHME reported on deaths associated with 23 pathogens and pegged the number of deaths due to antimicrobial-resistant pathogens at 4.95 million. However, the current study analyses deaths caused by bacteria that are both susceptible and resistant to antimicrobials. 

More R&D funding 

Bacterial pathogens such as E coli and K pneumoniae are collectively associated with more deaths than S pneumoniae or tuberculosis, but they receive much less funding and attention than other diseases. 

“A 2020 analysis of global funding for infectious disease research found that HIV research was awarded $42 billion in funding compared with $1.4 billion for research on Staphylococcus spp and $800 million for E coli research over the same period (between 2000 and 2017),” the paper stated. 

IHME director Chris Murray urged those who invest in research and development to take a “pathogen view” when making decisions, adding that governmental research authorities and private players like pharmaceutical companies need to keep this in mind when developing new antibiotics and vaccines. 

It also helps get a sense in different parts of the world. We put a lot of emphases, appropriately so, on HIV, TB, and malaria but we probably need to pay as much attention to something that’s quite neglected, like Staph aureus, that’s affecting poor countries as well as rich countries.”

Need for coordinated action

Targeted efforts must be made to improve access to healthcare and antibiotics in order to reduce mortality due to bacterial pathogens, according to the report. 

However, it warned that while addressing access issues, it is crucial to also assess the risk of misuse of antibiotics. 

“Improving access to antibiotics requires a nuanced and location-specific response because ease of access must be weighed against the risk of antibiotic overuse (a problem compounded by the issue of self-medication in LMICs), which contributes to the increase in antimicrobial resistance.”

The study also advocates for higher uptake of vaccines that target the most common pathogens and vaccine development for bacteria for which no vaccine exists.

In July, the WHO released a report on the antibacterial vaccines in the pipeline, calling for higher investment into vaccine candidates that can tackle drug-resistant bacteria. 

Vaccines exist to tackle four of the priority pathogens identified by WHO, but there are no vaccine candidates in the pipeline against six of the priority pathogens in WHO’s list including those that cause common infections like urinary tract infections and gastro-intestinal illnesses.  

Image Credits: Photo by CDC on Unsplash, Photo by Myriam Zilles on Unsplash.

Should the World Health Organization (WHO) intervene on social networks and other organic platforms that are providing health information? And, if so, how?

These were pressing questions raised on Tuesday during a webinar presented by the Global Health Centre at the Graduate Institute Geneva in coordination with the Digital Health and Rights Project. 

Project researchers and participants presented their findings from a transnational participatory action research study into young adults’ experiences with digital health in Bangladesh, Colombia, Ghana, Kenya and Vietnam, raising important questions around the role that the organized health community can play in regulating organic digital health content. 

They also offered policy recommendations and good practices to help challenge structural inequalities and meet the needs of young people in their diversity based on the results of their work. 

Tabitha Ha, an advocacy manager for STOPAIDS, called on WHO to update its definition of digital health to include Google and social networks as digital health platforms, which could then enable the organization to evaluate the health content on these platforms and support local health agencies doing the same.

But Ha cautioned that while there is a need for collective approaches to managing health data on the world wide web: “If an institution like WHO was to come in, how would that change the dynamics? It could potentially influence the way people use social media to create this type of [health] content.”

Maintaining basic standards

Ha and colleague, Stephen Agbenyo, executive director of Savana Signatures, recommended that WHO works from a distance, perhaps providing supervisory support and ensuring that certain basic standards are maintained, while not interfering directly with the content creators on the ground.

WHO could, for example, communicate with large tech companies about the need for relevant sexual health information to get out to youth, including more explicit information that may, at first glance, appear to violate community standards on some social platforms.

Terry Gachie, country coordinator for Love Matters Kenya, said that her team faces consistent censorship by the social networks – especially Facebook – for posting content that could appear to violate community standards when, in fact, this is the edgy information her constituents need to learn about sexual and reproductive health. 

“We want to speak their language. But what happens in most cases is that our information is flagged, perhaps labeled as escort services or inappropriate, and then taken down,” Gachie explained. She called on WHO to bring social networks into the conversation to help find a solution. 

“We need to ensure there are consistent conversations with big tech companies in terms of what young people want to see,” Gachie said. 

Finally, the issue of regulation was raised, less as a means to control the flow of information on social networks than to ensure that people accessing the information on these networks can feel safe. 

