COVID-19 testing in Shanghai

China’s COVID-19 situation is getting worse, and strategies to control the spread of the Omicron variant are getting stricter as the country registered 20,472 daily cases on Wednesday – the highest-ever infection rate.

The epicentre of the outbreak is Shanghai, which recorded 17,007 cases on Wednesday and municipal authorities are conducting mass testing in the city populated by 26 million in an attempt to identify infected people and place them under quarantine.

Shanghai authorities have also been separating SARS-COV2 positive young children under the age of seven from their parents. According to reports, and videos on the Chinese microblogging application Weibo, children have been separated from their COVID-19 positive parents in Shanghai’s Jinshan district. 

The incidents of separation of young children from their parents were reported to be from the Shanghai Public Health Clinical Centre. This separation is a part of China’s strict zero-COVID strategy, a policy that has now been questioned for being overly regimented. 

Even as Shanghai health authorities continue to defend the policy of separating COVID-19 positive children from their parents, they clarified on Monday that if parents of COVID-19 positive children also test positive, they can isolate together and will not be separated. 

Wu Qianyu, an official from the Shanghai Municipal Health Commission said that according to the Law on the Prevention and Control of Infectious Diseases and the requirements for prevention and control work, infected people should be isolated from non-infected persons.

“In accordance with the principle of classified treatment, we have made it clear that if the parent of the child is also a positive infected person, they can live in the children’s area to accompany and care for them and receive observation and treatment together.” 

Zero-COVID policy under scrutiny

China is under scrutiny for sticking to its zero-COVID policy which includes strict isolation for those with COVID-19, contact tracing, and long lockdowns with very little movement allowed in cities with perceived outbreaks. If your area has been identified for mass-testing, you  cannot leave the home for any reason. 

Professor Antoine Flahault, Director of the Institute of Global Health at the Univerity of Geneva’s Faculty of Medicine, said that China’s “zero-COVID approach seems to continue to be effective up to date, at least in terms of reported numbers of contaminations and deaths which remain very low in comparison to other countries”.

According to Flahault, China fears a “Hong Kong scenario” since they share the same weakness in their vaccine coverage, with low uptake among the elderly population. Currently, only 50% of the population over the age of 80 is vaccinated in Hong Kong. 

Hong Kong has experienced a huge Omicron wave with one of the highest death tolls in the world that has overwhelmed health care system after the region gave up its zero-COVID strategy. 

“Continental China’s authorities believe they have no other choice today than maintaining their zero COVID strategy to avoid similar health disaster,” said Flahault.

China is one of the few countries where the zero-COVID strategy is still in action. Australia, Singapore, New Zealand also tried this approach but have abandoned it, Dr Flahault said. 

Weaker vaccines

“Hong Kong followed them in the midst of their crisis, but China and to a lesser extent Taiwan decided to keep it [zero-COVID strategy]. China probably hesitated and was expected to switch to suppression strategy after the Olympic Games,” he said. “Even as the strategy to suppress was less stringent than an elimination strategy, the Omicron variant changed the rules of the game.”

One of the disadvantages China faces is that immunity gained from two doses of its vaccines, Sinopharm and Coronavac, is only about 56% on average, while the mRNA vaccines, Pfizer and Moderna, have over 95% protection, said Sayantan Bose, Principal Scientist of Virology at Autonomous Therapeutics in the US.

Bose added that China is extremely capable of carrying out mass vaccinations and the regime could very effectively vaccinate the whole population with a third dose which would boost the immunity to a “large extent.”

“Ultimately, the virus has infiltrated the human population to such an extent that it will not completely disappear ever. We just have to figure out the best way to deal with it.”

According to the state media CCTV, China’s zero-COVID approach has “proved effective and necessary” in curbing the spread of the virus despite the recent flare-ups of the epidemic in multiple places across the country. 

Isolated in Shanghai

Shanghai is turning an exhibition centre into a COVID-19 hospital

Currently in Shanghai, all those who test positive for the disease – irrespective of whether they are symptomatic or asymptomatic – have to be isolated at a facility. This has brought fresh fears to people who will be separated from their young dependent children. Isolation is not limited to adults but also to children who test positive but whose family members do not. 

In its crackdown over the dominant omicron variant of SARS-COV-2 that has taken over the major financial hub, Shanghai has converted multiple hospitals, gymnasiums, apartment blocks and other venues into central quarantine sites. Further, according to media reports, Individuals who refuse to be tested for COVID for no justifiable reason will face administrative or criminal punishment. 

Shanghai’s lockdown was supposed to end this week, but it has been extended and military personnel have been deployed to Shanghai to assist in the mandatory screening. 

The images from the Shanghai health centre showed several young children crammed together in rooms with cribs and beds. The health centre, according to media reports, verified the images and said they were real and did not deny the separation of parents from their children. However, after gaining traction and attention of many shocked citizens, the post showing the reality of the children’s separation in Shanghai was deleted. 

According to a report in Reuters, children as young as three months old are being separated from their breastfeeding mothers. In a video shared by a popular Chinese science writer, children can be seen separated and crying in the health centre:

Booster doses are ‘a must’

Last week, China’s National Health Commission published new guidelines that narrowed down the geographic scope of mass testing and said that local governments must aim to complete testing of each designated area within 24 hours.

Such changes in protocols come after Chinese President Xi Jinping has pledged to achieve “maximum prevention and control” while minimising damage to China’s economic and social development earlier last month. 

According to Flahault, China seems determined to continue its zero-COVID strategy and make it a success, whatever social and economic costs.  

“It was a policy which was waiting for the vaccines, but vaccines never allowed for substantially contributing to elimination. By stubbornly continuing with the elimination strategy, Chinese authorities have no other choices now but to implement very tough measures which may become highly unpopular, and even strongly rejected by the population,” said Flahault.

However, Bose says that “it does seem like the zero-Covid policy is outdated as it is impossible to completely stop the virus from spreading in the population, even if you manage to vaccinate every single person in China”.

He said that, according to recent reports, immunity from these vaccines is waning quickly in China and a third dose is a must. 

“So overall, it appears that at this point in the pandemic, the Zero-Covid policy seems like more of a burden to the suffering population. It is unlikely to yield further success and in the end could just add to the suffering of the people and their lives could be further pushed into poverty,” said Bose.

Complex and difficult path out

Jeremy Farrar, Director of the  Wellcome Trust

Meanwhile, Jeremy Farrar, director of the Wellcome Trust, gave credit to China for having succeeded in controlling its COVID-19 pandemic with “minimal loss to life and impact on their broader health systems”.

“China have managed to control the pandemic to the point that there is no natural immunity.  Effectively they’ve had no real waves of this epidemic,” Farrar told a media briefing called by the International Monetary Fund on Tuesday.

However, he added that the vaccines China was using were “not quite as effective as some of the vaccines available in other parts of the world” and it had struggled to vaccinate “their most vulnerable populations, particularly people over the ages of 70”. 

“China has a very complex and difficult path out of this pandemic. What I hope that they do is to use the current programme of trying to reduce transmission whilst having a very active and inclusive ability to get vaccines out to everybody, particularly those who are most vulnerable. If they can buy time, like New Zealand did like Australia did, to get their vaccine programme out to as many people as possible including booster doses, I think that gives them the best strategy of trying to exit from the pandemic,” said Farrar.

Image Credits: CGTN, Wellcome Trust.

ICRC members prepare to deliver emergency supplies in Ukraine

Just as members of the International Committee of the Red Cross (ICRC) in the besieged Ukrainian city of Mariupol were released on Tuesday  by Russian forces, the humanitarian organisation warned that its resources are going to be strained in the coming months as it deals with the crisis in that country.

Dr Micaela Serafini, ICRC’s head of health, told Health Policy Watch that “until now we had reserves, but these are expected to be stretched too thin in the coming months. I think we will start to see the impact Ukraine will have on other emergencies we are trying to deal with, such as in Afghanistan or Myanmar.”

