One Month After Russia’s Invasion, Half of Ukrainians are Refugees or Stuck in Conflict Zones – And Their Needs Are Growing 23/03/2022 Kerry Cullinan People at the railway station in Lviv wait in line for hours to board trains to leave Ukraine. A month after the start of Russia’s invasion of Ukraine, almost 10 million people have been displaced, 64 attacks on health facilities have been verified – and the situation is set to worsen. This was the grim assessment of World Health Organization (WHO) officials briefing the media on Wednesday. “Nearly a quarter of Ukraine’s population has now been forcibly displaced. The humanitarian situation continues to deteriorate in many parts of the country and is critical in the Mariupol and Bucha districts,” said WHO Director-General Dr Tedros Adhanom Ghebreysus. Meanwhile, Dr Mike Ryan, director of health emergencies, said that “a further massive scaling up of assistance within Ukraine” is going to be needed in the coming weeks. Around 3.5 million Ukrainians have left the country, 6.5 million are internally displaced while 12 million are in conflict zones, said Ryan. “So across a population of 44 million, half the population of Ukraine has either the left the country, has been displaced within the country or is in a direct conflict zone,” said Ryan. “I have never myself seen such complex needs and a crisis that has developed so fast,” added Ryan, castigating the aggressors in both Ukraine and Tigray for refusing to allow unfettered humanitarian access to those in need. The WHO has raised less than a quarter of the $57.5 million it estimates it needs to deliver assistance in Ukraine over the next few months. “The disruption to services and supplies throughout Ukraine is posing an extreme risk to people with cardiovascular disease, cancer, diabetes, HIV and TB, which are among the country’s leading causes of mortality,” said Tedros. Displacement, poor shelter, and overcrowded living conditions caused by the conflict are also increasing the risk of diseases such as measles, pneumonia, and polio as well as COVID-19, he added. Preparing for nuclear, chemical warfare Dr Ibrahima Socé Fall, WHO Assistant General Secretary for Emergency Response Dr Ibrahima Socé Fall, Assistant General Secretary for Emergency Response, said the WHO was in a bind because it did not know how to get medical supplies from its warehouses to health facilities. “The really high confirmed attacks on health care includes attacks on ambulances. So It is difficult even for very simple movement [such as] making sure that the medical supplies will reach the hospitals where it is needed,” said Socé Fall. Meanwhile, the WHO has been working with the International Atomic Energy Agency (IAEA) and Ukrainian officers to prepare for chemical, biological or nuclear hazards. “There is another obvious layer to this, which is the horrific potential that weapons could be used that are either chemical or nuclear in nature,” said Ryan. “We are part of the UN system for response to such incidents if they occur, and we’re ready to do so. But it’s unconscionable even to think that that would be the case.” COVID resurgence is driven by BA.2 Dr Maria van Kerkhove The more infectious Omicron BA.2 sub-lineage is sweeping the world, accounting for 86% of the sequences available from the last four weeks, said WHO COVID-19 lead Dr Maria van Kerkhove. There have been large COVID-19 outbreaks in Asia and a fresh wave of infections in Europe. “Several countries are now seeing their highest death rates since the beginning of the pandemic,” said Tedros. “This reflects the speed with which Omicron spreads and the heightened risk of deaths for those who are not vaccinated, especially older people. We all want to move on from the pandemic. But no matter how much we wish it away, this pandemic is not over.” However, Ryan said that while transmission has taken off again in many places – especially where rules had been relaxed. But countries with high levels of vaccination, especially amongst vulnerable people, were not seeing high rates of hospitalisation, and deaths. Ethiopia finally allows access to Tigray The Ethiopian government, which has maintained a siege of Tigray for almost 500 days, had finally agreed to allow the WHO to deliver 95 tonnes of medical supplies to the territory, said Tedros. “If we can deliver the supplies safely, they will help people in desperate need. But much more is needed. So far, only 4% of the needs for health supplies have been delivered to Tigray. That is insignificant,” said Tedros. “With dire shortages of fuel and food, people are starving to death. Actually, giving them food is more important than medicine. We continue to call on the Ethiopian and Eritrean governments to end the blockade.” Ryan added that the WHO had experienced “all kinds of bureaucratic restrictions in the past, including cancellations” in getting aid to Tigray. “t is the responsibility of all parties to facilitate the process of giving access, not to take away piecemeal small bits of a blockade and allow some aid to trickle in,” said Ryan. “This is about opening up unfettered access to millions of people who are in desperate need.” He added that the basic principles of humanitarian law were being forgotten in Tigray and Ukraine – which is to ensure access to populations who desperately need aid . Image Credits: People in Need, Sam Mednick/TNH. Over a Million People Could Die of Omicron in China 23/03/2022 Maayan Hoffman More than a million people could die of Omicron in China unless it takes action to boost its elderly population with a Western COVID-19 vaccine, according to a new analysis by Airfinity. Potential cumulative deaths in China The analysis shows that, although China vaccinated 80% of its population over the age of 60, Chinese people have low protection because its Sinovac and Sinopharm vaccines – used to inoculate the majority of citizens – have significantly lower efficacy and provide less protection against infection and death. In addition, only 40% of Chinese people have taken a booster shot, the report showed. Airfinity compared China to nearby Hong Kong, which has experienced one of the most devastating waves of infections and deaths caused by COVID-19 which has been attributed to low protection levels due to reliance on less efficacious Chinese vaccines and a lack of community immunity. “The death rate in Hong Kong is the highest in the world and much higher than Western countries have ever experienced, peaking at 37.6 daily deaths per million – more than double the United Kingdom’s peak in January 2021,” according to the report. The case fatality rate (CFR) is 20 times higher than in New Zealand, which also had a “zero COVID” policy and relied heavily on Chinese vaccines. “Should China have similar levels of protection, they too could experience a very high CFR,” writes Airfinity. Case fatality ratio over time for countries However, “most of these deaths can be prevented,” the team advised. “If China faced an Omicron wave with protection levels similar to New Zealand, our analysis shows deaths could be reduced to 45,000. China could bolster protection in its population by administering booster jabs with higher efficacy vaccines.” Airfinity said that there are enough alternative vaccines that could be redistributed immediately to jab 54% of China’s population and save their lives. Image Credits: Flickr, Airfinity. UN Appeals for Groundwater Protection as Large Tracts of Africa Battle Drought 23/03/2022 Kerry Cullinan A family feeds their cattle with straw plucked from the roof of their home in Adadle in the Somali region of Ethiopia. As global water experts meet at the World Water Forum in Senegal this week, large swathes of Africa are facing famine as severe droughts prevail in the Horn of Africa and large parts of southern Africa. “Harvests are ruined, livestock is dying and families are bearing the consequences of increasingly frequent climate extremes,” according to Michael Dunford, the UN World Food Programme’s Regional Director for Eastern Africa. The countries most affected are Somalia, Kenya, Djibouti and Ethiopia in the east, and Angola, Madagascar, Mozambique and Namibia in the south. The UN launched its World Water Development Report at the forum to coincide with World Water Day on Wednesday, appealing for better management of groundwater, which is usually stored in aquifers, many of which are vulnerable to climate change and human settlements. Aquifers are under threat in rapidly expanding low-income cities, including Dakar (Senegal) and Lusaka (Zambia), as well as informal communities reliant on on-site sanitation where “the increased frequency of extreme rainfall can amplify leaching of surface and near-surface contaminants”, warns the report. Low-storage, low-recharge aquifer systems in drylands, such as Bulawayo (Zimbabwe) and Ouagadougou(Burkina Faso), are also at risk, in situations where “alternative perennial water sources are limited or do not exist, and recharge is episodic so that even small reductions in recharge can lead to groundwater depletion”, the report warns. Water scarcity affects over 40% of the 🌍 population.And for every 1°C ⬆️ in global temperature, an additional 500 million people will face #waterscarcity.🔗 https://t.co/4WYuzYPgpM #WorldWaterDay💦 @WorldBankWater pic.twitter.com/k4lshprKoA — World Bank India (@WorldBankIndia) March 22, 2022 Lack of research Meanwhile, information about the impact of climate change on Africa is scarce, according to the Intergovernmental Panel on Climate Change latest (sixth) report on Impacts, Adaptation, and Vulnerability. “Many countries lack regularly reporting weather stations, and data access is often limited. From 1990–2019 research on Africa received just 3.8% of climate-related research funding globally: 78% of this funding went to EU and North American institutions and only 14.5% to African institutions,” notes the IPCC report in a special section on Africa. “Increased funding for African partners, and direct control of research design and resources can provide more actionable insights on climate risks and adaptation options in Africa.” To address this, the World Water Council and the Organisation for Economic Co-operation and Development (OECD) launched a new programme this week to produce new data, evidence and policy guidance on water security in Africa. “With 250 million Africans expected to live in water-stressed areas by 2030, and 60% of the population expected to live in cities by 2050, now is the time to get water policies right for sustainable development in Africa,” according to Jose Angel Gurria Trevino, OECD’s Secretary-General. Image Credits: Michael Tewelde / World food Programme. Ukraine’s ‘Model’ TB Programme Destroyed by War, as Global TB Response Faces ‘Disastrous’ Funds Shortfall 22/03/2022 Kerry Cullinan & Elaine Ruth Fletcher Yana Terleeva, head of the Ukranian Ministry of Health’s TB programme Speaking in her car from an undisclosed location somewhere in war-torn Ukraine, Yana Teerleva, head of TB in the country’s Ministry of Health, lamented the destruction that she is witnessing every day in hospitals and clinics – including the shelling of three huge dispensaries where the country had stockpiled sufficient TB medications for the remainder of 2022. This month, Teerleva had been planning to implement an innovative new TB treatment regimen to further step up the national response to its drug resistant TB burden – which TB control officials in Geneva had praised as a model. “Instead we are dealing with the Russian invasion and discussing military hardware”, Teerleva said in a media briefing Tuesday, just ahead of World Tuberculosis Day, 24 March. Global TB experts are bemoaning the destruction of Ukraine’s innovative TB programme, which had made significant progress in addressing the country’s high burden of multi-drug resistant TB (MDR-TB) over the past 15 years. Meanwhile, with global TB funding well below needs, prospects of meeting the UN Sustainable Development Goal target for ending the TB epidemic by 2030 look increasingly dim, Lucica Ditui, executive director of the Geneva-based STOP TB Partnership, told Health Policy Watch in an interview. “This gives us very little chance of meeting the UN 2030 targets,” she said. Model programme now in ashes – literally Almost one-third of Ukraine’s TB cases are drug-resistant, and last year the country diagnosed and treated 24,000 people with TB, including almost 5,000 people with MDR-TB. But the Ukrainian government had been “extremely committed” to addressing TB over the past two to three years, paying for new drugs and diagnostics and building strong relationships with civil society organisations, Ditiu told Health Policy Watch. “The country did a lot to improve their health system. It is devastating to see these bombs destroying everything. These are losses that will take decades to regain.” A doctor shows Oleg Chutvatov, who was receiving TB treatment at the hospital in Kharkiv, an x-ray photo of his lungs in July 2021. The city is now under heavy attack from the Russian invasion. Over the past 15 years, Ukraine had significantly reduced its TB cases from over 127 cases per 100 000 people in 2005 to just 42.2 cases per 100 000 people in 2020. Just before the war, says Ditiui, “The country was paying for their own TB drugs as well as diagnostics – and they had secured enough to treat and diagnose everyone in need in Ukraine. “They were very keen to implement new tools like rapid molecular diagnosis, as well as new drugs. They had cohorts of people enrolled in studies for new TB treatments. Collaboration between public health officials, civil society and communities also was very good.” The gains in TB treatment were part of a broader health sector reform that had been underway, Ditiu added, saying: “What I am really upset about is that the country did a lot to improve their health system, their hospitals, to do health sector reform. To see these bombs destroying everything. These are losses that will take decades to regain.” “Ukraine was always at the forefront of the fight against tuberculosis,” Teleeva told the Stop TB briefing Tuesday. “We wanted Ukraine and the entire world to be free from the TB and for that, we have done everything possible.” However, she said that according to health ministry information, “more than 135 hospitals in Ukraine have been shelled by the Russian aggressors”, including “three huge regional anti-tuberculosis dispensaries” and the country’s health infrastructure “is not working”. WHO has confirmed some 60 attacks on hospitals and other health facilities. Appeal to combat stigma – among the war’s knock-on effects Both Ditiu and Teeleva stressed the need to focus now on countering the knock-on effects of the war – including how to treat internally displaced people, how to ensure people fleeing can continue their medications, and how to combat stigma that refugees elsewhere may encounter. “We worked to overcome the stigma discrimination of these people living with TB”, Teleeva said, of the pre-war period. She appealed to neighbouring countries that have a much lower burden of TB disease not to stigmatise Ukrainian refugees. “TB is very sensitive, and if we broadcast information about its uncontrolled spread, we will stigmatize people who are already stigmatized, for people who are already in a very difficult situation,” said Terleeva. Ditiu acknowledged that it’s very likely the war will lead to a higher level of TB cases -particularly inside Ukraine itself. “We’ll see an increase in TB, in drug-resistant TB and in mortality,” she predicted, “because people will be staying close together in shelters, in crowded places, with bad food and stress.” However, she said good tracking and surveillance by countries that receive refugees can help counter any spillover effect, beyond the borders. ‘Stupid war’ Romania’s Health Minister, Prof Alexandru Rafila Decrying the “stupid war”, Romania’s Health Minister, Professor Alexandru Rafila, told the briefing that his country was doing everything it could to assist the refugees that had fled across the 600km border with his country, including identifying and ensuring treatment for TB patients. As a country with a relatively high burden of TB itself, Romania has “a network of TB hospitals and TB ambulatory care centres where we can perform rapid diagnosis and treat Ukrainian patients if they are resistant or need to initiate treatment”, added Rafila. The Global Fund has also provided Romania with additional Gene Xpert rapid testing machines and TB medication to assist Ukranian patients, the health minister added. However, while Romania and Moldova had “some capacity” to deal with TB, Ditiu warned that Poland is in a different category – precisely because its own burden is quite low. “Poland is not a country with a lot of TB – so I’m not sure how well the network will be able to deal with it – even though the doctors certainly have a lot of knowledge”. In addition, prices of TB medication in both Romania and Poland are up to ten times higher than in Ukraine, as both countries are part of the European Union and pay EU prices for drugs that Ukraine was able to procure through the Global Fund, Ditiu added. “We are having a conversation with the Global Fund to see how we can lower the cost,” she added. TB civil society trying to locate patients Olya Klymenk, head of TB People Ukraine, a network of over 70 organisations, said that her organisation was doing its best to locate displaced patients who have fled their homes or their communities, and offer them humanitarian aid, including food. “We are trying to take care of the patients who are out of the hospital right now because we understand that, without social support, they will not have a good life,” said Klymenk. Teleeva stressed that in the emergency the primary need is to, “focus on ensuring patients know where to go and have a desire to continue treatment. “They have to be assured there is a reason to live, that they will go back to Ukraine, and they have to be healthy to help us rebuild. They need this optimism, to have this desire to live and continue living.” ‘Pathetic’ investment in TB Dr Lucica Ditiu, Executive Director of the Stop TB Partnership Meanwhile, Ditiu lamented that “investments in TB are pathetically low” – perhaps because 90% of the disease burden is in lower-income countries. “In 2020, we had $1.9 billion [in] domestic investments, which is very very, very little,” she said, referring to national governments’ own contributions to beating TB. In addition, “The Global Fund, which is a big donor for TB, gave around $800 million, which is completely insufficient.” Stop TB estimates that $19.6 billion per year will be needed over the next eight years for TB prevention and care, and $4 billion per year will be required for research and development (R&D) of the new diagnostics, medicines and vaccines needed to end TB. This represents about four times what is currently available for the TB response (in 2020, $5.3 billion was available for care and prevention and $0.9 billion for R&D). The year 2022 is critical for the global fight to end TB as the world faces a fast-running countdown to reaching the 2018 United Nations High-Level Meeting (UNHLM) TB targets, which the international community agreed to meet by the end of December. All projections show that the world is not on course to meet the UNHLM treatment targets set for 2022. “We simply cannot continue to stand on the sidelines and watch while people around the world fall ill and die from a preventable and treatable disease,” said Ditiu. “We also cannot continue to accept what we accepted for years—every year having less than 40% of the funding need for the TB response. Now we are facing a disastrous funding shortfall, bigger than what we had expected. We not only need to step up efforts to meet targets set at the 2018 United Nations High Level Meeting on TB,” she said, referring to the UN pledge to accelerate progress toward the 2030 targets, “but the TB response must also recover from the devastating impacts of the COVID-19 pandemic.” Image Credits: The Global Fund / Evgeny Maloletka. ‘There is No Safe Place in Ukraine’ 21/03/2022 Kerry Cullinan Ukrainian child with his dog -displaced by war, in a refugee camp on the Moldova-Ukranian border There have been 52 attacks on Ukrainian health facilities in the past 25 days, more than two every day, according to the World Health Organization (WHO). Meanwhile, the health of fleeing refugees, their impact on the health services of neighbouring countries, and the fate of Ukraine’s tuberculosis patients are foremost on healthcare providers’ minds. “In less than a month, over three million people have left the country and nearly two million have been internally displaced,” said Jarno Habicht, WHO’s Representative in Ukraine. “This has happened faster than in any previous European crisis. There is no safe place in Ukraine right now, yet we need to ensure that health services are available.” “The military offensive continues, with a number of cities being entirely isolated – people are running out of food and water, and hospitals might not have electricity,” added Habicht, who has been head of the Ukraine office since 2018. “Worse still, we have seen many attacks on health workers and health facilities as well as patients. This is happening daily and is unacceptable. So, if you ask me how to describe it, every day things are getting worse, which means every day the health response is becoming more difficult.” Jarno Habicht, WHO’s Representative in Ukraine (centre) Banned cluster munitions According to Bonnie Docherty, a senior advisor for Human Rights Watch, Russian forces have “relied heavily” on cluster munitions, which are banned in most countries in the world, and explosive weapons with wide-area effects. Cluster munitions, large bombs that contain dozens or hundreds of smaller sub-munitions, were used to attack a hospital in Vuhledar on 24 February in which four civilians were killed, and 10 people including six healthcare workers were injured, wrote Docherty in the online security news outlet, Just Security, on Monday. Unexploded, the submunitions can lie dormant like landmines, exploding months and years later when picked up by children or farmers, she explains. However, artillery shells, mortars, rockets, missiles, and enhanced blast (thermobaric) weapons, and aerial bombs, have caused the bulk of the damage in Ukraine, adds Docherty. Concern for drug-resistant TB patients On the eve of World Tuberculosis Day on Thursday, WHO TB experts also expressed concern for Ukrainian TB patients, particularly those with drug-resistant TB. “Ukraine is one of the 18 high-priority countries in the WHO European region for TB and is on the global list for having a high burden of multidrug-resistant tuberculosis,” Dr Askar Yedilbayev, WHO Europe’s Regional TB advisor, told a media briefing on Monday. Dr Askar Yedilbayev “Before the war, Ukraine was one of the pioneering countries in response to TB and drug-resistant TB in the WHO European region,” he added. “However, destroyed health infrastructure, including limited access to TB treatment and public health services, is affecting the provision of essential tuberculosis services, causing significant delays in diagnosis of TB, affecting initiation of TB preventive treatment, and treatment of active TB and MDR TB,” he added. Shortly before the war, all TB medication had been distributed to regional warehouses and patients had been given one or two months’ supply of medicine, he added. But some of these warehouses had been damaged or were under threat of damage, and there was a need for the “emergency redistribution of procurement of medicines to ensure continuity of treatment”. In addition, as Ukraine’s neighbours did not have the same burden of TB disease, they were unlikely to have the medicine to treat large numbers of people with TB. Yedilbayev appealed for donations to the Global Fund and WHO Foundation to enable the delivery of health services to Ukrainians. Every second, a Ukrainian child becomes a refugee Every second, a Ukrainian child becomes a refugee, according to UNICEF and half of the over 3.5 million refugees estimated to have fled to neighbouring countries since 24 February are children under the age of 15. Almost two million refugees have fled to Poland, according to the WHO. “Refugees can be vulnerable to infectious diseases because of lack of health care, interrupted care in the country of origin, because of exposure to infectious infections and lack of care in transit, and if living conditions are poor in the destination country,” said Yedilbayev. Image Credits: UNICEF/UN0599222/Moldovan. As Europe Moves to Improve Mental Health Services for Children, Experts Are Concerned About Men’s Mental State 21/03/2022 Kerry Cullinan Dr Hans Kluge Mental health practitioners worldwide are warning of a massive wave of pandemic-related mental health issues that many countries are ill-equipped to address. On Monday, the World Health Organization’s (WHO) Europe office and the government of Greece launched a new European programme to strengthen and improve the quality of mental health services for children and adolescents. WHO Europe Director Dr Hans Kluge told the launch that suicide was the leading cause of death in children and adolescents aged 10 to 19 living in low- and middle-income countries in the region and that over 4000 young people in this age group had killed themselves in 2015. 🔴Suicide is the leading cause of deathamong adolescents in low & middle income countries & 2nd in high income countries in the European Region Find guidance on how to approach child & adolescent #MentalHealth as a primary health care provider here👉 https://t.co/EUoragqO0q pic.twitter.com/AOvZRIY7HR — WHO/Europe (@WHO_Europe) March 21, 2022 “Ensuring that all children and adolescents in the region have access to quality mental health services is a moral imperative,” said Kluge, adding that this was as important as childhood vaccinations. The WHO Europe programme aims to work with member states to encourage them to share knowledge and expertise about how to boost the mental healthcare of children and adolescents, and to support member countries to develop their own strategies and frameworks. It will also “develop a package of tools to measure progress against evidence-based standards”, according to the regional office. Through this new programme, WHO/Europe will continue to help countries strengthen and improve #mentalhealth services for children and adolescents, as well as developing tools to measure progress pic.twitter.com/Fspx9hh2lN — WHO/Europe (@WHO_Europe) March 21, 2022 Mental health woes of COVID-19 COVID-19 has exacerbated mental health issues and, during the first year of the pandemic, there was a 25% increase in the global prevalence of anxiety and depression, according to a WHO brief published in early March. Approximately 140,000 children in the US have lost a parent or guardian to COVID, for example, and are likely to be struggling to come to terms with this loss. “One major explanation for the increase is the unprecedented stress caused by the social isolation resulting from the pandemic. Linked to this were constraints on people’s ability to work, seek support from loved ones and engage in their communities,” according to the WHO. “Loneliness, fear of infection, suffering and death for oneself and for loved ones, grief after bereavement and financial worries have also all been cited as stressors leading to anxiety and depression. Among health workers, exhaustion has been a major trigger for suicidal thinking,” it added. Calls to South Africa’s only mental health helpline, for example, have jumped exponentially during the pandemic – from around 400 to 600 calls a day before COVID-19 to over 2400 calls a day in 2021. Psychologist Zamo Mbele, a board member of the South African Depression and Anxiety Group (SADAG) that operates the helpline, said that his non-governmental organisation, which is wholly reliant on donations, had been struggling to keep up with demand. Psychologist Zamo Mbele, a board member of the South African Depression and Anxiety Group (SADAG) Male violence and mental health “One of the reasons we’ve seen an increase in our calls is because of COVID, but one of the other reasons is because people who would not previously access health are beginning to recognise that they need help,” said Mbele. He added that “toxic” manifestations of masculinity – seen in the country’s high levels of domestic violence, road rage and substance abuse – were indications that men, in particular, needed help. “It’s not as though men only recently starting to struggle with mental difficulties or emotional difficulties,” he added. “But they are just starting to see that the expression of their difficulties is no longer functional to them or to society. It’s no longer as socially acceptable to be violent in order to deal with your depression, or to have a big temper in order to deal irritability or anxiety – or to drink excessively or to spend copious amounts of hours at the gym. “Instead, we’re beginning to recognise that actually doing a lot of these things is masking a lot of symptoms.” https://twitter.com/SkosanaDr/status/1505834397391544323 Men and suicide In the vast majority of countries, men are far more likely to commit suicide than women, which mental health practitioners say is likely to be because men find it harder to ask for help. This is a worldwide trend, captured by the WHO’s Suicide Worldwide in 2019: Global Health Estimates. The report found that South Africa has the third-highest suicide rate on the African continent. Of the 13,774 suicides reported in South Africa, 10,681 were men in 2913 were women. Russia, South Korea, the US and Japan also have high suicide rates, particularly amongst men. However, while there has been an increase in suicidal thoughts during the pandemic, there has not been a global increase in actual suicides – with notable exceptions, such as Austria, and Japan (although there is very little information from LMICs). Mass Polio Vaccination Drive to Administer More Than 80 Million Doses to Southern African Children in Five Countries 18/03/2022 Raisa Santos Polio vaccinate campaign to target children