lviv
A volunteer helping a woman at the train station in Lviv.

(LVIV, Ukraine via The New Humanitarian) – Over the course of just two weeks, Russia’s invasion of Ukraine has created a vast humanitarian crisis inside the country and sent more than 2.3 million people fleeing into neighbouring states.

The UN has set out to raise more than $1 billion to support 18 million people it estimates will be impacted by the war over the next three months. Fighting has already crippled Ukraine’s economy and battered its infrastructure, disrupting supply chains and leaving people struggling to access food, medicine, water, heating, and other critical services. 

There have been at least 18 attacks on healthcare facilities and workers, including the Russian bombing of a maternity and children’s hospital in the southern city of Mariupol on 9 March that injured 17 and left three dead. Across the country, the civilian casualty count and death toll continue to mount – although the total number remains unknown because of difficulties collecting and verifying data.

Local aid groups and civilian volunteers have been at the centre of the humanitarian response – providing food, shelter, and other support to those displaced and affected by the fighting. When the Russian invasion began, UN agencies and most international aid groups in Ukraine paused operations and evacuated their international and local staff. But as the war looks set to drag on – defying early predictions of a swift Russian victory – the international aid response is gearing up. 

Meanwhile, many involved in the local response are wondering how long they will be able to continue, amid dwindling resources, dangers posed by the conflict, and concerns that volunteers in the largely civilian effort may become exhausted or overwhelmed.   

The western Ukrainian city of Lviv – located about 65 kilometres from the Polish border, and home to around 720,000 people – has become a hub both for people fleeing the conflict and for the response. Estimates of the number of displaced people in the city range between 100,000 and 200,000, and the mayor has warned that it is reaching a breaking point in terms of being able to welcome more. 

Yuri Popovych, a 39-year-old IT specialist, left his day job soon after the Russian invasion began and has become one of the lead volunteer coordinators in Lviv, helping the tens of thousands of displaced people taking shelter in the city, which is one of the few urban centres in Ukraine yet to face Russian bombardment. 

In the hours after the invasion began, Popovych got in his car and drove around Lviv asking people how he could help. He has ended up doing everything from buying chainsaws for soldiers to cut down trees to make roadblocks, to helping neighbours unload trucks full of donations. 

He worries that, if the volunteers continue at their current pace, the local response in the city may not be sustainable. “We thought it was going to be a sprint, but now it looks like it’s going to be a marathon,” Popovych told The New Humanitarian, referring to initial expectations that the conflict would end quickly.  

He was seated on the steps of an art exhibition centre turned volunteer operations headquarters in the heart of Lviv, where hundreds of Ukrainian volunteers sorted through donations of children’s games, stuffed animals, clothes, food, and shoes. “We need to be prepared to support this [over the long term],” Popovych said. “It’s not going to end soon, and even if the war [does] end soon, the aftermath will be very, very long lasting.”

The volunteer response 

On the surface, Lviv still has the feel of a vibrant city, with its restaurants and café-lined streets. But these are now crowded with foreign journalists and aid workers – most locals have stopped going to work, schools are closed, and anti-tank barriers line checkpoints at its entrances and exits. 

There is an atmosphere of fear and sadness as women and children on their way to Poland say painful goodbyes to their husbands, fathers, or brothers. People have little choice but to separate because the Ukrainian government has barred men between the ages of 18 and 60 from leaving the country.

So far, many of the displaced who have reached Lviv from the capital, Kyiv, and other hard-hit cities and towns are staying with relatives or strangers who have volunteered to host them. But there’s only so much excess room in the city’s houses and apartment blocks, and the mayor said the city might need to start erecting tents to house displaced people as they continue to arrive. 

It’s difficult to quantify how many volunteers are involved in the humanitarian response in Lviv and across the country. Locals say nearly everyone they know is doing something to help with the war effort. In addition to sorting and delivering donations, volunteers are helping the police patrol the streets at night – walking for eight hours in the cold to keep an eye out for suspicious activity and visiting displaced people to make sure they have enough food, water, and access to heating. Others are using their professional skills to help manage the logistics of distributing aid or to set up projects to allow people to report and document potential war crimes. 

This is not the first time ordinary Ukrainians have become involved in the humanitarian response to war. Following Russia’s annexation of Crimea in 2014 and the conflict that began the same year in the eastern regions of Donetsk and Luhansk between Russian-backed separatists and the Ukrainian government, a national volunteer network sprang up to support those affected by the fighting. But the mobilisation this time around is much bigger. 

“This isn’t a new war, but people didn’t really care before because the old war wasn’t impacting them,” said 43-year-old Alena Marshenko, who has been volunteering to help soldiers and displaced people since 2014, when she was forced to flee Luhansk. Marshenko, who settled in Kyiv, has now been displaced again to Lviv and is spending her time at the city’s train station providing psychological support to other displaced people.

Compared to formal aid groups, volunteers say they’ve been able to react more quickly because, as locals, they know the terrain, have good contacts, and don’t have to deal with the same organisational bureaucracy.

Anna Didukh, one of the founders of a new platform of several hundred volunteers, “I Am Not Alone: We Are Ukraine”, said the network had already sent 20 trucks and buses with medicine and food across the country to people in hard-to-reach villages outside Kyiv and Kharkiv, a city in the northeast that has come under heavy bombardment. “[The idea] started from problems, chaos, war, no fuel, people not knowing where to get aid,” Didukh said. 

The group is working with the Lviv mayor’s office and will soon launch a website where people around the world can make donations and track where their money goes, she said. So far, everyone who has contributed their expertise to get the project off the ground has done so for free. But those involved will need to earn a living to sustain themselves at some point, especially as so many people’s normal employment has been disrupted by the war.

This is one of the reasons why volunteers worry the local response could wane as the war drags on: people may burn out or have to return to their jobs – if they still have jobs to return to.

The effects of ongoing fighting could also make it harder for people to help others if they too are impacted. Already, the amount of food coming into the volunteer centre in Lviv has decreased compared to the first days of the invasion: Stores are running low on stock – or running out entirely – making it difficult for people to buy items to donate.

Need for a professional response

While the local aid response is continuing full steam ahead for now, international organisations are entering Ukraine to restart or set up operations. Many are conducting needs assessments and have launched fundraising efforts aimed at supporting activities ranging from delivering cash assistance to people forced to flee so they can rent accommodation in neighbouring countries, to providing food, hygiene supplies, and medical care inside Ukraine.

Some international organisations are partnering with local and national aid groups to support and scale up their efforts or are tapping into volunteer networks for local knowhow and expertise. The NGO Hungarian Interchurch Aid (HIA), for example, is now paying some of the volunteers it started working with when the invasion began to do surveys and assessments of temporary shelters in and around Lviv, Giuliano Stochino-Weiss, the group’s emergency director, told The New Humanitarian.

HIA is also providing training to volunteers on humanitarian principles as well as various practical skills that can be used to prepare and deliver aid, and the group is open to hiring Ukrainians currently involved in the volunteer response to work with them longer term, according to Stochino-Weiss. 

While grassroots efforts are commendable, many aid workers say they are not a substitute for a professional response.

“Individuals can have a lot of power when they work together. It’s good to have that spirit, but good to be organised,” Ignacio Leon Garcia, the Ukraine head of the UN’s emergency aid coordination body, OCHA, told The New Humanitarian. “[Volunteers] can have very good faith, but when you have a crisis situation, individual actions sometimes are more harmful for people,” he added.