Meanwhile, the ICRC is juggling a range of other related new and old challenges, from the impact of climate change and planetary health on humanitarian crises to the challenge of assisting populations experiencing food insecurity as a result of war. 

These are all topics that ICRC will be addressing at the Geneva Health Forum, which takes place 3-5 May. This year’s forum will host six ICRC speakers, including a keynote address by ICRC president, Peter Maurer, and sessions ranging from Planetary Health, to Innovation in the humanitarian context.  

Serafini, an Argentinian-trained medical doctor, has been working in the humanitarian sector for 15 years. Before joining the Red Cross in January 2021, she served as medical director for Médecins Sans Frontieres (MSF). Her aim has been to influence international health policies to the benefit the most vulnerable patients and communities. 

In conflict zones, everyone suffers, but the weakest populations tend to suffer the most, she explained.

The main challenge is access

The ICRC health division was formed under the terms of the four treaties of the Geneva Conventions, and particuarly the Fourth Geneva Convention of 1949, as well as related protocols, which set out international legal standards for humanitarian treatment of combatants and civilians in war zones, Serafini explained. Aside from providing care, the organization strives for open dialogue with all parties in conflicts to ensure the protection of civilians and healthcare personnel, including their safe passage through conflict zones. It also strives to ensure that prisoners of war are given access to healthcare and are treated with dignity.

The organization has been active in Ukraine since 2014, but has scaled up its activities since the 24 February invasion. 

“I am worried about our employees in Ukraine,” Serafini admitted during a recent call, saying that the main challenge in Ukraine has been “access.”

“The security aspects make us go slowly, and it is sometimes impossible to get to that specific last line where most of the needs are,” Serafini said. “While we managed to get close to the frontline, we are not really close enough to those who are trapped in Mariupol, for example, or sometimes even parts of Kyiv.”

The ICRC is operating a hotline in Ukraine where people can call and get virtual help. 

Part of the challenge is that humanitarian space has reduced with time and health structures and health staff have become more of a target than they were before, she explained, noting that even if healthcare workers are given access to vulnerable people, they are not necessarily accepted or protected. 

“There are incidents in places that should be protected by international law and they are not protected anymore… Respect for international law is not as present as it was before. Of course, this makes the need for ICRC more important and present.”

Three-phase emergency response

An emergency has three phases, she said. The first is coming up with “bulk support” when the needs are still unclear, so you are just trying to help with whatever you can. The second phase is where you “fine tune the need” because you understand better, and the third phase is when you consolidate those needs.

“We are still in the first phase,” Serafini said. “Today, it is difficult to say if we had an impact or not.”

See the full GHF 2022 programme. Register here: Rates are tiered and early-bird fees range from CHF 300-100 for the in-person event, and CHF 200-70 for digital participation. Daily rates are also available.

This is part of a Health Policy Watch series of stories on feature themes at the 2022 Geneva Health Forum.

 

Image Credits: ICRC.

Rwanda, Africa
A volunteer helps a woman fill out paperwork before her COVID-19 vaccine in Rwanda.

Although the world is facing multiple simultaneous challenges including the war in Ukraine, the COVID-19 pandemic is not over and it is essential for countries to invest in systems to address this pandemic as well as future pandemic threats.

This is a key message of a new International Monetary Fund (IMF) paper, which is calling for an investment of $15-billion this year and $10-billion per year in future to fight COVID and other pandemics, as well as strengthening health systems. 

Gita Gopinath, the IMF’s First Deputy Managing Director, said that these figures pale in comparison to the cost of COVID-19 the world economies, estimated to have reached $13.8 trillion by January. 

Gopinath was speaking at the launch of an IMF paper published on Tuesday in partnership with the Coalition for Epidemic Preparedness Innovations (CEPI), the Global Fund, and Wellcome Trust, which calls for a more comprehensive and integrated pandemic response from the international community.

“It is now clear that COVID-19 is likely to be with us for the long-term. Given the many possible scenarios for the evolution of COVID-19, from benign to severe scenarios, and given the limited resources countries have, we need a new strategy,” said Gopinath, adding that the focus could no longer be only COVID-19 alone – or vaccines alone.

“Countries need a more comprehensive COVID-19 toolkit for fighting the pandemic that includes vaccines, tests, treatments – and bolstering the resilience of health systems so they are in a better position to tackle both COVID-19 and other deadly diseases in a sustainable, effective way.”

Vaccination plateauing, Africa lacks absorption capacity

Gopinath conceded that over 100 countries are not on track to get to 70% vaccine coverage by the middle of this year, including the United States, which is plateauing at 65%.

“Many other countries, including African nations, are plateauing at much, much lower numbers. And we know that the Africa Centre for Disease Control has also called for a halt to sending vaccines because they are facing absorption capacity and vaccine hesitancy,” said Gopinath.

Peter Sands, Executive Director of the Global Fund, said that while vaccines have been, and remain, our most powerful weapon in the fight against COVID 19, the world needs a more comprehensive response. 

“The inequities in vaccine distribution have actually been exceeded by the inequities in, say testing, or the provision of oxygen. And we now have the prospect of novel antivirals that could also have a very significant impact on mortality,” said Sands.

“The advantage of moving from vaccine-only or very heavily vaccine approach to one which is kind of vaccine-plus, with a great with more emphasis on these other aspects of the response, is that it’s more resilient. It gives you better ability to detect variants, and also more resistant to different types of variants that might evolve,” said Sands.

However, vaccination of the most vulnerable people was of “utmost importance” – but there are “no silver bullets”, and a multi-pronged approach, Gopinath stressed.

The IMF has indicated that it is considering establishing a Resilience and Sustainability Trust (RST) to provide affordable long-term financing to support countries as they tackle structural challenges, including pandemic preparedness.

One in 12 Londoners have COVID

Wellcome Trust director Jeremy Farrar said that one in 12 people in London were infected with COVID-19, and the pandemic was clearly far from over.

“We have many parts of the world without access to vaccines, and we have many parts of the world where transmission remains very, very high. That throws up the possibility of new variants that will escape our current vaccination and current immunity,” said Farrar.

“The actions that we take now, the reforms that we put in place, the financial support we give, will enable a pandemic and its acute phase to come to an end quicker and allow all our societies, all of our economies to get back on track faster,” he added, warning that without an adequate response, COVID-19 would “continue to reverberate and disrupt the whole of societies for many, many years to come”.

Farrar said that the “last thing” that should happen is for vaccine manufacturing capacity to be scaled down.

Image Credits: WHO.

Anyang, China in January 2022. Despite significant efforst to clean up emissions, severe air pollution still persists in parts of China while South-East Asia, Africa and the Middle East are among the world’s pollution hot spots according to the largest-ever collection of WHO data.

In its largest release of data on air quality ever, WHO has found that most of the world’s population are breathing unsafe levels of air pollutant – particularly fine particulate matter (PM2.5)  and Nitrogen dioxide (NO2) – which cause excess illness and premature death from respiratory disease, as well as from cardiovascular disease and cancers. 

“Air Quality is poorest in specific regions, like the Eastern Mediterranean Region, the Southeast Asian region and also Africa, said Sophie Gumy, WHO technical officer of the updated data at a press briefing on Monday.  

Of the 117 countries now monitoring air quality, only 17% of cities and settlements, in mostly high-income areas, have air that meets WHO’s recently-updated Air Quality Guidelines for particulate matter.    

In low- and middle-income countries, less than 1% of settlements that measure air quality comply with WHO recommended thresholds for small particles – the pollutant most closely associated with air pollution-related premature mortality.  

Globally, only about 1% of the world’s population breathes air that meets WHO air quality standards, according to the new WHO assessment, which also analyzed air quality data from satellite images and measurements, along with the ground monitoring data collected from 6,000 cities and settlements across the world.

