Delegates at the CBD Geneva talk.

Two weeks of negotiations in Geneva over a critical new agreement to protect and conserve some 30% of the planet’s land and oceans spaces by 2030 have yielded only halting progress – with the parties to the UN Convention on Biodiversity (CBD) agreeing to meet again in Nairobi in late June. 

The Nairobi meeting, 21-26 June, will be the last, critical session before the Convention on Biological Diversity’s (CBD) 15th Conference of the Parties (COP15) in Kunming, China – where a new, landmark agreement on is supposed to be finalized, following a two year delay due to the pandemic. The new framework has been billed as the biodiversity equivalent of the 2015 Paris Climate deal, but the delay in talks and negotiations have not helped its profile.  

Some 91 countries and the European Union, have publicly supported incorporating a “30×30” agreement into the CBD – as part of the “High Ambition Coalition for Nature and People”. Observers said a number of new countries from the Caribbean, the Middle East, Asia and Latin America also had expressed support for the target at the Geneva meeting, which ended on Wednesday.  

But with the exception of India, the influential BRICS bloc, including Brazil, Russia, China, and South Africa, have refrained from supporting the goal.  Nor are the BRICS among the 72 members of the Global Ocean Alliance (GOA), which has publicly supported a 30×30 target for the world’s oceans. 

The proposed 30×30 framework has been portrayed by biodiversity advocates as equivalent to the 2015 Paris Climate deal in terms of its significance. 

The Convention on Biodiversity, however, lacks the high political profile of its sister climate agreement, the UN Framework Convention on Climate Change (UNFCCC).  A two-year delay in convening the recent negotiations, due to the pandemic, have not helped.  

“There is an emerging consensus in support of the science-based proposal to protect at least 30% of the planet’s land and ocean by 2030, which is encouraging,” said Brian O’Donnell, Director of Campaign for Nature, one of the groups that has been lobbying for the 30x 30 proposal. 

However, he said that the progress with the negotiations had been “painfully slow”, and the level of ambition with financing is “woefully inadequate”.

“Unfortunately, the negotiations in Geneva have not reflected the urgency that is needed to successfully confront the crisis facing our natural world,” O’Donnell said.  

One million species at risk of extinction 

Delegates at the negotiations meeting, UN CBD, Geneva.

Scientists warn that without more assertive action by the nations of the world, rapid overdevelopment will lead to the extinction of another one million species within decades.

Rapid deforestation and consequent losses of natural habitat, coupled with climate change, have already pushed major species like giraffes and koalas into the ‘endangered’ category. Currently, there are 17 critically endangered animal species while over two-dozen species are considered “endangered”, according to the World Wide Fund for Nature (WWF). That has made it imperative that the 30% target be achieved as the absolute minimum amount of conservation needed to curb global biodiversity loss, according to a recent paper in Science Advances. 

In January 2021, a group of scientists from around the world issued a stark warning that “humanity is causing a rapid loss of biodiversity, and, with it, Earth’s ability to support complex life.”

This year, an Intergovernmental Panel on Climate Change report further underlined the urgency of addressing the biodiversity crisis which is deeply interrelated with climate change. The number of endemic species subject to “very high extinction risks” in biodiversity hotspots is projected to at least double from 2% between 1.5°C and 2°C global warming levels and to increase at least tenfold if warming rises from 1.5°C to 3°C. 

For instance, according to another recent study of satellite imagery of the Amazon forest, deforestation and climate change, via increasing dry-season length and drought frequency, may already have pushed the Amazon close to a critical threshold of rainforest regeneration. When forests dies, so do the animal and insect species living in them – or else they relocate to areas inhabited by humans, bringing new pathogens with them. 

Increased risk of disease outbreaks

In terms of health, environmental health experts have also pointed to the increased risks of disease outbreaks, such as the recent COVID-19 pandemic, as the loss of biodiversity also means the loss of the natural system of checks and balances that keep many diseases under control. 

Notably, continued ecosystem destruction along with unsafe and unsustainable patterns of food production are bringing more and more people into closer contact with viruses and pathogens harboured by animals in the wild – from SARS-CoV2 that may have spread to humans via the sale and slaughter of wild animals in Chinese wet markets, to Ebola virus in Africa, which infects humans via bushmeat slaughter and consumption, among other factors. 

Square brackets, late nights and talks in circles

In the two-weeks of Geneva meetings, talks sometimes went up to 3 a.m with inconclusive endings, followed by new suggestions for the text. Some paragraphs had up to 30 square brackets, which implies that governments were yet to agree on the language. 

The final draft text showed a large portion of the framework’s 21 targets still in square brackets which pimples a lack of formal agreement, said those who saw the agreement. Continued areas of disagreement also included specific goals for reducing pesticide use and goals for removing billions of dollars in national government agricultural subsidies that incentivise farmers to destroy habitats. 

The COP 15 in Kunming is seen as an important stage for finalising new targets, more ambitious than the previous CBDs.

In 2002, the CBD convention in Montreal committed to achieve a significant reduction of the current rate of biodiversity loss by 2010, but failed to meet the targets. Targets that were set for 2020 in the 2010 Aichi Convention– which included protecting 17% of the planet’s land surfaces and 10% of the ocean– were also missed. This makes the Kunming summit even more important in drawing a line in the sand over the rapid loss of habitat and species loss, by setting new targets for 2030. 

Among the 2030 targets, the proposal to protect or conserve at least 30% of the planet’s land and oceans is a flagship initiative. Even so, it would not be binding on any single nation;  countries would determine their contributions in accordance with their national circumstances.

However, another note of progress at the meeting in Geneva was an agreement by countries to add the term ‘equitably governed’ to the text, in response to requests from indigenous leaders, as well as adding the phrase ‘giving effect to the rights of indigenous peoples and local communities’ to underscore the that implementation of the 30×30 dovetail with human rights protections. 

“There is growing recognition of the need to better safeguard the rights of Indigenous Peoples and Local Communities, who must be central to achieving the world’s biodiversity goals,” said O’Donnell.