under 5 across five southern African countries. Malawi is launching a mass vaccination campaign against wild poliovirus type 1, which is to extend to 23 million children across five southern African countries, WHO said on Friday. The campaign, to kick off Sunday, follows Malawi’s declaration of a polio outbreak on 17 February – three months after the first polio virus case in 30 years was identified in a young child in Lilongwe. The case was the first in Africa since the region was certified free of indigenous wild poliovirus in 2020. WHO said that the region’s certification as wild polio-free remains unchanged, as the wild poliovirus strain identified had been “imported” from Pakistan. So far, no clear explanation of how the Asian virus strain may have infected an African child who had never traveled outside of the country, has been provided by WHO or Malawi health authorities. Nor has there been any explanation of why it took three months between the time the child was diagnosed and the outbreak was formally declared by WHO. But the breadth of the new campaign makes it clear the incident has been perceived as a major threat to Africa’s wild polio virus free status – with risks of subtle, silent transmission of the virus much more widely, via contaminated water and sewage, food, or human-to-human contact. Malawi has since set up an environmental surveillance system for poliovirus in 11 cities across four sites, including the Lilongwe District that encompasses the capital Lilongwe, where the initial, and so far only reported case, was detected, WHO said. Asked by Health Policy Watch whether traces of the wild polio virus had also been identified in sewage sources, through the environmental surveillance, WHO did not reply as of publication time. Targeting children across four countries – then Zimbabwe More than 80 million doses will be administered to more than 23 million children under 5 years in a four-round vaccination campaign in five southern African countries, WHO said. The first phase of the campaign, beginning this month, will target 9.4 million children across Malawi, Mozambique, Tanzania, and Zambia. Three subsequent rounds – with Zimbabwe joining the campaign- are set for April, June, and July, and aim to reach more than 23 million children with more than 80 million doses of the bivalent Oral Polio Vaccine recommended by the World Health Organization (WHO). “Polio is a highly infectious and an untreatable disease that can result in permanent paralysis. In support of Malawi and its neighbours, we are acting fast to halt this outbreak and extinguish the threat through effective vaccinations,” said WHO Regional Director for Africa Dr Matshidiso Moeti. “The African region has already defeated wild poliovirus due to a monumental effort by countries. We have the know-how and are tirelessly working to ensure that every child lives and thrives in a continent free of polio.” Single case of polio in Malawi linked to Pakistan strain Pakistan is one of two countries where polio remains endemic. Laboratory analysis has linked the strain detected in Malawi to the one circulating in Pakistan’s Sindh Province in 2019. In addition to environmental surveillance, WHO has also been supporting the country to reinforce response measures including risk assessment, and preparations for the vaccination campaigns. A surge team from WHO is working with country-based counterparts, partner organizations, and the government to end the outbreak. The WHO team is a part of a broader multi-partner Global Polio Eradication Initiative to support the country. In an unrelated event, a vaccine-directed case of polio was also identified in February by Israeli authorities in Jerusalem, also for the first time in 30 years. The infected child is part of an ultra-orthodox Jewish community in which vaccination rates hover at around 50% or less. A vaccination drive also was launched in the city. Polio, a viral disease with no cure, can invade the nervous system and can cause total paralysis within hours, particular among children under 5 years. The virus is transmitted from person to person, mainly through contamination by fecal matter or, less frequently, through contaminated water or food, and multiplies in the intestine. While there is no cure for polio, the disease can be prevented through administration of a vaccine. Image Credits: Sanofi Pastuer/Flickr, Sanofi Pastuer/Flickr. UN Environment Programme Joins WHO Alliance to Advance One Health Approach 18/03/2022 Editorial team Safer and more sustainable food systems – from production to sales in food markets is key to a One-Health Approach. UN Environment has joined a three-way alliance with the Food and Agriculture Organization, the World Animal Health Organization (OIE), and WHO to advance “One-Health” solutions to both ecosystem degradation and pandemic threats, leaders of the four agencies said on Friday. The statement followed a meeting this week of the Tripartite FAO, WHO and OIE partnership – which now has become a “Quadripartite”. “The One Health approach aims to sustainably balance and optimize the health of people, animals, ecosystems and the wider environment,” said WHO in a press release. “It mobilizes multiple sectors, disciplines and communities to work together to foster well-being and tackle threats to health and ecosystems. And it addresses the collective need for clean water, energy and air, safe and nutritious food, action on climate change, and contributing to sustainable development.” The work of the newly expanded alliance will be focused on a One Health Joint Plan of Action, which includes six main action tracks: enhancing countries’ capacity to strengthen health systems under a One Health approach; reducing the risks from emerging or resurfacing zoonotic epidemics and pandemics; controlling and eliminating endemic zoonotic, neglected tropical or vector-borne diseases; strengthening the assessment, management and communication of food safety risks; curbing the silent pandemic of antimicrobial resistance (AMR) and better integrating the environment into the One Health approach. Increased awareness of One Health As the world enters the third year of the COVID-19 pandemic, with an estimated cost of $8 to 16 trillion, there is increased awareness and broad recognition of the importance of One Health as a long-term, viable and sustainable approach. The G7, G20 and UN Food Systems Summit have all given a nod to the approach, along with the increased references by WHO and its partners. But the hard work of reforming food systems, from production to markets, as well as halting related deforestation and ecosystem destruction, are much more formidable challenges that the organisations have barely begun to face. Last year saw the Tripartite implement a number of initial initiatives, including on antimicrobial resistance, a One Health High-Level Expert Panel, and guidance on better management – but not the banning – of wild animal sales in markets – in the wake of the COVID pandemic, whose origins may have emerged from the capture, transport and slaughter of SARS-CoV2 infected wild animals at the Wuhan, China market. Plan implementation the key challenge “Now the challenge is implementation: how do we translate our work on the ground to support our Members? And how do we mobilize funding and financing mechanisms to support the Joint Plan for Action?” said FAO Director QU Dongyu, handing over the chair of the Secretariat to WHO. WHO Director-General Tedros Adhanom Ghebreyesus, said: “We need to build a more comprehensive and coordinated One Health governance structure at global level. We need a strong workforce, committed political will, and sustained financial investment. We need to develop a more proactive way of communicating and engaging across sectors, disciplines and communities to elicit the change we need.” (WHO) Image Credits: Michael Casmir/Pierce Mill Media. Healthy Mouths, Healthy Planet 18/03/2022 Ihsane Ben Yahya, Nicolas Martin & Steven Mulligan Dental procedures produce a hefty amount of carbon emissions. In honour of World Oral Health Day, 20 March, three leading voices from the World Dental Federation highlight the unexpected linkages between the health of your mouth and that of the planet. It will come as a surprise to most people that the healthcare sector has a significant environmental impact. Healthcare systems are responsible for around 5% of global greenhouse gas emissions, of which oral healthcare is an important contributor. Indeed, if the healthcare sector was a country, it would be the fifth largest greenhouse gas emitter on the planet. Oral healthcare contributes to this environmental burden with air pollution arising from the release of CO2 associated with travel and transport, the incineration of waste, the greenhouse gas impact of anesthetic gases such as nitrous oxide and the high consumption of water. Specific to dentistry, the most routine procedures, all come with a hefty carbon price tag. Tooth-coloured fillings for instance, produce around 15 kilograms of CO2eq (carbon dioxide equivalent) per procedure, according to Public Health England, whose National Health Service has done some of the most extensive carbon footprint modeling of healthcare delivery in the world. A single root canal treatment, meanwhile, produces 23 kilograms of CO2eq, dentures between 58 and 71 kilograms CO2eq. Use of the anesthetic gas nitrous oxide (laughing gas), in a procedure, meanwhile, is responsible for 119 kilograms CO2eq. Nitrous oxide N2O, the most commonly used inhalation dental anesthetic, is a greenhouse gas with far more climate warming potential than CO2. Just one kilogram of nitrous oxide is equivalent to 298 kilogrammes of CO2 and 25 kilograms of methane – another powerful greenhouse gas. Meanwhile, silver amalgam fillings contain mercury. While more and more rarely used today, and still considered safe for dental treatments, there is an environmental impact through the release of residual mercury into sewage during procedures, as well as throughout its life cycle. Prevention is better than cure Ways to maintain good oral health. The dental industry has a collective responsibility to reduce these impacts – while also expanding access to oral healthcare. How can we do both? One simple solution is to look at how we can best minimize what we might label as “avoidable” oral procedures. Prevention is always better than cure and it is the most impactful and practical way of reducing the need for clinical interventions and their associated environmental impacts. This is best achieved through the promotion of good oral hygiene, a healthy diet and the avoidance of smoking. When treatment is required, oral healthcare also should focus on the provision of durable fillings, using high quality products and materials that will last longer and/or require fewer replacements. Legislation around water fluoridation for instance, complemented by targeted public health policies can help prevent tooth decay (caries) and ultimately cavities. The recent banning of TV and online advertising of junk food in the UK before 9pm is an indirect example of encouraging better diet. So too the campaign by UK footballer Marcus Rashford to promote healthier school lunches. At the same time, while many dental problems such as caries and periodontal (gum) disease are common preventable diseases, no amount of prevention can make them go away entirely. There will always be a need for accessible dental check-ups and treatments to facilitate good oral health. And it remains important to expand access to such treatments among disadvantaged groups as well as in many low- and middle-income countries so as to reduce inequalities in healthcare provision. Less trips to the dentist would also mean less travel and water consumption Dental procedures require a lot of water, which can be reduced by practicing good oral healthcare. Oral healthcare has higher levels of patient and staff transport than other medical specializations and this is partly due to the need for regular oral health maintenance, whereas other specializations tend only to treat illness. In the UK for instance, staff and patient commuting and travel accounts for approximately two thirds of all emissions from the oral healthcare sector and about eight per cent of the total UK NHS air pollution attributable to travel. This can be reduced significantly, through the maintenance of good oral health, that requires fewer interventions and consequently fewer trips to the dentist. Simple transport habit changes can have a great impact. For example, in October 2021 the Sustainability Committee at Harvard School of Dental Medicine (HSDM) implemented a `Step Challenge´ that encouraged staff, students and faculty to walk, or take public transport rather than drive during that month. They amassed over one million steps in total, preventing the release of approximately 0.28 metric tons of CO2. The practice of dentistry and personal oral healthcare is a significant consumer of water. As a conservative estimate, a bathroom tap delivers about four litres/minute. If we estimate that half the world population cleans their teeth once a day and runs the tap for one minute, the daily global water usage equates to 6,400 Olympic swimming pools. This figure is in addition to undocumented water consumption up and down the oral healthcare manufacturing and distribution supply chain. Reducing dental use of single use plastics and packaging Measures to reduce carbon footprint in dental offices. So what measures can be taken at the dentist office to reduce the carbon footprint of dentistry procedures that are nonetheless essential to good oral health? The use and consequent disposal of single use plastics for many procedures is one of the biggest contributors to the environmental footprint of healthcare generally – and that holds true for dentistry as well. Among single-use plastics, in fact it is the packaging in which the needles, gloves and other oral healthcare products are encased that is the single largest contributor to such waste in the dental industry, with over 90 % ending its life cycle in an incinerator or a landfill. A more thoughtful approach to the design of such packaging – from the plastics content, manufacture and transport, to the potential for reuse, recycling or biodegradability, is therefore one obvious starting point in reducing the carbon footprint of the typical dentist’s office. This is particularly important because packaging, as such, is not “contaminated” biomedical waste that needs special treatment, post-procedure. This requires greater engagement with consumers and waste management companies to segregate, collect and recycle uncontaminated clinical single use plastics (SUPs) as a valuable commodity. It also involves the design and development of more plastic items made from mono-polymer plastics that can be readily recycled. The Flexible Plastics Consortium which represents 34 European companies looking for better plastics content and design solutions for packaging is a good example of how this might work in practice. The United Kingdom’s Plastics Pact is another good example: it has set targets with the goal of 100% of plastic packaging to be reused, recycled or compostable by 2025. Major challenges in managing single use plastic waste from oral healthcare Many single use dental items end up in the waste bin, including gloves, aprons, masks. Once the box is opened, many of the everyday products used in dentistry are only briefly used and then end up in the waste bin. These single-use plastic (SUP) items range from personal protective equipment (aprons, gloves and masks) and other disposable sundries (the mouth-rinse cup or the dental suction tube). SUP biomedical waste requires more specialized management – since these are contaminated with blood and other bodily fluids from oral health procedures. The high safety and quality requirements for these products to be legally compliant, is often incompatible with recycling and materials recovery. The complex nature of items assembled from different plastics also makes recycling difficult, as does the prevailing view that plastic is simply waste and is not considered a valuable resource. Still there are many attempts at finding solutions around the world. These include incentivization schemes and professional education courses that can help manufacturers to design products that can be safely treated and reprocessed, as well as sensitizing dental practitioners to different waste streams, and the treatment they require. Initiatives like the development of a competency-based dental waste management course being undertaken at the Copperbelt University in Zambia are a step in the right direction. Even so, the lack of good technological solutions for the appropriate collection, disinfection/sterilization and subsequent recovery or reprocessing of single use plastics used in biomedical procedures remains an ongoing barrier. We need product research to come up with safe, sustainable solutions for a circular economy, including in the healthcare sector, and governments to adopt supportive policies. Assessing the environmental impacts of oral healthcare as a first step It is important to understand the environmental impacts of materials used in healthcare. A better understanding of the environmental impacts of products and materials used in healthcare systems, from procurement to disposal, is key to any of these measures. Solutions proposed have included more life cycle analysis for all materials used in the healthcare supply chain and the development of a credible ‘sustainability index’ to inform medical supply purchasers about the sustainability credentials of a product. The index could potentially include information on environmental sourcing, ethical manufacturing, supply chain distribution and procurement. This World Oral Health Day we can celebrate the fact that the oral health sector has recognised that it has a vital role to play in healthcare-related climate change mitigation. That is the first step. The next ones will be more challenging and will need ‘teeth’. The FDI World Dental Federation´s Code of Good Practice, which is to be launched later this year, following an extensive consultation with the sector, will be a good starting point for ensuring healthy mouths also help to produce a healthier planet. Steven Mulligan Nicolas Martin Ihsane Ben Yahya Ihsane Ben Yahya is the President of the FDI World Dental Federation and professor at the Dental University in Casablanca, Morocco. Nicolas Martin is the Chair of the FDI Sustainability in Dentistry Task Team. He is also Clinical Professor in Restorative Dentistry in the School of Clinical Dentistry, at the University of Sheffield, UK. Steven Mulligan is a Member of the FDI Sustainability in Dentistry Task Team. He is also a Clinical Lecturer in Restorative Dentistry in the School of Clinical Dentistry, at the University of Sheffield, UK. Image Credits: Mass Communication Specialist Seaman Apprentice Brian H. Abel/Flickr, FDI World Dental Federation , Jan Fidler/Flickr, World Dental Federation , Mass Communication Specialist 3rd Class Everett Allen/Flickr. From COVID to Humanitarian Crises – Medical Oxygen Needs More Prioritization for its Lifesaving Capacities 17/03/2022 Raisa Santos Lifesaving oxygen flows into the lungs of a COVID patient in Chernivtsi, southwest Ukraine before the start of the recent Russian invasion. Whether its due to COVID or conflict, oxygen supplies fall short in many parts of the world. From patients lying in the parking lots of hospitals, in the back seats of cars suffocating as their family members searched frantically for oxygen in India during its second wave of COVID last year, to the inability to receive emergency care amidst constant bombing and shelling in current war-torn Ukraine, global health experts and leaders are desperately searching for ways of improving the global oxygen supply. At a media briefing on the issue Thursday, speakers emphasized the need for both access to oxygen on the ground and more funding to the WHO co-sponsored Access to COVID-19 Tools Accelerator (ACT-A), which is attempting to beef up oxygen supplies in low and middle-income countries. “Oxygen has been treated for too long like a commodity, treated as something that must be delivered,” said WHO Executive Director of Health Emergencies Programme Dr Mike Ryan, speaking at the briefing, cosponsored by the Act Acccelerator and Unitaid. But “oxygen is a capability, not a commodity,” he stressed. Rethinking oxygen’s lifesaving capacities Mike Ryan, Executive Director, Health Emergencies Programme; World Health Organization Ryan and others made the case for rethinking oxygen as a health tool that requires not only a sustainable supply at a country level, but an entire ecosystem of supply and maintenance technology and infrastructure. Its role – and the chronic lack of capacity in many countries – has been underscored by COVID – and again in the very different setting of the Ukraine crisis – where the lack of access for people ranging from COVID patients to mothers in birth and children with pneumonia has prompted widespread alarm. Oxygen remains a critical component of the global COVID-19 response – 75% of patients hospitalized for COVID-19 can be treated with oxygen alone – without any further advanced care. Yet the current global supply of oxygen does not meet needs for both COVID-19 and other serious illnesses. “COVID didn’t cause [the oxygen shortage], COVID uncovered this. COVID laid bare, tore away the bandages from some very old wounds,” said Ryan. UNITAID Commits $56 million to boost access to global medical oxygen supply Robert Matiru, Chair, ACT-A Oxygen Emergency Taskforce & Director Programmes, Unitaid The ACT-A Strategic Plan and Budget for 2022 has identified a funding deficit of $1 billion for oxygen supplies worldwide for this year alone. As a first step to closing that gap, Unitaid has announced that it will invest $56 million to increase access to medical oxygen both for short-term needs related to COVID-19 as well as for the longer term – as a critical foundation for fighting future pandemics. The Unitaid pledge builds on the $50 million USAID has committed in funding for oxygen as pledged at US President Joe Biden’s Global COVID-19 Summit in September 2021. Four Unitaid-funded projects, designed to address global inequities in oxygen access, will be implemented by The Alliance for International Medical Action (ALIMA), the Clinton Health Access Initiative (CHAI), Partners in Health (PIH), and the WHO Health Emergencies Programme. These will also support the work of the ACT-A Oxygen Emergency Task Force by ensuring access to more affordable oxygen solutions such as bulk liquid oxygen, oxygen generation systems, and other important oxygen equipment. Unitaid called on donors, including governments, foundations, and private sector partners to join in the efforts. “Our call here is not just for the present, for this pandemic, but to recognize that donors and funders that come forward and step forward, over and above the generous contributors to date, will help drive a more sustainable ecosystem and [deliver] essential medicines to countries that are lacking it,” said Robert Matiru, Chair of the ACT-A Oxygen Emergency Taskforce and Director of Programmes at Unitaid. Children with pneumonia unrecognized victims – 40% of hospitals in some African countries lack oxygen Numerous countries are facing oxygen shortages, while readily available oxygen products are in short supply. Children are among the unrecognized victims of the lack of oxygen supplies – with childhood pneumonia still one of the biggest killers of under-fives. Accounting for almost a million deaths a year, the highest burden is in sub-Saharan African and South-East Asian countries where children face a double whammy of disease from both the lack of preventive treatments, like vaccinations, along with exposure to heavy indoor air pollution from the open burning of coal, biomass and other such fuels. But an estimated 20 to 40% of these deaths are preventable with increased availability of oxygen therapy. The shortage is particularly acute in low-income sub-Saharan African countries such as Tanzania, Sierra Leone, Liberia, and Gambia, where 40% of health facilities had no access to oxygen and other basic life saving supplies, said Atul Gawande of the United States Agency for International Development (USAID). COVID has led to big surges in needs Daily medical oxygen need for COVID-19 as of 16 March 2022 Along with the chronic shortages, COVID led to a major surge in oxygen needs. Low and middle-income countries (LMICs) need at least 23 million cubic meters of oxygen every day, just to treat COVID patients alone, according to the PATH COVID-19 Oxygen Needs Tracker. On the brighter side, the pandemic has brought a long-ignored aspect of health capacity in LMICs more to the forefront. USAID is currently working in 11 countries to build ‘oxygen ecosystems’ to support oxygen therapy for pneumonia patients, COVID patients, and others, Gawande said. Countries like Ghana now have oxygen generating capacity that can support up to 300,000 patients per day, per year. Gawande noted that the oxygen ecosystem includes liquid oxygen cylinders and concentrators, as well as the clinical engineering and technical assistance to use the technology. But expanding this initiative to other countries still needs more funding. Atul Gawande, USAID “As the Omicron variant abates, I think we’re all starting to feel that we can catch our breath. Oxygen demand may be lower right now. But it is the time that we have to make these investments to enable this kind of [sustainable] capacity.” Gawande said. Oxygen ‘natural security’ and ‘high-return’ health investment Leith Greenslade, Founder/CEO, JustActions & Coordinator, Every Breath Counts Coalition While the recent funding commitments are a positive sign, ‘it is not enough to fund protection’, said Leith Greenslade of the Every Breath Counts Coalition. “It took a pandemic of respiratory infection to wake up the world,” she pointed out. In the past year, about $700 million was invested into the ACT-A Oxygen Emergency Task Force, which has worked in LMICs to prevent oxygen shortages – jump-starting a more focused response. But so far, only a handful of governments – including the United States, Germany, Canada, and France – have borne the funding burden. “But most of the G-20 nations have not stepped up to invest in oxygen,” she charged. Greenslade appealed to donors to see oxygen as a high priority for three reasons: the moral obligation to flatten the COVID-19 curve; oxygen as a “national security” issue in moments of crisis; and finally, oxygen as a high-return health investment that will keep on saving lives beyond the pandemic. “When hospitals run out of oxygen, we have seen strikes and civil unrest in quite a few low- and middle-income countries,” she pointed out. “How many more deaths before this is over will largely depend on access to oxygen and critical care in the countries where the disease is greatest and the health systems are weakest,” she declared. Image Credits: Mstyslav Chernov/ Wikimedia Commons, UNICEF/Ralaivita, PATH, Every Breath Counts . Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. 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Over a Million People Could Die of Omicron in China 23/03/2022 Maayan Hoffman More than a million people could die of Omicron in China unless it takes action to boost its elderly population with a Western COVID-19 vaccine, according to a new analysis by Airfinity. Potential cumulative deaths in China The analysis shows that, although China vaccinated 80% of its population over the age of 60, Chinese people have low protection because its Sinovac and Sinopharm vaccines – used to inoculate the majority of citizens – have significantly lower efficacy and provide less protection against infection and death. In addition, only 40% of Chinese people have taken a booster shot, the report showed. Airfinity compared China to nearby Hong Kong, which has experienced one of the most devastating waves of infections and deaths caused by COVID-19 which has been attributed to low protection levels due to reliance on less efficacious Chinese vaccines and a lack of community immunity. “The death rate in Hong Kong is the highest in the world and much higher than Western countries have ever experienced, peaking at 37.6 daily deaths per million – more than double the United Kingdom’s peak in January 2021,” according to the report. The case fatality rate (CFR) is 20 times higher than in New Zealand, which also had a “zero COVID” policy and relied heavily on Chinese vaccines. “Should China have similar levels of protection, they too could experience a very high CFR,” writes Airfinity. Case fatality ratio over time for countries However, “most of these deaths can be prevented,” the team advised. “If China faced an Omicron wave with protection levels similar to New Zealand, our analysis shows deaths could be reduced to 45,000. China could bolster protection in its population by administering booster jabs with higher efficacy vaccines.” Airfinity said that there are enough alternative vaccines that could be redistributed immediately to jab 54% of China’s population and save their lives. Image Credits: Flickr, Airfinity. UN Appeals for Groundwater Protection as Large Tracts of Africa Battle Drought 23/03/2022 Kerry Cullinan A family feeds their cattle with straw plucked from the roof of their home in Adadle in the Somali region of Ethiopia. As global water experts meet at the World Water Forum in Senegal this week, large swathes of Africa are facing famine as severe droughts prevail in the Horn of Africa and large parts of southern Africa. “Harvests are ruined, livestock is dying and families are bearing the consequences of increasingly frequent climate extremes,” according to Michael Dunford, the UN World Food Programme’s Regional Director for Eastern Africa. The countries most affected are Somalia, Kenya, Djibouti and Ethiopia in the east, and Angola, Madagascar, Mozambique and Namibia in the south. The UN launched its World Water Development Report at the forum to coincide with World Water Day on Wednesday, appealing for better management of groundwater, which is usually stored in aquifers, many of which are vulnerable to climate change and human settlements. Aquifers are under threat in rapidly expanding low-income cities, including Dakar (Senegal) and Lusaka (Zambia), as well as informal communities reliant on on-site sanitation where “the increased frequency of extreme rainfall can amplify leaching of surface and near-surface contaminants”, warns the report. Low-storage, low-recharge aquifer systems in drylands, such as Bulawayo (Zimbabwe) and Ouagadougou(Burkina Faso), are also at risk, in situations where “alternative perennial water sources are limited or do not exist, and recharge is episodic so that even small reductions in recharge can lead to groundwater depletion”, the report warns. Water scarcity affects over 40% of the 🌍 population.And for every 1°C ⬆️ in global temperature, an additional 500 million people will face #waterscarcity.