WTO Director-General Ngozi Okonjo-Iweala

In a significant breakthrough, the World Trade Organization’s (WTO) TRIPS Council on Friday will finally discuss a compromise proposal on a waiver of intellectual property (IP) rights on COVID-19 vaccines – almost 18 months after it was first proposed by India and South Africa.

Members attending an informal meeting of the TRIPS Council on Tuesday were told that the text of an “outcome document” from the “quad” of the European Union, US, India and South Africa would be circulated to them “within hours” from WTO Director-General Ngozi Okonjo-Iweala’s office.

The outcome document, which was later posted on the WTO website, is very similar to that which was leaked in mid-March – but it has been termed an “outcome document” rather than an agreement as there are still a couple of points of disagreement.

Disagreement over who should be eligible

The main point of disagreement relates to which countries should be able to benefit from the waiver (footnote 1). All developing country members that have not yet achieved a significant export capacity – namely 10% of the world’s COVID-19 vaccine market – are supposed to benefit from the flexibilities. 

Apparently, China has been unhappy about being excluded while a country like India with large generic manufacturing capacity, may be included.

But the new TRIPS Council chairperson, Sierra Leone’s Ambassador Lansana Gberie, told Tuesday’s meeting that the superpower “seemed favourably disposed” towards the compromise – also contained in footnote 1 – that states “all developing country members with capacity are encouraged to opt out from these flexibilities”, according to a WTO official.

While the waiver only applies to vaccines, WTO members will have six months to decide whether to extend it to cover the production and distribution of COVID-19 diagnostics and therapeutics.

According to the draft document, eligible WTO members will be able to limit TRIPS article Section 28, which deals with exclusive patents, by authorizing the production and supply of COVID-19 vaccines without the patent holder’s consent, and with minimal transaction costs. 

Single authorisation for multiple patents

Another deviation from draft agreement that was leaked in mid-March is related to whether countries will have to list all the patents that they will be waiving – widely criticised for imposing onerous requirements on countries. This appears set to go, according to footnote 3.

Eligible countries may issue a single authorisation to use multiple patents and can export the vaccines they produce under this authorisation to other eligible members, particularly countries in greatest need, and to supply regional or international initiatives such as COVAX (a waiver of TRIPS Art. 31(f).)

Eligible members will also be able to use any of their legal instruments to impose a waiver on vaccines, and the protection of clinical trial data under TRIPS will not be an obstacle to implementing this proposal.

Payment for any vaccines produced under TRIPS waiver conditions for export is to take account of the humanitarian and not-for-profit purpose of the vaccine programme, to support manufacturers to produce and supply vaccines at affordable prices. 

The duration of the flexibilities would be either three or five years, and eligible members would be exempted from legal challenges under the WTO dispute settlement mechanism.

The earlier agreement was widely condemned by health activist groups, who objected the waiver being confined to vaccines and excluding some of the world’s major COVID-19 vaccine producers.

In addition, a diplomatic source told Health Policy Watch that he did not know the value of the waiver given that there was an apparent surplus of COVID-19 vaccines.

The results of the formal discussion on Friday will be reported to the General Council, which is scheduled to meet on 9 and 10 May. 

Image Credits: Jess Hurd/ Global Justice Now, Africa Centre for International Trade&Development.

Geneva Health Forum session, “Impact of climate change on health.” From left: Moderator Maximilian Jungmann, University of Heidelberg; Alfonso Gomez, City of Geneva; Maria Neira, World Health Organization; Gueladio Cisse, CGIEC Swiss TPH; and Valérie D’Acremont, University of Lausanne.
Geneva Health Forum session, “Impact of climate change on health.” From left: Moderator Maximilian Jungmann, University of Heidelberg; Alfonso Gomez, City of Geneva; Maria Neira, World Health Organization; Gueladio Cisse, CGIEC Swiss TPH; and Valérie D’Acremont, University of Lausanne.

Children sick with malaria, adults in bed with fevers and rashes as a result of the Zika virus, tick-borne illnesses – all of these diseases are on the rise as a result of climate change, according to Valérie D’Acremont of the University of Lausanne.

She spoke on Tuesday at the Geneva Health Forum during a special session on the impact of climate change on health, addressing the question: “what is the scale of the problem and what action needs to be taken?”

“It is clear that there has been an increase in transmission of [existing] pathogens and of new pathogens,” said D’Acremont, a Swiss physician who is also working on a project in Africa.

For example, the spread of malaria, caused by a parasite that spreads to humans and other animals through the bites of infected female mosquitoes, increases in temperatures of around 25ºC.

“In West Africa, it is too hot, so malaria might be going down, but in East Africa, the opposite is the case and we see an increase in malaria,” she said.

Adding to the challenge are compromised health systems, the result of two years of the COVID-19 pandemic, which has seen the world losing some of its gains against malaria over the last 20 years.

Mosquitoes, similarly, are more prone to spreading Zika virus in around 30ºC, which means that the world’s tropical areas are seeing more and more of the disease, and it is likely to extend to Europe and other countries.

“We see it already in Italy,” D’Acremont stressed. “We might one day have to sleep under bed nets like they do in Africa.”

Tick-borne diseases are spreading in Switzerland, also as a result of climate change, she added. There has been a two-thirds increase in the number of people hospitalized for ticks in Switzerland from 2009 to 2019, according to a recent report by RTS. Moreover, the number of tick bites rose from around 10,000 per year between 2012 and 2016 to around 14,000 a year in the last four years.

“Journalists like to hear this story because it frightens people,” D’Acremont said but added that the main challenge was that people die from these diseases when coupled with other pre-existing conditions, such as diabetes, hypertension or malnutrition. These are also often a result of climate change or failing to take care of the environment and our food sources.

“Climate change has a huge impact on this too, especially undernutrition and respiratory problems,” she said.

Alfonso Gomez of the City of Geneva addresses the Geneva Health Forum on May 3, 2022.
Alfonso Gomez of the City of Geneva addresses the Geneva Health Forum on May 3, 2022.

We need to stop exploiting animals, destroying nature

Climate change has become an inescapable reality. The most recent Intergovernmental Panel on Climate Change (IPPC) report showed what people already knew: There is now scientific consensus that climate change is impacting people’s health and wellbeing in all hemispheres.

Sometimes the effect is direct, Gueladio Cisse of CGIEC Swiss TPH, who also spoke at the session, said. Sometimes it is indirect. Sometimes the effect comes at once, and other times it has a slower but also longer-term impact.

“If there is a heatwave, the next thing you know people are dying over the course of two or three days,” Cisse said as an example. Other times, a general increase in temperature allows pathogens to grow and makes humans more vulnerable to disease.

The good news, said Dr Maria Neira, of the World Health Organization, is that the scientific community has been “pulling together in a historic way all the evidence we have on climate change… They are telling us things like if we don’t take measure now, this might put civilization at risk.”

D’Acremont agreed but said that while research was useful, now is the time to do research in the field by monitoring the impact of steps taken to curb environmental hazards.

“We need a paradigm shift to go to prevention,” she said. “Take COVID. It is nice to have a preparedness plan, but the problem is that another pandemic or event could come and it is new and we cannot be prepared.”

Instead, she said, “we need to stop destroying nature, stop exploiting animals and start preparing ourselves by being in better health. During the crisis is too late… We have to shift the reality now to preventive care. That is true for northern and southern countries.”