Only 3% of settlements in the Western Pacific and African region and only 13-23% in the Americas and Europe have safe air. In WHO’s South-East Asia and Eastern Mediterranean regions, no settlements measuring air pollution meet WHO Air Quality Guidelines for levels of fine particulate matter (PM2.5, annual average). More settlements meet “interim” WHO target guidelines (IT1-4).

Compared to the last analysis of air quality data by WHO in 2018, the proportion of cities and settlements compliant with WHO air quality guidelines, has in fact dropped sharply. That is due to the fact that WHO tightened its limits for key pollutants like PM 2.5 and NO2  in 2021. 

The 2021 WHO guidelines cut the annual average limit for safe PM2.5 by one-half, from 10 to 5 micrograms per cubic meter of air (10µg/m3 to 5µg/m3). The limit for safe NO2 levels was reduced by three-quarters. The WHO update was based on over a decade’s worth of new evidence that has strengthened the link between death and illness from key air pollutants.   

In terms of air pollution levels, China, once considered the world’s air pollution hot spot still has dozens of cities with annual PM2.5 air pollution levels that are 15-30 times higher than WHO’s new guideline average of 5µg/m3.  But it is now outpaced by India where Delhi reported an average annual PM2.5 level of 105 µg/m3, 21 times higher than WHO’s new guideline limit for PM2.5, according to 2019 data. 

India’s pollution levels, among the hightest in the world.  Pollution in Delhi peaks in late autumn when burning of rice stalks in rural areas drifts into the city, exacerbating urban sources.

However, the latest data published by WHO on Delhi hearkens back to 2014. Although more recent Indian data is available, a lack of endorsement from government officials can leave WHO unable to publish more recent synthesis of the numbers.

In the Eastern Mediterranean region, which stretches from Afghanistan as far west as Morocco, cities in Pakistan, Iran, Iraq, Egypt and Gulf States like Saudi Arabia and Bahrain were among those with the biggest air quality problems – with some cities exceeding WHO guidelines by a factor of 20 or more. However, there are comparatively fewer settlements measuring air pollution at all.  In Africa, only about 200 cities have reported data, with South Africa among the few countries consistently reporting. Bamenda, Cameroon and Kampala, Uganda were among the continent’s hot spots, with 132 µg/m3 and 104 µg/m3 of average annual PM 2.5 respectively.

Some politicians in arid parts of the Middle East, Asia and Africa argue that dust storms drive up measured levels of particulate air pollution in many cities of the region, distorting the data. However, the fact that NO2 levels, produced by both gasoline and diesel vehicles, also are very high, reflects the fact that overall, air pollution is still largely a product of humans, said Gumy.  In addition, WHO measurements are based around annual averages of air pollution, and not peaks that occur during dust storms.  

Rich regions fare much better

In WHO’s European region, the highest air pollution concentrations are several orders of magnitude lower than Asia and Africa.   Major hotspots were in Tajikistan, Bosnia and Herzegovina, Turkey, Poland and Czechia, where PM2.5 concentrations ranged from 8-14 times higher than WHO Guideline limits – while the United Kingdom, Israel, Spain  and France also showed mediocre results – although in the case of many European cities, as well, data is five years or more out of date.  On the other end of the spectrum,  cities in Scandanavia, Germany,  Finland and Estonia, Spain  were among the lucky ones with the best air quality, meeting WHO recommended limits.

In the Americas, cities and towns in North America’s Canada and the US boast the cleanest air, with hundreds meeting the WHO guidelines for PM2.5 – while those in Latin America generally fare worse.

Globally, NO2 pollution levels much more evenly distributed between rich and poor regions of the world – reflecting perhaps the lower priority that has been placed in curbing emissions of this pollutant -heavily emitted by diesel and gasoline vehicles – and even those newer models.

NO2 had been receiving more and more notice, however, from both health and climate activists. It is a leading ingredient in the development of ground-level ozone, which is in turn a short-lived climate pollutant. It now understood as a major factor in childhood asthma. And ozone also stunts crop growth as it drifts from cities across nearby rural areas – which in turn lowers economic outputs and creates risks for food security.

Unprecedented number of cities collecting air pollution data 

Average concentrations of fine (particulates) PM2.5 air pollutants show highest levels in low-income regions, primarily Africa, the Middle East and South-East Asia, according to new WHO data

The new WHO report is the first to capture data on NO2.  It found that about 4,000 cities/human settlements in 74 countries are now collecting and publicly reporting on nitrogen dioxide levels.   Among those, only 23% of cities and communities meet WHO  annual average concentrations for NO2, now set at 10 µg/m 3.  The WHO guideline limit for NO2 was also sharply last year reduced from its previous limit of 40 µg/m3  – based on new data about the associations between nitrogen dioxide exposures and chronic respiratory illnesses, including childhood asthma. 

The new WHO reflects the unprecedented number of cities worldwide that are now collecting data on air quality, which is a good thing – despite the results that the data reveals, WHO officials said.  

“This report shows that some 6000 cities are now monitoring the quality of the air that we are breathing,” said Maria Neira, Director of WHO’s Department of Environment, Climate Change and Health.

“Maybe we can say that 6000 is not enough. We have many cities around the world but compare with what’s happening previews here. This is a very important increase in the willingness by cities to measure the quality of that we are breathing.” 

Speed up clean energy transition – WHO Director General 

Along with traffic, other major sources of ambient (outdoor) air pollution include: industry, waste incineration, particularly in open areas in low- and middle-income countries, and the use of highly polluting coal, kerosene and biomass for heating and cooking in poor households.  

Together, air pollution is estimated to kill some 7 million people a year, WHO says.  

Particulate matter, especially PM2.5, is capable of penetrating deep into the lungs and entering the bloodstream, causing cardiovascular, cerebrovascular (stroke) and respiratory impacts.  There is emerging evidence that particulate matter impacts other organs and causes other diseases as well.

Traffic jam in Dhaka (Bangladesh) – Heavy traffic is a major source of NO2 emissions, as well as small and fine particulates (PM 10 and PM 2.5) that kill millions every year.

NO2 is associated with a range of chronic respiratory diseases, including asthma, leading to respiratory symptoms (such as coughing, wheezing or difficulty breathing), hospital admissions and visits to emergency rooms. 

Most of the sources of air pollution are also climate drivers, particularly fossil fuels used in transport, heating and electricity production. And that highlights further the urgency of transitioning to cleaner and greener energy, WHO stressed in a press statement.

“Current energy concerns highlight the importance of speeding up the transition to cleaner, healthier energy systems,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.  “High fossil fuel prices, energy security, and the urgency of addressing the twin health challenges of air pollution and climate change, underscore the pressing need to move faster towards a world that is much less dependent on fossil fuels.”

WHO also called for policymakers to accelerate adoption and enforcement of national air quality standards in line with the latest WHO Air Quality Guidelines. Many countries that suffer from air pollution, such as India, still have air pollution limits that far exceed those deemed safe by WHO – although those, too, are regularly exceeded during peak air pollution periods such as the late autumn.

Countries and cities also need to do more to identify key sources of air pollution and then support transition to cleaner alternatives for energy, transport and waste management in particular, WHO said.  Those include: 

  • Support the transition to exclusive use of clean household energy for cooking, heating and lighting; 
  • Build safe and affordable public transport systems and pedestrian- and cycle-friendly networks
  • Implement stricter vehicle emissions and efficiency standards; and enforce mandatory inspection and maintenance for vehicle
  • Invest in energy-efficient housing and power generation
  •  Improve industrial and municipal waste management;
  • Reduce agricultural waste incineration, forest fires and certain agro-forestry activities (e.g. charcoal production).

–Updated 14 April, 2022, with 2019 value for air PM2.5 pollution in Delhi, replacing the older 2014 value.

Image Credits: Rashed Shumon, V.T. Polywoda, World Health Organization , Flickr, World Health Organization , Flickr – joiseyshowaa.