🔗 https://t.co/4WYuzYPgpM #WorldWaterDay💦 @WorldBankWater pic.twitter.com/k4lshprKoA — World Bank India (@WorldBankIndia) March 22, 2022 Lack of research Meanwhile, information about the impact of climate change on Africa is scarce, according to the Intergovernmental Panel on Climate Change latest (sixth) report on Impacts, Adaptation, and Vulnerability. “Many countries lack regularly reporting weather stations, and data access is often limited. From 1990–2019 research on Africa received just 3.8% of climate-related research funding globally: 78% of this funding went to EU and North American institutions and only 14.5% to African institutions,” notes the IPCC report in a special section on Africa. “Increased funding for African partners, and direct control of research design and resources can provide more actionable insights on climate risks and adaptation options in Africa.” To address this, the World Water Council and the Organisation for Economic Co-operation and Development (OECD) launched a new programme this week to produce new data, evidence and policy guidance on water security in Africa. “With 250 million Africans expected to live in water-stressed areas by 2030, and 60% of the population expected to live in cities by 2050, now is the time to get water policies right for sustainable development in Africa,” according to Jose Angel Gurria Trevino, OECD’s Secretary-General. Image Credits: Michael Tewelde / World food Programme. Ukraine’s ‘Model’ TB Programme Destroyed by War, as Global TB Response Faces ‘Disastrous’ Funds Shortfall 22/03/2022 Kerry Cullinan & Elaine Ruth Fletcher Yana Terleeva, head of the Ukranian Ministry of Health’s TB programme Speaking in her car from an undisclosed location somewhere in war-torn Ukraine, Yana Teerleva, head of TB in the country’s Ministry of Health, lamented the destruction that she is witnessing every day in hospitals and clinics – including the shelling of three huge dispensaries where the country had stockpiled sufficient TB medications for the remainder of 2022. This month, Teerleva had been planning to implement an innovative new TB treatment regimen to further step up the national response to its drug resistant TB burden – which TB control officials in Geneva had praised as a model. “Instead we are dealing with the Russian invasion and discussing military hardware”, Teerleva said in a media briefing Tuesday, just ahead of World Tuberculosis Day, 24 March. Global TB experts are bemoaning the destruction of Ukraine’s innovative TB programme, which had made significant progress in addressing the country’s high burden of multi-drug resistant TB (MDR-TB) over the past 15 years. Meanwhile, with global TB funding well below needs, prospects of meeting the UN Sustainable Development Goal target for ending the TB epidemic by 2030 look increasingly dim, Lucica Ditui, executive director of the Geneva-based STOP TB Partnership, told Health Policy Watch in an interview. “This gives us very little chance of meeting the UN 2030 targets,” she said. Model programme now in ashes – literally Almost one-third of Ukraine’s TB cases are drug-resistant, and last year the country diagnosed and treated 24,000 people with TB, including almost 5,000 people with MDR-TB. But the Ukrainian government had been “extremely committed” to addressing TB over the past two to three years, paying for new drugs and diagnostics and building strong relationships with civil society organisations, Ditiu told Health Policy Watch. “The country did a lot to improve their health system. It is devastating to see these bombs destroying everything. These are losses that will take decades to regain.” A doctor shows Oleg Chutvatov, who was receiving TB treatment at the hospital in Kharkiv, an x-ray photo of his lungs in July 2021. The city is now under heavy attack from the Russian invasion. Over the past 15 years, Ukraine had significantly reduced its TB cases from over 127 cases per 100 000 people in 2005 to just 42.2 cases per 100 000 people in 2020. Just before the war, says Ditiui, “The country was paying for their own TB drugs as well as diagnostics – and they had secured enough to treat and diagnose everyone in need in Ukraine. “They were very keen to implement new tools like rapid molecular diagnosis, as well as new drugs. They had cohorts of people enrolled in studies for new TB treatments. Collaboration between public health officials, civil society and communities also was very good.” The gains in TB treatment were part of a broader health sector reform that had been underway, Ditiu added, saying: “What I am really upset about is that the country did a lot to improve their health system, their hospitals, to do health sector reform. To see these bombs destroying everything. These are losses that will take decades to regain.” “Ukraine was always at the forefront of the fight against tuberculosis,” Teleeva told the Stop TB briefing Tuesday. “We wanted Ukraine and the entire world to be free from the TB and for that, we have done everything possible.” However, she said that according to health ministry information, “more than 135 hospitals in Ukraine have been shelled by the Russian aggressors”, including “three huge regional anti-tuberculosis dispensaries” and the country’s health infrastructure “is not working”. WHO has confirmed some 60 attacks on hospitals and other health facilities. Appeal to combat stigma – among the war’s knock-on effects Both Ditiu and Teeleva stressed the need to focus now on countering the knock-on effects of the war – including how to treat internally displaced people, how to ensure people fleeing can continue their medications, and how to combat stigma that refugees elsewhere may encounter. “We worked to overcome the stigma discrimination of these people living with TB”, Teleeva said, of the pre-war period. She appealed to neighbouring countries that have a much lower burden of TB disease not to stigmatise Ukrainian refugees. “TB is very sensitive, and if we broadcast information about its uncontrolled spread, we will stigmatize people who are already stigmatized, for people who are already in a very difficult situation,” said Terleeva. Ditiu acknowledged that it’s very likely the war will lead to a higher level of TB cases -particularly inside Ukraine itself. “We’ll see an increase in TB, in drug-resistant TB and in mortality,” she predicted, “because people will be staying close together in shelters, in crowded places, with bad food and stress.” However, she said good tracking and surveillance by countries that receive refugees can help counter any spillover effect, beyond the borders. ‘Stupid war’ Romania’s Health Minister, Prof Alexandru Rafila Decrying the “stupid war”, Romania’s Health Minister, Professor Alexandru Rafila, told the briefing that his country was doing everything it could to assist the refugees that had fled across the 600km border with his country, including identifying and ensuring treatment for TB patients. As a country with a relatively high burden of TB itself, Romania has “a network of TB hospitals and TB ambulatory care centres where we can perform rapid diagnosis and treat Ukrainian patients if they are resistant or need to initiate treatment”, added Rafila. The Global Fund has also provided Romania with additional Gene Xpert rapid testing machines and TB medication to assist Ukranian patients, the health minister added. However, while Romania and Moldova had “some capacity” to deal with TB, Ditiu warned that Poland is in a different category – precisely because its own burden is quite low. “Poland is not a country with a lot of TB – so I’m not sure how well the network will be able to deal with it – even though the doctors certainly have a lot of knowledge”. In addition, prices of TB medication in both Romania and Poland are up to ten times higher than in Ukraine, as both countries are part of the European Union and pay EU prices for drugs that Ukraine was able to procure through the Global Fund, Ditiu added. “We are having a conversation with the Global Fund to see how we can lower the cost,” she added. TB civil society trying to locate patients Olya Klymenk, head of TB People Ukraine, a network of over 70 organisations, said that her organisation was doing its best to locate displaced patients who have fled their homes or their communities, and offer them humanitarian aid, including food. “We are trying to take care of the patients who are out of the hospital right now because we understand that, without social support, they will not have a good life,” said Klymenk. Teleeva stressed that in the emergency the primary need is to, “focus on ensuring patients know where to go and have a desire to continue treatment. “They have to be assured there is a reason to live, that they will go back to Ukraine, and they have to be healthy to help us rebuild. They need this optimism, to have this desire to live and continue living.” ‘Pathetic’ investment in TB Dr Lucica Ditiu, Executive Director of the Stop TB Partnership Meanwhile, Ditiu lamented that “investments in TB are pathetically low” – perhaps because 90% of the disease burden is in lower-income countries. “In 2020, we had $1.9 billion [in] domestic investments, which is very very, very little,” she said, referring to national governments’ own contributions to beating TB. In addition, “The Global Fund, which is a big donor for TB, gave around $800 million, which is completely insufficient.” Stop TB estimates that $19.6 billion per year will be needed over the next eight years for TB prevention and care, and $4 billion per year will be required for research and development (R&D) of the new diagnostics, medicines and vaccines needed to end TB. This represents about four times what is currently available for the TB response (in 2020, $5.3 billion was available for care and prevention and $0.9 billion for R&D). The year 2022 is critical for the global fight to end TB as the world faces a fast-running countdown to reaching the 2018 United Nations High-Level Meeting (UNHLM) TB targets, which the international community agreed to meet by the end of December. All projections show that the world is not on course to meet the UNHLM treatment targets set for 2022. “We simply cannot continue to stand on the sidelines and watch while people around the world fall ill and die from a preventable and treatable disease,” said Ditiu. “We also cannot continue to accept what we accepted for years—every year having less than 40% of the funding need for the TB response. Now we are facing a disastrous funding shortfall, bigger than what we had expected. We not only need to step up efforts to meet targets set at the 2018 United Nations High Level Meeting on TB,” she said, referring to the UN pledge to accelerate progress toward the 2030 targets, “but the TB response must also recover from the devastating impacts of the COVID-19 pandemic.” Image Credits: The Global Fund / Evgeny Maloletka. ‘There is No Safe Place in Ukraine’ 21/03/2022 Kerry Cullinan Ukrainian child with his dog -displaced by war, in a refugee camp on the Moldova-Ukranian border There have been 52 attacks on Ukrainian health facilities in the past 25 days, more than two every day, according to the World Health Organization (WHO). Meanwhile, the health of fleeing refugees, their impact on the health services of neighbouring countries, and the fate of Ukraine’s tuberculosis patients are foremost on healthcare providers’ minds. “In less than a month, over three million people have left the country and nearly two million have been internally displaced,” said Jarno Habicht, WHO’s Representative in Ukraine. “This has happened faster than in any previous European crisis. There is no safe place in Ukraine right now, yet we need to ensure that health services are available.” “The military offensive continues, with a number of cities being entirely isolated – people are running out of food and water, and hospitals might not have electricity,” added Habicht, who has been head of the Ukraine office since 2018. “Worse still, we have seen many attacks on health workers and health facilities as well as patients. This is happening daily and is unacceptable. So, if you ask me how to describe it, every day things are getting worse, which means every day the health response is becoming more difficult.” Jarno Habicht, WHO’s Representative in Ukraine (centre) Banned cluster munitions According to Bonnie Docherty, a senior advisor for Human Rights Watch, Russian forces have “relied heavily” on cluster munitions, which are banned in most countries in the world, and explosive weapons with wide-area effects. Cluster munitions, large bombs that contain dozens or hundreds of smaller sub-munitions, were used to attack a hospital in Vuhledar on 24 February in which four civilians were killed, and 10 people including six healthcare workers were injured, wrote Docherty in the online security news outlet, Just Security, on Monday. Unexploded, the submunitions can lie dormant like landmines, exploding months and years later when picked up by children or farmers, she explains. However, artillery shells, mortars, rockets, missiles, and enhanced blast (thermobaric) weapons, and aerial bombs, have caused the bulk of the damage in Ukraine, adds Docherty. Concern for drug-resistant TB patients On the eve of World Tuberculosis Day on Thursday, WHO TB experts also expressed concern for Ukrainian TB patients, particularly those with drug-resistant TB. “Ukraine is one of the 18 high-priority countries in the WHO European region for TB and is on the global list for having a high burden of multidrug-resistant tuberculosis,” Dr Askar Yedilbayev, WHO Europe’s Regional TB advisor, told a media briefing on Monday. Dr Askar Yedilbayev “Before the war, Ukraine was one of the pioneering countries in response to TB and drug-resistant TB in the WHO European region,” he added. “However, destroyed health infrastructure, including limited access to TB treatment and public health services, is affecting the provision of essential tuberculosis services, causing significant delays in diagnosis of TB, affecting initiation of TB preventive treatment, and treatment of active TB and MDR TB,” he added. Shortly before the war, all TB medication had been distributed to regional warehouses and patients had been given one or two months’ supply of medicine, he added. But some of these warehouses had been damaged or were under threat of damage, and there was a need for the “emergency redistribution of procurement of medicines to ensure continuity of treatment”. In addition, as Ukraine’s neighbours did not have the same burden of TB disease, they were unlikely to have the medicine to treat large numbers of people with TB. Yedilbayev appealed for donations to the Global Fund and WHO Foundation to enable the delivery of health services to Ukrainians. Every second, a Ukrainian child becomes a refugee Every second, a Ukrainian child becomes a refugee, according to UNICEF and half of the over 3.5 million refugees estimated to have fled to neighbouring countries since 24 February are children under the age of 15. Almost two million refugees have fled to Poland, according to the WHO. “Refugees can be vulnerable to infectious diseases because of lack of health care, interrupted care in the country of origin, because of exposure to infectious infections and lack of care in transit, and if living conditions are poor in the destination country,” said Yedilbayev. Image Credits: UNICEF/UN0599222/Moldovan. As Europe Moves to Improve Mental Health Services for Children, Experts Are Concerned About Men’s Mental State 21/03/2022 Kerry Cullinan Dr Hans Kluge Mental health practitioners worldwide are warning of a massive wave of pandemic-related mental health issues that many countries are ill-equipped to address. On Monday, the World Health Organization’s (WHO) Europe office and the government of Greece launched a new European programme to strengthen and improve the quality of mental health services for children and adolescents. WHO Europe Director Dr Hans Kluge told the launch that suicide was the leading cause of death in children and adolescents aged 10 to 19 living in low- and middle-income countries in the region and that over 4000 young people in this age group had killed themselves in 2015. 🔴Suicide is the leading cause of deathamong adolescents in low & middle income countries & 2nd in high income countries in the European Region Find guidance on how to approach child & adolescent #MentalHealth as a primary health care provider here👉 https://t.co/EUoragqO0q pic.twitter.com/AOvZRIY7HR — WHO/Europe (@WHO_Europe) March 21, 2022 “Ensuring that all children and adolescents in the region have access to quality mental health services is a moral imperative,” said Kluge, adding that this was as important as childhood vaccinations. The WHO Europe programme aims to work with member states to encourage them to share knowledge and expertise about how to boost the mental healthcare of children and adolescents, and to support member countries to develop their own strategies and frameworks. It will also “develop a package of tools to measure progress against evidence-based standards”, according to the regional office. Through this new programme, WHO/Europe will continue to help countries strengthen and improve #mentalhealth services for children and adolescents, as well as developing tools to measure progress pic.twitter.com/Fspx9hh2lN — WHO/Europe (@WHO_Europe) March 21, 2022 Mental health woes of COVID-19 COVID-19 has exacerbated mental health issues and, during the first year of the pandemic, there was a 25% increase in the global prevalence of anxiety and depression, according to a WHO brief published in early March. Approximately 140,000 children in the US have lost a parent or guardian to COVID, for example, and are likely to be struggling to come to terms with this loss. “One major explanation for the increase is the unprecedented stress caused by the social isolation resulting from the pandemic. Linked to this were constraints on people’s ability to work, seek support from loved ones and engage in their communities,” according to the WHO. “Loneliness, fear of infection, suffering and death for oneself and for loved ones, grief after bereavement and financial worries have also all been cited as stressors leading to anxiety and depression. Among health workers, exhaustion has been a major trigger for suicidal thinking,” it added. Calls to South Africa’s only mental health helpline, for example, have jumped exponentially during the pandemic – from around 400 to 600 calls a day before COVID-19 to over 2400 calls a day in 2021. Psychologist Zamo Mbele, a board member of the South African Depression and Anxiety Group (SADAG) that operates the helpline, said that his non-governmental organisation, which is wholly reliant on donations, had been struggling to keep up with demand. Psychologist Zamo Mbele, a board member of the South African Depression and Anxiety Group (SADAG) Male violence and mental health “One of the reasons we’ve seen an increase in our calls is because of COVID, but one of the other reasons is because people who would not previously access health are beginning to recognise that they need help,” said Mbele. He added that “toxic” manifestations of masculinity – seen in the country’s high levels of domestic violence, road rage and substance abuse – were indications that men, in particular, needed help. “It’s not as though men only recently starting to struggle with mental difficulties or emotional difficulties,” he added. “But they are just starting to see that the expression of their difficulties is no longer functional to them or to society. It’s no longer as socially acceptable to be violent in order to deal with your depression, or to have a big temper in order to deal irritability or anxiety – or to drink excessively or to spend copious amounts of hours at the gym. “Instead, we’re beginning to recognise that actually doing a lot of these things is masking a lot of symptoms.” https://twitter.com/SkosanaDr/status/1505834397391544323 Men and suicide In the vast majority of countries, men are far more likely to commit suicide than women, which mental health practitioners say is likely to be because men find it harder to ask for help. This is a worldwide trend, captured by the WHO’s Suicide Worldwide in 2019: Global Health Estimates. The report found that South Africa has the third-highest suicide rate on the African continent. Of the 13,774 suicides reported in South Africa, 10,681 were men in 2913 were women. Russia, South Korea, the US and Japan also have high suicide rates, particularly amongst men. However, while there has been an increase in suicidal thoughts during the pandemic, there has not been a global increase in actual suicides – with notable exceptions, such as Austria, and Japan (although there is very little information from LMICs). Mass Polio Vaccination Drive to Administer More Than 80 Million Doses to Southern African Children in Five Countries 18/03/2022 Raisa Santos Polio vaccinate campaign to target children under 5 across five southern African countries. Malawi is launching a mass vaccination campaign against wild poliovirus type 1, which is to extend to 23 million children across five southern African countries, WHO said on Friday. The campaign, to kick off Sunday, follows Malawi’s declaration of a polio outbreak on 17 February – three months after the first polio virus case in 30 years was identified in a young child in Lilongwe. The case was the first in Africa since the region was certified free of indigenous wild poliovirus in 2020. WHO said that the region’s certification as wild polio-free remains unchanged, as the wild poliovirus strain identified had been “imported” from Pakistan. So far, no clear explanation of how the Asian virus strain may have infected an African child who had never traveled outside of the country, has been provided by WHO or Malawi health authorities. Nor has there been any explanation of why it took three months between the time the child was diagnosed and the outbreak was formally declared by WHO. But the breadth of the new campaign makes it clear the incident has been perceived as a major threat to Africa’s wild polio virus free status – with risks of subtle, silent transmission of the virus much more widely, via contaminated water and sewage, food, or human-to-human contact. Malawi has since set up an environmental surveillance system for poliovirus in 11 cities across four sites, including the Lilongwe District that encompasses the capital Lilongwe, where the initial, and so far only reported case, was detected, WHO said. Asked by Health Policy Watch whether traces of the wild polio virus had also been identified in sewage sources, through the environmental surveillance, WHO did not reply as of publication time. Targeting children across four countries – then Zimbabwe More than 80 million doses will be administered to more than 23 million children under 5 years in a four-round vaccination campaign in five southern African countries, WHO said. The first phase of the campaign, beginning this month, will target 9.4 million children across Malawi, Mozambique, Tanzania, and Zambia. Three subsequent rounds – with Zimbabwe joining the campaign- are set for April, June, and July, and aim to reach more than 23 million children with more than 80 million doses of the bivalent Oral Polio Vaccine recommended by the World Health Organization (WHO). “Polio is a highly infectious and an untreatable disease that can result in permanent paralysis. In support of Malawi and its neighbours, we are acting fast to halt this outbreak and extinguish the threat through effective vaccinations,” said WHO Regional Director for Africa Dr Matshidiso Moeti. “The African region has already defeated wild poliovirus due to a monumental effort by countries. We have the know-how and are tirelessly working to ensure that every child lives and thrives in a continent free of polio.” Single case of polio in Malawi linked to Pakistan strain Pakistan is one of two countries where polio remains endemic. Laboratory analysis has linked the strain detected in Malawi to the one circulating in Pakistan’s Sindh Province in 2019. In addition to environmental surveillance, WHO has also been supporting the country to reinforce response measures including risk assessment, and preparations for the vaccination campaigns. A surge team from WHO is working with country-based counterparts, partner organizations, and the government to end the outbreak. The WHO team is a part of a broader multi-partner Global Polio Eradication Initiative to support the country. In an unrelated event, a vaccine-directed case of polio was also identified in February by Israeli authorities in Jerusalem, also for the first time in 30 years. The infected child is part of an ultra-orthodox Jewish community in which vaccination rates hover at around 50% or less. A vaccination drive also was launched in the city. Polio, a viral disease with no cure, can invade the nervous system and can cause total paralysis within hours, particular among children under 5 years. The virus is transmitted from person to person, mainly through contamination by fecal matter or, less frequently, through contaminated water or food, and multiplies in the intestine. While there is no cure for polio, the disease can be prevented through administration of a vaccine. Image Credits: Sanofi Pastuer/Flickr, Sanofi Pastuer/Flickr. UN Environment Programme Joins WHO Alliance to Advance One Health Approach 18/03/2022 Editorial team Safer and more sustainable food systems – from production to sales in food markets is key to a One-Health Approach. UN Environment has joined a three-way alliance with the Food and Agriculture Organization, the World Animal Health Organization (OIE), and WHO to advance “One-Health” solutions to both ecosystem degradation and pandemic threats, leaders of the four agencies said on Friday. The statement followed a meeting this week of the Tripartite FAO, WHO and OIE partnership – which now has become a “Quadripartite”. “The One Health approach aims to sustainably balance and optimize the health of people, animals, ecosystems and the wider environment,” said WHO in a press release. “It mobilizes multiple sectors, disciplines and communities to work together to foster well-being and tackle threats to health and ecosystems. And it addresses the collective need for clean water, energy and air, safe and nutritious food, action on climate change, and contributing to sustainable development.” The work of the newly expanded alliance will be focused on a One Health Joint Plan of Action, which includes six main action tracks: enhancing countries’ capacity to strengthen health systems under a One Health approach; reducing the risks from emerging or resurfacing zoonotic epidemics and pandemics; controlling and eliminating endemic zoonotic, neglected tropical or vector-borne diseases; strengthening the assessment, management and communication of food safety risks; curbing the silent pandemic of antimicrobial resistance (AMR) and better integrating the environment into the One Health approach. Increased awareness of One Health As the world enters the third year of the COVID-19 pandemic, with an estimated cost of $8 to 16 trillion, there is increased awareness and broad recognition of the importance of One Health as a long-term, viable and sustainable approach. The G7, G20 and UN Food Systems Summit have all given a nod to the approach, along with the increased references by WHO and its partners. But the hard work of reforming food systems, from production to markets, as well as halting related deforestation and ecosystem destruction, are much more formidable challenges that the organisations have barely begun to face. Last year saw the Tripartite implement a number of initial initiatives, including on antimicrobial resistance, a One Health High-Level Expert Panel, and guidance on better management – but not the banning – of wild animal sales in markets – in the wake of the COVID pandemic, whose origins may have emerged from the capture, transport and slaughter of SARS-CoV2 infected wild animals at the Wuhan, China market. Plan implementation the key challenge “Now the challenge is implementation: how do we translate our work on the ground to support our Members? And how do we mobilize funding and financing mechanisms to support the Joint Plan for Action?” said FAO Director QU Dongyu, handing over the chair of the Secretariat to WHO. WHO Director-General Tedros Adhanom Ghebreyesus, said: “We need to build a more comprehensive and coordinated One Health governance structure at global level. We need a strong workforce, committed political will, and sustained financial investment. We need to develop a more proactive way of communicating and engaging across sectors, disciplines and communities to elicit the change we need.” (WHO) Image Credits: Michael Casmir/Pierce Mill Media. Healthy Mouths, Healthy Planet 18/03/2022 Ihsane Ben Yahya, Nicolas Martin & Steven Mulligan Dental procedures produce a hefty amount of carbon emissions. In honour of World Oral Health Day, 20 March, three leading voices from the World Dental Federation highlight the unexpected linkages between the health of your mouth and that of the planet. It will come as a surprise to most people that the healthcare sector has a significant