This is part of a Health Policy Watch series of stories on feature themes at the 2022 Geneva Health Forum. Supported by a grant from the Canton of Geneva.

Image Credits: Maayan Hoffman.

The Geneva Health Forum opened with a panel discussion on, “One Health: is there a paradigm shift?” From left: Andrea Sylvia Winkler, Peter Ben Embarek, Lisa Crump, Jean Philippe Dop and Keith Sumption.
The Geneva Health Forum opened with a panel discussion on “One Health: is there a paradigm shift?” From left: Andrea Sylvia Winkler, Peter Ben Embarek, Lisa Crump, Jean Philippe Dop and Keith Sumption.

More accessible funding will be required for the international community to implement a broad One Health approach, scientist Lisa Crump of the UN Environmental Program (UNEP) told Health Policy Watch on Tuesday.

Speaking on the sidelines of the Geneva Health Forum’s (GHF) kick-off discussion, “One Health: is there a paradigm shift?” Crump said that “we need ways to get funding so that it is easy to access. We have some very old ways of releasing funds and they are not reactive or responsive, and that is what we need”.

“We need to make funding more accessible, make more of it and put fewer strings on it,” she continued. “It has to make economic sense. Or at least there has to be some benefit. It can be economic savings or it can be improved health or increased ecosystem resilience. It is not always money. But it takes money to figure out what is going to work and we cannot ignore that fact.”

Crump was one of four panellists who spoke during the session. The others included Jean Philippe Dop of the World Organization for Animal Health (OIE), Keith Sumption of the Food and Agriculture Organization (FAO) and Peter Ben Embarek of the World Health Organization (WHO). The session was moderated by Andrea Sylvia Winkler of the Center for Global Health at the Technical University of Munich and the Centre for Global Health at the University of Oslo.

More than 1,000 people attended the forum on Tuesday and almost as many were watching a selection of sessions that were aired virtually.

The concept of One Health is a big focus of the GHF after decades of the topic being consigned to the margins of health agendas. The COVID-19 pandemic has highlighted the importance of a holistic approach to health across species as the virus was most likely to have been transmitted to humans from a bat, via infected mammals housed and slaughtered in unsanitary conditions at a marketplace in Wuhan, China.

“The COVID-19 pandemic highlighted the intimate links between health, humans, animals and our environment,” stressed WHO Director-General Dr Tedros Adhanom Ghebreyesus in a video message to the conference. “Reducing future pandemics demands closer collaboration across sectors.”

Around 60% of known infectious diseases and as many as 75% of new or emerging infectious diseases are zoonotic in origin. As a result, the One Health approach is receiving broad support from the WHO, FAO, OIE and, most recently, UNEP – together, formally known as the Quadripartite.

One Health was defined in December 2021 by the inter-agency One Health High-Level Expert Panel (OHHLEP) as “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.”

Tuesday’s GHF session marked the first time that all four lead technical focal points of the quadripartite organizations have appeared together in a public forum to discuss the changing One Health landscape.

Common sense has come to the political arena

Ben Embarek explained that the biggest shift he has seen since COVID-19 is that now politicians and government officials are buying into One Health, too.

“When common sense comes into the political arena, that is where things start changing,” he said. “When we have heads of states talking about One Health, this is a shift for sure.”

Dop expressed similar sentiments, noting the involvement of these decision-makers in the One Health agenda as “a good effect of the pandemic, if there can be one”. And he said that this involvement will play a key role in being able to implement One Health concepts aligned by professors and doctors in academia in the field.

Another shift is the new and formal involvement of UNEP, with Crump saying that her organisation is ready to “mobilize our assets and partnerships to support a One Health approach”.

The UNEP has already helped establish a multi-partner trust seeded with €50 million to enhance countries’ investments in nature with the goal of stopping pandemics. Those funds will also go for working towards establishing four outcomes: providing multidisciplinary evidence on the links between biodiversity, climate change and health; enhancing One Health preventative actions and policies; providing target-specific capacity building and knowledge management, advocacy and awareness-raising programs on those links; and to create sustainable One Health collaborations with government structures.

Having UNEP involved in a greater capacity should also enable the team to focus more on issues such as soil, water and other environmental factors that play a role in health and wellbeing, said Sumption. He expects new opportunities from environmental ministries monitoring for pathogens to ecosystem restoration and biodiversity maintenance.

“There are hundreds of thousands of people whose livelihoods depend on forests so we need sustainable wildlife management in those settings,” Sumption stressed.

Food and Agriculture Organization Director-General QU Dongyu address the One Health opening session via video.
Food and Agriculture Organization Director-General Qu Dongyu addressed the One Health opening session via video.

‘Widening the perspective of students’

But the key to the future is educating the younger generation to take a One Health approach from the onset of their careers, said Ben Embarek.

He addressed students and teachers and called on them to break down silos in their universities from the podium.

“It is widening the perspective of students in the existing silos,” Ben Embarek told Health Policy Watch after the session. For example, he said, “medical students should be exposed to what vets are doing and what is happening out there in the environment so that they will get a better perspective and that they will see that the health of humans is connected to all of these things.”

At the same, he noted, while vets might be focused on producing healthy animals, at some point, someone is going to eat these animals and those who are going to do so should not die from eating them.

“It is important to not only protect the animals from animal disease but also to protect animals from pathogens that will affect humans,” Ben Embarek continued, “It is really about exposing students and including in their curriculum the perspectives that exist in other sectors, and understanding that some of the issues they are trained to solve in the future will depend on the health and actions of other sectors.

“So, when they are in these positions later on in life it will be easier to understand what others are doing, why they are doing it and how to change.”

This is part of a Health Policy Watch series of stories on feature themes at the 2022 Geneva Health Forum. Supported by a grant from the Canton of Geneva.

Image Credits: Maayan Hoffman.

When we think about the critical drivers of disease prevention and control – we need to stop thinking only about medicines, vaccines and diagnostics. 

In fact some of the most important forms of disease control can be found in forests – which harbor thousands of pathogens, known and unknown in relative isolation from humans and the damage that they could otherwise cause. 

But humankind is felling forests and wreaking other kinds of damage on ecosystems at an unprecedented rate – laying the groundwork for the next pandemic as we speak endlessly about how to get the world out of the present one. 

That is the key message of the new film “La Fabrique des pandémies” (Making Pandemics) by the French journalist and documentary filmmaker, Marie Monique Robin. 

Avant-premiere at Geneva Health Forum  

French star, Juliette Bionoche, who narrates the film.

The film will be aired at a public avant-premiere on Wednesday 4 May at 6 p.m – as part of the Geneva Health Forum. The Forum, which begins on Tuesday, has a climate and environmental health focus this year. 

The film, born out of reflections during the COVID lockdown, took Robin to eight countries across Africa, Asia and the Americas  – from French Guinea to DR Congo, Malaysia and Mexico, as well  as upstate New York. 

The result is the product of the relentless detective work of Robin, a seasoned journalist who also directed “The World According to Monsanto”, a critical look at the pesticide industry. 

Narrated by the French film star, Juliette Bionoche, the film aims to make the issue more accessible to the general public – despite its highly technical material. 

So it is Binoche that relates the stories of the deadly viruses, bacteria and parasites that have “escaped” from the wild to become major plagues to human health – as seen through the eyes of the scientists who have documented their destructive pathway.     

next pandemic
Pig farm in Sarawak, Borneo, Malaysia – a reservoir for Nipah virus.