For now, the international community is rallying behind Ukraine, pledging billions of dollars in humanitarian assistance in the past two weeks. But some aid workers say the money has yet to materialise on the ground. 

“We need the international community to understand that the headquarters-heavy international aid groups might have consultants and huge reach to raise funds, have people in Brussels to lobby, but we aren’t seeing them here actually operating and distributing aid,” said one international aid worker in Lviv who didn’t want to be named for fear of reprisal. Organisations being too risk-averse is resulting in a lagging response, they added.

An uncertain future

While international groups start planning for longer term support, many Ukrainians The New Humanitarian spoke to expressed shock at the intensity and scale of the violence overwhelming their lives and said they were taking things one day at a time. 

Olena Akhundova, 33, wiped tears from her cheeks as she recalled the panic attacks she and her husband had while hiding for a week in a bomb shelter in Kharkiv. They fled with their six-month-old and 16-year-old daughters with only the clothes on their backs, travelling by train for 24 hours before arriving in Lviv. 

People at the railway station in Lviv wait in line for hours to board trains to leave Ukraine.

For the moment, the family has been taken in by strangers, but Olena and her husband were worried about being able to earn a living now that they have been displaced, and they had no idea where they would go next. “I’m concerned that in future I won’t be able to get food or have a place to live,” Olena said. 

Local government officials in Lviv admitted they had not had a chance to look to the future and plan for a longer term humanitarian response. “Everything is unpredictable,” Andriy Moskalenko, the first deputy mayor, told The New Humanitarian. “Right now we have like a 24/7 war, and so, of course, it’s the main issue which we’re today [talking about] in order to give [displaced people] a safe place at this moment because we don’t know what will [happen] in our city.” 

There is also a pervasive sense that Lviv’s days as a safe haven may be numbered. Many think it’s only a matter of time before the city becomes a target of Russian bombardment. Even though it’s far from the current front lines, Russia bombed the airport in the nearby western city of Vinnytsia on 6 March. In Lviv, statues and buildings are being barricaded, sandbags line government buildings to protect them, and even locals are waiting in the cold for hours outside the train station, desperate to cross to Poland.

Meanwhile, local volunteers like Popovych say they will keep going until the government or the international community has a system in place to take over the humanitarian response. Popovych’s biggest fear now is that people will forget about Ukraine – like they did eight years ago when the conflict began. 

“I hope the world doesn’t get used to the war in Ukraine so people keep being shocked by what’s happening,” he said.  

Edited by Eric Reidy.

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This article was first published by The New Humanitarian, a non-profit newsroom reporting on humanitarian crises around the globe

Image Credits: Sam Mednick/TNH.

pandemic
Personal protective equipment was essential to protect healthcare workers during the pandemic

The applause has long ceased – while the ongoing pressures of the pandemic have left long-term scars on the physical, moral and mental health of the world’s nurses.  Two years into the COVID-19 pandemic, governments need to offer better solutions.

On 11 March 2020, the World Health Organization (WHO) declared a pandemic, and the world held its breath.

As COVID-19 swept the world, people in many major cities demonstrated their gratitude for healthcare workers with public shows of support, clapping and cheering for the heroism of nurses and their colleagues, the first responders to the surge in cases of a new and often deadly disease. 

But while the applause has long ceased, and more recently replaced by public protests against restrictions, the pandemic continues. And so does the work of the global nursing workforce in tackling it.

Pandemic happened during pre-existing health workforce crisis 

A nurse in full PPE completes patient forms at the Tehran Heart Centre

Already at the start, the world was in the midst of a global healthcare crisis. Decisions made in the previous decade had led to a fragile nursing workforce with dire shortages in many countries that were already putting public health at risk. 

The pandemic revealed how weakened our health systems had become, due to underinvestments in the people who are the system’s backbone.

The organized global response that was required took a long time to get off the ground, which meant that nurses and other healthcare workers around the world found themselves in the midst of a crisis for which there seemed to be no immediate functional plan, no handy playbook, and no stockpile of vital life-saving equipment and supplies.

Two years on, we can see the devastation and havoc COVID-19 has wrought, with more than 400 million cases and six million deaths, and as yet untold harm in the form of undiagnosed and untreated illness whose dimensions will only be revealed in the coming months and years.

Before the storm – shortage of six million nurses 

By coincidence, within days of the pandemic being declared, a landmark report, the State of the World’s Nursing (SOWN), was published. 

A joint venture between WHO, the International Council of Nurses (ICN) and Nursing Now, it provided the first-ever snapshot of the state of the global nursing workforce. And the picture was not a pretty one.

Findings included a  global shortage of almost six million nurses, mainly in poorer countries.

Among some 27.9 million nurses worldwide, there were also huge inequalities in the number of nurses per capita in different nations of the world, ranging from 8.7 nurses per 10,000 people in WHO’s Africa region to 83.4 in the Americas.  Nine out of ten were women. 

The SOWN report highlighted that countries experiencing low densities of nurses are mostly located in the WHO African, South-East Asia and Eastern Mediterranean regions, and in parts of Latin America. 

Data for 191 countries indicate a global stock of almost 28 million nursing personnel, comprising both the public and private sectors. This translates to a global density of 36.9 nurses per 10,000 population. However, this global figure masks deep variations within and across regions.

Inequalities income-driven

“Global inequalities in availability of nursing personnel are largely income driven, with a density of 9.1 nurses per 10,000 population in low-income countries compared to 107.7 per 10,000 population in high-income economies,” the SOWN report reads.

This imbalance was due to a general lack of investment and poor workforce planning, compounded by an over-reliance of wealthier nations on recruiting nurses from abroad, including lower-income countries which have fewer nurses in the first place. 

The SOWN report called for massive investment in nurse education, jobs and leadership, so as to achieve Universal Health Coverage (UHC) and the health-related aspects of the UN Sustainable Development Goals (SDGs).

The report also called for a programme of strategic investment in nurses to correct decades of complacency about workforce planning, which has always been too short-term, most often tied to government election cycles of four or five years. It concluded that such investment, continued over a much longer period, would also lead to more advancement in education, gender equality, the provision of decent work, and economic growth.

When the storm hit

But when the pandemic hit, those longer-term strategies and plans were once again put aside.  

Issues that had to be faced were much more immediate. 

Nurses were forced to cope with a highly infectious, and sometimes deadly virus, with little or no access to personal protective equipment (PPE), and little training or preparation. In some parts of the world, nurses cared for COVID-19 patients with little more than plastic gloves and aprons, and in some cases, even without access to running water.

While applauded by some communities, nurses also faced abuse, intimidation and violence from certain members of their communities, who were in denial about the virus or fearful about healthcare workers being carriers, according to the many messages received from our ICN National Nursing Association members around the world. 

Dreadful toll 

Nurses working at the isolation ward in Daegu, South Korea

Unsurprisingly, the pandemic has taken a dreadful toll on the nursing workforce. 

ICN’s January 2022 report on COVID-19 and nursing, Sustain and Retain, shows that the pandemic has had a “multiplier effect” on pre-existing trends. 