Image Credits: UN CBD Twitter .

WHO Director General Dr Tedros Adhanom Ghebreyesus at press conference on 30 March 2022

In some of his most forceful remarks to date, WHO Director General Dr Tedros Adhanom Ghebreyesus and other senior WHO officials slammed both Russia’s invasion of Ukraine and Ethiopia’s blockade of Tigray for both withholding vital health and humanitarian aid – as well as deliberately targeting civilians or putting them in harms way.

Speaking from Doha, Tedros called Russia’s war in Ukraine and invasion and slammed its continuing attacks on health facilities, saying, “We are outraged that attacks on health care are continuing. Since the beginning of the Russian Federation invasion there have been 82 attacks on health care facilities, leading to at least 72 deaths and 43 injuries, including patiens and health workers.  Attacks on health care are a violation of international humanitarian law and must stop immediately.”

As for Ethiopia’s warn in Tigray, he added that while WHO had welcomed last week’s declaration of a humanitarian truce in Tigray, between Tigrayan rebel forces and the Ethiopan government, “a week has passed and no food has been allowed into Tigray.

“Every hour makes a difference when people are starving to death. No food has reached Tigray since mid-December and almost nothing has been delivered since August. of last year. “The siege of 6 million people in Tigray by Eritrean and Ethiopian forces for more than 500 days is one of the longest in modern history,” Tedros said.  

WHO Executive Director of Health Emergencies, Dr Mike Ryan

“What’s so unusual about situations like we see in Ukraine like we see in Tigray, is that this is not is this is not people caught up in the fog of war. It is people being directly targeted, directly used as strategic implements, as chess pieces in horrific murders,” added Dr Mike Ryan, WHO Executive Director of Health Emergencies, Dr .  The world needs to look at why we end up with so many groups of people being used as pawns of war.”

Ryan added that the situation in Ukraine and Tigray, are both “a world of difference between that and a conflict situation where we struggle to get aid and assistance and because of conflict and all sides are trying to help in a way – and we struggle just because of conflict.

“That’s a very big difference between that situation, and the situation of access is being actively denied for the population – where actually cutting off of people is part of part of the tactics. It’s part of the military strategy.”

Tedros also called out the Taliban leadership in Afghanistan for the sudden turnabout last week that led to the banning of girls from secondary school classrooms – just hours after they had arrived to resume their studies for the first time since the fundamentalist Islamic group seized control of the government last August.

“Women and girls are especially at risk from lack of access to health services and lack of access to education,” Tedros said. “Last week’s decision by the Taliban leadership to ban girls from school is very troubling.”

Beseiged Mariupol remains blocked to WHO relief workers

Ian Clarke, WHO Incident Manager for Ukraine

In terms of recent relief efforts, WHO’s Incident Manager for Ukraine, Ian Clarke, said that over the past few days WHO had been able to dispatch more than 21 metric tons of medicines and other health supplies to eight locations in disputed parts of Ukraine, adding “We tried to get into Mariupol.  We have been unsuccessful today, together with our interagency partners, but we have been able to access places like Kherson”. Mariupol has been under a prolonged Russian seige that has also prevented aid groups from bringing in food and medical supplies, while Kherson already fell to Russian control several weeks ago.

Clarke added that a $57 million fund-raising drive to support short-term healthcare needs of Ukranians in the country as well as those who have abroad had nearly reached its goal.

“We’re now in the process of working with our health partners, both in Ukraine and the hosting countries to come up with a comprehensive strategic response plan that will cover the healthcare needs for Ukrainians regardless of where they are located, both in Ukraine or in hosting countries. And that will provide a longer term outlook,” Clarke said.

Remains committed to 70% COVID vaccination target – as virus continues to evolve

In other remarks, the WHO Director General said that he remains committed to a 70% goal for vaccinating people low- and middle-income countries against COVID-19, despite current trends that reflect a sharp decline in infections and less lethal variants. This, despite an undercurrent of criticism from both countries and some donors that a strategy of vaccinating the most high-risk groups like older people and health care workers might be preferable to such a broad goal.

“Even as high income countries roll out fourth doses, one third of the world’s population has yet to receive a single dose, including 83% of the population in Africa,” said Tedros.””This is not acceptable to me, and it should not be acceptable to anyone.” 

WHO is launching it’s third COVID response strategy since the pandemic began, he added, in which COVID vaccination of under-covered groups would remain a key priority along with better access to treatments, and continued testing and surveilance.

“This is our third plan and it could, or should be our last plan,” Tedros said, explaining that the plan etches out three scenarios for how the pandemic will evolve – from best to worst cases. As part of that, he said WHO is also launching a new strategy to scale up genomic surveillance globally for pathogens with epidemic and pandemic potential.

“Based on what we know now, the most likely scenario is that the virus continues to evolve. But the severity of disease it causes is reduced over time as immunity increases due to vaccination and infection. Periodic spikes in cases may occur as immunity wanes, which may require very early boosting for vulnerable populations,” he said.

“In the best case scenario, we may see less severe variants emerge, and boosters or new formulations of vaccines won’t be necessary. In the worst case scenario, a more violent and highly transmissible variant emerges. Against this new threat, peoples’ protection against disease and death either from prior vaccination or infection will wane rapidly. Addressing this situation would require significantly altered vaccines, and making sure that they get to the people who are most vulnerable.”

Tedros was speaking from Doha where he was meeting with Qatari officials, shortly after delivering an address to the World Government Summit, taking place in Dubai. 

 

A man at a protest in Geneva to demand the TRIPS waiver.

A compromise proposal on a World Trade Organisation’s (WTO) waiver on intellectual property for the production of COVID-19 vaccines is ‘problematic’, ‘largely insufficient’, and WTO members should not be politically pressured into adopting the  text, several dozen civil society organisations said in an open letter published today. 