The examples include the story of Malaysia’s deadly, bat-borne Nipah virus which became a threat to humans as bats driven from rainforests destroyed to create palm oil plantations found new homes in agricultural areas, and particularly around pig farms. Infected pigs, close to people both genetically and proximally, then began transmitting the virus to humans. 

While most of the stories relate to developing countries, developed regions are not immune. Lyme disease, transmitted by ticks in North America, has posed an increasing threat to human health as forests there become fragmented, biodiversity is reduced, and species such as the white-footed mouse proliferate, which are a reservoir for the deadly Borrelia bacterium that causes Lyme disease.    

COVID lockdown reflections 

Filming of Making Pandemics. Robin, on right, conducts an interview.

The film began with Robin’s own reading and reflections during the COVID lockdown – including an article that she read in the New York Times, which struck a special chord entitled “We made a pandemic.”

“I began searching and contacting scientists with whom I have been working for more than 30 years,” she relates. Among them was Serge Morand, a parasitologist living in Thailand – who will also be appearing himself at the Geneva Health Forum, running from 3-5 May. 

“And he said, oh it would be great if you could put all of us together in a book or a film.

“The thing is,” Robin adds, “is that there have been many, many dozens of studies published, showing the link between the destruction of biodiversity, on the one hand, and on the other, the emergence of infectious diseases. 

“And so Morand told me, ‘if you could put all of us together, it would be very powerful. Because we have been sounding the alarm for so many years, and just nobody is paying attention.”

Robin went on to interview some 62 scientists working in various parts of the world – with the stories of 14 condensed into the book, Making Pandemics, published last year, which has now been made into a film.  

Three drivers of disease 

Deforestation is a key driver of new infectious diseases – which leap from wild animal species to humans.

The interviews all weave together to underline a single message about the ecological factors driving the emergence of new infectious diseases – and the expansion of already well-known diseases.  

“The first factor is, of course, deforestation in tropical areas,” Robin says of the key drivers.  “And then intensive breeding [of animals], and then globalization.

“It means growing soybeans in Argentina or Brazil, to feed European cattle. It means cultivating palm trees.  It means mining, gold, copper, etc.  And also urbanization.  All of these factors which contribute to deforestation in tropical areas.”  

The dilution effect 

Maintaining biodiversity alongside food production is critical to preventing new pandemics.

While there is some growing awareness about how climate change and biodiversity loss is increasing the frequency at which diseases like Ebola, Nipah and others are emerging or expanding, Robin offers fresh insights into why this is the case.  

Just imagine the forest as a massive universe of bacteria, parasites and viruses, both known and unknown, circulating among the animal species that live there.  When forests are deep and expansive, pathogens are more likely to stay within their natural geographic boundaries, Robin explains. 

And when animal species are diverse and plentiful, then dangerous viruses are largely contained by a set of natural biological checks and balances that keep other species in check too.

In a well-balanced ecosystem, when pathogens have lots of different animals to infect – they won’t infect species that can transmit the disease to humans as frequently or as intensively – something that she describes as the “dilution effect”.

Animals that are more prone to dangerous infections also cannot become too dominant as a species, and thus pose an even greater risk to humans – because they also are the prey of other animals that keep them in check.    

Biodiversity protects your health

Deer in North America are becoming more infected with ticks carrying Lyme disease

But when the forest is cut away or fragmented – and its animals hunted down or otherwise destroyed by humans – then the chances of a pathogen infecting an animal species with a dangerous pathogen that may then carry the same disease to humans increase.  

Lyme disease is a good example of that principle, she explains.

“The dilution effect means that when you have a big community of mammals floating around in the forest, then the probability that a tick will feed on a white-footed mouse, which is a reservoir of the Borrelia bacterium, is diluted. 

“A tick, which needs a blood meal, may land on an opossum instead of a mouse – and the opossum won’t get infected because he cannot be a host for the bacteria,” says Robin.

And meanwhile other predators, like foxes, hunt and eat the mice, also keeping them in check.  “But if you fragment the forest as we have seen in the state of New York, then most of the predators, like foxes for instance, leave.” 

The ticks left with fewer animal choices, feed more on mice – in a vicious cycle.  

“So the white-footed mouse is proliferating, and becoming more infected by ticks,” says Robin. More infected ticks also land on deer, who are hunted by humans.  

“And scientists have shown that the probability of [humans] also getting infected in a fragmented forest is five times higher; this is the dilution effect,” she says. 

“The dilution effect shows that biodiversity protects your health because when you have a lot of biodiversity, the chances of anyone [human] getting infected are reduced.”

Click here to reserve a free ticket to the film., See the complete programme for  GHF 2022 here – and register for the full event Tuesday-Thursday or daily, in person or remotely.  

Check out Health Policy Watch’s ongoing coverage of other themes featured at this year’s Forum on our GHF 2022 microsite

This is part of a Health Policy Watch series of stories on feature themes at the 2022 Geneva Health Forum. Supported by a grant from the Canton of Geneva.

Image Credits: Thomas Quine/Flickr , nosha/Flickr.

Breast-feeding is key to improving health outcomes in mothers, babies, and communities

Digital ads for breast-milk substitutes are now one of the most popular and effective marketing strategies – negatively impacting breastfeeding practices, according to a new report published Friday by the World Health Organization. 

The report, ‘Scope and impact of digital marketing strategies for promoting breastmilk substitutes’, found that digital marketing of infant formulas has increased sales in every country studied. It is thus fueling the steady growth of the breast milk industry, now valued at $52 billion – and increasingly threatening healthy breastfeeding in the early months of life. 

In some countries reviewed, more than 80% of women who reported seeing breast-milk substitutes (BMS) advertisements were now seeing the content online.

This demonstrates the power of digital technologies, as they offer advertisers new marketing tools that are powerfully persuasive, extremely cost effective and often not easily recognizable as BMS promotions.

Lawrence Grummer-Strawn, WHO Unit Head of Food and Nutrition Action in Health Systems

“We have a huge threat on breastfeeding. Digital marketing is really going to make things difficult for us on breastfeeding, and therefore is a huge challenge to the health of mothers and the health of babies,” said Lawrence Grummer-Strawn, WHO Unit Head of Food and Nutrition Action in Health Systems, during a launch of the report.

“The reach of digital marketing is so great that, in many countries, it is inescapable… It is therefore not surprising that digital marketing has become the dominant form of BMS promotion,” reads the report. 

Ample evidence shows that exclusive and continued breastfeeding in the first months of life are key to health for children, women and communities.  But far too few children are breastfed as recommended.  And despite the World Health Assembly’s adoption of the International code of marketing of breast-milk substitutes (“the Code”) in 1981 – digital advertising is increasingly undermining the will of women to breast feed.  

The report includes findings from several studies including: a multi-country study of mothers’ and health professionals’ experience with digital marketing; individual country reports of BMS promotions; and an analysis of legal measures that have been taken to implement the Code to date.  Studies captured digital interactions that referenced infant feeding in 11 languages that originated from 17 countries, which together account for 61% of the global population and span all six WHO regions. 

The report further confirms findings aired at the World Health Assembly in 2020, that breast mild substitutes were making new inroads into households in the global South,  including through new and more effective modes of digital marketing.