It has driven up demand for nurses, who are the critical “front line” health professionals, whilst at the same time cutting across nurse supply due to infection, increased absences – and thousands, if not hundreds of thousands, COVID-related deaths. 

There are also more nurses who intend to, or are considering leaving the profession altogether. 

Indeed, in the most recent survey (2021) of some 5000 nurses and nurse managers, 11% said they intended to leave their position soon, with proportions much higher among the most senior nurses.

ICN now believes that, with a further four million nurses planning to retire by 2030, and the as yet unclear and untold toll of what we are calling the COVID Effect on nursing numbers, the previously reported nursing shortage of 6 million could double to 12 million over coming years.

In addition, nurses are experiencing increased mental health problems, as the intensity of their work has resulted in anxiety, stress and burnout. All of that has been exacerbated by more frequent experiences with death, and in nurses having to take the place of family members and friends holding the hands of patients who would otherwise have died alone.

On top of this, moral injuries, which result from nurses being required to make or witness ethically challenging decisions about patient care delivery, also are on the rise. 

Brighter side of the crisis 

Israel: COVID-19 brought many challenges to the delivery ward, but nurse midwives continued to provide quality care to patients.

But while all this was happening, there was one small chink of brightness in all the gloom: the pandemic did lead to greater public and policymaker awareness of nurses essential function, and the value they provide to the societies they serve. While many burnt-out nurses may be leaving the professions, younger groups are still entering the vocation – sometimes even more than before.  

In the UK, for example, there was a 32% increase in the number of applications to train as a nurse during the pandemic.

So two years on, as we move towards a different phase of pandemic response – we need to build on this positive residue of recognition in the importance of nurses and nursing – while focusing more policymaker and employers’ attention on the needs for adequate investments in nurses, decent pay, and  support for nurses’ wellbeing and mental health needs.

As WHO Director General Tedros Adhanom Ghebreyesus has recently said, a false sense of security about the hoped-for waning of the Omicron variant may also be ‘driving a dangerous narrative that the pandemic is over.’

But unless the global nursing workforce is brought up to full strength, even when the pandemic is finally over, grand plans about ‘healthcare for all’ will be nothing more than pipe dreams.

Preparing for the next pandemic – workforce investments

The training of nurse anesthetists in Kenya will help to increase access to surgery.

Investment in nursing capacity is also critical in preparing for future epidemic and pandemic risks. 

The report of the Independent Panel for Pandemic Preparedness and Response showed that the world was not prepared and must do better to be ready for the next pandemic threat – which is inevitable. 

As ICN’s Sustain and Retain report on COVID-19 and international nurse migration showed, a central weakness in our preparedness is the global nursing shortage. 

The report provides a blueprint for what is needed now. That is a decade-long, fully-funded global investment plan to bring the nursing workforce up to its required global size and strength – while correcting existing imbalances between countries in nursing staff, per capita. 

This means better planning by governments about their nursing needs, based on concrete projections of requirements of health systems with a clear strategy to meet those needs, without relying on mass recruitment from low and middle-income countries to end the brain drain of nurses from LMICs. 

ICN realizes this will be a tough call economically for governments, not least because of the financial effects of the pandemic, but it is necessary.

Just as the pandemic was unfolding, we witnessed a number of international efforts to raise the profile of nursing, including the WHO International Year of the Nurse and the Midwife in 2020 and last year’s Year of Health and Care Workers. 

But frankly, they were not enough and their goals were diverted by the immediate crisis. 

Nursing “offset credits” to countries that provide nurses 

The role of aged care nurses during the COVID-19 pandemic was taken to extraordinary heights, encompassing the balance of clinical work, psychosocial care and ensuring that all older people under their care were protected from the virus

Along with better planning at national level, high-income countries must become more self-sufficient in training their own nurses to meet the increasing demands of their ageing populations, rather than actively recruiting nurses who were trained elsewhere. 

The latter means that they are effectively exporting their nurse training costs to lower-income nations that can ill-afford that burden and the consequent nursing brain drain..

For example, according to the OECD, the proportion of foreign-trained nurses in 14 upper and high-income countries climbs as high as 16% in the United Kingdom and over 25% in New Zealand and Switzerland.  At the same time, other developed countries such as Denmark, France and the Netherlands have much lower rates, comparatively, of imported nursing staff. 

Proportion of foreign-trained nurses – based on OECD data, as of January 2022.

We think that low- and middle-income ‘donor’ countries should be compensated for losing their much-needed nurses. 

An ‘offsetting programme’ along the lines of international carbon credits, whereby destination countries pay for a nursing school or for individual nurses to complete their training as a remittance for taking a poorer country’s nurses is one possible solution.

Nurses at the policymaking table 

Finally, another critical element of a more forward-looking strategy is the greater inclusion of nurses – 90% of whom are women – in decision-making circles. 

Fewer than half of the world’s countries, for instance, have a fully functioning Government-leel Chief Nursing Officer, ICN has found.

Those countries are flying blind: their policies will end up being short-sighted and incomplete. Having nurses working in advanced roles, and services based on nurse-led models of care, are the keys to the brighter future we all deserve.

But nurses will only be able to fulfill their potential if all governments wake up to what they must do, and take action on the sustained measures necessary to bring about the massive growth in the nursing workforce that is needed right now.

Health and peace are inseparable 

Fast forward to 24 February 2022. We can anticipate that the recent outbreak of war in Ukraine will only compound the challenges seen during the past two years of the pandemic with strapped healthcare services, and insufficient investment in nursing services. 

Many governments will likely be looking to increase their defense spending, rather than enhance their health budgets. Particularly in the vast WHO European Region, longer-term thinking will be even more difficult as health care systems struggle to respond to the immediate crisis – and the largest wave of refugees since World War II. War and conflict are a threat to health and make health outcomes poorer. The international agreements we need to invest in and support our health systems and health workers will be more difficult to achieve.

We should never forget that health, peace and prosperity are inseparable. 

And whenever I hear governments say they can’t afford to invest in their nurses? I say, they can’t afford not to invest. 

______________________________________________________

Howard Catton, a registered nurse, is the Chief Executive Officer of the International Council of Nurses, a federation of more than 130 National Nursing Associations worldwide.

 

Image Credits: Tehran Heart Centre , Tehran Heart Centre , WHO, Korean Nurses Association, Shamir Medical Centre, Israel, International Federation of Nurse Anesthetists, Western Sydney University, ICN Report 2022.

nutrition
Some 155 million people in 55 countries – mostly in Africa – experienced a food crisis in 2020.

Amid rising hunger due to COVID-19, conflict and climate change, the African Union (AU) has declared 2022 as the Year of Nutrition.

Before 5am, Nigerian fishermen living in Lagos’s floating slum, Makoko, have paddled their wooden boats several kilometers into the main river for fishing activities. Their harvests are largely influenced by how far out they manage to paddle, seasonal changes, prevailing economic situations and other factors that are beyond the reach of individuals in the community. 

Fishing is the main source of food and livelihood for Makoko, but the dwindling fish supplies makes it hard for this community to get enough nutrition.

Some 155 million people in 55 countries – mostly in Africa – experienced a food crisis in 2020, representing an increase of around 20 million people on the previous year, according to the Global Report on Food Crises 2021.