environmental impact. Healthcare systems are responsible for around 5% of global greenhouse gas emissions, of which oral healthcare is an important contributor. Indeed, if the healthcare sector was a country, it would be the fifth largest greenhouse gas emitter on the planet. Oral healthcare contributes to this environmental burden with air pollution arising from the release of CO2 associated with travel and transport, the incineration of waste, the greenhouse gas impact of anesthetic gases such as nitrous oxide and the high consumption of water. Specific to dentistry, the most routine procedures, all come with a hefty carbon price tag. Tooth-coloured fillings for instance, produce around 15 kilograms of CO2eq (carbon dioxide equivalent) per procedure, according to Public Health England, whose National Health Service has done some of the most extensive carbon footprint modeling of healthcare delivery in the world. A single root canal treatment, meanwhile, produces 23 kilograms of CO2eq, dentures between 58 and 71 kilograms CO2eq. Use of the anesthetic gas nitrous oxide (laughing gas), in a procedure, meanwhile, is responsible for 119 kilograms CO2eq. Nitrous oxide N2O, the most commonly used inhalation dental anesthetic, is a greenhouse gas with far more climate warming potential than CO2. Just one kilogram of nitrous oxide is equivalent to 298 kilogrammes of CO2 and 25 kilograms of methane – another powerful greenhouse gas. Meanwhile, silver amalgam fillings contain mercury. While more and more rarely used today, and still considered safe for dental treatments, there is an environmental impact through the release of residual mercury into sewage during procedures, as well as throughout its life cycle. Prevention is better than cure Ways to maintain good oral health. The dental industry has a collective responsibility to reduce these impacts – while also expanding access to oral healthcare. How can we do both? One simple solution is to look at how we can best minimize what we might label as “avoidable” oral procedures. Prevention is always better than cure and it is the most impactful and practical way of reducing the need for clinical interventions and their associated environmental impacts. This is best achieved through the promotion of good oral hygiene, a healthy diet and the avoidance of smoking. When treatment is required, oral healthcare also should focus on the provision of durable fillings, using high quality products and materials that will last longer and/or require fewer replacements. Legislation around water fluoridation for instance, complemented by targeted public health policies can help prevent tooth decay (caries) and ultimately cavities. The recent banning of TV and online advertising of junk food in the UK before 9pm is an indirect example of encouraging better diet. So too the campaign by UK footballer Marcus Rashford to promote healthier school lunches. At the same time, while many dental problems such as caries and periodontal (gum) disease are common preventable diseases, no amount of prevention can make them go away entirely. There will always be a need for accessible dental check-ups and treatments to facilitate good oral health. And it remains important to expand access to such treatments among disadvantaged groups as well as in many low- and middle-income countries so as to reduce inequalities in healthcare provision. Less trips to the dentist would also mean less travel and water consumption Dental procedures require a lot of water, which can be reduced by practicing good oral healthcare. Oral healthcare has higher levels of patient and staff transport than other medical specializations and this is partly due to the need for regular oral health maintenance, whereas other specializations tend only to treat illness. In the UK for instance, staff and patient commuting and travel accounts for approximately two thirds of all emissions from the oral healthcare sector and about eight per cent of the total UK NHS air pollution attributable to travel. This can be reduced significantly, through the maintenance of good oral health, that requires fewer interventions and consequently fewer trips to the dentist. Simple transport habit changes can have a great impact. For example, in October 2021 the Sustainability Committee at Harvard School of Dental Medicine (HSDM) implemented a `Step Challenge´ that encouraged staff, students and faculty to walk, or take public transport rather than drive during that month. They amassed over one million steps in total, preventing the release of approximately 0.28 metric tons of CO2. The practice of dentistry and personal oral healthcare is a significant consumer of water. As a conservative estimate, a bathroom tap delivers about four litres/minute. If we estimate that half the world population cleans their teeth once a day and runs the tap for one minute, the daily global water usage equates to 6,400 Olympic swimming pools. This figure is in addition to undocumented water consumption up and down the oral healthcare manufacturing and distribution supply chain. Reducing dental use of single use plastics and packaging Measures to reduce carbon footprint in dental offices. So what measures can be taken at the dentist office to reduce the carbon footprint of dentistry procedures that are nonetheless essential to good oral health? The use and consequent disposal of single use plastics for many procedures is one of the biggest contributors to the environmental footprint of healthcare generally – and that holds true for dentistry as well. Among single-use plastics, in fact it is the packaging in which the needles, gloves and other oral healthcare products are encased that is the single largest contributor to such waste in the dental industry, with over 90 % ending its life cycle in an incinerator or a landfill. A more thoughtful approach to the design of such packaging – from the plastics content, manufacture and transport, to the potential for reuse, recycling or biodegradability, is therefore one obvious starting point in reducing the carbon footprint of the typical dentist’s office. This is particularly important because packaging, as such, is not “contaminated” biomedical waste that needs special treatment, post-procedure. This requires greater engagement with consumers and waste management companies to segregate, collect and recycle uncontaminated clinical single use plastics (SUPs) as a valuable commodity. It also involves the design and development of more plastic items made from mono-polymer plastics that can be readily recycled. The Flexible Plastics Consortium which represents 34 European companies looking for better plastics content and design solutions for packaging is a good example of how this might work in practice. The United Kingdom’s Plastics Pact is another good example: it has set targets with the goal of 100% of plastic packaging to be reused, recycled or compostable by 2025. Major challenges in managing single use plastic waste from oral healthcare Many single use dental items end up in the waste bin, including gloves, aprons, masks. Once the box is opened, many of the everyday products used in dentistry are only briefly used and then end up in the waste bin. These single-use plastic (SUP) items range from personal protective equipment (aprons, gloves and masks) and other disposable sundries (the mouth-rinse cup or the dental suction tube). SUP biomedical waste requires more specialized management – since these are contaminated with blood and other bodily fluids from oral health procedures. The high safety and quality requirements for these products to be legally compliant, is often incompatible with recycling and materials recovery. The complex nature of items assembled from different plastics also makes recycling difficult, as does the prevailing view that plastic is simply waste and is not considered a valuable resource. Still there are many attempts at finding solutions around the world. These include incentivization schemes and professional education courses that can help manufacturers to design products that can be safely treated and reprocessed, as well as sensitizing dental practitioners to different waste streams, and the treatment they require. Initiatives like the development of a competency-based dental waste management course being undertaken at the Copperbelt University in Zambia are a step in the right direction. Even so, the lack of good technological solutions for the appropriate collection, disinfection/sterilization and subsequent recovery or reprocessing of single use plastics used in biomedical procedures remains an ongoing barrier. We need product research to come up with safe, sustainable solutions for a circular economy, including in the healthcare sector, and governments to adopt supportive policies. Assessing the environmental impacts of oral healthcare as a first step It is important to understand the environmental impacts of materials used in healthcare. A better understanding of the environmental impacts of products and materials used in healthcare systems, from procurement to disposal, is key to any of these measures. Solutions proposed have included more life cycle analysis for all materials used in the healthcare supply chain and the development of a credible ‘sustainability index’ to inform medical supply purchasers about the sustainability credentials of a product. The index could potentially include information on environmental sourcing, ethical manufacturing, supply chain distribution and procurement. This World Oral Health Day we can celebrate the fact that the oral health sector has recognised that it has a vital role to play in healthcare-related climate change mitigation. That is the first step. The next ones will be more challenging and will need ‘teeth’. The FDI World Dental Federation´s Code of Good Practice, which is to be launched later this year, following an extensive consultation with the sector, will be a good starting point for ensuring healthy mouths also help to produce a healthier planet. Steven Mulligan Nicolas Martin Ihsane Ben Yahya Ihsane Ben Yahya is the President of the FDI World Dental Federation and professor at the Dental University in Casablanca, Morocco. Nicolas Martin is the Chair of the FDI Sustainability in Dentistry Task Team. He is also Clinical Professor in Restorative Dentistry in the School of Clinical Dentistry, at the University of Sheffield, UK. Steven Mulligan is a Member of the FDI Sustainability in Dentistry Task Team. He is also a Clinical Lecturer in Restorative Dentistry in the School of Clinical Dentistry, at the University of Sheffield, UK. Image Credits: Mass Communication Specialist Seaman Apprentice Brian H. Abel/Flickr, FDI World Dental Federation , Jan Fidler/Flickr, World Dental Federation , Mass Communication Specialist 3rd Class Everett Allen/Flickr. From COVID to Humanitarian Crises – Medical Oxygen Needs More Prioritization for its Lifesaving Capacities 17/03/2022 Raisa Santos Lifesaving oxygen flows into the lungs of a COVID patient in Chernivtsi, southwest Ukraine before the start of the recent Russian invasion. Whether its due to COVID or conflict, oxygen supplies fall short in many parts of the world. From patients lying in the parking lots of hospitals, in the back seats of cars suffocating as their family members searched frantically for oxygen in India during its second wave of COVID last year, to the inability to receive emergency care amidst constant bombing and shelling in current war-torn Ukraine, global health experts and leaders are desperately searching for ways of improving the global oxygen supply. At a media briefing on the issue Thursday, speakers emphasized the need for both access to oxygen on the ground and more funding to the WHO co-sponsored Access to COVID-19 Tools Accelerator (ACT-A), which is attempting to beef up oxygen supplies in low and middle-income countries. “Oxygen has been treated for too long like a commodity, treated as something that must be delivered,” said WHO Executive Director of Health Emergencies Programme Dr Mike Ryan, speaking at the briefing, cosponsored by the Act Acccelerator and Unitaid. But “oxygen is a capability, not a commodity,” he stressed. Rethinking oxygen’s lifesaving capacities Mike Ryan, Executive Director, Health Emergencies Programme; World Health Organization Ryan and others made the case for rethinking oxygen as a health tool that requires not only a sustainable supply at a country level, but an entire ecosystem of supply and maintenance technology and infrastructure. Its role – and the chronic lack of capacity in many countries – has been underscored by COVID – and again in the very different setting of the Ukraine crisis – where the lack of access for people ranging from COVID patients to mothers in birth and children with pneumonia has prompted widespread alarm. Oxygen remains a critical component of the global COVID-19 response – 75% of patients hospitalized for COVID-19 can be treated with oxygen alone – without any further advanced care. Yet the current global supply of oxygen does not meet needs for both COVID-19 and other serious illnesses. “COVID didn’t cause [the oxygen shortage], COVID uncovered this. COVID laid bare, tore away the bandages from some very old wounds,” said Ryan. UNITAID Commits $56 million to boost access to global medical oxygen supply Robert Matiru, Chair, ACT-A Oxygen Emergency Taskforce & Director Programmes, Unitaid The ACT-A Strategic Plan and Budget for 2022 has identified a funding deficit of $1 billion for oxygen supplies worldwide for this year alone. As a first step to closing that gap, Unitaid has announced that it will invest $56 million to increase access to medical oxygen both for short-term needs related to COVID-19 as well as for the longer term – as a critical foundation for fighting future pandemics. The Unitaid pledge builds on the $50 million USAID has committed in funding for oxygen as pledged at US President Joe Biden’s Global COVID-19 Summit in September 2021. Four Unitaid-funded projects, designed to address global inequities in oxygen access, will be implemented by The Alliance for International Medical Action (ALIMA), the Clinton Health Access Initiative (CHAI), Partners in Health (PIH), and the WHO Health Emergencies Programme. These will also support the work of the ACT-A Oxygen Emergency Task Force by ensuring access to more affordable oxygen solutions such as bulk liquid oxygen, oxygen generation systems, and other important oxygen equipment. Unitaid called on donors, including governments, foundations, and private sector partners to join in the efforts. “Our call here is not just for the present, for this pandemic, but to recognize that donors and funders that come forward and step forward, over and above the generous contributors to date, will help drive a more sustainable ecosystem and [deliver] essential medicines to countries that are lacking it,” said Robert Matiru, Chair of the ACT-A Oxygen Emergency Taskforce and Director of Programmes at Unitaid. Children with pneumonia unrecognized victims – 40% of hospitals in some African countries lack oxygen Numerous countries are facing oxygen shortages, while readily available oxygen products are in short supply. Children are among the unrecognized victims of the lack of oxygen supplies – with childhood pneumonia still one of the biggest killers of under-fives. Accounting for almost a million deaths a year, the highest burden is in sub-Saharan African and South-East Asian countries where children face a double whammy of disease from both the lack of preventive treatments, like vaccinations, along with exposure to heavy indoor air pollution from the open burning of coal, biomass and other such fuels. But an estimated 20 to 40% of these deaths are preventable with increased availability of oxygen therapy. The shortage is particularly acute in low-income sub-Saharan African countries such as Tanzania, Sierra Leone, Liberia, and Gambia, where 40% of health facilities had no access to oxygen and other basic life saving supplies, said Atul Gawande of the United States Agency for International Development (USAID). COVID has led to big surges in needs Daily medical oxygen need for COVID-19 as of 16 March 2022 Along with the chronic shortages, COVID led to a major surge in oxygen needs. Low and middle-income countries (LMICs) need at least 23 million cubic meters of oxygen every day, just to treat COVID patients alone, according to the PATH COVID-19 Oxygen Needs Tracker. On the brighter side, the pandemic has brought a long-ignored aspect of health capacity in LMICs more to the forefront. USAID is currently working in 11 countries to build ‘oxygen ecosystems’ to support oxygen therapy for pneumonia patients, COVID patients, and others, Gawande said. Countries like Ghana now have oxygen generating capacity that can support up to 300,000 patients per day, per year. Gawande noted that the oxygen ecosystem includes liquid oxygen cylinders and concentrators, as well as the clinical engineering and technical assistance to use the technology. But expanding this initiative to other countries still needs more funding. Atul Gawande, USAID “As the Omicron variant abates, I think we’re all starting to feel that we can catch our breath. Oxygen demand may be lower right now. But it is the time that we have to make these investments to enable this kind of [sustainable] capacity.” Gawande said. Oxygen ‘natural security’ and ‘high-return’ health investment Leith Greenslade, Founder/CEO, JustActions & Coordinator, Every Breath Counts Coalition While the recent funding commitments are a positive sign, ‘it is not enough to fund protection’, said Leith Greenslade of the Every Breath Counts Coalition. “It took a pandemic of respiratory infection to wake up the world,” she pointed out. In the past year, about $700 million was invested into the ACT-A Oxygen Emergency Task Force, which has worked in LMICs to prevent oxygen shortages – jump-starting a more focused response. But so far, only a handful of governments – including the United States, Germany, Canada, and France – have borne the funding burden. “But most of the G-20 nations have not stepped up to invest in oxygen,” she charged. Greenslade appealed to donors to see oxygen as a high priority for three reasons: the moral obligation to flatten the COVID-19 curve; oxygen as a “national security” issue in moments of crisis; and finally, oxygen as a high-return health investment that will keep on saving lives beyond the pandemic. “When hospitals run out of oxygen, we have seen strikes and civil unrest in quite a few low- and middle-income countries,” she pointed out. “How many more deaths before this is over will largely depend on access to oxygen and critical care in the countries where the disease is greatest and the health systems are weakest,” she declared. Image Credits: Mstyslav Chernov/ Wikimedia Commons, UNICEF/Ralaivita, PATH, Every Breath Counts . Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. 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UN Appeals for Groundwater Protection as Large Tracts of Africa Battle Drought 23/03/2022 Kerry Cullinan A family feeds their cattle with straw plucked from the roof of their home in Adadle in the Somali region of Ethiopia. As global water experts meet at the World Water Forum in Senegal this week, large swathes of Africa are facing famine as severe droughts prevail in the Horn of Africa and large parts of southern Africa. “Harvests are ruined, livestock is dying and families are bearing the consequences of increasingly frequent climate extremes,” according to Michael Dunford, the UN World Food Programme’s Regional Director for Eastern Africa. The countries most affected are Somalia, Kenya, Djibouti and Ethiopia in the east, and Angola, Madagascar, Mozambique and Namibia in the south. The UN launched its World Water Development Report at the forum to coincide with World Water Day on Wednesday, appealing for better management of groundwater, which is usually stored in aquifers, many of which are vulnerable to climate change and human settlements. Aquifers are under threat in rapidly expanding low-income cities, including Dakar (Senegal) and Lusaka (Zambia), as well as informal communities reliant on on-site sanitation where “the increased frequency of extreme rainfall can amplify leaching of surface and near-surface contaminants”, warns the report. Low-storage, low-recharge aquifer systems in drylands, such as Bulawayo (Zimbabwe) and Ouagadougou(Burkina Faso), are also at risk, in situations where “alternative perennial water sources are limited or do not exist, and recharge is episodic so that even small reductions in recharge can lead to groundwater depletion”, the report warns. Water scarcity affects over 40% of the 🌍 population.And for every 1°C ⬆️ in global temperature, an additional 500 million people will face #waterscarcity.🔗 https://t.co/4WYuzYPgpM #WorldWaterDay💦 @WorldBankWater pic.twitter.com/k4lshprKoA — World Bank India (@WorldBankIndia) March 22, 2022 Lack of research Meanwhile, information about the impact of climate change on Africa is scarce, according to the Intergovernmental Panel on Climate Change latest (sixth) report on Impacts, Adaptation, and Vulnerability. “Many countries lack regularly reporting weather stations, and data access is often limited. From 1990–2019 research on Africa received just 3.8% of climate-related research funding globally: 78% of this funding went to EU and North American institutions and only 14.5% to African institutions,” notes the IPCC report in a special section on Africa. “Increased funding for African partners, and direct control of research design and resources can provide more actionable insights on climate risks and adaptation options in Africa.” To address this, the World Water Council and the Organisation for Economic Co-operation and Development (OECD) launched a new programme this week to produce new data, evidence and policy guidance on water security in Africa. “With 250 million Africans expected to live in water-stressed areas by 2030, and 60% of the population expected to live in cities by 2050, now is the time to get water policies right for sustainable development in Africa,” according to Jose Angel Gurria Trevino, OECD’s Secretary-General. Image Credits: Michael Tewelde / World food Programme. Ukraine’s ‘Model’ TB Programme Destroyed by War, as Global TB Response Faces ‘Disastrous’ Funds Shortfall 22/03/2022 Kerry Cullinan & Elaine Ruth Fletcher Yana Terleeva, head of the Ukranian Ministry of Health’s TB programme Speaking in her car from an undisclosed location somewhere in war-torn Ukraine, Yana Teerleva, head of TB in the country’s Ministry of Health, lamented the destruction that she is witnessing every day in hospitals and clinics – including the shelling of three huge dispensaries where the country had stockpiled sufficient TB medications for the remainder of 2022. This month, Teerleva had been planning to implement an innovative new TB treatment regimen to further step up the national response to its drug resistant TB burden – which TB control officials in Geneva had praised as a model. “Instead we are dealing with the Russian invasion and discussing military hardware”, Teerleva said in a media briefing Tuesday, just ahead of World Tuberculosis Day, 24 March. Global TB experts are bemoaning the destruction of Ukraine’s innovative TB programme, which had made significant progress in addressing the country’s high burden of multi-drug resistant TB (MDR-TB) over the past 15 years. Meanwhile, with global TB funding well below needs, prospects of meeting the UN Sustainable Development Goal target for ending the TB epidemic by 2030 look increasingly dim, Lucica Ditui, executive director of the Geneva-based STOP TB Partnership, told Health Policy Watch in an interview. “This gives us very little chance of meeting the UN 2030 targets,” she said. Model programme now in ashes – literally Almost one-third of Ukraine’s TB cases are drug-resistant, and last year the country diagnosed and treated 24,000 people with TB, including almost 5,000 people with MDR-TB. But the Ukrainian government had been “extremely committed” to addressing TB over the past two to three years, paying for new drugs and diagnostics and building strong relationships with civil society organisations, Ditiu told Health Policy Watch. “The country did a lot to improve their health system. It is devastating to see these bombs destroying everything. These are losses that will take decades to regain.” A doctor shows Oleg Chutvatov, who was receiving TB treatment at the hospital in Kharkiv, an x-ray photo of his lungs in July 2021. The city is now under heavy attack from the Russian invasion. Over the past 15 years, Ukraine had significantly reduced its TB cases from over 127 cases per 100 000 people in 2005 to just 42.2 cases per 100 000 people in 2020. Just before the war, says Ditiui, “The country was paying for their own TB drugs as well as diagnostics – and they had secured enough to treat and diagnose everyone in need in Ukraine. “They were very keen to implement new tools like rapid molecular diagnosis, as well as new drugs. They had cohorts of people enrolled in studies for new TB treatments. Collaboration between public health officials, civil society and communities also was very good.” The gains in TB treatment were part of a broader health sector reform that had been underway, Ditiu added, saying: “What I am really upset about is that the country did a lot to improve their health system, their hospitals, to do health sector reform. To see these bombs destroying everything. These are losses that will take decades to regain.” “Ukraine was always at the forefront of the fight against tuberculosis,” Teleeva told the Stop TB briefing Tuesday. “We wanted Ukraine and the entire world to be free from the TB and for that, we have done everything possible.” However, she said that according to health ministry information, “more than 135 hospitals in Ukraine have been shelled by the Russian aggressors”, including “three huge regional anti-tuberculosis dispensaries” and the country’s health infrastructure “is not working”. WHO has confirmed some 60 attacks on hospitals and other health facilities. Appeal to combat stigma – among the war’s knock-on effects Both Ditiu and Teeleva stressed the need to focus now on countering the knock-on effects of the war – including how to treat internally displaced people, how to ensure people fleeing can continue their medications, and how to combat stigma that refugees elsewhere may encounter. “We worked to overcome the stigma discrimination of these people living with TB”, Teleeva said, of the pre-war period. She appealed to neighbouring countries that have a much lower burden of TB disease not to stigmatise Ukrainian refugees. “TB is very sensitive, and if we broadcast information about its uncontrolled spread, we will stigmatize people who are already stigmatized, for people who are already in a very difficult situation,” said Terleeva. Ditiu acknowledged that it’s very likely the war will lead to a higher level of TB cases -particularly inside Ukraine itself. “We’ll see an increase in TB, in drug-resistant TB and in mortality,” she predicted, “because people will be staying close together in shelters, in crowded places, with bad food and stress.” However, she said good tracking and surveillance by countries that receive refugees can help counter any spillover effect, beyond the borders. ‘Stupid war’ Romania’s Health Minister, Prof Alexandru Rafila Decrying the “stupid war”, Romania’s Health Minister, Professor Alexandru Rafila, told the briefing that his country was doing everything it could to assist the refugees that had fled across the 600km border with his country, including identifying and ensuring treatment for TB patients. As a country with a relatively high burden of TB itself, Romania has “a network of TB hospitals and TB ambulatory care centres where we can perform rapid diagnosis and treat Ukrainian patients if they are resistant or need to initiate treatment”, added Rafila. The Global Fund has also provided Romania with additional Gene Xpert rapid testing machines and TB medication to assist Ukranian patients, the health minister added. However, while Romania and Moldova had “some capacity” to deal with TB, Ditiu warned that Poland is in a different category – precisely because its own burden is quite low. “Poland is not a country with a lot of TB – so I’m not sure how well the network will be able to deal with it – even though the doctors certainly have a lot of knowledge”. In addition, prices of TB medication in both Romania and Poland are up to ten times higher than in Ukraine, as both countries are part of the European Union and pay EU prices for drugs that Ukraine was able to procure through the Global Fund, Ditiu added. “We are having a conversation with the Global Fund to see how we can lower the cost,” she added. TB civil society trying to locate patients Olya Klymenk, head of TB People Ukraine, a network of over 70 organisations, said that her organisation was doing its best to locate displaced patients who have fled their homes or their communities, and offer them humanitarian aid, including food. “We are trying to take care of the patients who are out of the hospital right now because we understand that, without social support, they will not have a good life,” said Klymenk. Teleeva stressed that in the emergency the primary need is to, “focus on ensuring patients know where to go and have a desire to continue treatment. “They have to be assured there is a reason to live, that they will go back to Ukraine, and they have to be healthy to help us rebuild. They need this optimism, to have this desire to live and continue living.” ‘Pathetic’ investment in TB Dr Lucica Ditiu, Executive Director of the Stop TB Partnership Meanwhile, Ditiu lamented that “investments in TB are pathetically low” – perhaps because 90% of the disease burden is in lower-income countries. “In 2020, we had $1.9 billion [in] domestic investments, which is very very, very little,” she said, referring to national governments’ own contributions to beating TB. In addition, “The Global Fund, which is a big donor for TB, gave around $800 million, which is completely insufficient.” Stop