As much as 99% of the world population breathes in air with pollution levels higher than WHO’s permissible limits. The majority of the world’s most polluted cities are in South Asia. Air pollution is linked to higher rates of miscarriages, pregnancy complications and stillbirths, affecting women’s reproductive health.

pollution
Women from Raipur, India commuting to work. Air pollution in South Asian cities have direct consequences on pregnant women and their births.

The pandemic is always on the back of Riya Gupta’s mind. As a pregnant commuter in Delhi, one of the world’s most densely populated cities, she worries about reports that COVID-19 can result in complications and affect her baby’s development. But while the sense of urgency around the pandemic recedes, another source of concern looms larger: air pollution.

If COVID-19 is a “direct killer”, Gupta, who works in public health communications, calls air pollution “the slow killer”.

“I’ve been coming across research recently on how [air] pollution, specifically in Delhi, would have direct consequences for my child, both in terms of weight and increasing the risk of prematurity,” said Gupta. “Given that I’m in my second trimester right now, all of this does scare me a lot.”

Gupta’s hometown Delhi is the world’s most polluted capital, according to data from IQAir, a Swiss company that collects real-time air quality information. The problem is a truly global one – as much as 99% of the world’s population breathes in air with pollution levels higher than World Health Organization (WHO)’s safe limits. But the highest levels are found in poor and developing countries, where most of the seven million annual deaths linked to air pollution are concentrated. 

Public health officials have mostly focused so far on respiratory diseases and the impact on young children. With relatively little research available on the impact of air pollution on women’s reproductive health, or the different ways in which men and women are exposed, the issue has mostly slipped under their radar. 

“Exposure to air pollution during pregnancy is associated with complications or adverse events during pregnancy (e.g., preeclampsia, miscarriage, gestational diabetes, high blood pressure) and adverse birth outcomes such as pre-term birth, low birth weight or in some cases, stillbirth,” said Pallavi Pant, a senior scientist at the Boston-based Health Effects Institute. “Some studies have also linked air pollution with lower fertility rates or depression among pregnant women.”

Indoor air pollution from cooking also contributes to poor health outcomes.

It is not just outdoor air pollution – women in the densely-populated region are also disproportionately hit by high levels of poor-quality air indoors as they tend to be primarily responsible for cooking, and firewood continues to be widely used as a source of cooking fuel, emerging studies show. In India alone, an estimate finds that 0.61 million deaths were attributable to indoor air pollution, though the data was not segregated by gender. 

“Lack of access to clean energy also means that women are often responsible for collection of fuelwood, and this takes time away from other productive or recreational tasks,” said Pant, a key contributor to the State of the Global Air report, which provides annual analysis of global trends in air quality and its impact on health. And as indoor air pollution also affects young children, women are saddled with the dual burden of caring for their own health as well as that of a sick child.

Much of this evidence has only emerged in recent years, as availability of data has improved.

Climate gains of improving air quality

Pollution levels are significantly higher in much of the developing world. It is worst in South Asia, where in 2021, 18 of the world’s 20 most polluted cities were spread across the Indo-Gangetic plain in India and Pakistan. Four of the 10 worst countries for air pollution according to IQAir are in South Asia: Bangladesh, Pakistan, India and Nepal. 

Here, most people breathe air with pollution levels several dozen times higher than the WHO safe limits, according to the State of the Global Air report 2020 released this March. And not much appears to be changing. The report found that air quality in India and Nepal in particular had shown very little improvement over the past decade. Existing research estimates the current air pollution could shave off up to a decade from the life expectancy of people in the region. And some modeling studies suggest improving air quality in South Asia alone would prevent 7% pregnancy losses in the region.

Many of the particulate pollutants that cause air pollution also contribute to the greenhouse effect and global temperature rise, according to the WHO, whose director for public health and environment Dr Maria Neira has, for the past few years, been making the case that the solutions to cleaning up our air will also have clear climate gains. 

Benefits to women go beyond better air quality

Women were more likely to be exposed to outdoor air pollution as most women walk to work.

Solutions to improve air quality could also have other benefits. Investments in cleaner household cooking and lighting solutions, including more renewables such as solar electrification and biogas, fuel go hand in hand with expanding affordable, reliable and modern energy access, a key UN Sustainable Development Goal (SDG 7). Moreover, expanded access to clean cooking fuels reduces the need for time-consuming wood and biogas gathering, usually done by women and girls, thus leading to gains in health and gender equality, said Pant. 

In the meantime, policy makers need to factor in gender differences in exposure levels, said Azra Khan, a program manager with the cities and transport team at the think tank WRI-India. 

Along with breathing in more polluted air in the home, women are more likely to be exposed to air pollution outdoors, she said. One pilot study in India’s Bhopal city found women were more likely to walk to work and hence breathe in higher levels of outdoor air pollution during their daily journeys to and from home.

Women engaged in low-paying jobs work such as like street sweeping, construction and street vending also face high levels of exposure, said Khan, observing that most data on gender inequalities in air pollution exposures focused on household air pollution. 

“But what beyond that, and how is it [air pollution] contributing to their overall health outside of their caregiving responsibilities?” Khan asked. “ That data is not there.”

Authorities don’t factor gender into solutions

Authorities do not currently factor gender in their solutions. Tanushree Ganguly, an air quality researcher at the Council of Energy, Environment and Water (CEEW), and her collaborators examined 102 air cleaning plans for Indian cities. She pointed out that though India’s National Clean Air Programme (NCAP) refers to the impact of indoor pollution on women and children, the city-level plans do not explicitly look at gender.

“[If] I’m undertaking actions which are aimed at reducing air pollution, they all impact the residents of the city, which of course includes women and children,” Ganguly observed.

One of the few national initiatives that does target women is, a flagship government program on household air pollution called Pradhan Mantri Ujjwala Yojana. It that aims to enable rural and poor households  to transition to cleaner cooking fuels by providing them with cooking gas cylinders, but has met with limited success as gaps remain. 

In terms of ambient air pollution issues, localized strategies such as the erection smog towers in Delhi also have failed to make an impact, while large scale initiatives supporting methods like transitioning to renewable energy appear promising but so far haven’t made a significant difference to air pollution as the country still heavily relies on highly polluting coal-powered thermal power plants.

While people can limit their exposure to air pollution by using air purifiers when indoors, there is not much they can do when outdoors, said Ganguly. Cities will have to find ways to promote clean transportation, improve waste management and reduce dust.   

Gupta, who grew up in Delhi, is resigned to breathing in polluted air, saying that even after installing indoor air purifiers there is only so much control she has over her immediate environment. “I have to travel to work. No matter what I do, I am exposed,” she said. 

This story was co-published with The Fuller Project

Image Credits: Prem Kumar Marni/Flickr, Sandeepachetan/Flickr, Niklas Morberg.

Indian children have to stay indoors in certain areas because of extreme heat.

When schools closed for the summer in March, the vibrant sound of children playing on the streets of Mumbai was conspicuously absent as they stayed indoors to avoid the scorching heat.

The early onset of heatwaves this year has affected several parts of India just as citizens were getting back to normal life after the Omicron wave subsided. The Indian Meteorological Department (IMD) noted that “heatwave to severe heatwave conditions were observed” in several parts of the country, with temperatures reaching 39 to 41 °C, which is  4 to 6 °C above normal.

The IPCC 6th assessment report (AR6) on ‘ Impacts, Adaptation and Vulnerability’, released this February, highlights heatwaves and rising surface temperatures as one of the major climate challenges faced by India. The report states that with increasing urbanization and land-use change, more people are likely to be vulnerable to heat stress.

“The frequency and intensity of heatwaves will increase exponentially as unplanned anthropocentric development has disrupted the landscape, and proper circulation of warmer air from land to oceans and vice-versa is not taking place,” Abinash Mohanty, program lead for the Council on Energy, Environment and Water (CEEW), New Delhi, told Health Policy Watch.

Last year, a CEEW analysis found that 45% of India’s landscape has been disrupted by unsustainable planning, and this is triggering microclimatic changes, such as surges in heatwaves and other extreme weather events.