Two-thirds of these people lived in 10 countries, namely the Democratic Republic of  the Congo (21.8 million), Yemen  (13.5 million), Afghanistan (13.2 million), Syrian Arab Republic (12.4 million), Sudan (9.6 million), Nigeria (9.2 million), Ethiopia (8.6 million), South Sudan (6.5 million), Zimbabwe (4.3 million)  and Haiti (4.1 million).

In his foreword for the report, António Guterres, Secretary-General of  the United Nations, decried the rising number of  people facing acute food insecurity and requiring urgent food, nutrition and livelihoods assistance. While noting that conflict is the main reason, combined with climate disruption and economic shocks, and is also aggravated by the COVID-19 pandemic, he noted the need to tackle hunger and conflict together. 

“Hunger and poverty combine with inequality, climate shocks and tensions over land and resources to spark and drive conflict,” Guterres said. 

“Likewise, conflict forces people to leave their homes, land and jobs. It disrupts agriculture and trade,  reduces access to vital resources like water and electricity,  and so drives hunger and famine. We must do everything we can to end this vicious cycle. Addressing hunger is a foundation for stability and peace.”  

The UN’s blueprint to address global problems is its 17 Sustainable Development Goals (SDGs) due to be achieved by 2030 – and SDG 2 aims for zero hunger, calling for the transformation of food systems to make them more inclusive, resilient and sustainable.

Addressing the issues

While under-5 mortality in Africa has decreased by more than 50% between 1994 to 2019, malnutrition remains high in Africa and undernutrition is particularly an underlying cause of almost half of child deaths, according to the AU.

The findings of the 2019 Continental Accountability Scorecard launched by the African Union and the Africa Leaders for Nutrition (ALN) also showed that in Africa, in 2019, 150.8 million children under the age of five years are stunted globally, and 58.7 million of these are in Africa.

Only seven member states have stunting rates below 19%, while 15 member states have child wasting prevalence below 5%, 38 countries have women’s anemia prevalence rates of more than 30%, only 18 member states have at least 50% of infants exclusively breastfed for six months, and only 20 member states have more than 70 percent prevalence rates for vitamin A supplementation.

At the recently held AU Summit, the theme for the AU in 2022 was officially launched. In her remarks at the launch, Dr Monique Nsanzabaganwa, Deputy Chairperson of the AU Commission said the aim of the theme is to maintain a strong political momentum on nutrition across the African continent. 

“It is a unique opportunity to strengthen political commitment to end malnutrition in all its forms and to further improve food and security through the implementation of Malabo commitments, and the goals and objectives of the Africa regional nutrition strategy for the years 2016 to 2025,” she told the summit.

In addition to securing greater political commitment, she added it is also expected to be used to secure investment in nutrition and to address the ongoing nutrition and food security challenges.

Multipronged approaches

While agricultural production in Africa is being boosted, the continent’s nutrition indices are still worsening, suggesting more still needs to be done beyond improving farming.

The wordings of the theme showed it is geared towards strengthening resilience in nutrition, and food security on the African continent, strengthening agro food systems, health and social protection systems for the acceleration of human social and economic capital development. 

The vast multiple issues that the AU wants to bring attention to with its theme, critics say, are too ambitious for the commission to be asking countries to address, especially considering the pressure that the COVID-19 pandemic has had on the countries’ systems.

“I personally think the AU itself knows that the countries cannot squeeze out major substantial new investments on their own to address nutrition considering COVID-19 has badly hit member states and there is not much that cannot be done, including the attention it hopes to give the issues, when COVID-19 vaccine uptake is not yet optimal,” a Kenyan public health expert told Health Policy Watch.

But initiatives aimed at addressing issues in Africa had been ongoing prior to the decision to make the issue the theme of 2022, and in her remarks at the AU Summit, Nsanzabaganwa mentioned several of them are being championed and financed by the Africa Development Bank’s (AfDB) “significant investments through the Africa Leaders Initiative in support of the continent’s policy, on nutrition and food security.”

A few days before the AU Summit approved the prioritization of nutrition in 2022, Babatunde Olumide Omilola, Manager for Public Health, Security and Nutrition Division at the AfDB told Health Policy Watch that the bank is ensuring nutrition smartness in its investments in a number of sectors including agriculture, social protection, health, water, sanitation and hygiene, and education. 

“It means that we mainstream, we integrate nutrition into these investments so that we have what we call a nutrition marker that says what is going into the nutrition component of all of these investments across these different sectors,” he said. 

Considering the enormous nature of nutrition-related issues coupled with the short duration that the continent has to achieve the set goals, Omilola said the best approach is not to focus on food security through agriculture alone, but to also mainstream and focus on food and nutrition security, so that investments in the agriculture sector also have nutrition components that address malnourishment in the targeted areas.

“There is [also] a big focus on nutrition-specific interventions which are those direct interventions that can deal with the underlying determinants of malnutrition and these include issues such as exclusive breastfeeding, supplementations, dietary supplementation, both for mothers and their children. It will also include issues that we see around making more finance available in the sector,” Omilola added.

Interplay between the private sector and governments to promote good nutrition

The Food and Agriculture Organization of the United Nations (FAO) was instrumental in the emergence of AU’s 2022 theme on nutrition. 

David Phiri, FAO Sub-regional Coordinator for Eastern Africa and FAO Representative to the African Union (AU), told Health Policy Watch that one of the aims of the theme is to ensure that African governments play more active roles in ensuring that food products that being produced and marketed by the private sector are healthy and do not cause or drive nutrition crises that could overburden the public health sector.

“The private sector will provide products that make money but may not be nutritious. People will engage and buy these products, then the health costs related to these products then become the problem of the government — of the public sector,” he said. 

“I think it is important that governments provide an environment with a regulatory framework, where even the private sector provides to the consumer products that will not be bad on the population and on the government. Having said that, the private sector is very important for agriculture and I think we need to actively engage them.”

Optimism despite uphill battles for nutrition

While African countries are responding to  multiple health, development, social and other categories of crises that project a less enthusiastic and pessimistic outlook for the plan to focus on nutrition in 2022, Prof Wasiu Afolabi, President of the Nutrition Society of Nigeria, told Health Policy Watch that progress is already being recorded in several areas, especially the initiatives that localize strategies to respond to peculiar local initiatives. 

“I must say that more than any other time in history, attention is being drawn to the importance of nutrition as a foundation to development in Africa,” he told Health Policy Watch.

“We have come to realize that yes, there is food. We are producing food. People are consuming food [but] it is not translating into improvements in the nutritional status of the populace, especially, as shown by statistics of malnutrition among children. Attention is now focused on how we can reduce the level of malnutrition,” he added.

Aside from the attention, there is also the existence, emergence and development of several policies, policy guidance and documents. 

Afolabi noted that most African countries now have a multi-sectoral plan of action arising from their food system policy to solve nutrition problems across sectors, not just in agriculture, but in health as well as in education and other relevant sectors of the economy.

“We now have an enabling environment and some level of political will on the part of policymakers to want to solve the problem. These are the things that I considered as the achievements so far in our country, in our sub region, as well as the African continent,” he told Health Policy Watch. 

Going forward, to quickly meet the targets, Afolabi enjoined African countries to quickly scale up interventions that they know are low cost and have impact in reducing the problem of malnutrition. By doing this, he said the continent will be able to meet the ambitious nutritional targets including ending hunger by 2030.