TB estimates that $19.6 billion per year will be needed over the next eight years for TB prevention and care, and $4 billion per year will be required for research and development (R&D) of the new diagnostics, medicines and vaccines needed to end TB. This represents about four times what is currently available for the TB response (in 2020, $5.3 billion was available for care and prevention and $0.9 billion for R&D). The year 2022 is critical for the global fight to end TB as the world faces a fast-running countdown to reaching the 2018 United Nations High-Level Meeting (UNHLM) TB targets, which the international community agreed to meet by the end of December. All projections show that the world is not on course to meet the UNHLM treatment targets set for 2022. “We simply cannot continue to stand on the sidelines and watch while people around the world fall ill and die from a preventable and treatable disease,” said Ditiu. “We also cannot continue to accept what we accepted for years—every year having less than 40% of the funding need for the TB response. Now we are facing a disastrous funding shortfall, bigger than what we had expected. We not only need to step up efforts to meet targets set at the 2018 United Nations High Level Meeting on TB,” she said, referring to the UN pledge to accelerate progress toward the 2030 targets, “but the TB response must also recover from the devastating impacts of the COVID-19 pandemic.” Image Credits: The Global Fund / Evgeny Maloletka. ‘There is No Safe Place in Ukraine’ 21/03/2022 Kerry Cullinan Ukrainian child with his dog -displaced by war, in a refugee camp on the Moldova-Ukranian border There have been 52 attacks on Ukrainian health facilities in the past 25 days, more than two every day, according to the World Health Organization (WHO). Meanwhile, the health of fleeing refugees, their impact on the health services of neighbouring countries, and the fate of Ukraine’s tuberculosis patients are foremost on healthcare providers’ minds. “In less than a month, over three million people have left the country and nearly two million have been internally displaced,” said Jarno Habicht, WHO’s Representative in Ukraine. “This has happened faster than in any previous European crisis. There is no safe place in Ukraine right now, yet we need to ensure that health services are available.” “The military offensive continues, with a number of cities being entirely isolated – people are running out of food and water, and hospitals might not have electricity,” added Habicht, who has been head of the Ukraine office since 2018. “Worse still, we have seen many attacks on health workers and health facilities as well as patients. This is happening daily and is unacceptable. So, if you ask me how to describe it, every day things are getting worse, which means every day the health response is becoming more difficult.” Jarno Habicht, WHO’s Representative in Ukraine (centre) Banned cluster munitions According to Bonnie Docherty, a senior advisor for Human Rights Watch, Russian forces have “relied heavily” on cluster munitions, which are banned in most countries in the world, and explosive weapons with wide-area effects. Cluster munitions, large bombs that contain dozens or hundreds of smaller sub-munitions, were used to attack a hospital in Vuhledar on 24 February in which four civilians were killed, and 10 people including six healthcare workers were injured, wrote Docherty in the online security news outlet, Just Security, on Monday. Unexploded, the submunitions can lie dormant like landmines, exploding months and years later when picked up by children or farmers, she explains. However, artillery shells, mortars, rockets, missiles, and enhanced blast (thermobaric) weapons, and aerial bombs, have caused the bulk of the damage in Ukraine, adds Docherty. Concern for drug-resistant TB patients On the eve of World Tuberculosis Day on Thursday, WHO TB experts also expressed concern for Ukrainian TB patients, particularly those with drug-resistant TB. “Ukraine is one of the 18 high-priority countries in the WHO European region for TB and is on the global list for having a high burden of multidrug-resistant tuberculosis,” Dr Askar Yedilbayev, WHO Europe’s Regional TB advisor, told a media briefing on Monday. Dr Askar Yedilbayev “Before the war, Ukraine was one of the pioneering countries in response to TB and drug-resistant TB in the WHO European region,” he added. “However, destroyed health infrastructure, including limited access to TB treatment and public health services, is affecting the provision of essential tuberculosis services, causing significant delays in diagnosis of TB, affecting initiation of TB preventive treatment, and treatment of active TB and MDR TB,” he added. Shortly before the war, all TB medication had been distributed to regional warehouses and patients had been given one or two months’ supply of medicine, he added. But some of these warehouses had been damaged or were under threat of damage, and there was a need for the “emergency redistribution of procurement of medicines to ensure continuity of treatment”. In addition, as Ukraine’s neighbours did not have the same burden of TB disease, they were unlikely to have the medicine to treat large numbers of people with TB. Yedilbayev appealed for donations to the Global Fund and WHO Foundation to enable the delivery of health services to Ukrainians. Every second, a Ukrainian child becomes a refugee Every second, a Ukrainian child becomes a refugee, according to UNICEF and half of the over 3.5 million refugees estimated to have fled to neighbouring countries since 24 February are children under the age of 15. Almost two million refugees have fled to Poland, according to the WHO. “Refugees can be vulnerable to infectious diseases because of lack of health care, interrupted care in the country of origin, because of exposure to infectious infections and lack of care in transit, and if living conditions are poor in the destination country,” said Yedilbayev. Image Credits: UNICEF/UN0599222/Moldovan. As Europe Moves to Improve Mental Health Services for Children, Experts Are Concerned About Men’s Mental State 21/03/2022 Kerry Cullinan Dr Hans Kluge Mental health practitioners worldwide are warning of a massive wave of pandemic-related mental health issues that many countries are ill-equipped to address. On Monday, the World Health Organization’s (WHO) Europe office and the government of Greece launched a new European programme to strengthen and improve the quality of mental health services for children and adolescents. WHO Europe Director Dr Hans Kluge told the launch that suicide was the leading cause of death in children and adolescents aged 10 to 19 living in low- and middle-income countries in the region and that over 4000 young people in this age group had killed themselves in 2015. 🔴Suicide is the leading cause of deathamong adolescents in low & middle income countries & 2nd in high income countries in the European Region Find guidance on how to approach child & adolescent #MentalHealth as a primary health care provider here👉 https://t.co/EUoragqO0q pic.twitter.com/AOvZRIY7HR — WHO/Europe (@WHO_Europe) March 21, 2022 “Ensuring that all children and adolescents in the region have access to quality mental health services is a moral imperative,” said Kluge, adding that this was as important as childhood vaccinations. The WHO Europe programme aims to work with member states to encourage them to share knowledge and expertise about how to boost the mental healthcare of children and adolescents, and to support member countries to develop their own strategies and frameworks. It will also “develop a package of tools to measure progress against evidence-based standards”, according to the regional office. Through this new programme, WHO/Europe will continue to help countries strengthen and improve #mentalhealth services for children and adolescents, as well as developing tools to measure progress pic.twitter.com/Fspx9hh2lN — WHO/Europe (@WHO_Europe) March 21, 2022 Mental health woes of COVID-19 COVID-19 has exacerbated mental health issues and, during the first year of the pandemic, there was a 25% increase in the global prevalence of anxiety and depression, according to a WHO brief published in early March. Approximately 140,000 children in the US have lost a parent or guardian to COVID, for example, and are likely to be struggling to come to terms with this loss. “One major explanation for the increase is the unprecedented stress caused by the social isolation resulting from the pandemic. Linked to this were constraints on people’s ability to work, seek support from loved ones and engage in their communities,” according to the WHO. “Loneliness, fear of infection, suffering and death for oneself and for loved ones, grief after bereavement and financial worries have also all been cited as stressors leading to anxiety and depression. Among health workers, exhaustion has been a major trigger for suicidal thinking,” it added. Calls to South Africa’s only mental health helpline, for example, have jumped exponentially during the pandemic – from around 400 to 600 calls a day before COVID-19 to over 2400 calls a day in 2021. Psychologist Zamo Mbele, a board member of the South African Depression and Anxiety Group (SADAG) that operates the helpline, said that his non-governmental organisation, which is wholly reliant on donations, had been struggling to keep up with demand. Psychologist Zamo Mbele, a board member of the South African Depression and Anxiety Group (SADAG) Male violence and mental health “One of the reasons we’ve seen an increase in our calls is because of COVID, but one of the other reasons is because people who would not previously access health are beginning to recognise that they need help,” said Mbele. He added that “toxic” manifestations of masculinity – seen in the country’s high levels of domestic violence, road rage and substance abuse – were indications that men, in particular, needed help. “It’s not as though men only recently starting to struggle with mental difficulties or emotional difficulties,” he added. “But they are just starting to see that the expression of their difficulties is no longer functional to them or to society. It’s no longer as socially acceptable to be violent in order to deal with your depression, or to have a big temper in order to deal irritability or anxiety – or to drink excessively or to spend copious amounts of hours at the gym. “Instead, we’re beginning to recognise that actually doing a lot of these things is masking a lot of symptoms.” https://twitter.com/SkosanaDr/status/1505834397391544323 Men and suicide In the vast majority of countries, men are far more likely to commit suicide than women, which mental health practitioners say is likely to be because men find it harder to ask for help. This is a worldwide trend, captured by the WHO’s Suicide Worldwide in 2019: Global Health Estimates. The report found that South Africa has the third-highest suicide rate on the African continent. Of the 13,774 suicides reported in South Africa, 10,681 were men in 2913 were women. Russia, South Korea, the US and Japan also have high suicide rates, particularly amongst men. However, while there has been an increase in suicidal thoughts during the pandemic, there has not been a global increase in actual suicides – with notable exceptions, such as Austria, and Japan (although there is very little information from LMICs). Mass Polio Vaccination Drive to Administer More Than 80 Million Doses to Southern African Children in Five Countries 18/03/2022 Raisa Santos Polio vaccinate campaign to target children under 5 across five southern African countries. Malawi is launching a mass vaccination campaign against wild poliovirus type 1, which is to extend to 23 million children across five southern African countries, WHO said on Friday. The campaign, to kick off Sunday, follows Malawi’s declaration of a polio outbreak on 17 February – three months after the first polio virus case in 30 years was identified in a young child in Lilongwe. The case was the first in Africa since the region was certified free of indigenous wild poliovirus in 2020. WHO said that the region’s certification as wild polio-free remains unchanged, as the wild poliovirus strain identified had been “imported” from Pakistan. So far, no clear explanation of how the Asian virus strain may have infected an African child who had never traveled outside of the country, has been provided by WHO or Malawi health authorities. Nor has there been any explanation of why it took three months between the time the child was diagnosed and the outbreak was formally declared by WHO. But the breadth of the new campaign makes it clear the incident has been perceived as a major threat to Africa’s wild polio virus free status – with risks of subtle, silent transmission of the virus much more widely, via contaminated water and sewage, food, or human-to-human contact. Malawi has since set up an environmental surveillance system for poliovirus in 11 cities across four sites, including the Lilongwe District that encompasses the capital Lilongwe, where the initial, and so far only reported case, was detected, WHO said. Asked by Health Policy Watch whether traces of the wild polio virus had also been identified in sewage sources, through the environmental surveillance, WHO did not reply as of publication time. Targeting children across four countries – then Zimbabwe More than 80 million doses will be administered to more than 23 million children under 5 years in a four-round vaccination campaign in five southern African countries, WHO said. The first phase of the campaign, beginning this month, will target 9.4 million children across Malawi, Mozambique, Tanzania, and Zambia. Three subsequent rounds – with Zimbabwe joining the campaign- are set for April, June, and July, and aim to reach more than 23 million children with more than 80 million doses of the bivalent Oral Polio Vaccine recommended by the World Health Organization (WHO). “Polio is a highly infectious and an untreatable disease that can result in permanent paralysis. In support of Malawi and its neighbours, we are acting fast to halt this outbreak and extinguish the threat through effective vaccinations,” said WHO Regional Director for Africa Dr Matshidiso Moeti. “The African region has already defeated wild poliovirus due to a monumental effort by countries. We have the know-how and are tirelessly working to ensure that every child lives and thrives in a continent free of polio.” Single case of polio in Malawi linked to Pakistan strain Pakistan is one of two countries where polio remains endemic. Laboratory analysis has linked the strain detected in Malawi to the one circulating in Pakistan’s Sindh Province in 2019. In addition to environmental surveillance, WHO has also been supporting the country to reinforce response measures including risk assessment, and preparations for the vaccination campaigns. A surge team from WHO is working with country-based counterparts, partner organizations, and the government to end the outbreak. The WHO team is a part of a broader multi-partner Global Polio Eradication Initiative to support the country. In an unrelated event, a vaccine-directed case of polio was also identified in February by Israeli authorities in Jerusalem, also for the first time in 30 years. The infected child is part of an ultra-orthodox Jewish community in which vaccination rates hover at around 50% or less. A vaccination drive also was launched in the city. Polio, a viral disease with no cure, can invade the nervous system and can cause total paralysis within hours, particular among children under 5 years. The virus is transmitted from person to person, mainly through contamination by fecal matter or, less frequently, through contaminated water or food, and multiplies in the intestine. While there is no cure for polio, the disease can be prevented through administration of a vaccine. Image Credits: Sanofi Pastuer/Flickr, Sanofi Pastuer/Flickr. UN Environment Programme Joins WHO Alliance to Advance One Health Approach 18/03/2022 Editorial team Safer and more sustainable food systems – from production to sales in food markets is key to a One-Health Approach. UN Environment has joined a three-way alliance with the Food and Agriculture Organization, the World Animal Health Organization (OIE), and WHO to advance “One-Health” solutions to both ecosystem degradation and pandemic threats, leaders of the four agencies said on Friday. The statement followed a meeting this week of the Tripartite FAO, WHO and OIE partnership – which now has become a “Quadripartite”. “The One Health approach aims to sustainably balance and optimize the health of people, animals, ecosystems and the wider environment,” said WHO in a press release. “It mobilizes multiple sectors, disciplines and communities to work together to foster well-being and tackle threats to health and ecosystems. And it addresses the collective need for clean water, energy and air, safe and nutritious food, action on climate change, and contributing to sustainable development.” The work of the newly expanded alliance will be focused on a One Health Joint Plan of Action, which includes six main action tracks: enhancing countries’ capacity to strengthen health systems under a One Health approach; reducing the risks from emerging or resurfacing zoonotic epidemics and pandemics; controlling and eliminating endemic zoonotic, neglected tropical or vector-borne diseases; strengthening the assessment, management and communication of food safety risks; curbing the silent pandemic of antimicrobial resistance (AMR) and better integrating the environment into the One Health approach. Increased awareness of One Health As the world enters the third year of the COVID-19 pandemic, with an estimated cost of $8 to 16 trillion, there is increased awareness and broad recognition of the importance of One Health as a long-term, viable and sustainable approach. The G7, G20 and UN Food Systems Summit have all given a nod to the approach, along with the increased references by WHO and its partners. But the hard work of reforming food systems, from production to markets, as well as halting related deforestation and ecosystem destruction, are much more formidable challenges that the organisations have barely begun to face. Last year saw the Tripartite implement a number of initial initiatives, including on antimicrobial resistance, a One Health High-Level Expert Panel, and guidance on better management – but not the banning – of wild animal sales in markets – in the wake of the COVID pandemic, whose origins may have emerged from the capture, transport and slaughter of SARS-CoV2 infected wild animals at the Wuhan, China market. Plan implementation the key challenge “Now the challenge is implementation: how do we translate our work on the ground to support our Members? And how do we mobilize funding and financing mechanisms to support the Joint Plan for Action?” said FAO Director QU Dongyu, handing over the chair of the Secretariat to WHO. WHO Director-General Tedros Adhanom Ghebreyesus, said: “We need to build a more comprehensive and coordinated One Health governance structure at global level. We need a strong workforce, committed political will, and sustained financial investment. We need to develop a more proactive way of communicating and engaging across sectors, disciplines and communities to elicit the change we need.” (WHO) Image Credits: Michael Casmir/Pierce Mill Media. Healthy Mouths, Healthy Planet 18/03/2022 Ihsane Ben Yahya, Nicolas Martin & Steven Mulligan Dental procedures produce a hefty amount of carbon emissions. In honour of World Oral Health Day, 20 March, three leading voices from the World Dental Federation highlight the unexpected linkages between the health of your mouth and that of the planet. It will come as a surprise to most people that the healthcare sector has a significant environmental impact. Healthcare systems are responsible for around 5% of global greenhouse gas emissions, of which oral healthcare is an important contributor. Indeed, if the healthcare sector was a country, it would be the fifth largest greenhouse gas emitter on the planet. Oral healthcare contributes to this environmental burden with air pollution arising from the release of CO2 associated with travel and transport, the incineration of waste, the greenhouse gas impact of anesthetic gases such as nitrous oxide and the high consumption of water. Specific to dentistry, the most routine procedures, all come with a hefty carbon price tag. Tooth-coloured fillings for instance, produce around 15 kilograms of CO2eq (carbon dioxide equivalent) per procedure, according to Public Health England, whose National Health Service has done some of the most extensive carbon footprint modeling of healthcare delivery in the world. A single root canal treatment, meanwhile, produces 23 kilograms of CO2eq, dentures between 58 and 71 kilograms CO2eq. Use of the anesthetic gas nitrous oxide (laughing gas), in a procedure, meanwhile, is responsible for 119 kilograms CO2eq. Nitrous oxide N2O, the most commonly used inhalation dental anesthetic, is a greenhouse gas with far more climate warming potential than CO2. Just one kilogram of nitrous oxide is equivalent to 298 kilogrammes of CO2 and 25 kilograms of methane – another powerful greenhouse gas. Meanwhile, silver amalgam fillings contain mercury. While more and more rarely used today, and still considered safe for dental treatments, there is an environmental impact through the release of residual mercury into sewage during procedures, as well as throughout its life cycle. Prevention is better than cure Ways to maintain good oral health. The dental industry has a collective responsibility to reduce these impacts – while also expanding access to oral healthcare. How can we do both? One simple solution is to look at how we can best minimize what we might label as “avoidable” oral procedures. Prevention is always better than cure and it is the most impactful and practical way of reducing the need for clinical interventions and their associated environmental impacts. This is best achieved through the promotion of good oral hygiene, a healthy diet and the avoidance of smoking. When treatment is required, oral healthcare also should focus on the provision of durable fillings, using high quality products and materials that will last longer and/or require fewer replacements. Legislation around water fluoridation for instance, complemented by targeted public health policies can help prevent tooth decay (caries) and ultimately cavities. The recent banning of TV and online advertising of junk food in the UK before 9pm is an indirect example of encouraging better diet. So too the campaign by UK footballer Marcus Rashford to promote healthier school lunches. At the same time, while many dental problems such as caries and periodontal (gum) disease are common preventable diseases, no amount of prevention can make them go away entirely. There will always be a need for accessible dental check-ups and treatments to facilitate good oral health. And it remains important to expand access to such treatments among disadvantaged groups as well as in many low- and middle-income countries so as to reduce inequalities in healthcare provision. Less trips to the dentist would also mean less travel and water consumption Dental procedures require a lot of water, which can be reduced by practicing good oral healthcare. Oral healthcare has higher levels of patient and staff transport than other medical specializations and this is partly due to the need for regular oral health maintenance, whereas other specializations tend only to treat illness. In the UK for instance, staff and patient commuting and travel accounts for approximately two thirds of all emissions from the oral healthcare sector and about eight per cent of the total UK NHS air pollution attributable to travel. This can be reduced significantly, through the maintenance of good oral health, that requires fewer interventions and consequently fewer trips to the dentist. Simple transport habit changes can have a great impact. For example, in October 2021 the Sustainability Committee at Harvard School of Dental Medicine (HSDM) implemented a `Step Challenge´ that encouraged staff, students and faculty to walk, or take public transport rather than drive during that month. They amassed over one million steps in total, preventing the release of approximately 0.28 metric tons of CO2. The practice of dentistry and personal oral healthcare is a significant consumer of water. As a conservative estimate, a bathroom tap delivers about four litres/minute. If we estimate that half the world population cleans their teeth once a day and runs the tap for one minute, the daily global water usage equates to 6,400 Olympic swimming pools. This figure is in addition to undocumented water consumption up and down the oral healthcare manufacturing and distribution supply chain. Reducing dental use of single use plastics and packaging Measures to reduce carbon footprint in dental offices. So what measures can be taken at the dentist office to reduce the carbon footprint of dentistry procedures that are nonetheless essential to good oral health? The use and consequent disposal of single use plastics for many procedures is one of the biggest contributors to the environmental footprint of healthcare generally – and that holds true for dentistry as well. Among single-use plastics, in fact it is the packaging in which the needles, gloves and other oral healthcare products are encased that is the single largest contributor to such waste in the dental industry, with over 90 % ending its life cycle in an incinerator or a landfill. A more thoughtful approach to the design of such packaging – from the plastics content, manufacture and transport, to the potential for reuse, recycling or biodegradability, is therefore one obvious starting point in reducing the carbon footprint of the typical dentist’s office. This is particularly important because packaging, as such, is not “contaminated” biomedical waste that needs special treatment, post-procedure. This requires greater engagement with consumers and waste management companies to segregate, collect and recycle uncontaminated clinical single use plastics (SUPs) as a valuable commodity. It also involves the design and development of more plastic items made from mono-polymer plastics that can be readily recycled. The Flexible Plastics Consortium which represents 34 European companies looking for better plastics content and design solutions for packaging is a good example of how this might work in practice. The United Kingdom’s Plastics Pact is another good example: it has set targets with the goal of 100% of plastic packaging to be reused, recycled or compostable by 2025. Major challenges in managing single use plastic waste from oral healthcare Many single use dental items end up in the waste bin, including gloves, aprons, masks. Once the box is opened, many of the everyday products used in dentistry are only briefly used and then end up in the waste bin. These single-use plastic (SUP) items range from personal protective equipment (aprons, gloves and masks) and other disposable sundries (the mouth-rinse cup or the dental suction tube). SUP biomedical waste requires more specialized management – since these are contaminated with blood and other bodily fluids from oral health procedures. The high safety and quality requirements for these products to be legally compliant, is often incompatible with recycling and materials recovery. The complex nature of items assembled from different plastics also makes recycling difficult, as does the prevailing view that plastic is simply waste and is not considered a valuable resource. Still there are many attempts at finding solutions around the world. These include incentivization schemes and professional education courses that can help manufacturers to design products that can be safely treated and reprocessed, as well as sensitizing dental practitioners to different waste streams, and the treatment they require. Initiatives like the development of a competency-based dental waste management course being undertaken at the Copperbelt University in Zambia are a step in the right direction. Even so, the lack of good technological solutions for the appropriate collection, disinfection/sterilization and subsequent recovery or reprocessing of single use plastics used in biomedical procedures remains an ongoing barrier. We need product research to come up with safe, sustainable solutions for a circular economy, including in the healthcare sector, and governments to adopt supportive policies. Assessing the environmental impacts of oral healthcare as a first step It is important to understand the environmental impacts of materials used in healthcare. A better understanding of the environmental impacts of products and materials used in healthcare systems, from procurement to disposal, is key to any of these measures. Solutions proposed have included more life cycle analysis for all materials used in the healthcare supply chain and the development of a credible ‘sustainability index’ to inform medical supply purchasers about the sustainability credentials of a product. The index could potentially include information on environmental sourcing, ethical manufacturing, supply chain distribution and procurement. This World Oral Health Day we can celebrate the fact that the oral health sector has recognised that it has a vital role to play in healthcare-related climate change mitigation. That is the first step. The next ones will be more challenging and will need ‘teeth’. The FDI World Dental Federation´s Code of Good Practice, which is to be launched later this year, following an extensive consultation with the sector, will be a good starting point for ensuring healthy mouths also help to produce a healthier planet. Steven Mulligan Nicolas Martin Ihsane Ben Yahya Ihsane Ben Yahya is the President of the FDI World Dental Federation and professor at the Dental University in Casablanca, Morocco. Nicolas Martin is the Chair of the FDI Sustainability in Dentistry Task Team. He is also Clinical Professor in Restorative Dentistry