The letter, addressed to European Commissioners, European members of Parliament, and WTO Ambassadors, and signed by 42 European and International civil society organisations, called on the European Union and WTO Director General Dr Ngozi Okonjo-Iweala to “refrain from rushing WTO members” to rapidly adopt what the civil society groups termed as an “unsound proposal”.  

The draft compromise text, was brokered in mid-March with United States support between the European Union, which had until then opposed any IP waiver at all for COVID health products, and the initiative’s sponsors, India and South Africa – referred to in some quarters as “the Quad”.  However, the draft agreement still needs to be put to all 164 WTO members, which typically decide by consensus. 

To make the compromise possible, South Africa and India had to make major concessions in narrowing the waiver to only vaccines, as well as narrowing the list of countries that would be eligible to take advantage of the waiver on patents and other IP.

In their letter, the civil society critics charged that “The text under consideration by some WTO members contains problematic and contradictory elements (see Annex) and remains largely
insufficient as an effective pandemic response.

Exclusion of therapeutics and burdensome requirements among the complaints

The main innovation of the proposed waiver is that most low- and middle-income countries that decide to produce their own generic versions of vaccines would be also allowed to export their products to other low- and middle-income countries in deed – providing that the country historically produces less than 10% of the global COVID vaccine supply – effectively excluding China from the waiver provisions.  Bulky and complex requirements around export of generic products are a key complaint of the current WTO Agreement on Trade Related Intellectual Property (TRIPS).

Among the main civil soceity complaints about the new agreement, detailed further in an annex, are the exclusion of COVID diagnostics and treatments from the IP waiver.  Those products, proponents say, are even more critical now in the battle by low- and middle-income countries against the pandemic in light of the comparatively higher costs of such drugs and lower vaccination rates.

Critics also say that the compromise would require new “burdensome, unecessary, TRIPS-plus requirements for countries seeking to issue a compulsory license” for the generic production of a vaccine – in terms of notification procedures.

While patents are part of the waiver, “the draft text also does not address barriers arising from confidential information/trade secrets held by corporations or contained in documentation submitted to regulatory authorities,” the critics say.

“And eligibility requirements still exclude too many low- and middle-income countries from either “producing, supplying, export and importing” even vaccines, they add.

Ultimately, the measures create “more legal uncertainty compared to the existing TRIPS flexibilities due to textual ambiguity and a confusing structure,” the critics further charge.

Final decision set for June

A final decision on the IP waiver is expected is to be taken at the 12th WTO Ministerial Conference, now set to take place during the week of 13 June in Geneva. 

But until then, the civil society groups said that there is a need for “further negotiations are needed to ensure an effective outcome in a multilateral manner.

“Throughout the COVID-19 pandemic, the EU has repeatedly ignored evidence of the effects of restrictive licensing practices on access to COVID-19 medical tools and resisted meaningful negotiations on a proposal for a temporary TRIPS waiver at the WTO to address limited production and shortage of supply,” the letter said. 

The critics charge that the terms of the waiver, as stated now, would also cast legal doubts around the work of the mRNA tech-transfer up recently set up by WHO in South Africa, and which the European Commission has suported.  The mRNA hub recently announced that scientists there had duplicated the Moderna version of a COVID vaccine.

“We find it hard to comprehend how the EU would endorse a so-called compromise that could hamper the functioning of the mRNA tech-transfer hub that the European Commission and some Member States strongly support. It’s hard to see countries in the Global South believing in the promise of equity that the European Council assures guides its push for a pandemic preparedness treaty,” Health Action International Senior Policy Advisor Jaume Vidal said in a press release.

The current compromise reached, however, now has good chances of being approved by consensus insofar as EU countries have been the major opponents to the proposal by South Africa and India, submitted in October 2020.  The original proposal called for a blanket waiver on all IP related to COVID-19 vaccines and other pandemic-related health products for the duration of the pandemic. 

According to organisations, including Amnesty International, Human Rights Watch, Oxfam, the People’s Vaccine Alliance and others that signed the letter today, the compromise text is a “reiteration of existing TRIPS flexibilities with a narrow export waiver and additional cumbersome requirements” and that a large number of WTO members whom these proposals affect were not a part of the negotiations. 

Image Credits: Aishwarya Tendolkar.

A mother and her newborn baby at Karenga Health Center, Uganda.

Between childbirth and six weeks is the most dangerous time for mothers and babies and when most deaths occur, and the World Health Organization (WHO) issued a new guideline called ‘Recommendations on maternal and newborn care for a positive postnatal experience‘ on Wednesday aimed at guiding all role-players during this period.

One of the key recommendations is that women and their babies remain at health facilities for at least 24 hours after the birth, and have check-ups at least three times over the next six weeks. At present, around 30% of mothers and newborns don’t get health care during this crucial period, according to the WHO.

“A positive postnatal experience is defined as one in which women, newborns, partners, parents, caregivers and families receive information, reassurance and support in a consistent manner from motivated health workers, and where a resourced and flexible health system recognizes the needs of women and babies and respects their cultural context,” says the WHO.

In total, the new guidelines bring together over 60 recommendations that help shape a positive postnatal experience for women, babies and families. Some of the key proposals include:

  • Identifying and responding to danger signs needing urgent medical attention in the woman or the baby
  • Treatment, support and advice to aid recovery and manage common problems that women can experience after childbirth, such as perineal pain and breast engorgement  
  • Screening of all newborns for eye abnormalities and hearing impairment, as well as vaccination at birth
  • Support to help families interact and respond to babies’ signals, providing them with close contact, warmth and comfort 
  • Exclusive breastfeeding counselling, access to postnatal contraception and health promotion, including for physical activity
  • Encouraging partner involvement, for example by being part of checkups and attending to the newborn
  • Screening for postnatal maternal depression and anxiety, with referral and management services where needed.

Image Credits: UNICEF/Zahara Abdul 2019.

A Ukrainian wheat field

Food price hikes, hunger and instability are predicted globally – but particularly in North Africa and the Middle East, which are already in the midst of serious droughts and heavily dependent on Russia and Ukraine for wheat.