Breast-milk substitute sales boosted through online social media 

breast-milk
TV and the internet (social media) plays a huge role in BMS marketing across those included in the multi-country study

In one of the reviews, women in seven countries – Bangladesh, China, Mexico, Morocco, United Kingdom, and Vietnam, who recorded BMS promotions in marketing diaries over a single week reported seeing advertisements for formula on social media and e-commerce sites.

In Indonesia and Vietnam, the most frequently identified sources of advertising for BMS products were the Internet and Facebook. In Thailand, Facebook was the most commonly reported source of BMS marketing, with most of these advertisements (58%) originating from company/brand websites, followed by the companies’ Facebook accounts. 

Exploiting women’s most vulnerable moments to sell formula

 

Seven of eight countries reported seeing increasing amounts of BMS promotions after one week of recording in phone diaries

The Facebook promotions include targeted advertising about infant formulas, follow-on formula and toddler formula, virtual support groups known as baby clubs hosted by BMS brands, BMS branded apps and social media influencers promoting BMS products. 

“The precision with which digital marketing platforms can identify users by their characteristics, their traits, their spending patterns, and their likeness to other users is quite uncanny,” remarked Nina Chad, an expert in WHO’s Department of Nutrition and Food Safety.   

“When women share information about pregnancy with family and friends online or purchase maternity clothing, search for a health provider, or join an online support group, they’re often identified as targets for advertising for baby related products and brands, including BMS.” 

“This technology enables advertisers to exploit their most vulnerable moments, disguise their marketing content as information or advice and enlist people women respect most to influence their infant feeding choices,” the report adds.  

Only one in five countries prohibits online marketing of infant formulas  

BMS promotion through influencers, who cannot be regulated by the Code, as they are not directly employed by the BMS manufacturers/distributors.

Digital marketing techniques described in the report present challenges for regulation with fewer than one in five countries (19%) explicitly prohibiting the promotion of BMS. 

These technologies enable advertisers to evade scrutiny from enforcement agencies by delivering BMS promotions to personal accounts without ever publishing them publicly. 

However, it is difficult to hold manufacturers and distributors of the products accountable as their promotions are generated by virtual support groups that consist of the general public and mothers, as well as social media influencers, who are not directly employed or contracted by these companies.  

Additionally, product promotions more frequently target the mothers of infants 6-12 months old, as compared to newborns. This practice, known as line extension or cross promotion, is used to circumvent regulation that prohibits the promotion of infant formula products suitable for infants up to 6 or 12 months of age.  

The report advises new approaches to implementing the Code and potentially even new and updated strategies to monitor and enforce its regulations in order to protect both mother and infants from the harms of digital marketing. 

“We need to have greater regulation of the platforms themselves. We can’t put all of this on the shoulders of those who want to be advertising. It’s also among those who are actually carrying out the advertising who are making this targeting possible and who are hiding the information that is needed for monitoring and enforcement,” said Grummer-Strawn. 

Image Credits: Flickr, WHO.

Registered nurses look after newborns at the Princess Christian Maternity Hospital, in Freetown Sierra Leone

Geneva Health Forum’s Global Health Lab 3-5 May will showcase over 100 new diagnostics and treatment tools designed for resource-constrained settings. The Autothermo device for continuous, real-time temperature monitoring is one of the innovations being featured there. 

Early detection of patients’ temperature changes, especially in the case of newborns who lack adequate temperature control, can be lifesaving in almost any setting. 

This is especially the case for infants and newborns in hot climates, where conditions like hyperthermia, informally known as “evening fever syndrome” EFS can be life-threatening, particularly for premature babies in hospital and health clinic nurseries where cooling systems are inadequate  and air conditioning frequently fails. 

In addition, being able to leverage technology to monitor a child’s temperature in real time can also be important in many other contexts of childhood illness. 

And this is what the new device Autothermo aims to achieve. Autothermo is a wearable continuous temperature measuring bracelet with a remote display. It includes an alarm system and SMS capability for remote caretaker notification. It  is among more than 100 innovations on display at the Global Health Lab innovation exhibit next week. 

The exhibition is part of the Geneva Health Forum 3-5 May, which brings hundreds of global health policymakers and practitioners together from around the world. 

The Global Health Lab will be showcasing dozens of low-cost, digital, and hand-held tools that aim to make common diagnostic procedures and treatments more accessible, especially for resource-constrained countries.

Simple needs often overlooked in access to healthcare debates   

Autothermo team leader Nura Izath

When the poor state of healthcare in some African regions is discussed, it is often in the context of the lack of easy access to advanced automations and complex lifesaving procedures. 

While these concerns are valid, they often occlude, or minimize, the importance of certain basic-yet-essential indices such as body temperature. 

In human physiology, temperature is regarded as an index of illness because every metabolic reaction in the human body occurs at a certain temperature level. This makes it an age-old, but oft-forgotten index of disease and body states. 

However, a wide range of factors make adequate monitoring of this simple and basic metric challenging resource-constrained settings – including newborn nurseries. And this is what Autothermo is trying to address, the project’s team leader, Nura Izath, told Health Policy Watch.

“First of all, we have very few health workers, including pediatricians, versus the large number of newborns they have to manage at a time. It becomes hard for them to identify which newborns are in urgent need of thermocare interventions,” said Izath, a science and tech developer based in Mbarara, a city in south-central Uganda, who is the front-end developer and co-founder of the Autothermo innovation.

Managing 40 newborns at a time 

Autothermo’s innovation can be used to manage babies at risk.

At the Mbarara Regional Referral Hospital, for instance, there is only one nurse per shift, managing over 40 newborns in the hospital nursery at a time, notes Izath, who holds a degree from the Mbarara University of Science and Technology. 

Many of the newborns are premature or have other sensitive conditions, in which slight and subtle changes in temperature could signal the difference between life or death.  

“It’s so hard that by the time this nurse knows there is a baby in need of thermocare, it’s very late. In such scenarios we have lost lives. These are things that can be prevented by using interventions such as Autothermo.”

She says that the innovation should change the narrative regarding temperature management for newborns – insofar as health workers can remotely monitor babies at risk, and will also be able to prioritize thermocare interventions through the alerts they receive about newborns in need of the intervention.

“It will help them to manage the daily routines and will also save many lives,” she added.

Innovation emerged out of personal experience watching a young infant 

Izath’s innovation emerged out of a personal experience minding  newborn at home. 

“In 2014, I was tasked to babysit my one-day old nephew as his mother had to go for an exam,” she relates. “I was excited and at the same time understood the importance of this task. At the beginning, I held the baby until he slept, then kept checking on an almost 10 minute interval while I was doing other house chores. 

“To be honest, the back and forth was a bit tiresome. That’s when I thought of innovating something that could monitor and inform the parent or caregiver the status of their newborns in case of emergency and also support health workers in hospitals during admissions.” 

She shared the idea with a local clinician and pediatrician, Dr. Gloria Karirirwe – who quickly recognized the need such a device could fill in light of the challenges she had faced in her own practice, managing newborns with temperature-related challenges. 

They shared the idea further. Together with a group of six other professionals, they took the concept to Dr. Data Santorino, director of the Consortium for Affordable Medical Technologies, an innovation hub based at Mbarara University of Science and Technology, where Izath earned her degree.

“Dr. Data, together with his team, took us through concept development, proposal writing and the initial prototype development. Both the proposal and the initial prototype were helpful in aiding Autothermo to acquire its seed grant from the Ugandan Ministry of ICT and National Guidance. This fund was used to develop the minimum viable product that we currently have for studies.”