in the School of Clinical Dentistry, at the University of Sheffield, UK. Steven Mulligan is a Member of the FDI Sustainability in Dentistry Task Team. He is also a Clinical Lecturer in Restorative Dentistry in the School of Clinical Dentistry, at the University of Sheffield, UK. Image Credits: Mass Communication Specialist Seaman Apprentice Brian H. Abel/Flickr, FDI World Dental Federation , Jan Fidler/Flickr, World Dental Federation , Mass Communication Specialist 3rd Class Everett Allen/Flickr. From COVID to Humanitarian Crises – Medical Oxygen Needs More Prioritization for its Lifesaving Capacities 17/03/2022 Raisa Santos Lifesaving oxygen flows into the lungs of a COVID patient in Chernivtsi, southwest Ukraine before the start of the recent Russian invasion. Whether its due to COVID or conflict, oxygen supplies fall short in many parts of the world. From patients lying in the parking lots of hospitals, in the back seats of cars suffocating as their family members searched frantically for oxygen in India during its second wave of COVID last year, to the inability to receive emergency care amidst constant bombing and shelling in current war-torn Ukraine, global health experts and leaders are desperately searching for ways of improving the global oxygen supply. At a media briefing on the issue Thursday, speakers emphasized the need for both access to oxygen on the ground and more funding to the WHO co-sponsored Access to COVID-19 Tools Accelerator (ACT-A), which is attempting to beef up oxygen supplies in low and middle-income countries. “Oxygen has been treated for too long like a commodity, treated as something that must be delivered,” said WHO Executive Director of Health Emergencies Programme Dr Mike Ryan, speaking at the briefing, cosponsored by the Act Acccelerator and Unitaid. But “oxygen is a capability, not a commodity,” he stressed. Rethinking oxygen’s lifesaving capacities Mike Ryan, Executive Director, Health Emergencies Programme; World Health Organization Ryan and others made the case for rethinking oxygen as a health tool that requires not only a sustainable supply at a country level, but an entire ecosystem of supply and maintenance technology and infrastructure. Its role – and the chronic lack of capacity in many countries – has been underscored by COVID – and again in the very different setting of the Ukraine crisis – where the lack of access for people ranging from COVID patients to mothers in birth and children with pneumonia has prompted widespread alarm. Oxygen remains a critical component of the global COVID-19 response – 75% of patients hospitalized for COVID-19 can be treated with oxygen alone – without any further advanced care. Yet the current global supply of oxygen does not meet needs for both COVID-19 and other serious illnesses. “COVID didn’t cause [the oxygen shortage], COVID uncovered this. COVID laid bare, tore away the bandages from some very old wounds,” said Ryan. UNITAID Commits $56 million to boost access to global medical oxygen supply Robert Matiru, Chair, ACT-A Oxygen Emergency Taskforce & Director Programmes, Unitaid The ACT-A Strategic Plan and Budget for 2022 has identified a funding deficit of $1 billion for oxygen supplies worldwide for this year alone. As a first step to closing that gap, Unitaid has announced that it will invest $56 million to increase access to medical oxygen both for short-term needs related to COVID-19 as well as for the longer term – as a critical foundation for fighting future pandemics. The Unitaid pledge builds on the $50 million USAID has committed in funding for oxygen as pledged at US President Joe Biden’s Global COVID-19 Summit in September 2021. Four Unitaid-funded projects, designed to address global inequities in oxygen access, will be implemented by The Alliance for International Medical Action (ALIMA), the Clinton Health Access Initiative (CHAI), Partners in Health (PIH), and the WHO Health Emergencies Programme. These will also support the work of the ACT-A Oxygen Emergency Task Force by ensuring access to more affordable oxygen solutions such as bulk liquid oxygen, oxygen generation systems, and other important oxygen equipment. Unitaid called on donors, including governments, foundations, and private sector partners to join in the efforts. “Our call here is not just for the present, for this pandemic, but to recognize that donors and funders that come forward and step forward, over and above the generous contributors to date, will help drive a more sustainable ecosystem and [deliver] essential medicines to countries that are lacking it,” said Robert Matiru, Chair of the ACT-A Oxygen Emergency Taskforce and Director of Programmes at Unitaid. Children with pneumonia unrecognized victims – 40% of hospitals in some African countries lack oxygen Numerous countries are facing oxygen shortages, while readily available oxygen products are in short supply. Children are among the unrecognized victims of the lack of oxygen supplies – with childhood pneumonia still one of the biggest killers of under-fives. Accounting for almost a million deaths a year, the highest burden is in sub-Saharan African and South-East Asian countries where children face a double whammy of disease from both the lack of preventive treatments, like vaccinations, along with exposure to heavy indoor air pollution from the open burning of coal, biomass and other such fuels. But an estimated 20 to 40% of these deaths are preventable with increased availability of oxygen therapy. The shortage is particularly acute in low-income sub-Saharan African countries such as Tanzania, Sierra Leone, Liberia, and Gambia, where 40% of health facilities had no access to oxygen and other basic life saving supplies, said Atul Gawande of the United States Agency for International Development (USAID). COVID has led to big surges in needs Daily medical oxygen need for COVID-19 as of 16 March 2022 Along with the chronic shortages, COVID led to a major surge in oxygen needs. Low and middle-income countries (LMICs) need at least 23 million cubic meters of oxygen every day, just to treat COVID patients alone, according to the PATH COVID-19 Oxygen Needs Tracker. On the brighter side, the pandemic has brought a long-ignored aspect of health capacity in LMICs more to the forefront. USAID is currently working in 11 countries to build ‘oxygen ecosystems’ to support oxygen therapy for pneumonia patients, COVID patients, and others, Gawande said. Countries like Ghana now have oxygen generating capacity that can support up to 300,000 patients per day, per year. Gawande noted that the oxygen ecosystem includes liquid oxygen cylinders and concentrators, as well as the clinical engineering and technical assistance to use the technology. But expanding this initiative to other countries still needs more funding. Atul Gawande, USAID “As the Omicron variant abates, I think we’re all starting to feel that we can catch our breath. Oxygen demand may be lower right now. But it is the time that we have to make these investments to enable this kind of [sustainable] capacity.” Gawande said. Oxygen ‘natural security’ and ‘high-return’ health investment Leith Greenslade, Founder/CEO, JustActions & Coordinator, Every Breath Counts Coalition While the recent funding commitments are a positive sign, ‘it is not enough to fund protection’, said Leith Greenslade of the Every Breath Counts Coalition. “It took a pandemic of respiratory infection to wake up the world,” she pointed out. In the past year, about $700 million was invested into the ACT-A Oxygen Emergency Task Force, which has worked in LMICs to prevent oxygen shortages – jump-starting a more focused response. But so far, only a handful of governments – including the United States, Germany, Canada, and France – have borne the funding burden. “But most of the G-20 nations have not stepped up to invest in oxygen,” she charged. Greenslade appealed to donors to see oxygen as a high priority for three reasons: the moral obligation to flatten the COVID-19 curve; oxygen as a “national security” issue in moments of crisis; and finally, oxygen as a high-return health investment that will keep on saving lives beyond the pandemic. “When hospitals run out of oxygen, we have seen strikes and civil unrest in quite a few low- and middle-income countries,” she pointed out. “How many more deaths before this is over will largely depend on access to oxygen and critical care in the countries where the disease is greatest and the health systems are weakest,” she declared. Image Credits: Mstyslav Chernov/ Wikimedia Commons, UNICEF/Ralaivita, PATH, Every Breath Counts . Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. 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Ukraine’s ‘Model’ TB Programme Destroyed by War, as Global TB Response Faces ‘Disastrous’ Funds Shortfall 22/03/2022 Kerry Cullinan & Elaine Ruth Fletcher Yana Terleeva, head of the Ukranian Ministry of Health’s TB programme Speaking in her car from an undisclosed location somewhere in war-torn Ukraine, Yana Teerleva, head of TB in the country’s Ministry of Health, lamented the destruction that she is witnessing every day in hospitals and clinics – including the shelling of three huge dispensaries where the country had stockpiled sufficient TB medications for the remainder of 2022. This month, Teerleva had been planning to implement an innovative new TB treatment regimen to further step up the national response to its drug resistant TB burden – which TB control officials in Geneva had praised as a model. “Instead we are dealing with the Russian invasion and discussing military hardware”, Teerleva said in a media briefing Tuesday, just ahead of World Tuberculosis Day, 24 March. Global TB experts are bemoaning the destruction of Ukraine’s innovative TB programme, which had made significant progress in addressing the country’s high burden of multi-drug resistant TB (MDR-TB) over the past 15 years. Meanwhile, with global TB funding well below needs, prospects of meeting the UN Sustainable Development Goal target for ending the TB epidemic by 2030 look increasingly dim, Lucica Ditui, executive director of the Geneva-based STOP TB Partnership, told Health Policy Watch in an interview. “This gives us very little chance of meeting the UN 2030 targets,” she said. Model programme now in ashes – literally Almost one-third of Ukraine’s TB cases are drug-resistant, and last year the country diagnosed and treated 24,000 people with TB, including almost 5,000 people with MDR-TB. But the Ukrainian government had been “extremely committed” to addressing TB over the past two to three years, paying for new drugs and diagnostics and building strong relationships with civil society organisations, Ditiu told Health Policy Watch. “The country did a lot to improve their health system. It is devastating to see these bombs destroying everything. These are losses that will take decades to regain.” A doctor shows Oleg Chutvatov, who was receiving TB treatment at the hospital in Kharkiv, an x-ray photo of his lungs in July 2021. The city is now under heavy attack from the Russian invasion. Over the past 15 years, Ukraine had significantly reduced its TB cases from over 127 cases per 100 000 people in 2005 to just 42.2 cases per 100 000 people in 2020. Just before the war, says Ditiui, “The country was paying for their own TB drugs as well as diagnostics – and they had secured enough to treat and diagnose everyone in need in Ukraine. “They were very keen to implement new tools like rapid molecular diagnosis, as well as new drugs. They had cohorts of people enrolled in studies for new TB treatments. Collaboration between public health officials, civil society and communities also was very good.” The gains in TB treatment were part of a broader health sector reform that had been underway, Ditiu added, saying: “What I am really upset about is that the country did a lot to improve their health system, their hospitals, to do health sector reform. To see these bombs destroying everything. These are losses that will take decades to regain.” “Ukraine was always at the forefront of the fight against tuberculosis,” Teleeva told the Stop TB briefing Tuesday. “We wanted Ukraine and the entire world to be free from the TB and for that, we have done everything possible.” However, she said that according to health ministry information, “more than 135 hospitals in Ukraine have been shelled by the Russian aggressors”, including “three huge regional anti-tuberculosis dispensaries” and the country’s health infrastructure “is not working”. WHO has confirmed some 60 attacks on hospitals and other health facilities. Appeal to combat stigma – among the war’s knock-on effects Both Ditiu and Teeleva stressed the need to focus now on countering the knock-on effects of the war – including how to treat internally displaced people, how to ensure people fleeing can continue their medications, and how to combat stigma that refugees elsewhere may encounter. “We worked to overcome the stigma discrimination of these people living with TB”, Teleeva said, of the pre-war period. She appealed to neighbouring countries that have a much lower burden of TB disease not to stigmatise Ukrainian refugees. “TB is very sensitive, and if we broadcast information about its uncontrolled spread, we will stigmatize people who are already stigmatized, for people who are already in a very difficult situation,” said Terleeva. Ditiu acknowledged that it’s very likely the war will lead to a higher level of TB cases -particularly inside Ukraine itself. “We’ll see an increase in TB, in drug-resistant TB and in mortality,” she predicted, “because people will be staying close together in shelters, in crowded places, with bad food and stress.” However, she said good tracking and surveillance by countries that receive refugees can help counter any spillover effect, beyond the borders. ‘Stupid war’ Romania’s Health Minister, Prof Alexandru Rafila Decrying the “stupid war”, Romania’s Health Minister, Professor Alexandru Rafila, told the briefing that his country was doing everything it could to assist the refugees that had fled across the 600km border with his country, including identifying and ensuring treatment for TB patients. As a country with a relatively high burden of TB itself, Romania has “a network of TB hospitals and TB ambulatory care centres where we can perform rapid diagnosis and treat Ukrainian patients if they are resistant or need to initiate treatment”, added Rafila. The Global Fund has also provided Romania with additional Gene Xpert rapid testing machines and TB medication to assist Ukranian patients, the health minister added. However, while Romania and Moldova had “some capacity” to deal with TB, Ditiu warned that Poland is in a different category – precisely because its own burden is quite low. “Poland is not a country with a lot of TB – so I’m not sure how well the network will be able to deal with it – even though the doctors certainly have a lot of knowledge”. In addition, prices of TB medication in both Romania and Poland are up to ten times higher than in Ukraine, as both countries are part of the European Union and pay EU prices for drugs that Ukraine was able to procure through the Global Fund, Ditiu added. “We are having a conversation with the Global Fund to see how we can lower the cost,” she added. TB civil society trying to locate patients Olya Klymenk, head of TB People Ukraine, a network of over 70 organisations, said that her organisation was doing its best to locate displaced patients who have fled their homes or their communities, and offer them humanitarian aid, including food. “We are trying to take care of the patients who are out of the hospital right now because we understand that, without social support, they will not have a good life,” said Klymenk. Teleeva stressed that in the emergency the primary need is to, “focus on ensuring patients know where to go and have a desire to continue treatment. “They have to be assured there is a reason to live, that they will go back to Ukraine, and they have to be healthy to help us rebuild. They need this optimism, to have this desire to live and continue living.” ‘Pathetic’ investment in TB Dr Lucica Ditiu, Executive Director of the Stop TB Partnership Meanwhile, Ditiu lamented that “investments in TB are pathetically low” – perhaps because 90% of the disease burden is in lower-income countries. “In 2020, we had $1.9 billion [in] domestic investments, which is very very, very little,” she said, referring to national governments’ own contributions to beating TB. In addition, “The Global Fund, which is a big donor for TB, gave around $800 million, which is completely insufficient.” Stop TB estimates that $19.6 billion per year will be needed over the next eight years for TB prevention and care, and $4 billion per year will be required for research and development (R&D) of the new diagnostics, medicines and vaccines needed to end TB. This represents about four times what is currently available for the TB response (in 2020, $5.3 billion was available for care and prevention and $0.9 billion for R&D). The year 2022 is critical for the global fight to end TB as the world faces a fast-running countdown to reaching the 2018 United Nations High-Level Meeting (UNHLM) TB targets, which the international community agreed to meet by the end of December. All projections show that the world is not on course to meet the UNHLM treatment targets set for 2022. “We simply cannot continue to stand on the sidelines and watch while people around the world fall ill and die from a preventable and treatable disease,” said Ditiu. “We also cannot continue to accept what we accepted for years—every year having less than 40% of the funding need for the TB response. Now we are facing a disastrous funding shortfall, bigger than what we had expected. We not only need to step up efforts to meet targets set at the 2018 United Nations High Level Meeting on TB,” she said, referring to the UN pledge to accelerate progress toward the 2030 targets, “but the TB response must also recover from the devastating impacts of the COVID-19 pandemic.” Image Credits: The Global Fund / Evgeny Maloletka. ‘There is No Safe Place in Ukraine’ 21/03/2022 Kerry Cullinan Ukrainian child with his dog -displaced by war, in a refugee camp on the Moldova-Ukranian border There have been 52 attacks on Ukrainian health facilities in the past 25 days, more than two every day, according to the World Health Organization (WHO). Meanwhile, the health of fleeing refugees, their impact on the health services of neighbouring countries, and the fate of Ukraine’s tuberculosis patients are foremost on healthcare providers’ minds. “In less than a month, over three million people have left the country and nearly two million have been internally displaced,” said Jarno Habicht, WHO’s Representative in Ukraine. “This has happened faster than in any previous European crisis. There is no safe place in Ukraine right now, yet we need to ensure that health services are available.” “The military offensive continues, with a number of cities being entirely isolated – people are running out of food and water, and hospitals might not have electricity,” added Habicht, who has been head of the Ukraine office since 2018. “Worse still, we have seen many attacks on health workers and health facilities as well as patients. This is happening daily and is unacceptable. So, if you ask me how to describe it, every day things are getting worse, which means every day the health response is becoming more difficult.” Jarno Habicht, WHO’s Representative in Ukraine (centre) Banned cluster munitions According to Bonnie Docherty, a senior advisor for Human Rights Watch, Russian forces have “relied heavily” on cluster munitions, which are banned in most countries in the world, and explosive weapons with wide-area effects. Cluster munitions, large bombs that contain dozens or hundreds of smaller sub-munitions, were used to attack a hospital in Vuhledar on 24 February in which four civilians were killed, and 10 people including six healthcare workers were injured, wrote Docherty in the online security news outlet, Just Security, on Monday. Unexploded, the submunitions can lie dormant like landmines, exploding months and years later when picked up by children or farmers, she explains. However, artillery shells, mortars, rockets, missiles, and enhanced blast (thermobaric) weapons, and aerial bombs, have caused the bulk of the damage in Ukraine, adds Docherty. Concern for drug-resistant TB patients On the eve of World Tuberculosis Day on Thursday, WHO TB experts also expressed concern for Ukrainian TB patients, particularly those with drug-resistant TB. “Ukraine is one of the 18 high-priority countries in the WHO European region for TB and is on the global list for having a high burden of multidrug-resistant tuberculosis,” Dr Askar Yedilbayev, WHO Europe’s Regional TB advisor, told a media briefing on Monday. Dr Askar Yedilbayev “Before the war, Ukraine was one of the pioneering countries in response to TB and drug-resistant TB in the WHO European region,” he added. “However, destroyed health infrastructure, including limited access to TB treatment and public health services, is affecting the provision of essential tuberculosis services, causing significant delays in diagnosis of TB, affecting initiation of TB preventive treatment, and treatment of active TB and MDR TB,” he added. Shortly before the war, all TB medication had been distributed to regional warehouses and patients had been given one or two months’ supply of medicine, he added. But some of these warehouses had been damaged or were under threat of damage, and there was a need for the “emergency redistribution of procurement of medicines to ensure continuity of treatment”. In addition, as Ukraine’s neighbours did not have the same burden of TB disease, they were unlikely to have the medicine to treat large numbers of people with TB. Yedilbayev appealed for donations to the Global Fund and WHO Foundation to enable the delivery of health services to Ukrainians. Every second, a Ukrainian child becomes a refugee Every second, a Ukrainian child becomes a refugee, according to UNICEF and half of the over 3.5 million refugees estimated to have fled to neighbouring countries since 24 February are children under the age of 15. Almost two million refugees have fled to Poland, according to the WHO. “Refugees can be vulnerable to infectious diseases because of lack of health care, interrupted care in the country of origin, because of exposure to infectious infections and lack of care in transit, and if living conditions are poor in the destination country,” said Yedilbayev. Image Credits: UNICEF/UN0599222/Moldovan. As Europe Moves to Improve Mental Health Services for Children, Experts Are Concerned About Men’s Mental State 21/03/2022 Kerry Cullinan Dr Hans Kluge Mental health practitioners worldwide are warning of a massive wave of pandemic-related mental health issues that many countries are ill-equipped to address. On Monday, the World Health Organization’s (WHO) Europe office and the government of Greece launched a new European programme to strengthen and improve the quality of mental health services for children and adolescents. WHO Europe Director Dr Hans Kluge told the launch that suicide was the leading cause of death in children and adolescents aged 10 to 19 living in low- and middle-income countries in the region and that over 4000 young people in this age group had killed themselves in 2015. 🔴Suicide is the leading cause of deathamong adolescents in low & middle income countries & 2nd in high income countries in the European Region Find guidance on how to approach child & adolescent #MentalHealth as a primary health care provider here👉 https://t.co/EUoragqO0q pic.twitter.com/AOvZRIY7HR — WHO/Europe (@WHO_Europe) March 21, 2022 “Ensuring that all children and adolescents in the region have access to quality mental health services is a moral imperative,” said Kluge, adding that this was as important as childhood vaccinations. The WHO Europe programme aims to work with member states to encourage them to share knowledge and expertise about how to boost the mental healthcare of children and adolescents, and to support member countries to develop their own strategies and frameworks. It will also “develop a package of tools to measure progress against evidence-based standards”, according to the regional office. Through this new programme, WHO/Europe will continue to help countries strengthen and improve #mentalhealth services for children and adolescents, as well as developing tools to measure progress pic.twitter.com/Fspx9hh2lN — WHO/Europe (@WHO_Europe) March 21, 2022 Mental health woes of COVID-19 COVID-19 has exacerbated mental health issues and, during the first year of the pandemic, there was a 25% increase in the global prevalence of anxiety and depression, according to a WHO brief published in early March. Approximately 140,000 children in the US have lost a parent or guardian to COVID, for example, and are likely to be struggling to come to terms with this loss. “One major explanation for the increase is the unprecedented stress caused by the social isolation resulting from the pandemic. Linked to this were constraints on people’s ability to work, seek support from loved ones and engage in their communities,” according to the WHO. “Loneliness, fear of infection, suffering and death for oneself and for loved ones, grief after bereavement and financial worries have also all been cited as stressors leading to anxiety and depression. Among health workers, exhaustion has been a major trigger for suicidal thinking,” it added. Calls to South Africa’s only mental health helpline, for example, have jumped exponentially during the pandemic – from around 400 to 600 calls a day before COVID-19 to over 2400 calls a day in 2021. Psychologist Zamo Mbele, a board member of the South African Depression and Anxiety Group (SADAG) that operates the helpline, said that his non-governmental organisation, which is wholly reliant on donations, had been struggling to keep up with demand. Psychologist Zamo Mbele, a board member of the South African Depression and Anxiety Group (SADAG) Male violence and mental health “One of the reasons we’ve seen an increase in our calls is because of COVID, but one of the other reasons is because people who would not previously access health are beginning to recognise that they need help,” said Mbele. He added that “toxic” manifestations of masculinity – seen in the country’s high levels of domestic violence, road rage and substance abuse – were indications that men, in particular, needed help. “It’s not as though men only recently starting to struggle with mental difficulties or emotional difficulties,” he added. “But they are just starting to see that the expression of their difficulties is no longer functional to them or to society. It’s no longer as socially acceptable to be violent in order to deal with your depression, or to have a big temper in order to deal irritability or anxiety – or to drink excessively or to spend copious amounts of hours at the gym. “Instead, we’re beginning to recognise that actually doing a lot of these things is masking a lot of symptoms.” https://twitter.com/SkosanaDr/status/1505834397391544323 Men and suicide In the vast majority of countries, men are far more likely to commit suicide than women, which mental health practitioners say is likely to be because men find it harder to ask for help. This is a worldwide trend, captured by the WHO’s Suicide Worldwide in 2019: Global Health Estimates. The report found that South Africa has the third-highest suicide rate on the African continent. Of the 13,774 suicides reported in South Africa, 10,681 were men in 2913 were women. Russia, South Korea, the US and Japan also have high suicide rates, particularly amongst men. However, while there has been an increase in suicidal thoughts during the pandemic, there has not been a global increase in actual suicides – with notable exceptions, such as Austria, and Japan (although there is very little information from LMICs). Mass Polio Vaccination Drive to Administer More Than 80 Million Doses to Southern African Children in Five Countries 18/03/2022 Raisa Santos Polio vaccinate campaign to target children under 5 across five southern African countries. Malawi is launching a mass vaccination campaign against wild poliovirus type 1, which is to extend to 23 million children across five southern African countries, WHO said on Friday. The campaign, to kick off Sunday, follows Malawi’s declaration of a polio outbreak on 17 February – three months after the first polio virus case in 30 years was identified in a young child in Lilongwe. The case was the first in Africa since the region was certified free of indigenous wild poliovirus in 2020. WHO said that the region’s certification as wild polio-free remains unchanged, as the wild poliovirus strain identified had been “imported” from Pakistan. So far, no clear explanation of how the Asian virus strain may have infected an African child who had never traveled outside of the country, has been provided by WHO or Malawi health authorities. Nor has there been any explanation of why it took three months between the time the child was diagnosed and the outbreak was formally declared by WHO. But the breadth of the new campaign makes it clear the incident has been perceived as a major threat to Africa’s wild polio virus free status – with risks of subtle, silent transmission of the virus much more widely, via contaminated water and sewage, food, or human-to-human contact. Malawi has since set up an environmental surveillance system for poliovirus in 11 cities across four sites, including the Lilongwe District that encompasses the capital Lilongwe, where the initial, and so far only reported case, was detected, WHO said. Asked by Health Policy Watch whether traces of the wild polio virus had also been identified in sewage sources, through the environmental surveillance, WHO did not reply as of publication time. Targeting children across four countries – then Zimbabwe More than 80 million doses will be administered to more than 23 million children under 5 years in a four-round vaccination campaign in five southern African countries, WHO