Bread is the staple food in Tunisia, Morocco and Egypt, and the price of wheat had already increased by 70-80% over the past year – even before Russia’s invasion of Ukraine – according to the International Monetary Fund.

Around 10 million tonnes of wheat, 10 million tonnes of corn, as well as sunflower oil and barley have been unable to leave the Black Sea area (Ukraine and Russia), according to Gro Intelligence..

Meanwhile, wheat crops in the US and Canada have also been affected by drought with an estimated 20 million tonnes lost, and available wheat stocks are the tightest since 2007/8, according to Gro Intelligence.

Food production is down 21%

The World Food Programme (WFP) warned this week of “destabilization, migration and starvation” if climate change is not addressed.

“If emissions are not reduced, the risk of food supply shocks will greatly increase with harvests failing simultaneously in multiple major food-producing countries, leading to shortages and price spikes. Food productivity growth is already down 21% because of global heating,” said the WFP in a statement on Monday.

The WFP added that 2021 was the third-costliest year on record for climate-related disasters, totalling $329 billion in economic losses, with “more frequent and intense droughts, floods and storms” which had led to “widespread food insecurity, crippling agricultural production, devastating livelihoods and forcing people from their homes”.

Fragile states face political instability

Morocco, a major wheat-producing area in North Africa, is likely to have to import wheat for domestic use because of severe drought, while similar conditions are being experienced by wheat-growing countries in the Middle East.

Australian and Indian imports might ease the stresses faced by the region, but are unlikely to be able to meet all the demands of North Africa and the Middle East.

Meanwhile, the fragile economies of Yemen, Tunisia and Lebanon – which are heavily dependent on wheat from Ukraine – are already facing food shortages in tense political environments that could lead to instability, according to reports.

Climate action failure

Climate action failure was ranked as the most severe risk in the World Economic Forum’s Global Risks Report 2022, with the most severe threat in both the medium term (2-5 years) and long term (5-10 years).

The WFP has appealed for more climate finance to be directed to fragile states to limit their  climate-related risks, and for urgent funds to be channelled to “integrated adaptation programmes at scale”, rather than simply confined to humanitarian aid to address crises.

“Climate action requires integrated approaches, which combine nature-based solutions with access to climate and early warning information and financial safety nets,” said WFP.

It advocates for early warning systems to anticipate climate crises and “trigger pre-positioned financing for preventative action”, the restoration of ecosystems so that they can act as  “natural shields against climate impacts”, and safety nets and insurance against climate extremes to protect those most vulnerable.

Image Credits: Polna Rytova/ Unsplash.

India’s Ministry of Ayush signed the Host Country Agreement with the WHO on March 25 to build a Global Centre for Traditional Medicine.

The government of India and the World Health Organisation (WHO) on Friday signed an agreement to set up a one-of-its-kind Global Centre for Traditional Medicine. India will invest $250 million in this centre which will be established in Jamnagar city in the state of Gujarat. 

The centre will work towards harnessing the potential of ‘traditional medicine’ from across the world through modern science and technology to improve the health of people and the planet, the press release said.

“Ensuring all people have access to safe and effective treatment is an essential part of WHO’s mission, and this new centre will help to harness the power of science to strengthen the evidence base for traditional medicine. I’m grateful to the Government of India for its support, and we look forward to making it a success,” Dr Tedros Adhanom Ghebreyesus, WHO Director-General said in the press release. 

India’s Ministry of Ayush, which is the designated ministry for Ayurveda, Yoga, Naturopathy, Unani, Siddha, Sowa-Rigpa and Homoeopathy, signed the Host Country Agreement with the WHO. The interim office will be at the Institute of Training and Research in Ayurveda in Gujarat and the onsite launch of this new global centre will take place on April 21. 

The centre will concentrate on building a solid evidence base for policies and standards on traditional medicine practices and products and help countries integrate it as appropriate into their health systems and regulate its quality and safety for optimal and sustainable impact, according to the WHO. 

Around 80% of the world’s population is estimated to use traditional medicine and 170 of the 194 WHO Member States have reported the use of traditional medicine. However, national health systems and strategies do not yet fully integrate the millions of traditional medicine workers, accredited courses, health facilities, and health expenditures.

“Through various initiatives, our government has been tireless in its endeavour to make preventive and curative healthcare, affordable and accessible to all. May the global centre at Jamnagar help in providing the best healthcare solutions to the world,” Indian Prime Minister Narendra Modi said. 

WHO defines traditional medicine as: “the total knowledge, skills and practices indigenous and different cultures have used over time to maintain health and prevent, diagnose and treat physical and mental illness and its reach encompasses ancient practices such as acupuncture, ayurvedic medicine and herbal mixtures as well as modern medicines”.

India’s Ayush ministry was established in November 2014 to revive the knowledge of ancient Indian systems of medicine and to ensure the optimal development and propagation of the Ayush systems of healthcare.

Image Credits: WHO Twitter.

The COVID-19 pandemic has shed light on how human health and ‘planetary health’ are inextricably linked – through deforestation, urbanization and climate change, all of which increase future disease risks. This year’s Geneva Health Forum explores these and other critical global health challenges, as well as emerging solutions,  just ahead of the World Health Assembly.   

In one of the first major in-person global health gatherings since the pandemic began, over a thousand researchers, policymakers and activists are expected to descend on Switzerland’s global health hub 3-5 May for the 2022 edition of the Geneva Health Forum. 

The GHF has morphed from a modest Geneva-based event focused mostly on the sharing of clinical experiences, to one of the world’s leading global public health events, its sponsors say. 

It straddles the worlds of innovation, clinical advances, and increasingly, health diplomacy, observes GHF Executive Director Eric Comte, a staff member at the Institute of Global Health at the University of Geneva. 