Also practical for outpatient clinics – where fever is one of main motives for seeking healthcare 

Other diagnostics and treatment tools, including Autothermo for newborns, will be found at Geneva Health Forum’s Global Health Lab 3-5 May

A fever also is one of the most common reasons for which parents will bring their toddlers and young children to a local health clinic or hospital, Izath adds. In fact, some 60% of children presenting to most medical emergency departments in Uganda have a raised temperature, she notes.

Unfortunately, many arrive too late — after complications have already set in — leading to febrile seizures and worsening of the underlying illnesses. High fever among under-fives can also result in heat stroke, often leaving affected children paralyzed and, sometimes, death.

Another selling point for Autothermo is that caregivers can easily interpret the temperature fluctuation situations and respond accordingly – based on the color-coded bars that it reports. And at a production cost of just $18 – it is a device that could be made widely available at simple health posts as well as hospitals. 

However, the Uganda-designed prototype still faces a long road ahead to obtain regulatory approval from the Ugandan National Council for Science and Technology.

“The health workers want to start using it but they cannot use it yet because we need  approval,” Izath said. “We are now seeking approval from the Mbarara University Of Science and Technology Ethics committee. After that, we will be moving to the Council. All these are the bodies that need to authorize the use of the Autothermo.” 

Izath will be attending the Geneva Health Forum, which will give her an opportunity to learn from other innovators in attendance, as well as seek out partnership and fund-raising opportunities.  

“We hope to see partnerships that can help us pilot studies in different facility settings. We also believe that the problem we are trying to solve is not only in Uganda, it’s a global challenge. We are not doing a solution only for Uganda. We would like to reach out to many stakeholders and see how we can make this come to light,” she concluded.

See the complete GHF 2022 programme. Register here: Until 2 May fees are CHF 400 for the entire event and CHF 150 for participants from low- and middle-income countries (OECD classification).  Daily rates are also available. 

Check out Health Policy Watch’s ongoing coverage of other themes featured at this year’s Forum on our GHF 2022 microsite

Image Credits: World Bank/Flickr, Unicef, Geneva Health Forum .

ebola
Ebola vaccination campaign in Mbandaka, Équateur Province (DRC) in 2020

In DR Congo’s latest Ebola outbreak, the two people with confirmed cases are dead and response is focusing on identifying and vaccinating contacts – because of insufficient doses to conduct a mass vaccination campaign in the outbreak area. Meanwhile, public health officials are trying to reboot Africa’s mainstream immunization programmes, which saw setbacks during the COVID pandemic. 

A targeted Ebola vaccination campaign aimed at tracing and immunizing contacts is underway in Mbandaka, a city in DR Congo’s north-western Equateur Province where two people with confirmed cases of Ebola have both died, according to the World Health Organization (WHO) on Thursday.

Addressing a press briefing on Thursday, Dr Mory Keita, Incident Manager for Ebola outbreak response in the DRC, confirmed the deaths of the two people with confirmed cases since the country’s latest outbreak was declared on April 23.

“So far, 78 direct contacts have been vaccinated and we are using the method of identifying contacts to vaccinate, because it has proven to be an effective means of quickly stopping outbreaks. And we do not have enough doses to vaccinate everyone in the country,” Keita said.

Dr Mory Keita, Incident Manager for Ebola outbreak response in the DRC

The vaccination exercise is commencing while DRC joins the rest of the world in marking the African Immunization Week, part of the larger World Immunization Week observance. For this year, attention is being drawn to what the WHO described as a surge in outbreaks of vaccine-preventable diseases over the past year.

Between January and March 2022 alone, WHO almost 17,500 cases of measles were recorded in the African region and this represents a 400% increase compared with the same period in 2021, WHO’s Africa Regional Office noted: 

“20 African countries reported measles outbreaks in the first quarter of this year, eight more than that in the first three months of 2021.” 

In 2021, 24 countries in WHO’s Africa region also confirmed outbreaks of a polio variant.  New yellow fever outbreaks were reported in 13 countries. as compared to nine  in 2020 and three in 2019. The agency has not yet reported on 2022 data. 

WHO noted that inequalities in accessing vaccines, disruptions by the COVID-19 pandemic including a huge strain on health system capacities impaired routine immunization services in many  countries and forced the suspension of other more routine vaccination drives.

“The rise in outbreaks of other vaccine-preventable diseases is a warning sign. As Africa works hard to defeat COVID-19, we must not forget other health threats. Health systems could be severely strained not only by COVID-19 but by other diseases,” said Dr Matshidiso Moeti, the WHO Regional Director for Africa. “Vaccines are at the heart of a successful public health response, and as countries restore services, routine immunization must be at the core of revived and resilient health systems.”

Lessons from COVID about vaccination in Africa

Professor Helen Rees, Executive Director, Wits Reproductive Health and HIV Institute, University of Witwatersrand, South Africa

As of April 28, only about 16% of the African population has been fully vaccinated against COVID. Even though this is still far from the 70% vaccination goal, it has been an enormous task for the continent’s public health stakeholders, as well as an eye-opener to the issues that influence and direct impact vaccination on the continent.

Delays in COVID vaccination in Africa – as rich countries hoarded vaccines – damaged overall uptake of COVID vaccines on the continent, said Professor Helen Rees, Executive Director, Wits Reproductive Health and HIV Institute, University of Witwatersrand, South Africa.

Africans, having already lived through two years of the pandemic without the vaccines, are now no longer very keen on getting the shots, she observed.

“The delay in accessing vaccines allowed misinformation and disinformation to come in. But it also allowed questions to be raised at the population level about “well, is this disease really as bad for us as we see in the northern hemisphere?

“And people don’t necessarily understand that we have different demographics, we have younger populations, we’re going to see more asymptomatic mild infections,” she said.

Dr Benido Impouma, Director of Communicable and Noncommunicable Diseases Cluster at WHO Regional Office for Africa

The perception of a reduced risk now presents a conundrum, necessitating a combination of strategies to scale up COVID-19 vaccination, Dr Benido Impouma, Director of Communicable and Noncommunicable Diseases Cluster at WHO Regional Office for Africa. 

“We are trying to diversify. In fact, our strategy is to ensure that we can first of all achieve high coverage in priority groups, and then as time goes on, we now go to the lower priority groups,” he said.  That has included running public service ads in social media in countries with a history of vaccine hesitancy during African Immunization Week, urging the general public to speak to their health care workers about the benefits of COVID vaccination. 

https://twitter.com/WHO_Tanzania/status/1520032402462158855

Image Credits: WHO/Junior D. Kannah.

Members of the WHO Working Group on Sustainable Finance hammer out the final agreement on increasing member state contributions this week, Germany’s Björn Kümmel on far left.

A core group of WHO member states have agreed on a landmark move to boost their annual “assessed” contributions to the global health organization to cover 50% of its core budget needs by 2028-2029 – but contingent on internal WHO reforms to boost efficiency and transparency.  

Partly in response to the reform call, a reshuffle of WHO’s senior management is expected to be announced shortly after WHO Director General Dr Tedros Adhanom Ghebreyesus is re-elected at the 75th World Health Assembly, which meets 22-28 May. 