said. The first phase of the campaign, beginning this month, will target 9.4 million children across Malawi, Mozambique, Tanzania, and Zambia. Three subsequent rounds – with Zimbabwe joining the campaign- are set for April, June, and July, and aim to reach more than 23 million children with more than 80 million doses of the bivalent Oral Polio Vaccine recommended by the World Health Organization (WHO). “Polio is a highly infectious and an untreatable disease that can result in permanent paralysis. In support of Malawi and its neighbours, we are acting fast to halt this outbreak and extinguish the threat through effective vaccinations,” said WHO Regional Director for Africa Dr Matshidiso Moeti. “The African region has already defeated wild poliovirus due to a monumental effort by countries. We have the know-how and are tirelessly working to ensure that every child lives and thrives in a continent free of polio.” Single case of polio in Malawi linked to Pakistan strain Pakistan is one of two countries where polio remains endemic. Laboratory analysis has linked the strain detected in Malawi to the one circulating in Pakistan’s Sindh Province in 2019. In addition to environmental surveillance, WHO has also been supporting the country to reinforce response measures including risk assessment, and preparations for the vaccination campaigns. A surge team from WHO is working with country-based counterparts, partner organizations, and the government to end the outbreak. The WHO team is a part of a broader multi-partner Global Polio Eradication Initiative to support the country. In an unrelated event, a vaccine-directed case of polio was also identified in February by Israeli authorities in Jerusalem, also for the first time in 30 years. The infected child is part of an ultra-orthodox Jewish community in which vaccination rates hover at around 50% or less. A vaccination drive also was launched in the city. Polio, a viral disease with no cure, can invade the nervous system and can cause total paralysis within hours, particular among children under 5 years. The virus is transmitted from person to person, mainly through contamination by fecal matter or, less frequently, through contaminated water or food, and multiplies in the intestine. While there is no cure for polio, the disease can be prevented through administration of a vaccine. Image Credits: Sanofi Pastuer/Flickr, Sanofi Pastuer/Flickr. UN Environment Programme Joins WHO Alliance to Advance One Health Approach 18/03/2022 Editorial team Safer and more sustainable food systems – from production to sales in food markets is key to a One-Health Approach. UN Environment has joined a three-way alliance with the Food and Agriculture Organization, the World Animal Health Organization (OIE), and WHO to advance “One-Health” solutions to both ecosystem degradation and pandemic threats, leaders of the four agencies said on Friday. The statement followed a meeting this week of the Tripartite FAO, WHO and OIE partnership – which now has become a “Quadripartite”. “The One Health approach aims to sustainably balance and optimize the health of people, animals, ecosystems and the wider environment,” said WHO in a press release. “It mobilizes multiple sectors, disciplines and communities to work together to foster well-being and tackle threats to health and ecosystems. And it addresses the collective need for clean water, energy and air, safe and nutritious food, action on climate change, and contributing to sustainable development.” The work of the newly expanded alliance will be focused on a One Health Joint Plan of Action, which includes six main action tracks: enhancing countries’ capacity to strengthen health systems under a One Health approach; reducing the risks from emerging or resurfacing zoonotic epidemics and pandemics; controlling and eliminating endemic zoonotic, neglected tropical or vector-borne diseases; strengthening the assessment, management and communication of food safety risks; curbing the silent pandemic of antimicrobial resistance (AMR) and better integrating the environment into the One Health approach. Increased awareness of One Health As the world enters the third year of the COVID-19 pandemic, with an estimated cost of $8 to 16 trillion, there is increased awareness and broad recognition of the importance of One Health as a long-term, viable and sustainable approach. The G7, G20 and UN Food Systems Summit have all given a nod to the approach, along with the increased references by WHO and its partners. But the hard work of reforming food systems, from production to markets, as well as halting related deforestation and ecosystem destruction, are much more formidable challenges that the organisations have barely begun to face. Last year saw the Tripartite implement a number of initial initiatives, including on antimicrobial resistance, a One Health High-Level Expert Panel, and guidance on better management – but not the banning – of wild animal sales in markets – in the wake of the COVID pandemic, whose origins may have emerged from the capture, transport and slaughter of SARS-CoV2 infected wild animals at the Wuhan, China market. Plan implementation the key challenge “Now the challenge is implementation: how do we translate our work on the ground to support our Members? And how do we mobilize funding and financing mechanisms to support the Joint Plan for Action?” said FAO Director QU Dongyu, handing over the chair of the Secretariat to WHO. WHO Director-General Tedros Adhanom Ghebreyesus, said: “We need to build a more comprehensive and coordinated One Health governance structure at global level. We need a strong workforce, committed political will, and sustained financial investment. We need to develop a more proactive way of communicating and engaging across sectors, disciplines and communities to elicit the change we need.” (WHO) Image Credits: Michael Casmir/Pierce Mill Media. Healthy Mouths, Healthy Planet 18/03/2022 Ihsane Ben Yahya, Nicolas Martin & Steven Mulligan Dental procedures produce a hefty amount of carbon emissions. In honour of World Oral Health Day, 20 March, three leading voices from the World Dental Federation highlight the unexpected linkages between the health of your mouth and that of the planet. It will come as a surprise to most people that the healthcare sector has a significant environmental impact. Healthcare systems are responsible for around 5% of global greenhouse gas emissions, of which oral healthcare is an important contributor. Indeed, if the healthcare sector was a country, it would be the fifth largest greenhouse gas emitter on the planet. Oral healthcare contributes to this environmental burden with air pollution arising from the release of CO2 associated with travel and transport, the incineration of waste, the greenhouse gas impact of anesthetic gases such as nitrous oxide and the high consumption of water. Specific to dentistry, the most routine procedures, all come with a hefty carbon price tag. Tooth-coloured fillings for instance, produce around 15 kilograms of CO2eq (carbon dioxide equivalent) per procedure, according to Public Health England, whose National Health Service has done some of the most extensive carbon footprint modeling of healthcare delivery in the world. A single root canal treatment, meanwhile, produces 23 kilograms of CO2eq, dentures between 58 and 71 kilograms CO2eq. Use of the anesthetic gas nitrous oxide (laughing gas), in a procedure, meanwhile, is responsible for 119 kilograms CO2eq. Nitrous oxide N2O, the most commonly used inhalation dental anesthetic, is a greenhouse gas with far more climate warming potential than CO2. Just one kilogram of nitrous oxide is equivalent to 298 kilogrammes of CO2 and 25 kilograms of methane – another powerful greenhouse gas. Meanwhile, silver amalgam fillings contain mercury. While more and more rarely used today, and still considered safe for dental treatments, there is an environmental impact through the release of residual mercury into sewage during procedures, as well as throughout its life cycle. Prevention is better than cure Ways to maintain good oral health. The dental industry has a collective responsibility to reduce these impacts – while also expanding access to oral healthcare. How can we do both? One simple solution is to look at how we can best minimize what we might label as “avoidable” oral procedures. Prevention is always better than cure and it is the most impactful and practical way of reducing the need for clinical interventions and their associated environmental impacts. This is best achieved through the promotion of good oral hygiene, a healthy diet and the avoidance of smoking. When treatment is required, oral healthcare also should focus on the provision of durable fillings, using high quality products and materials that will last longer and/or require fewer replacements. Legislation around water fluoridation for instance, complemented by targeted public health policies can help prevent tooth decay (caries) and ultimately cavities. The recent banning of TV and online advertising of junk food in the UK before 9pm is an indirect example of encouraging better diet. So too the campaign by UK footballer Marcus Rashford to promote healthier school lunches. At the same time, while many dental problems such as caries and periodontal (gum) disease are common preventable diseases, no amount of prevention can make them go away entirely. There will always be a need for accessible dental check-ups and treatments to facilitate good oral health. And it remains important to expand access to such treatments among disadvantaged groups as well as in many low- and middle-income countries so as to reduce inequalities in healthcare provision. Less trips to the dentist would also mean less travel and water consumption Dental procedures require a lot of water, which can be reduced by practicing good oral healthcare. Oral healthcare has higher levels of patient and staff transport than other medical specializations and this is partly due to the need for regular oral health maintenance, whereas other specializations tend only to treat illness. In the UK for instance, staff and patient commuting and travel accounts for approximately two thirds of all emissions from the oral healthcare sector and about eight per cent of the total UK NHS air pollution attributable to travel. This can be reduced significantly, through the maintenance of good oral health, that requires fewer interventions and consequently fewer trips to the dentist. Simple transport habit changes can have a great impact. For example, in October 2021 the Sustainability Committee at Harvard School of Dental Medicine (HSDM) implemented a `Step Challenge´ that encouraged staff, students and faculty to walk, or take public transport rather than drive during that month. They amassed over one million steps in total, preventing the release of approximately 0.28 metric tons of CO2. The practice of dentistry and personal oral healthcare is a significant consumer of water. As a conservative estimate, a bathroom tap delivers about four litres/minute. If we estimate that half the world population cleans their teeth once a day and runs the tap for one minute, the daily global water usage equates to 6,400 Olympic swimming pools. This figure is in addition to undocumented water consumption up and down the oral healthcare manufacturing and distribution supply chain. Reducing dental use of single use plastics and packaging Measures to reduce carbon footprint in dental offices. So what measures can be taken at the dentist office to reduce the carbon footprint of dentistry procedures that are nonetheless essential to good oral health? The use and consequent disposal of single use plastics for many procedures is one of the biggest contributors to the environmental footprint of healthcare generally – and that holds true for dentistry as well. Among single-use plastics, in fact it is the packaging in which the needles, gloves and other oral healthcare products are encased that is the single largest contributor to such waste in the dental industry, with over 90 % ending its life cycle in an incinerator or a landfill. A more thoughtful approach to the design of such packaging – from the plastics content, manufacture and transport, to the potential for reuse, recycling or biodegradability, is therefore one obvious starting point in reducing the carbon footprint of the typical dentist’s office. This is particularly important because packaging, as such, is not “contaminated” biomedical waste that needs special treatment, post-procedure. This requires greater engagement with consumers and waste management companies to segregate, collect and recycle uncontaminated clinical single use plastics (SUPs) as a valuable commodity. It also involves the design and development of more plastic items made from mono-polymer plastics that can be readily recycled. The Flexible Plastics Consortium which represents 34 European companies looking for better plastics content and design solutions for packaging is a good example of how this might work in practice. The United Kingdom’s Plastics Pact is another good example: it has set targets with the goal of 100% of plastic packaging to be reused, recycled or compostable by 2025. Major challenges in managing single use plastic waste from oral healthcare Many single use dental items end up in the waste bin, including gloves, aprons, masks. Once the box is opened, many of the everyday products used in dentistry are only briefly used and then end up in the waste bin. These single-use plastic (SUP) items range from personal protective equipment (aprons, gloves and masks) and other disposable sundries (the mouth-rinse cup or the dental suction tube). SUP biomedical waste requires more specialized management – since these are contaminated with blood and other bodily fluids from oral health procedures. The high safety and quality requirements for these products to be legally compliant, is often incompatible with recycling and materials recovery. The complex nature of items assembled from different plastics also makes recycling difficult, as does the prevailing view that plastic is simply waste and is not considered a valuable resource. Still there are many attempts at finding solutions around the world. These include incentivization schemes and professional education courses that can help manufacturers to design products that can be safely treated and reprocessed, as well as sensitizing dental practitioners to different waste streams, and the treatment they require. Initiatives like the development of a competency-based dental waste management course being undertaken at the Copperbelt University in Zambia are a step in the right direction. Even so, the lack of good technological solutions for the appropriate collection, disinfection/sterilization and subsequent recovery or reprocessing of single use plastics used in biomedical procedures remains an ongoing barrier. We need product research to come up with safe, sustainable solutions for a circular economy, including in the healthcare sector, and governments to adopt supportive policies. Assessing the environmental impacts of oral healthcare as a first step It is important to understand the environmental impacts of materials used in healthcare. A better understanding of the environmental impacts of products and materials used in healthcare systems, from procurement to disposal, is key to any of these measures. Solutions proposed have included more life cycle analysis for all materials used in the healthcare supply chain and the development of a credible ‘sustainability index’ to inform medical supply purchasers about the sustainability credentials of a product. The index could potentially include information on environmental sourcing, ethical manufacturing, supply chain distribution and procurement. This World Oral Health Day we can celebrate the fact that the oral health sector has recognised that it has a vital role to play in healthcare-related climate change mitigation. That is the first step. The next ones will be more challenging and will need ‘teeth’. The FDI World Dental Federation´s Code of Good Practice, which is to be launched later this year, following an extensive consultation with the sector, will be a good starting point for ensuring healthy mouths also help to produce a healthier planet. Steven Mulligan Nicolas Martin Ihsane Ben Yahya Ihsane Ben Yahya is the President of the FDI World Dental Federation and professor at the Dental University in Casablanca, Morocco. Nicolas Martin is the Chair of the FDI Sustainability in Dentistry Task Team. He is also Clinical Professor in Restorative Dentistry in the School of Clinical Dentistry, at the University of Sheffield, UK. Steven Mulligan is a Member of the FDI Sustainability in Dentistry Task Team. He is also a Clinical Lecturer in Restorative Dentistry in the School of Clinical Dentistry, at the University of Sheffield, UK. Image Credits: Mass Communication Specialist Seaman Apprentice Brian H. Abel/Flickr, FDI World Dental Federation , Jan Fidler/Flickr, World Dental Federation , Mass Communication Specialist 3rd Class Everett Allen/Flickr. From COVID to Humanitarian Crises – Medical Oxygen Needs More Prioritization for its Lifesaving Capacities 17/03/2022 Raisa Santos Lifesaving oxygen flows into the lungs of a COVID patient in Chernivtsi, southwest Ukraine before the start of the recent Russian invasion. Whether its due to COVID or conflict, oxygen supplies fall short in many parts of the world. From patients lying in the parking lots of hospitals, in the back seats of cars suffocating as their family members searched frantically for oxygen in India during its second wave of COVID last year, to the inability to receive emergency care amidst constant bombing and shelling in current war-torn Ukraine, global health experts and leaders are desperately searching for ways of improving the global oxygen supply. At a media briefing on the issue Thursday, speakers emphasized the need for both access to oxygen on the ground and more funding to the WHO co-sponsored Access to COVID-19 Tools Accelerator (ACT-A), which is attempting to beef up oxygen supplies in low and middle-income countries. “Oxygen has been treated for too long like a commodity, treated as something that must be delivered,” said WHO Executive Director of Health Emergencies Programme Dr Mike Ryan, speaking at the briefing, cosponsored by the Act Acccelerator and Unitaid. But “oxygen is a capability, not a commodity,” he stressed. Rethinking oxygen’s lifesaving capacities Mike Ryan, Executive Director, Health Emergencies Programme; World Health Organization Ryan and others made the case for rethinking oxygen as a health tool that requires not only a sustainable supply at a country level, but an entire ecosystem of supply and maintenance technology and infrastructure. Its role – and the chronic lack of capacity in many countries – has been underscored by COVID – and again in the very different setting of the Ukraine crisis – where the lack of access for people ranging from COVID patients to mothers in birth and children with pneumonia has prompted widespread alarm. Oxygen remains a critical component of the global COVID-19 response – 75% of patients hospitalized for COVID-19 can be treated with oxygen alone – without any further advanced care. Yet the current global supply of oxygen does not meet needs for both COVID-19 and other serious illnesses. “COVID didn’t cause [the oxygen shortage], COVID uncovered this. COVID laid bare, tore away the bandages from some very old wounds,” said Ryan. UNITAID Commits $56 million to boost access to global medical oxygen supply Robert Matiru, Chair, ACT-A Oxygen Emergency Taskforce & Director Programmes, Unitaid The ACT-A Strategic Plan and Budget for 2022 has identified a funding deficit of $1 billion for oxygen supplies worldwide for this year alone. As a first step to closing that gap, Unitaid has announced that it will invest $56 million to increase access to medical oxygen both for short-term needs related to COVID-19 as well as for the longer term – as a critical foundation for fighting future pandemics. The Unitaid pledge builds on the $50 million USAID has committed in funding for oxygen as pledged at US President Joe Biden’s Global COVID-19 Summit in September 2021. Four Unitaid-funded projects, designed to address global inequities in oxygen access, will be implemented by The Alliance for International Medical Action (ALIMA), the Clinton Health Access Initiative (CHAI), Partners in Health (PIH), and the WHO Health Emergencies Programme. These will also support the work of the ACT-A Oxygen Emergency Task Force by ensuring access to more affordable oxygen solutions such as bulk liquid oxygen, oxygen generation systems, and other important oxygen equipment. Unitaid called on donors, including governments, foundations, and private sector partners to join in the efforts. “Our call here is not just for the present, for this pandemic, but to recognize that donors and funders that come forward and step forward, over and above the generous contributors to date, will help drive a more sustainable ecosystem and [deliver] essential medicines to countries that are lacking it,” said Robert Matiru, Chair of the ACT-A Oxygen Emergency Taskforce and Director of Programmes at Unitaid. Children with pneumonia unrecognized victims – 40% of hospitals in some African countries lack oxygen Numerous countries are facing oxygen shortages, while readily available oxygen products are in short supply. Children are among the unrecognized victims of the lack of oxygen supplies – with childhood pneumonia still one of the biggest killers of under-fives. Accounting for almost a million deaths a year, the highest burden is in sub-Saharan African and South-East Asian countries where children face a double whammy of disease from both the lack of preventive treatments, like vaccinations, along with exposure to heavy indoor air pollution from the open burning of coal, biomass and other such fuels. But an estimated 20 to 40% of these deaths are preventable with increased availability of oxygen therapy. The shortage is particularly acute in low-income sub-Saharan African countries such as Tanzania, Sierra Leone, Liberia, and Gambia, where 40% of health facilities had no access to oxygen and other basic life saving supplies, said Atul Gawande of the United States Agency for International Development (USAID). COVID has led to big surges in needs Daily medical oxygen need for COVID-19 as of 16 March 2022 Along with the chronic shortages, COVID led to a major surge in oxygen needs. Low and middle-income countries (LMICs) need at least 23 million cubic meters of oxygen every day, just to treat COVID patients alone, according to the PATH COVID-19 Oxygen Needs Tracker. On the brighter side, the pandemic has brought a long-ignored aspect of health capacity in LMICs more to the forefront. USAID is currently working in 11 countries to build ‘oxygen ecosystems’ to support oxygen therapy for pneumonia patients, COVID patients, and others, Gawande said. Countries like Ghana now have oxygen generating capacity that can support up to 300,000 patients per day, per year. Gawande noted that the oxygen ecosystem includes liquid oxygen cylinders and concentrators, as well as the clinical engineering and technical assistance to use the technology. But expanding this initiative to other countries still needs more funding. Atul Gawande, USAID “As the Omicron variant abates, I think we’re all starting to feel that we can catch our breath. Oxygen demand may be lower right now. But it is the time that we have to make these investments to enable this kind of [sustainable] capacity.” Gawande said. Oxygen ‘natural security’ and ‘high-return’ health investment Leith Greenslade, Founder/CEO, JustActions & Coordinator, Every Breath Counts Coalition While the recent funding commitments are a positive sign, ‘it is not enough to fund protection’, said Leith Greenslade of the Every Breath Counts Coalition. “It took a pandemic of respiratory infection to wake up the world,” she pointed out. In the past year, about $700 million was invested into the ACT-A Oxygen Emergency Task Force, which has worked in LMICs to prevent oxygen shortages – jump-starting a more focused response. But so far, only a handful of governments – including the United States, Germany, Canada, and France – have borne the funding burden. “But most of the G-20 nations have not stepped up to invest in oxygen,” she charged. Greenslade appealed to donors to see oxygen as a high priority for three reasons: the moral obligation to flatten the COVID-19 curve; oxygen as a “national security” issue in moments of crisis; and finally, oxygen as a high-return health investment that will keep on saving lives beyond the pandemic. “When hospitals run out of oxygen, we have seen strikes and civil unrest in quite a few low- and middle-income countries,” she pointed out. “How many more deaths before this is over will largely depend on access to oxygen and critical care in the countries where the disease is greatest and the health systems are weakest,” she declared. Image Credits: Mstyslav Chernov/ Wikimedia Commons, UNICEF/Ralaivita, PATH, Every Breath Counts . Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. 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‘There is No Safe Place in Ukraine’ 21/03/2022 Kerry Cullinan Ukrainian child with his dog -displaced by war, in a refugee camp on the Moldova-Ukranian border There have been 52 attacks on Ukrainian health facilities in the past 25 days, more than two every day, according to the World Health Organization (WHO). Meanwhile, the health of fleeing refugees, their impact on the health services of neighbouring countries, and the fate of Ukraine’s tuberculosis patients are foremost on healthcare providers’ minds. “In less than a month, over three million people have left the country and nearly two million have been internally displaced,” said Jarno Habicht, WHO’s Representative in Ukraine. “This has happened faster than in any previous European crisis. There is no safe place in Ukraine right now, yet we need to ensure that health services are available.” “The military offensive continues, with a number of cities being entirely isolated – people are running out of food and water, and hospitals might not have electricity,” added Habicht, who has been head of the Ukraine office since 2018. “Worse still, we have seen many attacks on health workers and health facilities as well as patients. This is happening daily and is unacceptable. So, if you ask me how to describe it, every day things are getting worse, which means every day the health response is becoming more difficult.” Jarno Habicht, WHO’s Representative in Ukraine (centre) Banned cluster munitions According to Bonnie Docherty, a senior advisor for Human Rights Watch, Russian forces have “relied heavily” on cluster munitions, which are banned in most countries in the world, and explosive weapons with wide-area effects. Cluster munitions, large bombs that contain dozens or hundreds of smaller sub-munitions, were used to attack a hospital in Vuhledar on 24 February in which four civilians were killed, and 10 people including six healthcare workers were injured, wrote Docherty in the online security news outlet, Just Security, on Monday. Unexploded, the submunitions can lie dormant like landmines, exploding months and years later when picked up by children or farmers, she explains. However, artillery shells, mortars, rockets, missiles, and enhanced blast (thermobaric) weapons, and aerial bombs, have caused the bulk of the damage in Ukraine, adds Docherty. Concern for drug-resistant TB patients On the eve of World Tuberculosis Day on Thursday, WHO TB experts also expressed concern for Ukrainian TB patients, particularly those with drug-resistant TB. “Ukraine is one of the 18 high-priority countries in the WHO European region for TB and is on the global list for having a high burden of multidrug-resistant tuberculosis,” Dr Askar Yedilbayev, WHO Europe’s Regional TB advisor, told a media briefing on Monday. Dr Askar Yedilbayev “Before the war, Ukraine was one of the pioneering countries in response to TB and drug-resistant TB in the WHO European region,” he added. “However, destroyed health infrastructure, including limited access to TB treatment and public health services, is affecting the provision of essential tuberculosis services, causing significant delays in diagnosis of TB, affecting initiation of TB preventive treatment, and treatment of active TB and MDR TB,” he added. Shortly before the war, all TB medication had been distributed to regional warehouses and patients had been given one or two months’ supply of medicine, he added. But some of these warehouses had been damaged or were under threat of damage, and there was a need for the “emergency redistribution of procurement of medicines to ensure continuity of treatment”. In addition, as Ukraine’s neighbours did not have the same burden of TB disease, they were unlikely to have the medicine to treat large numbers of people with TB. Yedilbayev appealed for donations to the Global Fund and WHO Foundation to enable the delivery of health services to Ukrainians. Every second, a Ukrainian child becomes a refugee Every second, a Ukrainian child becomes a refugee, according to UNICEF and half of the over 3.5 million refugees estimated to have fled to neighbouring countries since 24 February are children under the age of 15. Almost two million refugees have fled to Poland, according to the WHO. “Refugees can be vulnerable to infectious diseases because of lack of health care, interrupted care in the country of origin, because of exposure to infectious infections and lack of care in transit, and if living conditions are poor in the destination country,” said Yedilbayev. Image Credits: UNICEF/UN0599222/Moldovan. As Europe Moves to Improve Mental Health Services for Children, Experts Are Concerned About Men’s Mental State 21/03/2022 Kerry Cullinan Dr Hans Kluge Mental health practitioners worldwide are warning of a massive wave of pandemic-related mental health issues that many countries are ill-equipped to address. On Monday, the World Health Organization’s (WHO) Europe office and the government of Greece launched a new European programme to strengthen and improve the quality of mental health services for children and adolescents. WHO Europe Director Dr Hans Kluge told the launch that suicide was the leading cause of death in children and adolescents aged 10 to 19 living in low- and middle-income countries in the region and that over 4000 young people in this age group had killed themselves in 2015. 