Trapped heat 

“Further, heat islands are being created – imagine having a heater in your room on a warm day – where the heat is trapped and cannot go out. This is seen more in urban hamlets because urban areas also emit a lot more carbon emissions that increase the local temperature,” Mohanty added.

Chandni Singh, Senior Research Consultant at the Indian Institute of Human Settlements in Bangalore and a lead author of the AR6 report warned that India faced more heatwaves.

“The IPCC report says that the globe has already warmed by 1.1 °C above pre-industrial level.  India has warmed by 0.9 °C on average. If we continue to emit as we are doing now, we will see more heat waves – especially in cities, where we are seeing hot days, and hot nights,” Singh told Health Policy Watch.

She explained that after a hot day, cool nights were important to enable the body to recuperate from the heat. But if the night is also hot, this will have a negative impact on the health of many people, particularly those who work outdoors or in small, poorly ventilated, rooms, people with comorbidities, children, older people and pregnant women.

Exacerbating inequality

Anjal Prakash, also a lead author on the AR6 report and research director of Bharti Institute of Public Policy at Hyderabad’s Indian School of Business, said that the IPCC assessment emphasizes the fact that social and economic inequities compound vulnerability to climate change and could further exacerbate injustices, as well as constrain climate actions. 

“People and livelihoods that are climate-sensitive will be directly affected. “Agriculture, fisheries and coastal and Himalayan ecosystems will have bearing on around 60% of people in India who are directly dependent on these primary sources of livelihood,” Prakash told Health Policy Watch.

The IPCC assessment uses the wet-bulb globe temperature – an index of the impact of heat and humidity combined, to gauge the impact of heat stress. The critical wet bulb temperature threshold above which humans are unlikely to survive is 35°C.

“in some of the densely populated regions of South Asia, the critical threshold of the wet-bulb temperature of 35 °C will be exceeded under the business-as-usual scenario of future greenhouse gas emissions. Based on this, it is most likely that India will be facing the issues of heat and humidity, the decline in glacial mass balance, sea level rise and cyclones,” said Prakash.

Meanwhile, Singh pointed out that, in many coastal areas across India, we have already reached wet-bulb temperatures of 24 to 25 °C. 

“If carbon emissions are not mitigated, we can hit 35 °C by 2050/2060- we are not adequately thinking about the impacts of this,” she added.

More heat stroke and tropical diseases

Heatwaves since the 1990s have claimed 17,000 deaths in India and impacted health. 

“Heat stress affects health, productivity and livelihoods. Exposure to heat causes heat exhaustion. If this is not treated, it will lead to heat stroke where fatality is very high,” said Rohit Mogatra, deputy director of Integrated Research and Action for Development in New Delhi.

“Unfortunately, people are not aware of how heat affects them since they are living in a tropical climate. Even doctors have trouble identifying if the patients are suffering from normal fever or heat stroke,” added Mogatra.

Training doctors, providing oral rehydration solutions in Primary Healthcare Centres (PHCs), ensuring access to drinking water, clean toilets, and proper housing design are important measures to adapt to heat stress, he said.

Increasing temperature also changes the transmission of vector-borne diseases such as dengue and malaria.  

“Places that were not seeing these diseases will start seeing incidences. Dengue could spread to the foothills of Himalayas and places where the disease is prevalent, may have increasing incidences,” said Singh.

Ministry of Climate?

However, the future is not all bleak. India has introduced some adaptation policies such as early warning colour coded alerts issued by the IMD. For coastal cities, a yellow alert is issued at 35.9°C, orange at 41.5°C, and red at 43.5°C, for cities with a dry and arid climate, orange is 43°C  and red at 45°C, and for hilly regions above 30 °C is considered a heatwave.

Other initiatives include heat action plans (HAPs) and cool roofs, which have helped to  reduce loss of lives, but there are still gaps in implementation of these policies.

But Singh opined that while heat action plans are doing well, as are other measures such as shifting neonatal wards to lower floors and asking people to stay indoors, these are short -term measures. What is lacking is the link between HAPs and city development plan, she said.

“For example, how can we harness green cover to mitigate heat? Low-income groups have very low green cover as they are densely populated. Where do you plant tress with space constraints? Can we look at other forms such as terrace gardens or balcony gardens? There is anecdotal evidence that this helps people feel the reduction of temperature in their homes.”

Meanwhile, Prakash advocated for a separate ministry for climate change staffed by climate scientists and climate change practitioners to work in the science-policy-diplomacy space “so that we have the required acumen and skills to combat climate change at the central level”.

 

Image Credits: Loren Joseph/ Unsplash.

Kenya
Selena Ruto, community health volunteer visits the Kibet family in Narok County, Kenya to discuss the risk of anthrax.

The COVID-19 pandemic has pushed the scientific community to start to implement a  ‘One Health’ approach – encompassing people, animals, plants and the environment – to ensure the early identification of infectious diseases and make the world a healthier place.

The issues that “One Health” may tackle are diverse. They can range from curbing deforestation to prevent new pathogens from being released from the wild to targeted efforts to improve sanitation and food safety in slaughterhouses, to vaccination as an alternative to the overuse of antibiotics in both humans and animals.

‘One Health’ is a key theme at the upcoming Geneva Health Forum, but it is often difficult for many people to fully understand what it means.

Until the pandemic, ‘One Health’ was often consigned to the margins of health agendas. But the importance of a holistic approach to health across species became evident when it emerged that the SARS-CoV2 virus was likely to have originated in a bat and could have been transmitted to humans via infected mammals that were housed and slaughtered in unsanitary conditions at a marketplace in Wuhan, China.

Freshly slaughtered animals in a market in Wuhan, Hubei, China

Suddenly, the once-obscure ‘One Health’ approach has become a broad international movement supported by the World Health Organization (WHO), the Food and Agriculture Organization (FAO), the World Organization for Animal Health (OIE) and, most recently, the United Nations Environment Program (UNEP).

There has been some heated debate about the definition of One Health, Dr Rafael Ruiz De Castañeda, a researcher and lecturer in the Institute of Global Health at the University of Geneva, told Health Policy Watch.

Only in December 2021, did an inter-agency One Health High-Level Expert Panel (OHHLEP) roll out a formal definition. This definition states: “One Health is an integrated, unifying approach that aims to sustainably balance and optimize the health of people, animals and ecosystems. It recognizes the health of humans, domestic and wild animals, plants, and the wider environment (including ecosystems) are closely linked and inter-dependent.”

According to OHHLEP, One Health collaborations will contribute to protecting health and addressing the full spectrum of disease control challenges, while improving and promoting health and environmental sustainability.

“One Health is the added value of a close cooperation between human and animal health experts and those working in related disciplines,” Dr Jakob Zinsstag-Klopfenstein, deputy head of the Department of Epidemiology and Public Health at the Swiss Tropical and Public Health Institute, told Health Policy Watch.

Ruiz de Castañeda describes the approach as “transdisciplinary”, encompassing veterinary health, human health disciplines, natural and environmental sciences, and even social sciences and the humanities. It also engages non-academic actors, including civil society and communities affected by the health problem that can become active players in the One Health approach.

“One Health has sometimes been criticized for remaining too high level and we need to make it more operational and implementable at the national and subnational levels,” Ruiz de Castañeda said.

Geneva Health Forum

At the next month’s Geneva Health Forum (GHF) from 3 to 5 May, One Health is a key point of focus, within the broader theme of the conference, which is the COVID pandemic and the environmental health emergency.

The event will kick off with a high-level discussion on why One Health is a “paradigm shift” requiring much closer cooperation between health and the environment sectors as well as between human health and animal health sectors.

Addressing the link between health and environment is critical because climate change, deforestation, biodiversity loss and unsustainable urbanization have increased the risks of human infection from pathogens once harbored mainly in the wild – from insect-borne diseases like dengue to pathogens carried by birds and mammals, including Ebola virus, coronaviruses, influenza viruses and more.