Straddling Geneva’s global health hub and regional realities 

Eric Comte

“With the COVID crisis and with the environmental crisis, we are in front of really big, big challenges in terms of global health,” Compte said in an interview with Health Policy Watch.  

“We cannot continue, as usual, thinking that the health system will solve the problems.  We need a much more multilateral approach.”

But the conference also links the world of field researchers with movers and shakers in Geneva’s global health hub, home to the World Health Organization and other international organizations, with the voices of civil society – as well as the private sector. 

“We need to break the silos between the health organizations but also with other domains, and we think that Geneva can play a role to facilitate actions addressing all of these challenges,” Comte said.  

Dual theme: Covid pandemic and environmental emergency  

pandemic planetary health
‘Planetary Health’ is one of the key issues being addressed at this year’s Forum

Now in its ninth edition as a biennial event, this year’s conference has a dual theme: COVID-19 Pandemic and Environmental Emergency; Reinventing Global Health in Times of Global Changes.

The conference involves some two dozen partner organizations including: all of Geneva’s  major multilateral health organizations such as WHO, UNAIDS, GAVI the Vaccine Alliance, and the Global Fund; leading Swiss university and hospital research centers; and major non-profit organizations, such as Drugs for Neglected Disease Initiative (DNDi) and PATH. 

Since this year’s theme includes ‘Planetary Health’, and related to that the ‘One Health’ relationship between the human and animal world, other UN agencies, including the World Organization for Animal Health (OIE), the United Nations Environment Programme, and the Food and Agriculture Organization, are also playing a role.

“Working with the environmental organizations, also including the IUCN and WWF, and bringing them together with the health organizations is one way that we can make the bridge,” says Comte.

Humanitarian relief and sustainable finance   

The forum will open to a keynote address on the Ukraine war, and the related refugee crisis.

Humanitarian relief agencies, such as the International Committee of the Red Cross and Médecins Sans Frontières also play an important role in the Geneva landscape, and are also partners in the event.  And, so another stream of GHF sessions will address issues involving migrants, refugees and related humanitarian challenges –  from impact of climate change on conflict and migration to the war in Ukraine.

“We will also have a keynote address the Ukraine war, its displacement of populations, migration, and the related refugee crisis – we will open the Forum on this point,” said Professor Antoine Flahault, Director of the Institute of Global Health of the University of Geneva (UNIGE), co-organizer of the conference with Geneva University Hospitals (HUG).  

Antoine Flahault

But the current crisis also needs to be seen in proportion with other longstanding humanitarian issues that the world faces.  “Given that the war is an enormous public health problem, it’s sure it will get our attention,” he says, while at the same time bemoaning the fact that, “today no one is speaking about Afghanistan, about Ethiopia.” 

Finally, another major thread running through the conference is economics and sustainable finance – something that also comes naturally to Geneva, a global financial services center.

Collaborators span the range from the World Economic Forum and major pharmaceutical actors – many of which also are headquartered in Switzerland. Financial actors, working together under the Sustainable Finance Geneva consortium, also are contributing.  

“We [in Geneva] are a humanitarian hub, environmental hub, a health hub, but we think it’s also important to make the link to the financial world, to include more of the economic sector,’’ Comte says. 

Global Health Lab showcases affordable innovations  

Geneva Health Forum (2018) – Global Health Lab showcases affordable interventions

One more major element of the Forum is the Global Health Lab exhibit, a large space at the International Conference Centre Geneva venue (CICG), which will be showcasing more than 100 tech innovations from around the world. 

These include dozens of new breakthroughs in telemedicine diagnostics and treatment, such as a Vital signs monitor from Bangladesh, a Brazilian telecardiology tool, a Ghanaian “virtual mental health space” as well as affordable medical devices. These include  an Indian “skin spray gun” as well as a solution to tackle antimicrobial resistance in waste-water. 

The exhibits will interface with special sessions on e-health, which is being used more and more in the health sector, with exploration of what Comte describes as a comprehensive “digital pathway for a patient – from appointment to test results and treatment”. 

“The Forum has been extremely successful in taking very concrete research from the field and sharing it with practitioners… to see how to scale up the approaches,” observes Flahault, and the exhibit is a big part of that effort. 

But alongside that, he sees an increasing emphasis on “health diplomacy” linking the findings at the research level with policy-making. “In the ‘One Health’ arena in particular, there are a lot of discussions that are no longer just about clinical research, but are policy questions.”

Public avant-premiere of “Making Pandemics” 

Scene from the ‘Making Pandemics’ trailer

While understanding the “One Health” link between the animal world and human disease risks is sometimes hard to grasp – a major new film being premiered at the conference draws out the linkages in visual images and stories that are easy to understand. 

Making Pandemics (La Fabrique des Pandémies), is a film by the French documentary producer and director, Marie Monique Robin, author of an earlier documentary on the infamous pesticide Roundup, “The World According to Monsanto”. This latest film, narrated by Juliette Binoche, takes the viewer to Congo, Thailand and the site of industrial livestock production, to witness the ecosystem destruction taking place today – and to understand how that increases animal-human contacts and subsequent disease risks.  

On 4 May, the film will be aired for free at the Conference’s CICG venue before conference participants and the public alike, in an “avant-premiere” ahead of the film’s world premiere on 22 May, the International Day of Biodiversity, in 30 countries around the world.

“As we say, the Geneva Health Forum is a forum for people who are already involved. But this film gives us the opportunity to enlighten the public that we want to motivate,” says Comte. 

Looking forward to a return to an in-person event 

While GHF went virtual in 2020 as a result of the pandemic, this year’s conference will feature mostly in-person sessions, with one stream online.

In the spring of 2020, the in-person GHF conference had to be canceled at the last minute due to the pandemic and proceedings shifted to an all virtual forum.

Both Comte and Flahault are delighted that this year’s event is a hybrid that should offer the best of both worlds. 

In fast, most sessions will be exclusively face to face in order to restore more direct participation  – although the major plenary stream will also be online.   