“Countries are supposed to redirect their efforts with support of development partners and international agencies, civil society organizations, and research universities. It is a movement for stakeholders to join us to get out to promote and invest in those interventions that will bring about change, change that will deliver the changes that we require in operational improvements to be able to reach the goals in 2030,” he told Health Policy Watch.

Image Credits: Paul Adepoju.

30x30
Protecting at least 30% of the planet is necessary to respond to the biodiversity crisis. Underwater landscape at Beveridge Reef, Niue.

In advance of critical biodiversity negotiations in Geneva, over twenty former headers of state, ministers, and environmental and indigenous leaders urgently called on governments – including their own – to back the protection of at least 30% of the planet by 2030. 

Led by former US Senator Russ Feingold and comprised of either former Heads of State, two former Prime Ministers, six former Ministers, and four environmental and indigenous and local experts, the Campaign for Nature’s Global Steering Committee (GSC) has released a joint statement asserting that the success of an upcoming global biodiversity agreement hinges on the adoption the global, science-backed 30×30 target.

“We urge all leaders to join us in this moment of decisive action to safeguard our future…We now know that protecting at least 30% of the planet is a necessary component of any strategy to effectively respond to the biodiversity crisis as well as the climate crisis,” read the statement. 

The statement urged governments that have not yet endorsed the 30×30 goal to join the High Ambition Coalition for Nature and People (HAC), a group of countries championing the target on a global scale. Many GSC members hail from countries that have not yet signed on in support of the HAC, including the Philippines, Indonesia, Malaysia, South Africa, Thailand, and Iceland.

HAC members currently include over 85 countries in Africa, Latin America, Europe, the Caribbean, Asia, and more. 

The statement was released on the eve of the UN Convention on Biodiversity’s third and last round of negotiations – set to take place in Geneva, Switzerland 13 – 27 March – before the final final biodiversity agreement – known as the post-2020 Global Biodiversity Framework – is signed by more than 190 countries later this summer at a summit in Kunming, China, the fifteenth meeting of the Conference of the Parties (COP 15). 

30×30 target is ‘necessary component’ to combat biodiversity and climate crisis 

In the statement, the GSC commended the progress made in response to the overwhelming evidence that backed the 30×30 target as a “necessary component of any strategy to effectively respond to the biodiversity crisis as well as the climate crisis”.

Progress made over the last year includes the unprecedented philanthropic commitment of $5 billion to support the implementation of 30×30, announced during the September 2020 UN General Assembly in New York.

Calls to close biodiversity gaps were also endorsed, particularly the call for developed countries to provide at least $60 billion annually in international finance for biodiversity. 

The GSC also acknowledged how nature and biodiversity featured even more prominently at the UN Climate Change Conference (COP 26) in Glasgow in November 2020. 

Conservation efforts must protect Indigenous people

The Indigenous people of New Zealand – the Maori.

The statement also underscored that all conservation efforts must protect the rights of Indigenous peoples and local communities, “who know the land we seek to protect better than anyone.” 

“It is also vital to acknowledge that Indigenous People are inextricably linked to biodiversity and that expanding recognition of their rights is an effective, moral, and affordable solution for conserving nature,” said Russ Feingold in a separate statement. 

Feingold emphasized the need for Indigenous Peoples to be “central partners” in the development and implementation of the Post 2020 Global BIodiversity Framework.” 

More must be done to build on progress as COP15 approaches 

Building on this momentum of unprecedented progress, the GSC called for the further expansion of political and financial support, welcoming the endorsement of the 30×30 goal by the recent Intergovernmental Panel on Climate Change (IPCC) report. 

The report asserts that protection of 30-50% of the world’s land and ocean is required to maintain the resilience of biodiversity and ecosystem services at a global scale. 

But the GSC reiterated that more must be done, calling on countries, funders, corporate leaders, and youth to play a role in meaningful change. 

“Now is the time to redouble our efforts. Every nation has a critical role to play as we approach the UN Biodiversity Conference (COP15) in Kunming, China.“ 

“Everyone has a role to play in protecting nature and our time is now. Let us rise to the occasion together and set a course that secures a better tomorrow for us all,” the statement reads. 

Other members of the GSC echoed these calls in separate statements.

“With COP26 behind us, it might be easy to think we can take a breath. But we cannot, we do not have time. It is vital that all parties to the UN Convention on Biodiversity come together at COP15 to commit to bold and ambitious targets, 30×30 included, said former Foreign Minister of Argentina Susana Malcorra. 

“None of our futures are certain unless we are united in this effort.”

Image Credits: UNDP / Vlad Sokhin, einalem.

A maternity and children´s hospital in the southern Ukranian city of Mariupol was bombed Wednesday, reportedly injuring 17 people, while WHO warned that Ukrainians who manage to escape direct injury in Russian bombings and shellings face hypothermia, frostbite and respiratory diseases, as well as conflict-related trauma – while the lack of access to treatment for cardiovascular disease, cancer and mental health is exacerbating chronic health conditions. 

Infectious diseases such as measles, tuberculosis, COVID-19 and even polio also are expected to increase as millions of people flee the Russian bombing of their towns and communities, WHO officials told a media briefing.  Cities like the southern Ukranian city of Mariupol remain cut off from adequate food, water and sanitation services, furtherin increasing infectious disease risks. Two million people have fled the country so far, while relief workers say that the number may double shortly. 

Mariupol shelling

In Wednesday’s shelling of the maternity hospital, including a children’s ward, in Mariupol, the Black Sea port city under siege by Russian troops, the region’s governor said 17 people were wounded, including women in labour.

A video circulated by Ukranian authorities showed a heavily damaged three-storey building, in a large compound also devastated by mangled glass, steel and wood outside. Much of the front of the building had been ripped away. BBC later released what it described as verified pictures of the Russian strike on the hospital.

“WHO is aware of disturbing news reports about an attack on a maternity hospital in Mariupol, Ukraine,” said Director General Dr Tedros Adhanom Ghebreyesus, in a Twitter post on Wednesday evening, condemning the ongoing violence, including the attacks on health facilities. As of Tuesday, WHO had verified 16 other Russian attacks on health facilities.

Fears of radiation accident

Meanwhile, there are growing fears of nuclear incidents in Ukraine after Russia seized control of both the Zaporizhzhya and Chernobyl nuclear power plants, after bombing Zaporizhzhya and causing a fire that burnt for almost five hours.

The Union of Concerned Scientists’ director of nuclear safety, Ed Lyman, warned on Tuesday that if the nuclear plants’ cooling systems are interrupted, it could result in the release of radioactive material.

The loss of power reported at Chernobyl on Wednesday “violates a key safety pillar on ensuring uninterrupted power supply”, according to the International Atomic Energy Agency (IAEA), but added “ in this case IAEA sees no critical impact on safety”.

According to the IAEA “the heat load of the spent fuel storage pool and the volume of cooling water contained in the pool is sufficient to maintain effective heat removal without the need for electrical supply”.

“The Zaporizhzhia plant is just one of four Ukrainian nuclear facilities whose 15 reactors provide more than half of the country’s electricity. None of the reactors was built to withstand a military assault,” said Lyman.

“Although there is no way to know if Russia intentionally targeted Zaporizhzhia, all of the plants are also vulnerable to indirect fire that could damage critical support systems and surrounding infrastructure, potentially resulting in a fuel meltdown and a radiological release that could contaminate thousands of square miles of terrain,” added Lyman.