At the same time, the overuse and misuse of many drugs in both animal health, as well as human health, is increasing the threat of antimicrobial resistance – which also increases future pandemic risks.

Among the One Health sessions, Ruiz de Castañeda will take part in a panel entitled “Science and Global Health Diplomacy to Preventing and Tackling Pandemics: Opportunities and Challenges for One Health.” He and other speakers will address how diplomacy and international cooperation can further contribute to One Health research and action, and how systemic, integrated and cross-sectoral approaches in science and global health practice can support cooperation.

Other sessions will include: a look at achieving more sustainable antibiotic access using a One Health approach, how the private sector could be a key player in the operationalization of the One Health concept and what training might be needed to move One Health forward.

Finally, Zinsstag-Klopfenstein will run a workshop on the One Health model as it pertains to the health of nomadic pastoralists, of which there are an estimated 50 million to 200 million globally. Pastoralists have frequent exposure to animal reservoirs of pathogens with emerging epidemic potential.

An integrated approach to surveillance

Kenya
Selena Ruto, community health volunteer visits the Kibet family in Narok County, Kenya to discuss the risk of anthrax. Droughts in the area often push herders to seek greener pastures in areas where wild game mingle, and this can put herders’ families at risk too.

As the COVID-19 pandemic continues to surge in countries worldwide, the discussion will focus on how to implement an integrated approach to epidemiological surveillance in humans and animals.

“Studies have shown that two-thirds of emerging infectious diseases emerge from animals,” Ruiz de Castañeda said – usually wild animals, but sometimes livestock. This phenomenon is expected to grow due to anthropogenic pressure on the environment. But he said that we often fail to catch these pathogens on time, detecting them when they are already in humans, which “puts up behind an epidemic and potential pandemic.”

An integrated approach to epidemiological surveillance in humans and animals could detect these pathogens in animals before they reach humans or when only a few humans are infected, which would save time, money and improve public health outcomes.

This is already working in Italy, for example, Zinsstag-Klopfenstein explained. Since 2012, the country’s health services have managed an integrated approach to surveillance of West Nile virus. This is an arbovirus first identified in Africa that is transmitted by mosquitoes, infecting wild birds, horses and humans. With warmer temperatures it has been found in Europe and the United States, after being first discovered in New York state in 1999. That programme has shown evidence of cost-effectiveness.

“The earlier a zoonotic pathogen can be detected in the environment, in wildlife or in domestic animals – and the better human, animal and environmental surveillance communicate with each other to prevent an outbreak – the lower are the cumulative costs,” wrote Zinsstag-Klopfenstein and his colleagues in a paper titled “Why One Health?”, published by CAB International in 2021.

In contrast, a lack of integration and collaboration can have detrimental effects, according to Zinsstag-Klopfenstein. In a recent outbreak in the Netherlands of Q-fever, a disease caused by the bacteria Coxiella burnetii, public health authorities were not informed by veterinary authorities about a wave of abortions in goats. Likewise, outbreaks of Rift Valley fever in humans in Mauritania were misidentified as yellow fever until public health services contacted livestock services and learned about the occurrence of abortions in cattle.

One Health: the human and livestock nexus

Another area where One Health could have an impact is in terms of food security and nutrition, Zinsstag-Klopfenstein told Health Policy Watch. That’s because, for a large portion of the developing world, animals directly provide physical and financial sustenance.

“Animals play a very important role in most semi-arid areas, such as Mongolia or among the Bedouin community in Israel’s Negev,” Zinsstag-Klopfenstein said, adding that even in the Swiss Alps “if you do not want to survive on tourism, you need a cow. A cow can convert grass into milk. If a drought comes and there is no grass, you have nothing.”

While a farmer can grow fruits and vegetables, the harvest is usually only once or twice a year. A chicken, in contrast, can lay an egg a day and a goat can provide a litre of milk, providing a family with daily income.

Around 800 million small-scale farmers rely on livestock production to keep themselves out of extreme poverty, so maintaining the health of livestock is essential, added Zinsstag-Klopfenstein.

Ways need to be found to improve animal health while controlling the overuse of antibiotics, which also are critical to human health,and can lead to antimicrobial resistance.

Ugandan dairy farmer Tony Kidega has taken a keen interest in turning the tide of antimicrobial resistance (AMR) in his country.

Sometimes there are unexpected benefits. Zinsstag-Klopfenstein highlighted an example in Chad, where a team of doctors and veterinarians discovered that more cattle were vaccinated than children against childhood diseases.

“Recognition of this fact enabled subsequent joint human and animal vaccination campaigns, providing preventive vaccination to children who would otherwise not have had access to health services,” he wrote. “This is one of the rare and first examples of One Health in healthcare provision, where you can save money from working together to provide health services.”

He said it could work for the eradication of rabies, too. Today, humans are vaccinated against rabies if they are bitten by a dog, in what is a painful and prolonged series of shots. But if you want to eliminate the disease, you really have to vaccinate the dogs once or twice.

Case study: Snakebite envenoming

While better infectious disease surveillance and prevention is the major value of a One Health approach, improved diagnosis and treatment are important as well. This is particularly true for neglected tropical diseases (NTDs), which by their nature often lack high-quality medicines and vaccines and because many of these diseases involve animals, Ruiz de Castañeda told Health Policy Watch.

“If you look at the problem only with a human perspective, you are often missing a big part of the problem. You need a broader systemic One Health approach to understand, prevent and better control NTDs,” he said.

One example is snakebite envenoming, in which Ruiz de Castañeda has done extensive research.

Snakebites kill between 81,000 to 138,000 people every year, according to the latest research. And most victims are among the world’s poorest, living in rural Africa, Asia and South America. It was only in 2017, that WHO included snakebite envenoming on its list of neglected tropical diseases.

Because anti-venom treatments are often hard to access, snakebite is often fatal. In Nepal, for instance, snakebite impacts 252 out of 100,000 people with a 7.8% fatality rate. They injure both domestic livestock and people which cause a significant loss of livelihoods.

Ruiz de Castañeda and team assessed the effect of snakebite in the Terai region of Nepal using a One Health perspective that encompasses health and socioeconomic losses associated with snakebites of people and domestic animals. They used primary data from a large-scale household survey to produce estimates for disease burden, out-of-pocket healthcare expenditure, productivity losses for people who had been bitten and their families and losses associated with cases in domestic animals.

“Our results confirm that snakebite is an important problem in the Terai region that affects livelihood and DALYs [disability-adjusted life years], which are mostly associated with envenoming in women, high pediatric mortality and losses in domestic animals,” the report said.

Households whose domestic animals were impacted by snakebite experienced a median loss of $90.80 out of average monthly earnings of $250.36, meaning that snakebite can lead to an economic crisis and feed the vicious cycle of poverty.

What’s next?

Ruiz de Castañeda said that One Health has gained a lot of momentum due to COVID-19 and “we see a very interesting discussion among countries trying to see how One Health can be part of their national strategies and their international relations”.

“Pandemics often emerge far away from the Western world – Ebola in West Africa and COVID-19 in China, for example – but they are quickly on our doorstep,” he said. “One Health needs to become part of the international strategy for countries: Science for diplomacy and diplomacy for science.”

See the full GHF 2022 programme. Register here: Rates are tiered and early-bird fees range from CHF 300-100 for the in-person event, and CHF 200-70 for digital participation. Daily rates are also available.

Part of a Health Policy Watch series of stories on feature themes at the 2022 Geneva Health Forum.

Image Credits: International Federation of Red Cross and Red Crescent Societies / The Kenya Red Cross Society, Arend Kuester/Flickr, Tony Kidega, Geneva Health Forum.

virtual healthcare
Digital healthcare services are growing and can play crucial roles in crises, including pandemics and violent conflicts that disrupt traditional healthcare facilities.

The World Health Organization (WHO) has confirmed 82 attacks on healthcare in Ukraine since 24 February. The country’s virtual healthcare services, already strong from the pandemic, have stepped-up in response.