“We are looking forward to returning to an in-person event,” Comte says. “We learned a lot from the digital Geneva Health Forum that we did the last time. It can offer us an opportunity to link to people who will never be able to come to Geneva.”

“At the same time, we see that one of the real advantages of the GHF is to facilitate networking between people and collaborations. For this, you have to have in-person meetings and deeper discussions.” 

Fostering year-round collaborations 

Geneva Health Forum Exhibition (2018)

As a conference based in Geneva, the world’s second UN headquarters, the Forum offers a special draw to UN Missions officials, and particularly their health attachés, adds Flahault. 

“A health attaché can be a very lonely post,” he says. “They may be based in smaller missions, they have a lot of duties, and health issues are complex. So they appreciate being able to come to the Forum, as a kind of preliminary to the World Health Assembly, and gain insights that will be useful when the WHA comes along three weeks later.

The Forum’s Geneva position also enjoys a natural audience from the dozens of global health organizations, large and small, already operating in the city – which bring together a very diverse array of researchers, practitioners, and policymakers. 

“There are not so many forums where you gather people from academic institutions, NGOs, international organizations, and the private sector altogether,” he observes.  

While about half of the GHF participants are drawn locally, or from nearby European countries – the other half hail from dozens of nations around the world. For both local diplomats, as well as more far-flung participants, Switzerland’s traditional position as a “neutral” intermediary – unaffiliated with the world’s big power blocs, also remains an enduring draw to the event – which is also supported financially by the Swiss Confederation.  See related story here.

Says Flahault: “It’s important for participants to have the Swiss neutral venue for debate without vested interests attached.”

Drawing from its diverse base of participants, the GHF is also now incubating a series of ongoing collaborations, which extend well beyond the biennial conference dates.  

Those included a series of webinars last year, and this year, a series of eight workshops in which researchers and clinicians are exploring key themes like a new suite of recommended Digital Health interventions, which WHO could consider; improving pediatric surgery as well as sustainable pharmaceutical distribution in Africa; and a training programme for One Health/ Planetary Health. 

“So we are no longer only a health conference,” declares Comte. “We are creating permanent activities with working groups that will foster ongoing opportunities for collaboration. This is very important for us, because it’s really a place where people can work together.” 

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. 

Image Credits: Geneva Health Forum , Geneva Health Forum, World Meteorological Organizations, UNICEF, Antoine Flahault, M2R Films, Geneva Health Forum.

Pierre Strauss

The Swiss Confederation has been a key financial backer of the Geneva Health Forum since its early days. As the GHF prepares for its 2022 edition, 3-5 May, Pierre Strauss, health attaché to the Permanent Mission of Switzerland to the United Nations, spoke with Health Policy Watch about the evolution of the Forum and its relevance to the “International Geneva’’ landscape. 

Health Policy Watch: Given the situation we have now in Ukraine and the increasing polarization we see between Russia, China and the Western world – which could lead to fall out in other big meetings Geneva will be hosting, such as the World Health Assembly, what can you say about the Geneva Health Forum. Does this forum offer opportunities for more bridge-building?

Pierre Strauss: The forum is not a political platform. The forum makes the link between scientific practices at country level, researchers, practitioners and the Geneva ecosystem. So as dramatic as the situation is in Ukraine right now and notwithstanding the worldwide consequences of the war, the issue here is really health, global health. If there are initiatives that can be taken from it to alleviate medical needs in specific countries, including Ukraine, certainly this is very positive. But this is not the objective of the forum. 

HPW: What’s your vision for the GHF’s outcomes? 

Strauss: A. For us, as the Swiss Mission to the UN in Geneva, Geneva is a “Center of Excellence” when it comes to global health, and so the Forum is a unique platform for people to come and discuss, share experience, when it comes to health. So we see the forum as a place with convening power, which brings together various stakeholders of the Geneva ecosystem and beyond.  We see this as a very important tool, not only to make the link between the researchers, but between the researchers and the international organizations – because this is what makes Geneva unique.  We have an extremely rich ecosystem of organizations, such as: the University of Geneva, the Graduate Institute, the HUG, WHO, as well as other international organizations and health-focused NGOs, so I think the Forum offers this unique perspective and opportunity to link the two worlds.

HPW: Do you have a vision for future developments? What kind of new ideas or new energies would you like to see developed in the Geneva Health Forum in the coming years?

Strauss: I should emphasize that the Federal Department of Foreign Affairs is supporting the Forum financially, but we are not part of the organizers. We are supporting the event because we think it has a role to play in the international Geneva. We think the current Forum has been extremely successful to date, in taking concrete research from the field and sharing it with practitioners – to see how knowledge can be shared or approaches can be scaled up. Alongside that, I think there is a potential for the Forum to play more of a role in health diplomacy, making the link between recent research findings and the international organizations when it comes to policy – and how all of this fits into the health agenda here in Geneva.  

Geneva Health Forum 2020 discussion on NCDs. Increasingly the Forum is focusing on the broader global health agenda, alongside sharing clinical experiences.

HPW: So it’s evolving into a kind of two-pronged effort, you could say?

Strauss: Yes, the Forum is a place where you can learn about recent clinical research and medical research. But in terms of future directions, as shown with the Planetary Health approach, we can reinforce the link between the Forum, international organizations and the broader global health agenda of International Geneva. 

HPW: The Planetary Health and One-Health theme this year might be an example of that kind of evolving focus? 

Strauss: Yes, we can see that in the One Health, for instance, we see that there are actually a lot of discussions that are no longer only about clinical research, but about policy, as well. You know, like in Geneva, you have for instance, the discussion over the Pandemic Treaty. And you have questions aligning to biodiversity, for instance, and how, nowadays, we see that biodiversity has also an impact on health. So, if you look at the theme of the Forum this year, here, looking at One Health, which reflects  the complexity of health risks, it is opening up new doors into issues of health diplomacy that the Forum can explore further in future editions.