“How do we facilitate the relationship between disseminating accurate information to people who might be at risk, who might be marginalized, and who want to hop onto this platform to access that content?” Nomtika Mjwana, project manager for the Global Network of People Living with HIV, asked. 

Nomtika Mjwana

She recommended leveraging the direct involvement of young people and the communities who use these platforms to come up with data protection mechanisms so that people can trust the platforms they are on. 

This could mean finding ways to halt data security breaches before they happen, to ensuring that when a young person enters a chat room he or she will not be met with an imposter nor need to fear that the digital voice on the other end will engage in discriminatory or insulting behavior. 

These regulations could also include rules around the use of data, so that if a person is being asked to provide information about his or her sexual orientation or identity, there is an understanding of to whom that information is going and how it will be used. 

“It’s really critiquing the way we’re collecting certain types of data and how that data is going to continue to empower the people we are getting the data from, but also just doing a thorough scan, and understanding from people that we’ve defined as prospective users of the platform or people that will access the information, what are some of their fears, and how can we very actively and proactively ensure that some of those are at least incubated in the initial stages,” Mjwana said. 

Digital transformation 

The Digital Health and Rights Project, overseen by the Graduate Institute’s Sara Davis, came about as a result of the transformation of the world’s health systems by technology. 

“The global context for our study is really this very rapid rise of the digital transformation and digital health, which was of course accelerated by the COVID pandemic,” Davis said in her opening remarks on Tuesday. “Global health and national health agencies are really embracing this trend. In 2021, the World Health Organization launched a global strategy for digital health, which called on countries to strengthen health systems with digital technologies and data.”

She highlighted how global agencies are forming partnerships with big tech companies while, at the same time, there have been a lot of concerns raised by United Nations human rights experts and scholars about threats to privacy, non-discrimination and the threat of potential privatization of public services. 

Digital Health and Rights

“In addition, because we’re working closely with people living with HIV and vulnerable to HIV, we have over three decades of evidence showing the impact of stigma, discrimination, criminalization and gender inequality on health responses, and also the impact of these things on data, access to technologies and access to power in different forums,” Davis added. “We really wondered … how these inequalities would play out in the digital transformation.”

The project research was conducted in five countries and has so far included 174 young adults between the ages of 18 and 30, in addition to 83 key informant interviews. The report released Tuesday centered on efforts in Ghana, Kenya and Vietnam, and teased the results coming out of Bangladesh and Colombia, where the team just finished the fieldwork.

Empowering access

“One of our first key findings has been specifically based on the fact that young people actually appreciate having access to digital health technologies,” Mjwana explained. “They’ve described it as empowering.”

Google came up in a number of focus group discussions and some key informant interviews, along with social media and WhatsApp, as one of the most important ways in which people find information, a community, and safe spaces to engage and address some of the concerns that they had but did not want to address by going to health facilities where they might feel judged. 

“The online space has actually afforded some people a platform to not necessarily feel that they have to out themselves,” Mjwana said.

A second finding centered around the fact that a lot of inequalities seen offline continue to play a role in the online space, such as gender, socioeconomic status, education, language, disability, sexual orientation or even location. This could mean individuals not having the funds to purchase needed technologies, or experiencing censorship, violence or harm in the online sphere. 

“We’ve come to realize how the digital divide is actually intersectional,” Mjwana said.

Issues of surveillance and regulation also came out as concerns in the study. 

When people were asked where they think their data is going, many did not know and felt this was a concern that they had to deal with on their own. Some young people assumed their data was going to a third party, while others imagined the data was going to the platform itself or even the police. 

Digital health literacy and empowerment was also emphasized, as well as having a voice in policy making and calling on health officials to bring young people into conversations as champions on social media. 

Dr Mike Ryan, one of the senior WHO officials who has survived the cut, with Dr Tedros, and Maria Van Kerkhove.

Half of the World Health Organization’s (WHO) 16-member senior leadership team at the Geneva headquarters will leave the global body at the end of November, including Chief Scientist Dr Soumya Swaminathan and Dr Mariângela Simão, Assistant Director-General for access to medicines and health products.

The announcement of the departure of the eight senior leaders was made in a short email to staff by Director-General Dr Tedros Adhanom Ghebreyusus on Tuesday, thanking the leaders for their service.