While the IAEA was taking the lead on managing the nuclear risk, all countries have preparedness plans for nuclear events, said WHO’s head of emergency response, Dr Mike Ryan.

“Given the risks that have been risen in terms of an accidental event occurring, governments are well-advised to ensure that their preparedness plans and their supply chains are in place,” he added.

The WHO has raised the issues of chemical and bio-radio safety since the start of the conflict and ensured that any “high threat pathogens” in Ukraine had been autoclaved and destroyed,” added Ryan.

Dr Mike Ryan

Rising risk of infectious diseases

“We are tracking the risk of the emergence and spread of infectious diseases, such as measles, polio, and COVID-19,” said Dr Adelheid Marschang, WHO senior emergency officer. 

“Due to population movements and disruptions, we will have to look very, very carefully at that. We have further health risks related to mental health, psychosocial health. People are very, very stressed.”

Marschang added that the most vulnerable people “are those that cannot move because they have a chronic disease” and don’t have access to their usual treatment.

“There is increased risk of gender-based violence as women, children and the elderly travel, stay at reception centres or apartments or remain alone,” she added.

Adelheid Marschang

“The only real solution to this situation is peace, and WHO continues to call on the Russian Federation to commit to a peaceful resolution to this crisis, and to allow safe, unimpeded access to humanitarian assistance for those in need,” said Dr Tedros.

“The WHO has delivered 81 metric tonnes of supplies and is establishing a pipeline of supplies for health facilities throughout Ukraine, especially in the most affected areas,” added Tedros.

Supplies delivered to Kyiv include surgical care for 150 trauma patients and a month’s supply of medical supplies for a range of health conditions for 45,000 people, he added.

A further 400 cubic metres of supplies were waiting to be transported for Ukraine from the WHO’s logistics hub in Dubai, added Tedros.

Although the health sector had been remarkably resilient, about 1000 health facilities are either on frontlines are within 10 kilometres of the frontline of conflict and were becoming “engulfed” in it, said Ryan.

Dr Maria van Kerkhove

Second anniversary of COVID-19 

Friday marks the second anniversary of the declaration of COVID-19 spread as a pandemic, and over six million people had since died, said Tedros.

But although reported cases and deaths are declining globally, “countries in Asia and the Pacific are facing surges of cases and as the virus continues to evolve, and we continue to face major obstacles in distributing vaccines, tests and treatments everywhere they are needed,” said Tedros.

He expressed concern that countries were reducing testing, and said that the WHO was recommending that self-testing for COVID-19 should be offered in addition to professionally administered testing services.

“This recommendation is based on evidence that shows users can reliably and accurately self-test and that self-testing may reduce inequalities in testing access,” said Tedros.

COVID-19 Delta-Omicron ‘recombinant’ in Europe

Meanwhile, Dr Maria van Kerkhove, WHO’s COVID-19 lead, said that a COVID-19 “recombinant” made up of “Delta AY.4 and Omicron VA.1” had been identified in France, the Netherlands and Denmark.

“The recombinant is something that is expected given the intense amount of circulation that we saw with both Omicron and Delta”, and that both were circulating at high levels in Europe at the same time, said Van Kerkhove.

“There’s very good surveillance in many countries right now. And given the sheer number of changes and mutations within Omicron, it was much easier for researchers, scientists, public health professionals, people who are studying the genome to be able to detect these recombinants.

“We have not seen any change in the epidemiology with this recombinant. We haven’t seen any change in severity. But there are many studies that are underway.”

 

Image Credits: Gayatri Malhotra/ Unsplash.

Pro-abortion demonstrators in the US

The World Health Organization (WHO) released new guidelines on abortion care on Wednesday, that include recommendations on telemedicine for the first time.

Telemedicine has helped support access to abortion and family planning services during the COVID-19 pandemic, and is also being used in places where abortion access is limited.

Over 25 million unsafe abortions occur each year, causing around 39,000 deaths and millions more women being hospitalized with complications, according to the WHO. 

Most of these deaths are concentrated in lower-income countries – with over 60 percent in Africa and 30 percent in Asia – and among those living in the most vulnerable situations., according to the WHO.

“Being able to obtain safe abortion is a crucial part of health care,” said Craig Lissner, acting Director for Sexual and Reproductive Health and Research at WHO. “Nearly every death and injury that results from unsafe abortion is entirely preventable. That’s why we recommend women and girls can access abortion and family planning services when they need them.”

The guideline includes recommendations on many simple primary care level interventions that improve the quality of abortion care provided to women and girls. These include task sharing by a wider range of health workers; ensuring access to medical abortion pills, and making sure that accurate information on care is available to all those who need it.

Remove legal barriers

Alongside the clinical and service delivery recommendations, the guidelines recommend removing medically unnecessary policy barriers to safe abortion, such as criminalization, mandatory waiting times, the requirement that approval must be given by other people (e.g., partners or family members) or institutions, and limits on when during pregnancy an abortion can take place. 

While most countries permit abortion under specified circumstances, about 20 countries provide no legal grounds for abortion. Around three-quarters of countries have legal penalties for abortion, which can include lengthy prison sentences or heavy fines for people having or assisting with the procedure.

“It’s vital that an abortion is safe in medical terms,” said Dr Bela Ganatra, Head of WHO’s Prevention of Unsafe Abortion Unit. “But that’s not enough on its own. As with any other health services, abortion care needs to respect the decisions and needs of women and girls, ensuring that they are treated with dignity and without stigma or judgement. No one should be exposed to abuse or harms like being reported to the police or put in jail because they have sought or provided abortion care.”

Evidence shows that restricting access to abortions does not reduce the number of abortions that take place. In fact, restrictions are more likely to drive women and girls towards unsafe procedures. In countries where abortion is most restricted, only 1 in 4 abortions are safe, compared to nearly 9 in 10 in countries where the procedure is broadly legal.

“The evidence is clear – if you want to prevent unintended pregnancies and unsafe abortions, you need to provide women and girls with a comprehensive package of sexuality education, accurate family planning information and services, and access to quality abortion care,” Dr Ganatra added.

Following the launch of the guidelines, WHO will support interested countries to implement these new guidelines and strengthen national policies and programmes related to contraception, family planning and abortion services, helping them provide the highest standard of care for women and girls.

Image Credits: Gayatri Malhotra/ Unsplash.

NATAN Worldwide Disaster Relief organization volunteers, including Dr Dorit Nitzan
Former WHO/Europan Emergencies Director Dorit Nitzan (centre), now a front-line volunteer on the Polish-Ukraine border.

The Ukrainian refugees are crossing the border with only their coats on their backs. The women are holding their children’s hands. The children’s eyes are wide and their jaws clenched in fear.

“They come here exhausted and cold,” said Dr Dorit Nitzan, former Health Emergencies Coordinator for the World Health Organization´s European region.

Nitzan only retired from WHO within the last two months and already she has returned to the field.  But this time she is not a visiting high-level official to a humanitarian crisis zone, but a front-line volunteer sleeping on a mattress in a mall with hundreds of other refugees.

Nitzan is part of a team of first responders offering critical medical care to Ukranian refugees just inside the Polish-Ukranian border – after having finally managed to flee to safety from war torn communities in Ukraine.