To Register for the Geneva Health Forum click here. See more about the themes and features of the Geneva Health Forum’s 2022 edition:

https://healthpolicy-watch.news/geneva-health-forum-pandemic-planetary/

Image Credits: Geneva Health Forum.

Nkengasong recently appeared before the US Senate regarding his nomination

The current Director of the Africa CDC is a vote away from leading PEPFAR. He unveils his vision for the US-led global HIV/AIDS response and future wishes for the Africa CDC.

Dr John Nkengasong, Director of the Africa Centres for Disease Control and Prevention (Africa CDC) is on track to lead the United States President’s Emergency Plan for AIDS Relief (PEPFAR) as the Ambassador at Large and coordinator of US activities to combat HIV/AIDS globally. 

Although Nkengasong is yet to officially announce his exit plans for Africa CDC, he has already appeared before the United States Senate Committee on Foreign Relations to answer questions from senators ahead of a vote to confirm his nomination by President Joe Biden. He would fill a position that has been left vacant for two years – ever since Deborah Birx stepped away from the post to join President Donald Trump’s COVID-19 response team.

The road ahead for Africa CDC

africa cdc
Nkengasong at the Africa CDC briefing on Thursday, 24 March.

If finally confirmed to lead PEPFAR, Nkengasong’s departure from the Africa CDC is expected to raise concerns about the future of the African Center – which rose to prominence under his guidance steering a steady course in the storms of the COVID pandemic – and only recently gained the status of an independent agency. 

Asked by Health Policy Watch about his pending PEPFAR appointment in a Thursday briefing, Nkengasong refrained from speculating on how his departure might affect the agency or who would replace him at its helm.  

But he said that the next agenda for Africa CDC is to leverage the gains of its COVID-19 response in strengthening its healthcare systems across the African Union’s 55 member states, and to be better positioned to fight future pandemics.

“The continent has been extremely innovative in developing platforms that are continuously being used to fight this COVID pandemic but we need to focus our energy on developing them to fight other diseases,” he said.

He noted that initiatives such as the African Medical Supplies Platform that was set up to fight COVID can now be expanded to fight other diseases in terms of commodities and supply chain management. 

“So I’m really pleased to see the initiatives that have come out of this continent [and] my greatest wish would be that these initiatives be sustained and developed further so that they can be used in managing other diseases, including future pandemics,” he told Health Policy Watch.

Testimony before the US Senate

PEPFAR has a long history of involvement in Africa, dating back to its inception in 2003. Africa HIV/AIDS programs have largely been the beneficiaries of PEPFAR investments exceeding over $100 billion. The plan claims it has saved 21 million lives, prevented millions of HIV infections, and is supporting several countries to achieve HIV epidemic control – all while significantly strengthening global health security.

In Nkengasong’s opening testimony before the US Senate on Tuesday, March 15, 2022, the Cameroonian virologist said he will draw upon his three decades of experience with research and programmes public health and HIV to advance PEPFAR’s mission, assure its continued success, collaborate with partner governments and communities, and sustain the strong partnership it enjoys with the US Congress.

“If confirmed, I would be stepping into this role at a critical moment when the world is confronted with dual global pandemics.  We have seen how COVID-19 has affected some progress in our HIV efforts with devastating results. But we have also witnessed how the health systems and institutions built and strengthened by PEPFAR’s investments have been central to the COVID-19 response,” he told the senators.

As Director of the Africa CDC, Nkengasong said he has seen how PEPFAR’s investments in health systems over the past 19 years have strengthened—and in some cases, established—the fundamental health infrastructure, laboratories, surveillance systems, and human resources for health in the countries where it helps serve.

While noting that previous efforts around HIV prevention, treatment and control were premised upon building ‘vertical’ systems as semi-independent entities, almost from the ground up, the goal has now shifted. PEPFAR’s future efforts must now ensure that these HIV services and systems are well integrated into national health systems, sustainably financed, and resilient to prevent and respond to HIV/AIDS in the future, as well as other diseases.  

“For this to happen, it is my belief that we need to capitalize on the capacity and experience of those in the countries where we work, coming to the table with a deep respect for their perspectives and needs, taking account of their insights, their knowledge of local contexts, and their reservoirs of expertise.  For such systems to be sustainable and keep infectious disease in check, we must act collectively to support the capabilities of local leaders and regional institutions and work in respectful partnership and accountability with them,” he said.

A dual US-Cameroonian citizen  

A native of Cameroon, Nkengasong earned his undergraduate degree at the University of Yaounde, and later studied at graduate level at the Institute of Tropical Medicine Antwerp, at the encouragement of the famed Belgian-British microbiologist, Peter Piot. After completing his second master’s degree in medical sciences in Brussels, he joined the World Health Organization in 1993.

In the mid-1990s, he moved to the United States where he spent a stint at the University of California at Berkeley, as a Fogarty International Center trainee, after joining the US Centers for Disease Control and Prevention. He then took over the leadership of the US CDC’s virology lab in Abijdjan, Ivory Coast. 

Nkengasong subsequently returned to the States and rose to the role of acting deputy principal director for the CDC’s Center for Global Health in Atlanta, Georgia – the state where he also holds US citizenship. 

In early 2017, he was appointed director of the newly-created African CDC. 

“In 2014, when Ebola hit West Africa, the heads of state met again and asked the African Union commission to accelerate the establishment of the Africa CDC,” Nkengasong recalled in a 2017 interview, published by the Fogarty International Center. “For all the human and economic destruction wrought by Ebola, it ended up being the catalyst that pushed African leaders to rapidly advance the concept that they nurtured in 2013 to bolster the continent’s public health response, and Africa’s continent-wide public health agency was launched in January 2017.”

Hopefully, the COVID-19 pandemic can have a similar effect on promoting Africa CDC’s continued development – regardless of who remains at its helm. 

TB patient at Brooklyn Chest Hospital in Cape Town, South Africa

The world remains fixated on getting new TB vaccines. But expanding the circle of progress on shorter TB regimes, and more early detection, may be more important to overcoming setbacks of the COVID pandemic, says one expert on World TB Day. 