Despite the low-key internal announcement, this is the biggest single leadership change that Tedros has made since 2019, two years after he took office, when he made a set of sweeping changes as part of his “Transformation” agenda for the organization. It has been anticipated for months by Geneva insiders who say the Director-General has been itching to shake up his team since being re-elected for a second term. Additionally, there have been pressures from large donors for Tedros to streamline his senior team, which was unprecedentedly large, and some said, top-heavy.  

Although Tedros said that the officials were all leaving because their appointments are coming to an end, he has obviously chosen not to renew the appointments of a number of those who are not at retirement age and were available.

Tedros said that the departing staff members had “contributed to a significant and enduring transformation of the organisation and helped steer WHO through a global pandemic that ravaged the health and well-being of the entire world and had a profound and ongoing impact on global public health”.

Thanking them, he added that they have made “a truly positive difference, and their legacy is a strengthened and more agile, equitable, and resilient WHO”.

Health Policy Watch was the first to report on Swaminathan’s departure in early October, reporting that the Indian paediatrician’s leadership style may have been too independent for Tedros.

Medicine access stalwarts

Dr Mariângela Simão, WHO Assistant to the Director General.

Swaminathan and Simão, who came to the WHO via UNIAIDS, have consistently  championed access to COVID-19 vaccines for low and middle-income countries, often criticising wealthy countries and pharmaceutical companies for obstructing this.

Simão has spent much of her career working to expand access to medicine, particularly for those living with HIV, and she served as Director of STDs, AIDS and Hepatitis Department in Brazil’s Health Ministry between 2006 and 2010, where she led successful price negotiations with pharmaceutical companies to lower the price of HIV medication

Dr Agnès Buzyn, the WHO Director-General’s Envoy for Multilateral Affairs, was recently appointed executive director of the WHO Academy in Lyon, and the former French health minister remains on the leadership team in her new role. Former French Global Health Ambassador Stéphanie Seydoux has already been announced as her successor.

Who’s out – and who’s still in?

On his way out: Dr Jaouad Mahjour

Jane Ellison, executive director for external relations and governance and former UK health minister, is also leaving, as is Dr Jaouard Mahjour, Assistant Director-General for emergency preparedness and international health regulations. Mahjour held various positions in the WHO’s Eastern Mediterranean Regional Office.

As previously reported, Dr Ren Minghui, Assistant Director-General for universal health coverage (UHC), and communicable and non-communicable diseases, also joins the exodus. Chinese national Minghui was previously director-general for international cooperation at the National Health and Family Planning Commission of China.

South African Dr Princess Nothemba Simelela, Assistant Director-General and special adviser on strategic priorities, who has been working on cervical cancer, is also departing. Simelela previously headed South Africa’s HIV programme. 

Key managerial appointments to the major WHO work clusters made in 2019, not including DGO advisors, most of which have left or will now be departing.

Finally,  Japanese national Dr Naoko Yamamoto, Assistant Director-General for UHC and healthier populations, will also be departing. 

The departure of WHO Deputy Director Dr Zsuzsanna Jakab, the 71-year-old Hungarian who is well over the WHO mandatory retirement age of 65, is also expected to be imminent. 

Also leaving are the WHO’s chief nursing officer, Dr Elizabeth Iro and Min-Whee Kang, senior adviser in the Director-General’s Office, neither of whom are part of the senior leadership team, as such.

Surviving the cut are Dr Mike Ryan, Dr Samira Asma, Prof Hanan Balkhy, Dr Ibrahima Socé Fall, Raul Thomas and special advisers Bruce Aylward and Peter Singer, alongside Dr Chikwe Ihekweazu, who was recently appointed as head of the WHO Hub for Pandemic and Epidemic Intelligence, and Stewart Simonson, who heads the WHO’s US office. 

Other than Seydoux, no replacements have been named. However, in light of the pressure Tedros has been under from member states, particularly the US, to cut costs, it is possible that he may also cut the size of his team.  WHO staff had also complained about the swollen management team, including the pattern of appointing senior advisors housed in the DGO’s office, who were not responsible for any particular WHO cluster, and enjoy exceedingly high salaries.  

Image Credits: Twitter: @WHO, WHO.

Ukraine
Russian airstrike hits Mariupol maternity hospital, 9 March 2022.

As the first snows fall across Ukraine, World Health Organization officials in Kyiv warn the coming winter will be “life-threatening for millions” of Ukrainians.