According to the latest United Nations High Commissioner for Refugees (UNHCR), more than two million people, the vast majority of whom are women and children, have left Ukraine since 24 February, the day that the war started.

“The needs are immense, and we are doing our best in a small clinic,” Nitzan said this week on a call with Health Policy Watch – a call that was interrupted more than once by a sick person in need of care or an emergency.

Nitzan arrived in Poland last week with a delegation of physicians, nurses and social workers affilated with the all-volunteer NATAN Worldwide Disaster Relief organization, an Israeli-based network. Working closely with the Red Cross of Poland, the US-based Operation Blessing, the Mexican CADENA and WHO, Nitzan’s team has taken over a shopping mall in Medica, where it is serving some 3000 refugees.

Nitzan said they are expected to stay in the field for at least two months, with volunteers rotating in and out of the country every couple of weeks. The volunteers sleep on mattresses in the mall just like the refugees.

“We live with the people,” Nitzan said. “We aim to be wherever we are needed for as long as we are needed.”

Although Nitzan recently left WHO after reaching the mandatory retirement age of 65, she told Health Policy Watch that she still feels a part of the organization.

Secured a top job – then left for a war zone

Nitzan had only just returned to her home country in Israel and secured a top job at Ben-Gurion University, when the war broke out. She felt particularly compelled to respond – having also served in Ukraine on behalf of WHO from 2012 to 2016. That was during the last period of major conflict in which Russia occupied Crimea, and then supported the establishment of two pro-Russian breakaway enclaves in eastern Ukraine.

“I know Ukraine and I know the Ukrainians,” she said. “We were hoping Ukraine was marching towards a better future and this is a big slap. It really hurts me. It is extremely hard to see.”

A paediatrician, Nizan has been helping the refugee children. “I loved my job in the high chair and at the table, but here, with kids around me, I love it – I feel fulfilled,” she told Health Policy Watch.

A NATAN volunteer assists a Ukrainian refugee child at a clinic in Poland.
A NATAN volunteer assists a Ukrainian refugee child at a clinic in Poland.

More supplies are on the way

Nitzan has been in touch with the Polish branch of WHO, and through NATAN continues to stay abreast of WHO’s efforts in the region.

WHO Europe’s regional director, Dr Hans Kluge, told a press briefing on Tuesday that WHO was working to ensure the safe passage of critical medical supplies into Ukraine.


“Lifesaving essential medicines, such as oxygen and insulin, personal protective equipment, surgical supplies, anesthetics, and safe blood products, are in short supply,” Kluge said. “So far, two shipments totalling 76 tonnes of trauma and emergency health supplies, as well as freezers, refrigerators, ice packs and cool boxes are in transit in Ukraine. We have further shipments of 500 oxygen concentrators and more supplies are on their way.”

WHO is also supplying infrastructure and support to border countries and the clinics that have opened up in them, like the one in which Nitzan is operating. Kluge said that expert WHO teams have been sent to Hungary, Poland, the Republic of Moldova and Romania.

“We are working with UNHCR and coordinating closely with the relevant governments, local authorities and partners to assess the needs of incoming refugees upon entry at the border, build health system capacity to accommodate large numbers of refugees and ensure access to services,” he noted.

Next week, a meeting is planned on refugee and migrant health in Turkey where current events will be addressed by health ministers, representatives of refugee and migrant groups, partner organizations and the WHO African and Eastern Mediterranean regions.

“Continuity of care for those with long-term health needs is a major challenge because broken supply lines are affecting the treatment of conditions such as diabetes and hypertension, as well as for cancer,” Kluge said. “According to [the United Nations Population Fund] UNFPA, an estimated 80,000 women will give birth in the next three months without access to critical maternal care. Re-establishing and maintaining vaccination programs and continuing treatment for people living with TB and HIV, are priorities, as is the provision of mental health services.”

Nitzan explained that WHO also serves as a watchdog for attacks on healthcare and health workforce during the work, “which is not permitted at any time. Any attack we need to report,” she added.

To date, according to Kluge, there have been 16 confirmed reports of attacks on health facilities in Ukraine. However, on Wednesday, a Russian attack on a large maternity and children´s hospital in the beseiged city of Mariupol left at least 17 people injured, Ukranian authorities said.  WHO said it was aware of the reports and investigating that latest incident.

The day after: conflict, COVID-19 sap ‘ability to cope’

Nitzan said that while the doctors and other medical staff are now working in emergency mode, she worries for the day after the war. With so many refugees fleeing to other parts of Europe, there will be a “brain drain” in Ukraine.

“The strongest people left,” she said. “The people left behind will be the sick, the elderly and poor.”

And it will cost the country and the world a steep price to rebuild Ukraine, which could detract from other global health priorities, though she was not specific.

Dr Dorit Nitzan with a partner volunteer at the NATAN Worldwide Disaster Relief organization healthcare clinic in Medica.
Dr Dorit Nitzan (right) with another volunteer from the NATAN Worldwide Disaster Relief organization.

Over the last six or seven years, WHO worked closely with Ukraine to improve its health system, including offering universal health coverage and improving hospital care. The country had stocked medicine warehouses and was more prepared than expected, she said.

“The conflict, together with COVID, has left Ukraine with no ability to cope,” Nitzan said. “The margins are so thin, and everything is so fragile.

“I am afraid that whatever was achieved from 2015 until now and so much more will have to be rebuilt.”

Image Credits: NATAN Worldwide Disaster Relief organization, NATAN Worldwide Disaster Relief organization .

Women make up 75% of the global health workforce but hold only 25% of senior positions.

Commercialising the health sector and leaving healthcare up to the markets is “dangerous” and “really amoral” the World Health Organization’s (WHO) Director-General Dr Tedros Adhanom Ghebreyesus told the launch of a brief on measuring value in the economy on Tuesday. 

The policy brief, produced by the WHO Council on the Economics of Health for All, proposes a new system of value and measurement based on valuing planetary health, diverse social foundations and activities that promote equity, rather than Gross Domestic Product (GDP).

The panellists at the brief launch.

Value the right things to take right actions

The use of GDP as a “monolithic monetary measurement metric” of value for health was condemned by panellists at the launch. Instead, they proposed that the world should move toward a more holistic data measure that abandons purely monetary indices. 

“It’s all about ensuring that we value the right things because we need to take the right actions. And sometimes a focus on GDP, on increasing economic activity at all costs, leads us away from valuing those rights actions,” said economics professor Jayati Ghosh, from the University of Massachusetts in US.

“We need this holistic approach because Health for All has all these different dimensions…Governments have to move away from the single-minded focus on economic activity as the resolution of all the other problems.”

Jayati Ghosh said that a focus on GDP on increasing economic activity at all costs, leads us away from valuing those rights actions

Value women’s work

Using GDP as a metric of development also does not take into account the value of care and unpaid labour – work that is mainly done by women, who spend two and a half hours per day more than men on unpaid work, according to the brief.

The brief thus proposes the inclusion of new metrics that value goods and services that remain unaccounted for, such as growing food, cooking, cleaning, childcare and other unpaid household and community activities including environmental conservation – all predominantly performed by women.

“The contribution that women around the world make to sustaining human and planetary health is constantly undervalued. The most meaningful celebration of International Women’s Day would be to initiate a radical re-evaluation of these contributions, and drive economic policies that benefit communities, families and individuals,” said Tedros.