IBADAN, Nigeria – The Government Chest Hospital in the city’s Jericho neighborhood is regarded as one of the top hubs for TB testing, treatment and care in Nigeria. Even though health workers at the facility try to encourage TB patients to sustain their course of treatment until the very end, they often see patients are unwilling to do so.

“We have those that do not want people around them to know they have TB, so it’s difficult for them to meet all of their appointments. We also have those that live very far from here. They often start well but over time, as the symptoms clear, they default and drug resistance may arise,” a nursing officer at the hospital told Health Policy Watch.

So the World TB Day 2022 announcement of an updated WHO guideline recommending a shorter four-month treatment course for children with “non-severe” TB was a much-heralded development in the TB space as further highlighted the existing research gaps in TB. The latest recommendation relied heavily on the findings of the University College London’s SHINE Study that was conducted in South Africa, Uganda, Zambia and India.

Professor Diana Gibb of University College London

In an interview with Health Policy Watch, the study’s principal investigator, Professor Diana Gibb of University College London noted that the focus of TB treatment research for both adults and children now is shorter treatment plans considering its effectiveness in preventing resistance.

“That’s where the research of both adults and children is focused because you can give shorter treatment and people take it properly, you’re less likely to get drug resistance, which is of course a major issue in some parts of the world,” she told Health Policy Watch.

Estimates for total number of people who died from any form of TB in 2020.On World TB Day, WHO Director General, Dr Tedros Adhanom Ghebreyesus, revealed that the spotlight is on the urgent need to invest in the fight against TB to achieve the commitments made by global leaders.

“Tuberculosis kills more than 1.5 million people each year and affects millions more, with enormous impacts on families and communities. Ending this debilitating disease remains a priority for WHO,” he said.

Better treatment with shorter courses

With no new TB vaccines yet in site, shortening TB treatment duration is gradually becoming a more immediate goal considered to be within reach near-term, one which could provide the TB ecosystem opportunities to recoup the big setbacks seen in treatment coverage during the pandemic. 

Along with the new four-month course for children, other recent treatment gains have included a six-month regimen for TB meningitis instead of 12 months. Moreover, bedaquiline and delamanid, two of the newest TB medicines to treat drug resistant TB, are now recommended for use in children of all ages, making it possible for children with drug-resistant TB to receive all-oral treatment regimens regardless of their age.  

Currently, however, treatment regimens for adults still require a six month course. And with patients seeing improvements in the early days of the treatment, it remains  difficult to ensure adherence to the end of the regimen. That, in turn, can pave the way for resurgence and even multi-drug resistant TB. 

Gibb, for one, is hopeful that new studies targeting adults with non-severe TB could also yield similarly shorter treatment courses in the near future –  although this remains more challenging  because adult TB diagnosis is still often delayed and their symptoms are more severe at the commencement of treatment.

“I think if you get adults at an early stage, it may be beneficial,” she told Health Policy Watch.

Progress on vaccine candidates 

tb
Funding Needs for TB Program Implementation in USD

One major feature of conversations during World TB Days since the COVID-19 pandemic in 2020 has been the stark comparisons between the fact that available TB vaccines remain limited to the century-old BCG vaccine, which is only partially effective and primarily targeted to children, in comparison with the tens of new COVID-19 vaccines that have become available just one year after the pandemic – with more in the pipeline. 

However, with the huge shortfall in TB investments seen to date – including investments in R&D, money is sorely needed to bring the most promising candidates to clinical trials and market. 

In a statement for this year’s World TB Day, the World Health Organization (WHO) called for the need to build on lessons learnt from COVID-19 research to catalyze investment accelerated  development of new TB vaccines. 

An additional US$ 1.1 billion per year is needed specifically for TB research and development – aside from the $13 billion required for TB diagnostics, treatments and prevention – asks for which only one-third or less has actually been received.

“Urgent investments are needed to develop and expand access to the most innovative services and tools to prevent, detect and treat TB that could save millions of lives each year, narrow inequities and avert huge economic losses,” said Ghebreyesus. “These investments offer huge returns for countries and donors, in averted health care costs and increased productivity.”

Improving TB detection 

A patient in the waiting room of the Government Chest Hospital, Ibadan Nigeria. More funding, expanded short-course treatments and faster detection are critical to overcoming setbacks of the COVID pandemic.

Improving TB diagnosis, especially among children is another attainable goal that needs to rank high on health system agendas, Gibb said. This can be done if public health systems  channel the financial gains of shorter regimens and more affordable drugs towards improving TB testing.

She also noted the need to improve TB treatment for other forms of TB, such as TB meningitis in children in which there is TB infection around the brain. 

Taken together, new point-of-care testing kits, early detection of latent TB, and related to that, the ability to predict the transition from latent to active TB cases offer a cascade of solutions that can enable earlier detection of disease, when less of the lung is affected. And that, in turn, will lead to options for shorter treatment duration over time, she said. 

Overcoming previous side effects and limitations

Government Chest Hospital in Ibadan Nigeria – considered a top national hub for TB testing, treatment, and care in the country.

One of the major concerns that plagued the adoption of new TB treatment recommendations is the concern of serious side effects ranging from deleterious impacts on cognitive functions to impairment of liver functions.

While admitting that these were real concerns in the past, Gibb, however, noted that new regimens have been able to overcome the side effects barrier in addition to requiring fewer daily tablets, better tasting tablets, and doing away with injections.

“Actually the children tolerate the medicine very well,” said Gibb. “And we are using new medicines, in which the drugs are taken all together in one pill, which then can be dissolved in a little bit of liquid. 

“So it’s not as bad as it used to be in the old days when you had to take them more often. And we no longer use injections for children to get them as it used to be part of the old TB treatment,” she added.

Image Credits: USAID, Southern Africa/Flickr, STOP TB Partnership , Fatola Babafemi/Google Maps, Fatola Babafemi/Google Maps .