At a press conference in Kyiv on Monday, WHO’s European Regional Director Dr Hans Kluge called the Russian airstrikes on Ukraine’s energy and medical infrastructure “the largest attack on health care on European soil since the Second World War.”

“This winter will be about survival,” Kluge said. “Today 10 million people – a quarter of the population – are without power, and cold weather can kill.”

Russian forces have conducted 703 attacks on Ukrainian healthcare infrastructure since the start of their invasion in February. As of 16 November, 144 medical facilities have been reduced to rubble, according to Ukraine’s Ministry of Health. 

“This is a clear breach of international humanitarian law and the rules of war,” Kluge told reporters. “This war must end before the health system and the health of the Ukrainian nation are compromised any further. Access to healthcare cannot be held hostage.”

Kluge called on Russian forces to immediately open humanitarian corridors to the remaining occupied regions. Russia has so far blocked efforts by international organisations to deliver aid to the territories it controls, leaving many Ukranians cut off from the more than 9 thousand tons of medical supplies delivered by 35 countries from around the world since February. 

“This is an unacceptable situation,” Kluge said. “What’s happening in Mariupol, what’s happening in Donbas. We know there are 17,000 people with HIV in Donetsk alone who may soon run out of the critical antiretroviral drugs that help keep them alive.”  Donetsk is one of two major subregions in the historical Donbas in the eastern part of Ukraine, the other being Luhansk, where large parts of territory remain under Russian military control. 

In his appeal to the international community for further financial support for the Ukrainian health sector, Kluge outlined the actions being taken by the WHO and international partners to help Ukraine’s health system prepare for the coming winter months. 

These include repairs to health facilities, heating infrastructure and energy lifelines, and the provision of portable heating devices, medical supplies, diesel generators, and ambulances. 

“Ukraine’s medical system saves the lives of our citizens every minute – sometimes it takes minutes, so increasing the number of such machines increases the chances of providing timely and high-quality care and saving the lives of patients,” Ukrainian Minister of Health Viktor Lyashko said of the delivery of two ambulances to the Sumy region this week. 

The Government of Ukraine, WHO and key international organisations will hold a series of high level meetings to discuss support for Ukraine’s health care system over the coming days. 

“No primary health care centers” in war-torn east

WHO
WHO Europe Regional Director Hans Kluge and WHO Ukraine representative Jarno Habicht preparing to speak at a press conference in Kyiv on Monday. Journalists were warned of the possibility the session could be postponed if air raid sirens forced attendees to relocate to safety.

The most urgent mission facing the WHO and its international partners is getting aid to newly liberated territories like Kherson and Mykolaiv. Russian troops fleeing the cities left health, energy, water and sanitation infrastructure in total disrepair, spurring Ukrainian authorities to begin voluntary evacuations in the region amid fears of a humanitarian crisis brought on by arrival of the harsh Ukrainian winter. 

“In the newly liberated territories there is the big challenge non-communicable diseases, chronic diseases – diabetes, hypertension, chronic respiratory infections – because there is quite an elderly population,” said Kluge.

In Kherson, people did not have hot water or electricity for over two weeks leading up to its liberation by Ukrainian troops recently following a Russian withdrawl from the city. The Russian blockade of medical and humanitarian supplies has left food stocks running low, pharmacy shelves empty, and medical facilities without medicine. 

“In the liberated areas, there are no pharmacies,” Kluge said of his contacts with authorities and volunteer organizations on the ground. “There are not any primary health care centers functioning.”

Rolling blackouts hit homes and hospitals as winter approaches 

Kyiv
Temperatures in the Ukrainian winter can drop as low as -20°C.

Meanwhile, rolling blackouts caused by the continued Russian assault on Ukraine’s energy grid are threatening the ability of medical facilities to continue operating, and depriving civilians of heat for their homes, access primary and urgent care, clean water, and essential humanitarian services.

“Without electricity the machines in intensive care units stop working, surgeries cannot continue, and cold chain facilities needed for vaccines and medicines will be disrupted” said WHO Ukraine Representative Dr Jarno Habicht. “One can only imagine the impact on civilians across Ukraine.”

The latest WHO estimates put the average number of patients treated in the healthcare facilities forced offline by attacks across Ukraine at 421 thousand patients per month. Already short on capacity, the threat of the remaining maternity wards, blood banks, and intensive care beds not having access to the electricity needed to run incubators, refrigeration units and ventilators to Ukraine’s health systems is generating fears of a deadly winter.  