The gender gap in unpaid work in 23 low-and middle-income and 23 high-income countries, 2005-2013 (latest available year)

The brief talks about the creation of a dashboard instead of using GDP to measure the multifaceted health system. Panellists also brought to light the need to have a dashboard.

Professor Mariana Mazzucato, chair of the WHO Council on the Economics of Health for All, pointed out that countries’ GDP cannot be interpreted as a good sign.

“When we go to war, things have to be produced to go to war and that increases GDP. When we pollute, GDP goes up, because someone has to go and clean it up,” Mazzucato said. 

Governments invested 40 times more in war than health, while attempts to re-imagine GDP were marginal and insufficient for the radical change needed to achieve Health for All, according to the brief.

Lessons in pandemic preparedness

A business-as-usual approach to health, implying that the health sector can single handedly tackle a pandemic, would be “a catastrophic mistake – and a missed opportunity – that would leave the world once more unprepared for the next health crisis,” the brief said, advocating for investing in long-term preparedness. 

Reasons for lack of access to essential health services by country-income group, available data 2021, WHO

“By measuring the wrong things or by not measuring certain things at all, we are actually endangering our response, and we are endangering our livelihood,” said Professor Ilona Kickbusch,  Chair of the Global Health Centre at the Graduate Institute of International and Development Studies in Geneva.

“Our understanding of social determinants of health has actually expanded through the pandemic. And we neglected the one factor that turned out to be in short supply: Trust.

“We don’t measure and value what actually keeps our societies running,” she added. “And what was it during the pandemic that kept our societies running? Women’s work; women’s work in the healthcare sector…and at home.” 

Image Credits: WHO, Aishwarya , WHO Council on Economic Health For All .

CEPI Chairpseron Jane Halton

The Coalition for Epidemic Preparedness Innovations (CEPI) raised over $1.5 billion to develop vaccines against emerging diseases in as little as 100 days over the past two days at a pandemic preparedness summit co-hosted by the UK government.

CEPI’s total budgetary ask is for $3.5 billion to implement its five-year plan to prepare and protect against “Disease X”, the unknown pathogen that will cause the next pandemic.

It has developed a roadmap to compress vaccine development to 100 days, develop a broadly protective vaccine against COVID-19 and other Betacoronaviruses, and create a “library” of vaccine candidates for use against known and unknown pathogens. 

As part of this, CEPI announced on Tuesday that it will partner with UK-based DIOSynVax – a biotech company linked to the University of Cambridge that specialises in the development of broadly protective, multi-virus vaccine antigen payloads (VAPs).

Betacoronavirus vaccine candidate

DIOSynVax will assist to develop a vaccine candidate based upon “intelligent computational design” against existing and future variants of SARS-CoV-2 and other major sub-genera of Betacoronaviruses including those that cause SARS and MERS.

The idea of a 100-day mission came from a commitment made by leaders at the G7 meeting in June last year to “support science in a mission to shorten the cycle for the development of safe and effective vaccines, treatments and tests from 300 to 100 days”.

“CEPI’s five-year strategy aims to make the development of vaccines against emerging pathogens within 100 days a reality, because the quicker a safe, effective and globally accessible vaccine is developed and deployed, the quicker an incipient pandemic can be contained and controlled,” the organisation said in a statement on Tuesday.

“Achieving the 100 Day Mission, through CEPI’s innovative programme of access-focused R&D, would give the world a fighting chance of defusing the threat of future pathogens with pandemic potential.”

International pandemic accord

Addressing the summit in support of CEPI, World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus said that CEPI had to be part of the new “enhanced global health architecture for pandemic prevention, preparedness and response”.

Negotiations on an international pandemic accord were beginning in order “to establish the rules of the road for a more cohesive and harmonised global response to future epidemics and pandemics – including the equitable sharing of countermeasures”, he added.

Dr Tedros said that the pandemic has taught the world “the incredible power of surveillance, genomics, diagnostics, vaccines and therapeutics” – but it had also exposed gaps and weaknesses in the global ecosystem.

“WHO is working with our Member States and partners to fill some of those gaps, including through the new WHO Hub for Epidemic and Pandemic Intelligence in Berlin, the WHO BioHub System for sharing pathogens in Geneva, and the soon-to-be-launched Global Genomics Surveillance strategy for pathogens with pandemic and epidemic potential,” said Tedros.

“But it’s clear that we also need to strengthen efforts to develop, evaluate and distribute vaccines, tests and treatments as rapidly and equitably as possible when a new pathogen emerges,” he added.

Over the past two days, health ministers, pharmaceutical company executives and other partners met in London and made a number of pledges to protect the world against future threats.

The UK Government has committed to delivering a research and development network, accessible to industry, to speed up the development and delivery of novel vaccines. 

Meanwhile,  associations representing vaccine manufacturers, as well as the broader biotech and biopharmaceutical industry and the International Federation of Pharmaceutical Manufacturers & Associations (IFPMA) committed to investing in R&D aimed at “target pathogens with epidemic and pandemic potential and to build a portfolio of promising candidate vaccines, treatments and technologies”. 

Commitment to speed

They also committed to speeding up vaccine manufacturing and capacity, as well as clinical trials.

“The faster an effective vaccine is developed and deployed, the faster an incipient pandemic can be contained and controlled,” according to CEPI.

“In the case of COVID-19, a 100-day timeline would have seen a vaccine ready to use in mid-April instead of December 2020. This could have saved millions of lives and trillions of dollars. Achieving the 100-day goal would give the world a fighting chance of containing an outbreak before it spreads globally and becomes a pandemic.”

“COVID-19 has taught the global healthcare community hard but important lessons. Let’s use them to make our defences against the next pandemic more nimble, more robust, and – above all – more equitable,” said IFPMA Director General Thomas Cueni.

“We have seen the strength of a strong innovation ecosystem leading to the rapid development of multiple solutions, acting to expand partnerships, knowledge-sharing, and technology transfer in unprecedented ways,” he added, commending CEPI for bringing people across the innovation ecosystem to address COVID-19.

Moderna has committed to permanently waiving its COVID-19 patents in 92 low- and middle-income countries, and is pursuing vaccines for 15 diseases identified as the world’s biggest public health risk, including ebola, tuberculosis and malaria.

The company has also offered outside researchers access to its mRNA technology to pursue research on emerging and neglected infectious diseases, it announced on Monday evening.

However, Moderna will not share its COVID-19 vaccine technology with the mRNA hub that the World Health Organization (WHO) has established in South Africa that has already made a copy of Moderna’s vaccine.

This prompted French virologist Marie-Paule Kieny, who chairs the hub and the Medicines Patent Pool, to appeal for “more” from the company.

Instead, it is setting up a $500-million vaccine manufacturing facility in Kenya, and has signed a Memorandum of Understanding with that government.

Moderna CEO Stephane Bancel said that it was “not a good use of our time” to work with the mRNA hub.

The company aims to have clinical trials for some of the 15 priority pathogens by 2025. Moderna is expanding its patent pledge to never enforce COVID-19 patents in the 92 low and middle-income countries identified for support by COVAX.

Earlier, it had pledged not to enforce patents during the emergency phase of the pandemic, which is why the South African mRNA hub opted to make its vaccine.

Image Credits: Gavi .