That reshuffle is likely to include the departure of WHO Deputy Director Dr Zsuzsanna Jakab as well as WHO Health Emergencies Executive Director, Mike Ryan who has led the agency’s pandemic response in its first two years, diplomatic sources told Health Policy Watch.  

Jakab, a Hungarian health professional born in 1951, is already well over the WHO mandatory retirement age of 65 – which can be exceptionally extended only by three years at the decision of the WHO director general. She previously was the Regional Director for WHO’s European office.

Ryan, a seasoned health emergencies professional, may leave WHO to return to his family in Ireland, sources say, noting that two-years leading a response to the COVID pandemic has taken its toll on senior staff. However, others say that Ryan’s departure also reflects Washington’s desire to see new leadership in the WHO emergencies operations – which was criticized for being unduly slow and cautious at key moments – including the WHO’s declaration of a public health emergency and WHO’s months-long resistance to acknowledging that the virus is “airborne” and required public use of face masks as well as by health personnel. 

Asked by Health Policy Watch about the pending senior management reshuffle, a WHO spokesperson was reportedly ‘checking into’ them – but would neither confirm nor deny the reports. 

Other sources said that a shakeup in the Organization’s senior leadership is to be expected anyway following Tedros’ re-election to a second term as WHO Director General, for which he is running unopposed. 

Decision on more sustainable WHO funding formula announced by Germany  

Regular, assessed US contributions to WHO have remained frozen for over a decade, while the majority of funding has been as “voluntary” contributions.

The decision on the new formula for WHO funding, by a Working Group on Sustainable Finance, was announced near midnight Wednesday, by Germany’s UN Mission in Geneva – following three days of intensive negotiations. 

It overcomes the impasse encountered in late December and early January 202, when a handful of holdback nations, including the United States, had blocked consensus over the move.   

The move is significant because member state contributions have stagnated over the past two decades to the point where they comprise only about $475 million a year – or  about 16% of WHO’s $3 billion annual budget – of which about $2.2 billion is regarded as “core.”

Large “voluntary contributions” from rich member states, including the United States, and donor organizations, led by the Bill and Melinda Gates Foundation, have played a growing role in WHO’s budget. That also gives a handful of member states and donors outsize influence in the member state body, critics have said. 

WHO’s Director General Dr Tedros Adhanom Ghebreyesys had repeatedly complained that such “voluntary donations” often made it more difficult to plan strategically, as well as making WHO vulnerable to donor whims about what they do and don’t want to finance. 

Stepwise increase conditioned on WHO reforms 

member states
Top contributors to WHO’s Budget (2018)

Sources told Health Policy Watch that the real breakthrough on the new finance formula came after the US shifted from being a holdback to a leader in the initiative. 

The breakthrough came as the Working Group agreed to link the new funding formula  to a member-state review of WHO progress on promised internal reforms – at each step of the step-wise increase toward the goal of 50% funding by member states. 

The US had previously stressed that it wanted to ensure any new finance formula would be tied to better WHO performance, including with respect to key gaps identified during the pandemic. 

Those reforms aim to make the Organization more efficient, accountable and transparent – in line with a series of recent external reviews of WHO’s response during the pandemic crisis, including a review of WHO Emergencies functions and another, even more sweeping review of pandemic response by The Independent Panel.  

Setting better priorities improving efficiencies

Ebola response workers in the DRC – at least 21 WHO staff and consultants were accused of abusing Congolese women, obtaining sex in exchange for promises of jobs.

“Practically speaking, it means setting better priorities, making sure that member states are well informed. financial situation, clarifying any new initiatives that need to be seen by governing bodies, ensuring that we have an agile workforce,” said one member of the Bureau, who requested anonymity. 

“Most of that is already in the mandate,” the Bureau member added, noting that in any case, approval of WHO’s biennial budget is conditioned upon member state support – but the compromise makes the conditionality more explicit.  

The source added that the sexual exploitation and harrassment scandal involving WHO Ebola response workers in the Democratic Republic of Congo, which came to light in late 2020 as a result of an investigation by The New Humanitarian and Thomson Reuters Foundation, “was a big concern for the US.

“But overall, it becomes clear that we need to set better priorities with what needs to happen with the available resources, and this is not new. 

“Obviously, some member states need to clarify to their constituencies, to their Parliaments or Congress, etc, that they are not giving carte blanche to an organization, but rather than providing the right resources, but at the end, also taking care that these resources are used the most appropriate way under the control of member states.”

The Working Group also agreed that the aspiration to reach the 50% goal in member state contributions by the 2028-29 budget biennium, could be delayed until 2030-31 as deemed appropriate at that time.   

US support led to other countries to swing behind financial reform measure 

(left) World Health Organization Headquarters in Geneva; White House in Washington, DC

A handful of other countries, ranging from Russia and Poland to Japan and Brazil had also been holdouts in agreement on the finance reforms. 

But once the US changed position, that opposition also melted away, other sources told Health Policy Watch.  

“The US has shown that they are back in the game. They want to be seen as a supporter of the WHO. I think that has changed in the negotiations. 

“Obviously, at the start, they were rather reluctant. Then there was a tipping point. And the US was very, very much supportive of the whole thing of the last three days that we wouldn’t have gotten to where we are without the strong support of the US.”

Indeed, Germany’s announcement was followed by supportive messages from the US Mission in Geneva – as well as Health and Human Services in Washington, DC.   

Germany’s Björn Kümmel credited with sustainable finance reform’s success

Björn Kümmel, Germany’s deputy head of global health in the Ministry of Health

Following that, Latin American states such as Brazil, as well as close US allies like Japan and Poland fell into line supporting the finance reform measure, sources said. 

And Russia, another holdout – also shifted its position to support the moves so long as they were linked to more WHO transparency.  

But it was Germany’s Björn Kümmel, deputy head of global health in the Ministry of Health, who was widely credited with saving the day on an agreement – nursing the negotiations to a successful conclusion over more than a year. 

Kummel, who in mid-December 2021 had bluntly declared that the current WHO finance structure is “fundamentally rotten” had made it an almost personal mission to leverage this highly-technical, but equally significant, institutional change.  

He also has underscored that the aggregate demand of the increased commitment from countries remains very modest – requiring only about $600 million more a year from all 194 WHA member states by 2028-2029 – or at the latest 2030-31. That would bring countries’ assessed contributions up to the desired 50% share of what is now WHO’s core annual budget of about $2.2 million a year.

And he “never gave up” said global health influencer Ilona Kickbusch, founding director of the Geneva Graduate Institute’s Global Health Centre, in a Twitter post. 

 

Achievement noteworthy in time of rising geopolitical tensions. 

The agreement is all the more noteworthy in a period in which the US, Germany and Poland are faced off squarely against Russia over the latter’s invasion of Ukraine. 

And while NATO-Russian geopolitical tensions could very well erupt somewhere on the WHA stage – and are even likely to do so somehow – for now, it appears that pitfall may have been avoided in the case of the sustainable finance accord.  

Agreement by the Working Group signals the likely smooth passage of the measure through the upcoming WHA – in line with traditional practice where most serious member state disputes are ironed out behind closed doors, and in advance of the member state assembly.  

The expected approval was signaled by comments from senior WHO officials, including Tedros himself, who said the “recommendation to increase assessed [member state] contributions to 50% will empower WHO & safeguard its unique expertise, mandate & legitimacy.”