Why it matters

Online healthcare has provided a crucial lifeline to thousands of Ukrainians as the war imposes physical and psychological trauma on those caught up in its fury and medical facilities restrict access, shut, or are reduced to rubble.

Attacks on healthcare facilities have killed at least 72 people and injured at least 43, the WHO’s director general said on Wednesday. In a recent attack on 9 March, the Russian military targeted and destroyed a maternity hospital in Mariupol. 

Approximately half of Ukraine’s pharmacies are thought to be closed, according to the UN, while many health workers are displaced themselves or unable to work.

Empty hospital beds line the hallways of the Kyiv Regional Perinatal Centre, Ukraine, on 7 March 2022. As hospitals are disrupted or destroyed, online healthcare services can mitigate gaps.

Ukraine’s pandemic telehealth

Ukraine’s digital healthcare infrastructure, bulked up during the pandemic, has aided the country’s resilience under the latest phase of the war. 

Ukraine’s ministry of digital transformation, established in 2019, has been expanding the country’s digital infrastructure with the goal of providing 100 per cent of public services digitally by 2024. 

As part of this transformation, the ministry of health is digitising all medical records, Oleksii Sukhovii, head of the Center for the Organization of Psychiatric Care of Ukraine’s ministry of health, tells Geneva Solutions.

The digitisation has improved ease of reference for healthcare providers and it will provide greater transparency within Ukraine’s National Healthcare System.

Many non-governmental initiatives have also sprung up. In 2021, UNICEF and Giva Care Group, a Ukrainian medical technology company, launched 50 digital healthcare platforms in the country’s east where the conflict has been ongoing since 2014. 

Among the digital healthcare tools UNICEF and GIVA Care Group have distributed are Tyto Care kits for remote medical examination. A kit includes an otoscope for examining ears, a stethoscope for the heart, lungs, and abdomen, a basal thermometer, and a digital camera for taking pictures of skin and the throat. The devices transmit the data to a doctor who can advise patients in real-time. 

Virtual mental healthcare

Online services for mental healthcare have grown significantly since February in response to the heightened trauma and distress people are suffering. 

UNICEF, together with Ukraine’s ministry of education and science, the Ukrainian Institute of Cognitive Behavioral Therapy, and the All-Ukrainian Public Center “Volunteer”, launched a mental health lifeline for children, teenagers, and parents in late March. Known as the PORUCH project, the initiative offers online consultations with psychologists. 

Nezabutni, which translates as “Never-to-be forgotten”, is a local charity supporting those living with dementia and their caretakers and offers a similar service. Mental healthcare services for relatives have been central to Nezabutni’s work from the start. These services have gone entirely online since the COVID-19 pandemic and are increasingly in demand since the war’s February escalation, Irina Shevchenko, the foundation’s director tells Geneva Solutions. 

Nezabutni’s online services include individual consultations with psychiatrists and psychologists as well as group therapy sessions. Relatives of people with dementia can also connect via a group chat.

Over 90 percent of Ukrainians have Viber, the calling and messaging app, which is increasingly being used for remote medical consultations, Sukhovii says.

Family members of people with dementia were initially reluctant to continue with online group therapy early in the escalation, says Shevchenko. For two weeks, the groups stopped. “They were afraid to resume; to talk about this painful experience,” she adds. Some were on the move while others sought refuge in bomb shelters. 

Two of its three online therapy groups are now back up and running. The other is on hold as one of Nezabutni’s three psychologists is herself in the process of escaping the violence. 

Nezabutni’s forty volunteers have been getting medicines to patients as many pharmacies have closed. Early in the escalation, and still in areas of intense conflict, volunteers delivered medicines personally. “Sometimes it was by bicycle, sometimes it was by foot, sometimes by car,” Shevchenko says.

Online deliveries have resumed in some regions over the past couple of weeks and Nezabutni helps with ordering the medicines online.

In one of its last in-person social gatherings, Nezabutni organized the first Alzheimer / Memory Cafe in Ukraine in September 2021. Its mental health consultations and group therapies have gone entirely online.

Nezabutni has fewer members from the eastern Donbas region which has borne the brunt of the war over the past eight years. 

Tell Me is another free Ukrainian online mental health service, which was launched in response to the war. It specialises in cognitive-behavioural therapy and receives support from the Ukrainian Red Cross and Ukraine’s ministry of health. 

In addition to online consultations, online healthcare information services have grown since February. One is Viyna, which offers continuously updated information on a broad range of issues, including advice for those who are pregnant or have just given birth, what to do if you find an unaccompanied child, and a list of open pharmacies, shops, and gas stations. It has several pages on psychological support with contact information for psychologists in and beyond Ukraine and a page on how to manage insomnia. 

Nezabutni expects to launch a prototype website in the coming week that will provide up-to-date information and resources for those living with dementia and other mental and physical disabilities, both in Ukraine and abroad. 

Health information is currently not available through the Ukrainian Red Cross website, which the organisation has shutdown until it resolves a cyberattack. Information remains accessible through its Facebook page, Instagram, Telegram, and Twitter as well as by email and telephone at 0 800 332 656.

Digital challenges

Innovation and growth in telehealth has been able to fill some of the gaps left by bombarded hospitals, clinics and other medical facilities. But it comes with its own set of challenges. 

Elderly patients and medical professionals are often not adept at digital technologies and can struggle to connect with online services, Shevchenko and Sukhovii say. If they live in rural areas, they may lack internet access in the first place, Shevchenko adds.

Digital security is also a concern. Ukraine’s National Healthcare Service has removed all geographic data and doctor’s contact information from the system in case of a cyberattack, says Sukhovii. This means that doctors cannot look up other doctors, which impedes medical referral and getting in touch for online consultations. 

On top of this, digitisation of patient records has been slow. Psychiatry’s digitisation has especially lagged, says Sukhovii. This makes it difficult for doctors to assess new patients when conflict or other crises disrupt the transfer of paper files. This disruption has been amplified with both doctors and patients on the move. 

On the move

Displacement is a source of trauma and can worsen existing trauma. The WHO, International Organization for Migration (IOM), and Red Cross in collaboration with other members of the UN’s health cluster for emergency response are running mental health and psychosocial support technical working groups to assist those in Ukraine and those migrating to neighbouring countries. 

The working groups employ psychologists, counsellors, psychotherapists, and social workers to run mental health hotlines. IOM has set up separate hotlines for those displaced in Ukraine and those migrating to Poland, Romania, Lithuania, Slovakia, and Moldova. The Ukrainian Red Cross offers a mental health hotline at 0 800 331 800. Psychosocial support also can be sought from Red Cross and UNICEF staff at shelters on the ground in Ukraine and neighbouring countries. 

For further support, contact:  

PORUCH: https://poruch.me/ 

Nezabutni: https://www.nezabutni.org/

Tell Me: https://tellme.com.ua/ 

Viyna: https://viyna.net/

Ukrainian Red Cross: national@redcross.org.ua 

IOM hotlines: https://www.iom.int/ukraine-iom-hotlines-garyachi-linii-mom-persons-affected-war

This article was first published by Geneva Solutions.

Image Credits: Pexels/Tima Miroshnichenko, UNICEF/Oleksandr Ratushniak, Nezabutni.

Aedes aegypti mosquito can spread Zika fever, dengue, and other diseases.

WHO on Thursday launched a new global initiative that aims to tackle a group of fast-growing and poorly understood viral diseases that are carried by insects – and which have future pandemic potential.  

The Global Arbovirus Initiative aims to tackle diseases such as Dengue, Yellow fever, Chikungunya and Zika – which have few effective treatments, with the exception of yellow fever vaccines. 

Due to warmer climates, international travel and urbanization, one or more of the leading arboviruses are now present in most countries of the world.

Their span and impact is also rapidly expanding – borne by air and ocean transport to far-flung lands, leap-frogging from forests to cities, and moving into Europe and North America as global warming creates more favorable climate conditions in which mosquitoes can thrive.   