“We usually celebrate the snow,” Habicht said. “But this winter will be different.”

Almost one in five Ukrainians are unable to obtain the medicine they need. In the east, this number increases to one in three, the WHO said. Across the country, the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) estimates 9.3 million people require food and basic livelihood assistance, and 14.5 million are in need of health assistance.

COVID-19 threat heightened by arrival of winter

As of January, only one out of three Ukrainians remain vaccinated against COVID-19. It is during the winter season that respiratory infections are at their most dangerous, and coupled with the threats of pneumonia, influenza and a health care system under strain from the war effort, low-vaccination coverage poses a heightened risk. 

“Millions of Ukrainians have waning or no immunity to COVID-19,” said Kluge. “Couple that with an expected surge in seasonal influenza and difficulties in accessing health services, and this could spell disaster for vulnerable people.”

“Ukraine’s health system is facing its darkest days in the war so far,” he warned. “It is being squeezed from all sides, and the ultimate casualty is a patient.”

Elderly population at acute risk

Ivlev-Yorke
Many elderly people are not physically fit enough to evacuate by train on their own. Others are reluctant to leave their lives and homes behind.

At the onset of the war, hospitals and health facilities were asked to stop all non-emergency care in preparation for the burden of the wounded. This makes the elderly – especially those dependent on regular care for chronic diseases – acutely vulnerable. About 20% of the Ukrainian population is above the age of 60.

The reorientation of Ukraine’s medical system to wartime footing has left few staff available to provide primary healthcare for older people suffering from non-communicable diseases, and severely disrupted the availability of life-saving medications like insulin – especially in frontline regions.

“Access to healthcare, including primary care, has become extremely difficult,” Médecins Sans Frontières testified of their experience in Ukraine. “In combination with an already damaged and disrupted healthcare system, this creates serious issues for continuity of care [for patients suffering from chronic illnesses].” 

The social services relied on by many older Ukrainians have also been heavily impacted by the war, leaving many with no recourse to treatment.

The limited mobility of many elderly people also makes evacuation a more difficult task than for the young and healthy. Some choose to stay, unable to envision leaving the lives and cities they call home behind. 

Children caught in the cross-fire

A mother and her two children are evacuated from the frontlines of the Donbas region by an international team of volunteers.

War is particularly unkind to vulnerable populations, and the situation in Ukraine is no exception: children are caught in the cross-fire.

Today, some 3.4 million Ukrainian children need “child-protection interventions,” according to OCHA. These include services such as family tracing and reunification, psychological support and alternative care arrangements. 

As of 10 November, OCHA said 1.67 million children, parents and caregivers have received child-protection related support, with 650,000 children having received psycho-social support to cope with the traumatic effects of war and displacement. 550,000 caregivers – 71% of whom are women – who were provided sessions on supporting their children through the mental challenges of the war.

Caught between the mental weight of war and freezing temperatures, even warmth – absent access to clean electricity – poses its own set of dangers. 

“As desperate families try to stay warm, many will be forced to turn to alternative heating methods like burning charcoal, wood, or using generators fueled by diesel or electric heaters,” Kluge said. “These bring health risks, including exposure to toxic substances that are harmful for children.”

Many children have also been separated from their families as part of the thousands of Ukrainians forcibly deported to Russia and occupied territories since the start of the invasion. Exact numbers remain elusive, but the Ukrainian government has so far identified over 10,000 children matching this description.

Médecins Sans Frontières has reported treating patients as young as six-weeks old, and recent estimates count 437 children among the more than 8,300 civilians killed since February. The UN High Commissioner for Human Rights has confirmed an additional 505 children injured among the 10,000 injured civilians.

With no visibility on the situation in Russian occupied areas like Mariupol and casualty verification processes ongoing, the number is likely far higher.

October alone saw over 450,000 people flee to safety across Ukraine. Of these, 280,000 were people leaving the east of the country, according to the latest data from the International Organisation for Migration (IOM).

A total of 14.3 million Ukrainians have already been forcibly displaced by the conflict. As the harsh Ukrainian winter settles in, the WHO projects an additional 3 million will be forced to flee in search of warmth and safety over the winter.

Image Credits: Мstyslav Chernov, WHO, Mariusz Kluzniak, Ignatius Ivlev-Yorke, Ignatius Ivlev-Yorke.

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.