Against the current regional and global diplomatic landscape, that is no little accomplishment, noted Olaf Wientzek, Director of Multilateral Dialogue at the Geneva-based branch of Konrad-Adenauer-Stiftung, a German foundation. 

He noted that at the UN’s New York headquarters, countries’ attention has already shifted well away from the pandemic to issues like Russia’s war in Ukraine as well as other burning regional conflicts. 

That, in turn, leaves a “closing window of opportunity” for key reforms in the health arena that were identified as so critical during the COVID pandemic – to prevent and curb the risks from future epidemics and pandemics.   

“If you look at what we are seeing now, the war between Russia and Ukraine has repercussions across the UN spectrum; there is a strong danger of reduced funding [from member states] in certain cases; and we have seen that recent contributions from donor conferences, for instance in Afghanistan, were far less that had been expected,” Wientzek observed. 

“So against all of that, having an agreement on this is a big thing.”

Image Credits: Germany's UN Mission in Geneva , Kaiser Family Foundation , WHO , WHO AFRO, WHO/P. Virot; Obama Whitehouse Archives .

Women wait to be screened by Illumigyn's Gynescope in Qalansawe, Israel.
Women wait to be screened for cervical cancer using a new digital device at a discreetly placed mobile station, in Qalansawe, Israel.

Qalansawe, Israel – The women, heads covered in hijabs, sat outside a small purple aluminium mobile health station parked in a residential neighbourhood here, shooing away any men who happened to pass by.

Plastic chairs formed a small and intimate circle for the women waiting to be screened for cervical cancer – some for the first time ever, and others who had skipped their annual screenings for decades.

Once inside the mobile station, the women were greeted by a female nurse with a digital scope not much longer than the palm of her hand with a full HD camera at the top.

The Gynescope, which is produced by Israeli firm Illumigyn, digitally documents the cervix, vagina and external genitalia, using high-resolution and superior magnification.

It doesn’t need a fancy lab setup and can produce results within minutes. The digital cervical footprint is saved to the cloud and can be used for remote diagnosis, ongoing medical supervision and follow-up consultations.

“I do not have specific numbers,” Dr Gasem Jauousi, head of family medicine for the city’s largest health fund, told Health Policy Watch. “But Arab women get screened less than the Jewish women. They are less connected [to the health system]. If we do not call, they won’t come.”

Janousi, who spoke from his office adjacent to the caravan, is one of the lead collaborators in a field trial of the Gynescope, one of the latest of the new generation of cervical cancer screening tools that are easier diagnosis for the disease that killed more than 340,000 women in 2020, according to the World Health Organization.

Smart-Scope pencil-like device

The Indian-developed Smart-Scope device and monitoring screen can fit into an A-4 sized computer bag

Other devices include the handheld Indian “Smart-Scope” which will be feature in the innovation fair of the Geneva Health Forum 2022 (3-5 May). The Forum also is hosting a special day-long meeting on innovations in cervical cancer screening and care, Wednesday 4 May.

The Smart-Scope is an even smaller and more portable device, can detect cervical abnormalities in less than 10 minutes using artificial intelligence, with the aid of a tablet and an intuitive app, Veena Moktali, the founder of the Indian start-up Periwinkle Technologies, told Health Policy Watch.

The test result is color-coded and supplemented by a visual report, Moktali explained. The Smart-Scope stores data on a tablet not the cloud, which makes it accessible to clinics without internet access.

Key features of these new devices is their reliance on high-quality digital imagery instead of old-fashioned lab smear samples that entails taking a sample from a woman’s cervix which then has to be analyzed.

The digital storage of images makes for easy referral and portability, and mobile health clinics can offer the service to women who may not otherwise come to a clinic for a screening test, said Moktali.

Moktali is also speaking at the Geneva Health Forum hosted meeting on cervical cancer about how new AI devices like the Smart Scope are enabling improved point-of-care screening for cervical cancer. The full-day workshop, which evolved out of interactions by innovators and health care professionals at the biennial GHF meetings, will look at how new devices and strategies for cervical cancer screening and treatment can advance the World Health Organization goal of eliminating cervical cancer by 2030.

Solutions for harder-to-reach communities

While Israel is a high-income country with a strong public health system, more marginalized communities – including new immigrants, African asylum seekers, and Arab-Israeli citizens – can fall through the gaps of routine checks.

This is especially true when it comes to sensitive medical interventions such as cervical cancer screening around which there may also be cultural taboos.

For several decades, routine screening for cervical cancer has involved a “Pap smear,” a procedure developed in the 1920s by Georgios Papanikolaou and Aurel Babeș.

A trained health worker scrapes a woman’s cervix for a cell sample, which is then relayed to a laboratory for analysis by a trained technician seeking abnormalities that could indicate cancer or a precancerous growth.

Aside from needing laboratory and diagnostic capacity that is unavailable in many parts of the world, many women find Pap smears invasive and uncomfortable.

Over two days in March, Illumigyn in collaboration with the government health-fund Clalit, set up caravans in two disadvantaged Israeli neighborhoods, one of them Qalansawe. Clalit contacted women enrolled in the health fund, who had not previously been screened, and invited them to come for a visit. No appointment was needed.

Digital image of cervix illuminated on a Gynescope

The women were able to enter the mobile clinics, positioned in a fenced-off area near the neighborhood health clinic, and be screened by a female nurse. The image was sent to their doctors in real time to inform the women if further evaluation or other action was required.

“They told me to go to the hospital and get an ultrasound,” one woman, who asked to remain anonymous, told Health Policy Watch as she left the caravan. “I need to follow up,” she added, saying that she intended to follow their advice.

Another woman, who also asked to be anonymous, said that when she came to the mobile station, she didn’t even know what the check was intended to diagnose.  Her experience raised her awareness about the whole cervical cancer issue:

“I had no idea what to expect,” she said. “But I am told this is a good thing, that it could save lives, God willing. … Doing these screenings, thinking about people and worrying about them. It is really good,” she said, after leaving the mobile station, full of praise for the initiative.

“We know that women are busy – we don’t have time,” said Illumigyn vice president Yam Salman. “Especially women who are raising their families. But women want to live and now we have the technology that can help them do so. Illumigyn can save their lives,” she said.

Eliminating cervical cancer

Cervical cancer claims the lives of around 300,000 women each year, one woman every two minutes, according to WHO.

At the same time, the disease is highly preventable either by being vaccinated against the human papillomavirus (HPV), which causes the majority of cervical cancers, or by early detection through screening.

Most cervical cancer deaths now occur in low- and middle-income countries where fewer girls are vaccinated and women don’t get regularly screened.

In 2020, the World Health Assembly adopted a global strategy to eliminate cervical cancer, with weighty targets to be hit by 2030. The strategy focuses on three aims: vaccinating 90% of all girls against HPV by the age of 15; expanding access to screening services for 70% of women; expanding access to treatment for 90% of women with precancerous lesions; and offering palliative care for 90% of women with invasive cancer.

Smart Scope cervical cancer screening campaign in rural India

“Cervical cancer is the fourth most common cancer among women globally, but it is almost completely preventable and, if diagnosed early enough, is one of the most successfully treatable cancers,” said WHO’s Director General Dr Tedros Adhanom Ghebreyesus on Cervical Cancer Elimination Day in 2021.

“Like COVID-19, we have the tools to prevent, detect and treat this disease. But like COVID-19, cervical cancer is driven by inequitable access to those tools,” Tedros said.