The name ‘arbovirus’ is little known. But it is an acronym for “arthropod-borne” virusës, referring to viruses transmitted by mosquitoes and ticks. Although malaria is a mosquito-borne virus, it is in fact a parasitic disease, not a virus.

And unlike malaria, or many other parasitic diseases, there is also a dearth of ready treatments.  Notably, dengue fever, which infects 390 million people in 130 million countries where it is endemic, and Zika virus, which came to center stage during a 2016 epidemic in Latin America, have no readily available treatments. Zika causes birth defects, such as microencephaly, while dengue fever infections and subsequent attacks can recur, in worsening forms that cause dengue hemorrhagic fever and death.  Since the 2016 epidemic, outbreaks have occurred regularly in countries as far-flung as India. 

Sir Jeremy Farrar, director of Wellcome Trust

“These diseases are the diseases of our time,” said Jeremy Farrar, head of the Wellcome Trust, who appeared with a long line-up of WHO officials and virology experts from virtually all corners of the world in a launch event on Thursday. 

“These are things of the 21st century because the drivers of these diseases are drivers that are going to be with us in the 21st century,” he added. “And those drivers we all know are about: climate change. land use change, ecology change, urbanization… increasing trade and travel, for instance, between Asia and Africa, wholly welcomed but [this] will lead to changes in the dynamics of infections,” he added, noting that “the links between Central and South America, Southern United States, Southern Europe and all other parts of the world means that the mosquitoes, which are some of the most remarkable things on Earth, are adapting to different communities, in the context of 21st century, which is why this is just so important.”

Particularly in light of heightened awareness about pandemic risks from new or re-emerging viruses, post-COVID, this initiative that tackles a family of single strand RNA viruses is important, said Farrar. 

”In the context of the last two years, the world has changed, and we need to change with it, and provide the leadership that change requires,” Farrar concluded.  

Integrated approaches 

Six pillars of the global arbovirus initiative

The new six-point WHO initiative aims to better link the various research, surveillance and vector control efforts happening around the world in a more formal network of collaboration – building around six pillars, including: 

  • improved real-time monitoring of outbreak risks in countries; 
  • early detection, investigation and response;  
  • strengthened vector control initiatives, particularly in cities where viruses like dengue are now flourishing in waste and water containers; 

Along with that stronger global collaboration and surveillance; research innovation and partnerships are key to the new strategy, said WHO’s Sylvie Briand, Director of  Pandemic and Epidemic Diseases and WHO Assistant Director General, Minghui Ren. 

“As urban populations continue to expand, the threat of these diseases grows more alarming, as close living arrangements amplify the spread of these viruses,” said Ren.  “We must address these challenges now to prevent catastrophic impacts on health systems in the future.”  

Sylvie Briand, WHO Director of Pandemic and Epidemic Diseases

“We have been through two years of COVID-19 pandemic and we have learned the hard way what it costs not to be prepared enough for high impact events,” Briand added. 

“The next pandemic could very likely be due to a new arbovirus. And we already have some signals that the risk is increasing. Since 2016, more than 89 countries have faced epidemics due to the Zika virus,” she said, citing just one example among many. 

“In addition, many other viruses circulate in the wildlife,” Briand added. “As the interface between humans and animals expands, the opportunity for new zoonosis increases. 

“And given human mobility and urbanization, the risk of amplification of localized arbovirus  outbreaks is real. So what can we do to better manage this? What did we learn from the COVID-19 experience and from years of combating arboviral diseases to help us to get better prepared for the next high impact event? 

“I would like three cite three key aspects:  collaboration, trust and community engagement as essential.”

Building on a series of regional consultations 

who
Dr Mike Ryan, Executive Director of WHO Health Emergencies

The new initiative represents the culmination of a series of global and  regional consultations that was undertaken by WHO to ensure a “more integrated approach” to this family of viruses,  which have often been ignored, said WHO Health Emergencies Executive Director Mike Ryan, also appearing at the session. 

The buy-in gained from the consultations was evident in the launch session, which was attended by dozens of researchers from far flung countries in Latin America, Africa and Asia, as well as Europe and North America.  

The initiative “brings together a network of partners which has enabled an efficient and successful collaboration across a range of pathogens and disciplines,” said Ryan, referring to the consultations leading up to the launch. “The COVID 19 pandemic and the public health emergencies that preceded it continue to humble us. As a society we remain susceptible to many recognized and some unrecognized infectious disease threats. However, these events have also highlighted the possibilities for effective collaboration.”

Despite their relative neglect, recent “virus-specific” advances in the field of arboviruses can be leveraged by such a coalition, Ryan said. 

‘Integration’ key to progress

Leading arbovirus diseases today

Indeed, a more integrated approach to the prevention, detection and treatment, is key to success, stressed Farrar.  

“In fact, the progress in some of the areas around arboviruses in the last 10 to 15 years has also been staggering – and may have been forgotten a little bit in the last few years as everybody’s focused on COVID,” Farrar said. 

“But because there is no single bullet that is going to give an answer to every arbovirus, it is all about integration.” 

Along with that, he stressed that biomedical research needs to be linked up better with social science in terms of ensuring that communities and policymakers take up solutions and really use them. 

“It is about social sciences. It’s about anthropology. It’s about behavioral science. And if we don’t embrace that after the last few years, what have we learned?”

Image Credits: Sanofi Pasteur/Flickr.

plastics
Microplastics found from the US Chesapeake Bay.

Microplastics have been discovered in human blood for the first time, with scientists warning that these mostly invisible pieces of plastic could also make their way into organs, in a new study examining blood samples of 22 anonymous, healthy adult volunteers.

The study, published in the Environment International journal Thursday, found that 17 of 22 blood samples drawn from a group of volunteers in the Netherlands, or 80%, had some concentration of microplastics.

Additionally, half of the blood samples showed traces of PET plastic, which is widely used to make drink bottles, while more than a third had polystyrene, which is used for disposable food containers, electronics, automobile parts, and other products. Almost a quarter had polyethylene, the most commonly used plastic today. 

“This is the first time we have actually been able to detect and quantify” such microplastics in human blood, said Dick Vethaak, an ecotoxicologist at Vrije University in Amsterdam, and one of the authors of the study.

“This is proof that we have plastics in our body, and we shouldn’t,” he told AFP, calling for further research to investigate how it could be impacting health.

“Where is it going in your body? Can it be eliminated? Excreted? Or is it retained in certain organs, accumulating maybe, or is it even able to pass the blood-brain barrier?” 

The study noted that “it is scientifically plausible that plastic particles may be transported to organs via the bloodstream.”

‘Unequivocal’ proof that plastics pervade both environment and people 

Plastics at a local municipal recycling center.

While the fate of plastic particles in the bloodstream needs “further study”, scientist Alice Horton, of Britain’s National Oceanography, said that this “unequivocally” proved there was microplastics in blood. 

“The study contributes to the evidence that plastic particles have not just pervaded throughout the environment, but are pervading our bodies too,” Horton told the Science Media Center.

Uptake of plastic particulates is likely either through ingestion or inhalation, the study suggests.

These ubiquitous pollutants already make their home in our soil and food systems, as well as in the ocean, air, and our health systems. As a result, some 175 UN member states had agreed to negotiate a landmark treaty by 2024 to curb plastics pollution earlier this month.

Other studies have shown the human placenta able to absorb 50, 80, and 240 nanometer polystyrene beads, and possibly also microsized polypropylene, a plastic used for packaging in cleaning products, bleaches, and first-aid products. 

Despite the small sample size and lack of data on exposure level of the participants, Fay Couceiro, reader in biogeochemistry and environmental pollution at the University of Portsmouth, says that the study was “robust and will stand up to scrutiny.”

“Blood links all the organs of our body, it could be anywhere in us,” Couceiro told AFP.

Image Credits: Will Parson/Chesapeake Bay Program, JoLynne Martinez/Flickr.