The COVID pandemic has slowed progress to eliminating the cancer, but the new, low-cost screening measures that “democratize women’s health care” can help change that, argues Salman.

New AI devices can be used by any trained caregiver

Both the Smart-Scope and the Gynescope can be used by any trained caregiver or a nurse practitioner, allowing women to be screened and diagnosed even in locations where doctors may be unavailable or in short supply.

That is significant, insofar as around two-thirds of cervical cancer deaths now happen in low- and middle-income countries or communities, explains Dr Nomonde Mbatani, a gynaecologist at Groote Schuur Hospital in Cape Town, South Africa.

Women in rural settings also have a tough time taking off a day of work to reach distant clinics to get their Pap smear. And, if they do take off for the screening, they are unlikely to take a second day off to return to the clinic to get their results – which take several days or even longer to produce.  And that makes follow up action even more difficult, she said in an interview with Health Policy Watch.

“Sending them home is not ideal. The ideal is where their results can be readily available on the same day,” Mbatani said.

Awareness and cultural barriers also exist, she added.

“There is very little understanding of how cervical cancer is caused,” Mbatani said. “Some women feel uncomfortable about presenting problems they are experiencing in their lower genitalia or even having it looked at by a male doctor, except when it comes to birthing their children.”

Resistance to HPV vaccines

Along with better and more frequent screening of adult women, vaccination of pre-adolescent girls against the human papillomavirus virus (HPV), a leading cause of cervical cancer, is another important strategy being touted by WHO for eliminating cervical cancer.

South Africa, which has one of the best health systems in Africa, routinely offers the vaccine to young children in public schools, Mbatani said, noting the vaccines have been availalbe in the country for about a decade already. But any girl living in a rural area who does not regularly attend school may still miss out.

In addition, parents of children enrolled in the country’s extensive private school system have to “opt-in” and request that a doctor vaccinate their children in a private clinic, making immunization rates among these youths much lower.

“In public schools, they opt out rather than in,” Mbatani said.

More frequent exams are important

In South Africa, women are only recommended to get a Pap smear once in every 10 years.  It’s too long between examinations, Mbatani says.

WIth screening every 1-3 years, there is a 95% chance that any developing cervical cancer will be caught in time and can be treated. With screening every 10 years, the reduction of cancer risk drops to about 66%.

“That is not ideal, but to make this available to most women is better than not doing anything,” she said. “WHO suggests if women could even have one Pap smear once in their lifetime this could still reduce cervical cancer. The problem is that screening is opportunistic and not everyone takes advantage of that opportunity.”

Over time, it is hoped that the new AI devices can help overcome some of the barriers that Mbatani describes – allowing for better integration of cervical cancer screening into more routine, primary health care services that are already offered for women’s reproductive health or HIV/AIDS prevention and treatment.

As Salman says: “Why do we need to die from something that can be prevented?”

Image Credits: Illumigyn, Periwinkle Technologies , Illumigyn , Periwinkle Technologies.

A child is vaccinated against measles at the DFID and UNICEF-supported Nutrition Health Centre in Hargeisa, Somaliland on 3rd February 2021.

A 79% rise in the reported measles cases in the first two months of 2022, compared to the same period last year, has raised concerns over the possibility of an outbreak that could affect millions of children this year. 

Pandemic-related disruptions, increasing inequalities in access to vaccines, and the diversion of resources from routine immunization have created the ‘perfect storm’ of conditions for a measles outbreak, WHO and the United Nations Children’s Fund (UNICEF) warned on Wednesday. Children are not only at risk of being infected with measles –a disease which is preventable through vaccination– but also other vaccine-preventable diseases. 

Risks of a bigger outbreaks have also been heightened by the relaxation of social distancing norms in communities around the world, along with the mass displacement of people, including many children, due to conflicts and crises in countries ranging from Ukraine, Ethiopia, Somalia and Afghanistan.  

Some 17,338 measles cases were reported worldwide in January and February 2022, compared to 9,665 during the same period last year, said WHO and UNICEF. The possibility of underreporting looms large as the pandemic has disrupted global surveillance of cases and vaccinations. 

23 million children have missed out on basic vaccines  

There is rising concern over children becoming more susceptible to other vaccine-preventable diseases too.  Some 23 million children have missed out on basic childhood vaccines through routine health services in 2020. This is the highest number since 2009 and 3.7 million more than in 2019.

As of April 2022, 57 vaccine-preventable disease campaigns in 43 countries that were scheduled to take place since the start of the pandemic are still postponed, impacting 203 million people, most of whom are children, WHO and UNICEF said. Of these, 19 are measles campaigns, which puts an additional 73 million children at risk of measles due to missed vaccinations. In Ukraine, the measles catch-up campaign of 2019 was interrupted firstly by the COVID-19 pandemic and more recently, by Russia’s recent invasion.

“It is encouraging that people in many communities are beginning to feel protected enough from COVID-19 to return to more social activities. But doing so in places where children are not receiving routine vaccination creates the perfect storm for the spread of a disease like measles,” said Catherine Russell, UNICEF Executive Director.

According to Dr Tedros Adhanom Ghebreyesus, Director-General of the WHO, the disruptions caused by the COVID-19 pandemic in immunization services for many other diseases will be felt for decades to come. “Now is the moment to get essential immunization back on track and launch catch-up campaigns so that everybody can have access to these life-saving vaccines.”

Humanitarian crises disrupting vaccination programs 

In  2017-2019, there were over 115,000 cases of measles and 41 deaths in Ukraine which was the highest incidence in Europe.

Top 5 countries with reported measles cases in the last 12 months, until April 2022

Along with Ukraine, humanitarian crises in Ethiopia and Afghanistan are seriously disrupting vaccination programmes for measles and other diseases. 

Three of the five countries globally with the highest measles cases so far this year – Somalia, Ethiopia and Nigeria – are in Africa. Afghanistan and Yemen are the other two countries whose caseload of measles puts them in the top five countries burdened with measles. 

Because measles is one of the world’s most highly contagious infectious diseases, it has a high threshhold for herd immunity, meaning that vaccination rates need to be particularly high to prevent outbreaks. “When vaccination drops, measles is typically the first childhood disease to have an outbreak.” Andrew Noymer of the University of California was quoted as saying in an article on Ethiopia’s measles outbreak, published in The Lancet Infectious Diseases’ May 2022 edition. 

In the first three months of 2022, there were 2,156 confirmed cases of measles and 2,755 suspected cases, WHO’s Regional Office for Africa has reported. The vaccination status of 40% of the suspected cases was not known. The measles outbreak in Ethiopia comes at a time when the country is facing a complex humanitarian and armed conflict that has led to a high number of refugees and internally displaced people.  Other measles outbreaks are occurring in Chad, Congo, the Democratic Republic of Congo, Guinea, Liberia, Mali. Mozambique, Niger and Nigeria, Sierra Leone, South Sudan, and Togo, with thousands of confirmed cases and tens of thousands of suspected cases across the continent, WHO said. 

Measles also is known to weaken a child’s immune system and makes them susceptible to other infectious diseases like pneumonia and diarrhoea, the WHO and UNICEF said. At population level, vaccine coverage at or above 95%, with two doses of the safe and effective measles vaccine, can protect children against measles outbreaks.

Image Credits: UNICEF, UNICEF , UNICEF/WHO.