🔴Suicide is the leading cause of deathamong adolescents in low & middle income countries & 2nd in high income countries in the European Region Find guidance on how to approach child & adolescent #MentalHealth as a primary health care provider here👉 https://t.co/EUoragqO0q pic.twitter.com/AOvZRIY7HR — WHO/Europe (@WHO_Europe) March 21, 2022 “Ensuring that all children and adolescents in the region have access to quality mental health services is a moral imperative,” said Kluge, adding that this was as important as childhood vaccinations. The WHO Europe programme aims to work with member states to encourage them to share knowledge and expertise about how to boost the mental healthcare of children and adolescents, and to support member countries to develop their own strategies and frameworks. It will also “develop a package of tools to measure progress against evidence-based standards”, according to the regional office. Through this new programme, WHO/Europe will continue to help countries strengthen and improve #mentalhealth services for children and adolescents, as well as developing tools to measure progress pic.twitter.com/Fspx9hh2lN — WHO/Europe (@WHO_Europe) March 21, 2022 Mental health woes of COVID-19 COVID-19 has exacerbated mental health issues and, during the first year of the pandemic, there was a 25% increase in the global prevalence of anxiety and depression, according to a WHO brief published in early March. Approximately 140,000 children in the US have lost a parent or guardian to COVID, for example, and are likely to be struggling to come to terms with this loss. “One major explanation for the increase is the unprecedented stress caused by the social isolation resulting from the pandemic. Linked to this were constraints on people’s ability to work, seek support from loved ones and engage in their communities,” according to the WHO. “Loneliness, fear of infection, suffering and death for oneself and for loved ones, grief after bereavement and financial worries have also all been cited as stressors leading to anxiety and depression. Among health workers, exhaustion has been a major trigger for suicidal thinking,” it added. Calls to South Africa’s only mental health helpline, for example, have jumped exponentially during the pandemic – from around 400 to 600 calls a day before COVID-19 to over 2400 calls a day in 2021. Psychologist Zamo Mbele, a board member of the South African Depression and Anxiety Group (SADAG) that operates the helpline, said that his non-governmental organisation, which is wholly reliant on donations, had been struggling to keep up with demand. Psychologist Zamo Mbele, a board member of the South African Depression and Anxiety Group (SADAG) Male violence and mental health “One of the reasons we’ve seen an increase in our calls is because of COVID, but one of the other reasons is because people who would not previously access health are beginning to recognise that they need help,” said Mbele. He added that “toxic” manifestations of masculinity – seen in the country’s high levels of domestic violence, road rage and substance abuse – were indications that men, in particular, needed help. “It’s not as though men only recently starting to struggle with mental difficulties or emotional difficulties,” he added. “But they are just starting to see that the expression of their difficulties is no longer functional to them or to society. It’s no longer as socially acceptable to be violent in order to deal with your depression, or to have a big temper in order to deal irritability or anxiety – or to drink excessively or to spend copious amounts of hours at the gym. “Instead, we’re beginning to recognise that actually doing a lot of these things is masking a lot of symptoms.” https://twitter.com/SkosanaDr/status/1505834397391544323 Men and suicide In the vast majority of countries, men are far more likely to commit suicide than women, which mental health practitioners say is likely to be because men find it harder to ask for help. This is a worldwide trend, captured by the WHO’s Suicide Worldwide in 2019: Global Health Estimates. The report found that South Africa has the third-highest suicide rate on the African continent. Of the 13,774 suicides reported in South Africa, 10,681 were men in 2913 were women. Russia, South Korea, the US and Japan also have high suicide rates, particularly amongst men. However, while there has been an increase in suicidal thoughts during the pandemic, there has not been a global increase in actual suicides – with notable exceptions, such as Austria, and Japan (although there is very little information from LMICs). Mass Polio Vaccination Drive to Administer More Than 80 Million Doses to Southern African Children in Five Countries 18/03/2022 Raisa Santos Polio vaccinate campaign to target children under 5 across five southern African countries. Malawi is launching a mass vaccination campaign against wild poliovirus type 1, which is to extend to 23 million children across five southern African countries, WHO said on Friday. The campaign, to kick off Sunday, follows Malawi’s declaration of a polio outbreak on 17 February – three months after the first polio virus case in 30 years was identified in a young child in Lilongwe. The case was the first in Africa since the region was certified free of indigenous wild poliovirus in 2020. WHO said that the region’s certification as wild polio-free remains unchanged, as the wild poliovirus strain identified had been “imported” from Pakistan. So far, no clear explanation of how the Asian virus strain may have infected an African child who had never traveled outside of the country, has been provided by WHO or Malawi health authorities. Nor has there been any explanation of why it took three months between the time the child was diagnosed and the outbreak was formally declared by WHO. But the breadth of the new campaign makes it clear the incident has been perceived as a major threat to Africa’s wild polio virus free status – with risks of subtle, silent transmission of the virus much more widely, via contaminated water and sewage, food, or human-to-human contact. Malawi has since set up an environmental surveillance system for poliovirus in 11 cities across four sites, including the Lilongwe District that encompasses the capital Lilongwe, where the initial, and so far only reported case, was detected, WHO said. Asked by Health Policy Watch whether traces of the wild polio virus had also been identified in sewage sources, through the environmental surveillance, WHO did not reply as of publication time. Targeting children across four countries – then Zimbabwe More than 80 million doses will be administered to more than 23 million children under 5 years in a four-round vaccination campaign in five southern African countries, WHO said. The first phase of the campaign, beginning this month, will target 9.4 million children across Malawi, Mozambique, Tanzania, and Zambia. Three subsequent rounds – with Zimbabwe joining the campaign- are set for April, June, and July, and aim to reach more than 23 million children with more than 80 million doses of the bivalent Oral Polio Vaccine recommended by the World Health Organization (WHO). “Polio is a highly infectious and an untreatable disease that can result in permanent paralysis. In support of Malawi and its neighbours, we are acting fast to halt this outbreak and extinguish the threat through effective vaccinations,” said WHO Regional Director for Africa Dr Matshidiso Moeti. “The African region has already defeated wild poliovirus due to a monumental effort by countries. We have the know-how and are tirelessly working to ensure that every child lives and thrives in a continent free of polio.” Single case of polio in Malawi linked to Pakistan strain Pakistan is one of two countries where polio remains endemic. Laboratory analysis has linked the strain detected in Malawi to the one circulating in Pakistan’s Sindh Province in 2019. In addition to environmental surveillance, WHO has also been supporting the country to reinforce response measures including risk assessment, and preparations for the vaccination campaigns. A surge team from WHO is working with country-based counterparts, partner organizations, and the government to end the outbreak. The WHO team is a part of a broader multi-partner Global Polio Eradication Initiative to support the country. In an unrelated event, a vaccine-directed case of polio was also identified in February by Israeli authorities in Jerusalem, also for the first time in 30 years. The infected child is part of an ultra-orthodox Jewish community in which vaccination rates hover at around 50% or less. A vaccination drive also was launched in the city. Polio, a viral disease with no cure, can invade the nervous system and can cause total paralysis within hours, particular among children under 5 years. The virus is transmitted from person to person, mainly through contamination by fecal matter or, less frequently, through contaminated water or food, and multiplies in the intestine. While there is no cure for polio, the disease can be prevented through administration of a vaccine. Image Credits: Sanofi Pastuer/Flickr, Sanofi Pastuer/Flickr. UN Environment Programme Joins WHO Alliance to Advance One Health Approach 18/03/2022 Editorial team Safer and more sustainable food systems – from production to sales in food markets is key to a One-Health Approach. UN Environment has joined a three-way alliance with the Food and Agriculture Organization, the World Animal Health Organization (OIE), and WHO to advance “One-Health” solutions to both ecosystem degradation and pandemic threats, leaders of the four agencies said on Friday. The statement followed a meeting this week of the Tripartite FAO, WHO and OIE partnership – which now has become a “Quadripartite”. “The One Health approach aims to sustainably balance and optimize the health of people, animals, ecosystems and the wider environment,” said WHO in a press release. “It mobilizes multiple sectors, disciplines and communities to work together to foster well-being and tackle threats to health and ecosystems. And it addresses the collective need for clean water, energy and air, safe and nutritious food, action on climate change, and contributing to sustainable development.” The work of the newly expanded alliance will be focused on a One Health Joint Plan of Action, which includes six main action tracks: enhancing countries’ capacity to strengthen health systems under a One Health approach; reducing the risks from emerging or resurfacing zoonotic epidemics and pandemics; controlling and eliminating endemic zoonotic, neglected tropical or vector-borne diseases; strengthening the assessment, management and communication of food safety risks; curbing the silent pandemic of antimicrobial resistance (AMR) and better integrating the environment into the One Health approach. Increased awareness of One Health As the world enters the third year of the COVID-19 pandemic, with an estimated cost of $8 to 16 trillion, there is increased awareness and broad recognition of the importance of One Health as a long-term, viable and sustainable approach. The G7, G20 and UN Food Systems Summit have all given a nod to the approach, along with the increased references by WHO and its partners. But the hard work of reforming food systems, from production to markets, as well as halting related deforestation and ecosystem destruction, are much more formidable challenges that the organisations have barely begun to face. Last year saw the Tripartite implement a number of initial initiatives, including on antimicrobial resistance, a One Health High-Level Expert Panel, and guidance on better management – but not the banning – of wild animal sales in markets – in the wake of the COVID pandemic, whose origins may have emerged from the capture, transport and slaughter of SARS-CoV2 infected wild animals at the Wuhan, China market. Plan implementation the key challenge “Now the challenge is implementation: how do we translate our work on the ground to support our Members? And how do we mobilize funding and financing mechanisms to support the Joint Plan for Action?” said FAO Director QU Dongyu, handing over the chair of the Secretariat to WHO. WHO Director-General Tedros Adhanom Ghebreyesus, said: “We need to build a more comprehensive and coordinated One Health governance structure at global level. We need a strong workforce, committed political will, and sustained financial investment. We need to develop a more proactive way of communicating and engaging across sectors, disciplines and communities to elicit the change we need.” (WHO) Image Credits: Michael Casmir/Pierce Mill Media. Healthy Mouths, Healthy Planet 18/03/2022 Ihsane Ben Yahya, Nicolas Martin & Steven Mulligan Dental procedures produce a hefty amount of carbon emissions. In honour of World Oral Health Day, 20 March, three leading voices from the World Dental Federation highlight the unexpected linkages between the health of your mouth and that of the planet. It will come as a surprise to most people that the healthcare sector has a significant environmental impact. Healthcare systems are responsible for around 5% of global greenhouse gas emissions, of which oral healthcare is an important contributor. Indeed, if the healthcare sector was a country, it would be the fifth largest greenhouse gas emitter on the planet. Oral healthcare contributes to this environmental burden with air pollution arising from the release of CO2 associated with travel and transport, the incineration of waste, the greenhouse gas impact of anesthetic gases such as nitrous oxide and the high consumption of water. Specific to dentistry, the most routine procedures, all come with a hefty carbon price tag. Tooth-coloured fillings for instance, produce around 15 kilograms of CO2eq (carbon dioxide equivalent) per procedure, according to Public Health England, whose National Health Service has done some of the most extensive carbon footprint modeling of healthcare delivery in the world. A single root canal treatment, meanwhile, produces 23 kilograms of CO2eq, dentures between 58 and 71 kilograms CO2eq. Use of the anesthetic gas nitrous oxide (laughing gas), in a procedure, meanwhile, is responsible for 119 kilograms CO2eq. Nitrous oxide N2O, the most commonly used inhalation dental anesthetic, is a greenhouse gas with far more climate warming potential than CO2. Just one kilogram of nitrous oxide is equivalent to 298 kilogrammes of CO2 and 25 kilograms of methane – another powerful greenhouse gas. Meanwhile, silver amalgam fillings contain mercury. While more and more rarely used today, and still considered safe for dental treatments, there is an environmental impact through the release of residual mercury into sewage during procedures, as well as throughout its life cycle. Prevention is better than cure Ways to maintain good oral health. The dental industry has a collective responsibility to reduce these impacts – while also expanding access to oral healthcare. How can we do both? One simple solution is to look at how we can best minimize what we might label as “avoidable” oral procedures. Prevention is always better than cure and it is the most impactful and practical way of reducing the need for clinical interventions and their associated environmental impacts. This is best achieved through the promotion of good oral hygiene, a healthy diet and the avoidance of smoking. When treatment is required, oral healthcare also should focus on the provision of durable fillings, using high quality products and materials that will last longer and/or require fewer replacements. Legislation around water fluoridation for instance, complemented by targeted public health policies can help prevent tooth decay (caries) and ultimately cavities. The recent banning of TV and online advertising of junk food in the UK before 9pm is an indirect example of encouraging better diet. So too the campaign by UK footballer Marcus Rashford to promote healthier school lunches. At the same time, while many dental problems such as caries and periodontal (gum) disease are common preventable diseases, no amount of prevention can make them go away entirely. There will always be a need for accessible dental check-ups and treatments to facilitate good oral health. And it remains important to expand access to such treatments among disadvantaged groups as well as in many low- and middle-income countries so as to reduce inequalities in healthcare provision. Less trips to the dentist would also mean less travel and water consumption Dental procedures require a lot of water, which can be reduced by practicing good oral healthcare. Oral healthcare has higher levels of patient and staff transport than other medical specializations and this is partly due to the need for regular oral health maintenance, whereas other specializations tend only to treat illness. In the UK for instance, staff and patient commuting and travel accounts for approximately two thirds of all emissions from the oral healthcare sector and about eight per cent of the total UK NHS air pollution attributable to travel. This can be reduced significantly, through the maintenance of good oral health, that requires fewer interventions and consequently fewer trips to the dentist. Simple transport habit changes can have a great impact. For example, in October 2021 the Sustainability Committee at Harvard School of Dental Medicine (HSDM) implemented a `Step Challenge´ that encouraged staff, students and faculty to walk, or take public transport rather than drive during that month. They amassed over one million steps in total, preventing the release of approximately 0.28 metric tons of CO2. The practice of dentistry and personal oral healthcare is a significant consumer of water. As a conservative estimate, a bathroom tap delivers about four litres/minute. If we estimate that half the world population cleans their teeth once a day and runs the tap for one minute, the daily global water usage equates to 6,400 Olympic swimming pools. This figure is in addition to undocumented water consumption up and down the oral healthcare manufacturing and distribution supply chain. Reducing dental use of single use plastics and packaging Measures to reduce carbon footprint in dental offices. So what measures can be taken at the dentist office to reduce the carbon footprint of dentistry procedures that are nonetheless essential to good oral health? The use and consequent disposal of single use plastics for many procedures is one of the biggest contributors to the environmental footprint of healthcare generally – and that holds true for dentistry as well. Among single-use plastics, in fact it is the packaging in which the needles, gloves and other oral healthcare products are encased that is the single largest contributor to such waste in the dental industry, with over 90 % ending its life cycle in an incinerator or a landfill. A more thoughtful approach to the design of such packaging – from the plastics content, manufacture and transport, to the potential for reuse, recycling or biodegradability, is therefore one obvious starting point in reducing the carbon footprint of the typical dentist’s office. This is particularly important because packaging, as such, is not “contaminated” biomedical waste that needs special treatment, post-procedure. This requires greater engagement with consumers and waste management companies to segregate, collect and recycle uncontaminated clinical single use plastics (SUPs) as a valuable commodity. It also involves the design and development of more plastic items made from mono-polymer plastics that can be readily recycled. The Flexible Plastics Consortium which represents 34 European companies looking for better plastics content and design solutions for packaging is a good example of how this might work in practice. The United Kingdom’s Plastics Pact is another good example: it has set targets with the goal of 100% of plastic packaging to be reused, recycled or compostable by 2025. Major challenges in managing single use plastic waste from oral healthcare Many single use dental items end up in the waste bin, including gloves, aprons, masks. Once the box is opened, many of the everyday products used in dentistry are only briefly used and then end up in the waste bin. These single-use plastic (SUP) items range from personal protective equipment (aprons, gloves and masks) and other disposable sundries (the mouth-rinse cup or the dental suction tube). SUP biomedical waste requires more specialized management – since these are contaminated with blood and other bodily fluids from oral health procedures. The high safety and quality requirements for these products to be legally compliant, is often incompatible with recycling and materials recovery. The complex nature of items assembled from different plastics also makes recycling difficult, as does the prevailing view that plastic is simply waste and is not considered a valuable resource. Still there are many attempts at finding solutions around the world. These include incentivization schemes and professional education courses that can help manufacturers to design products that can be safely treated and reprocessed, as well as sensitizing dental practitioners to different waste streams, and the treatment they require. Initiatives like the development of a competency-based dental waste management course being undertaken at the Copperbelt University in Zambia are a step in the right direction. Even so, the lack of good technological solutions for the appropriate collection, disinfection/sterilization and subsequent recovery or reprocessing of single use plastics used in biomedical procedures remains an ongoing barrier. We need product research to come up with safe, sustainable solutions for a circular economy, including in the healthcare sector, and governments to adopt supportive policies. Assessing the environmental impacts of oral healthcare as a first step It is important to understand the environmental impacts of materials used in healthcare. A better understanding of the environmental impacts of products and materials used in healthcare systems, from procurement to disposal, is key to any of these measures. Solutions proposed have included more life cycle analysis for all materials used in the healthcare supply chain and the development of a credible ‘sustainability index’ to inform medical supply purchasers about the sustainability credentials of a product. The index could potentially include information on environmental sourcing, ethical manufacturing, supply chain distribution and procurement. This World Oral Health Day we can celebrate the fact that the oral health sector has recognised that it has a vital role to play in healthcare-related climate change mitigation. That is the first step. The next ones will be more challenging and will need ‘teeth’. The FDI World Dental Federation´s Code of Good Practice, which is to be launched later this year, following an extensive consultation with the sector, will be a good starting point for ensuring healthy mouths also help to produce a healthier planet. Steven Mulligan Nicolas Martin Ihsane Ben Yahya Ihsane Ben Yahya is the President of the FDI World Dental Federation and professor at the Dental University in Casablanca, Morocco. Nicolas Martin is the Chair of the FDI Sustainability in Dentistry Task Team. He is also Clinical Professor in Restorative Dentistry in the School of Clinical Dentistry, at the University of Sheffield, UK. Steven Mulligan is a Member of the FDI Sustainability in Dentistry Task Team. He is also a Clinical Lecturer in Restorative Dentistry in the School of Clinical Dentistry, at the University of Sheffield, UK. Image Credits: Mass Communication Specialist Seaman Apprentice Brian H. Abel/Flickr, FDI World Dental Federation , Jan Fidler/Flickr, World Dental Federation , Mass Communication Specialist 3rd Class Everett Allen/Flickr. From COVID to Humanitarian Crises – Medical Oxygen Needs More Prioritization for its Lifesaving Capacities 17/03/2022 Raisa Santos Lifesaving oxygen flows into the lungs of a COVID patient in Chernivtsi, southwest Ukraine before the start of the recent Russian invasion. Whether its due to COVID or conflict, oxygen supplies fall short in many parts of the world. From patients lying in the parking lots of hospitals, in the back seats of cars suffocating as their family members searched frantically for oxygen in India during its second wave of COVID last year, to the inability to receive emergency care amidst constant bombing and shelling in current war-torn Ukraine, global health experts and leaders are desperately searching for ways of improving the global oxygen supply. At a media briefing on the issue Thursday, speakers emphasized the need for both access to oxygen on the ground and more funding to the WHO co-sponsored Access to COVID-19 Tools Accelerator (ACT-A), which is attempting to beef up oxygen supplies in low and middle-income countries. “Oxygen has been treated for too long like a commodity, treated as something that must be delivered,” said WHO Executive Director of Health Emergencies Programme Dr Mike Ryan, speaking at the briefing, cosponsored by the Act Acccelerator and Unitaid. But “oxygen is a capability, not a commodity,” he stressed. Rethinking oxygen’s lifesaving capacities Mike Ryan, Executive Director, Health Emergencies Programme; World Health Organization Ryan and others made the case for rethinking oxygen as a health tool that requires not only a sustainable supply at a country level, but an entire ecosystem of supply and maintenance technology and infrastructure. Its role – and the chronic lack of capacity in many countries – has been underscored by COVID – and again in the very different setting of the Ukraine crisis – where the lack of access for people ranging from COVID patients to mothers in birth and children with pneumonia has prompted widespread alarm. Oxygen remains a critical component of the global COVID-19 response – 75% of patients hospitalized for COVID-19 can be treated with oxygen alone – without any further advanced care. Yet the current global supply of oxygen does not meet needs for both COVID-19 and other serious illnesses. “COVID didn’t cause [the oxygen shortage], COVID uncovered this. COVID laid bare, tore away the bandages from some very old wounds,” said Ryan. UNITAID Commits $56 million to boost access to global medical oxygen supply Robert Matiru, Chair, ACT-A Oxygen Emergency Taskforce & Director Programmes, Unitaid The ACT-A Strategic Plan and Budget for 2022 has identified a funding deficit of $1 billion for oxygen supplies worldwide for this year alone. As a first step to closing that gap, Unitaid has announced that it will invest $56 million to increase access to medical oxygen both for short-term needs related to COVID-19 as well as for the longer term – as a critical foundation for fighting future pandemics. The Unitaid pledge builds on the $50 million USAID has committed in funding for oxygen as pledged at US President Joe Biden’s Global COVID-19 Summit in September 2021. Four Unitaid-funded projects, designed to address global inequities in oxygen access, will be implemented by The Alliance for International Medical Action (ALIMA), the Clinton Health Access Initiative (CHAI), Partners in Health (PIH), and the WHO Health Emergencies Programme. These will also support the work of the ACT-A Oxygen Emergency Task Force by ensuring access to more affordable oxygen solutions such as bulk liquid oxygen, oxygen generation systems, and other important oxygen equipment. Unitaid called on donors, including governments, foundations, and private sector partners to join in the efforts. “Our call here is not just for the present, for this pandemic, but to recognize that donors and funders that come forward and step forward, over and above the generous contributors to date, will help drive a more sustainable ecosystem and [deliver] essential medicines to countries that are lacking it,” said Robert Matiru, Chair of the ACT-A Oxygen Emergency Taskforce and Director of Programmes at Unitaid. Children with pneumonia unrecognized victims – 40% of hospitals in some African countries lack oxygen Numerous countries are facing oxygen shortages, while readily available oxygen products are in short supply. Children are among the unrecognized victims of the lack of oxygen supplies – with childhood pneumonia still one of the biggest killers of under-fives. Accounting for almost a million deaths a year, the highest burden is in sub-Saharan African and South-East Asian countries where children face a double whammy of disease from both the lack of preventive treatments, like vaccinations, along with exposure to heavy indoor air pollution from the open burning of coal, biomass and other such fuels. But an estimated 20 to 40% of these deaths are preventable with increased availability of oxygen therapy. The shortage is particularly acute in low-income sub-Saharan African countries such as Tanzania, Sierra Leone, Liberia, and Gambia, where 40% of health facilities had no access to oxygen and other basic life saving supplies, said Atul Gawande of the United States Agency for International Development (USAID). COVID has led to big surges in needs Daily medical oxygen need for COVID-19 as of 16 March 2022 Along with the chronic shortages, COVID led to a major surge in oxygen needs. Low and middle-income countries (LMICs) need at least 23 million cubic meters of oxygen every day, just to treat COVID patients alone, according to the PATH COVID-19 Oxygen Needs Tracker. On the brighter side, the pandemic has brought a long-ignored aspect of health capacity in LMICs more to the forefront. USAID is currently working in 11 countries to build ‘oxygen ecosystems’ to support oxygen therapy for pneumonia patients, COVID patients, and others, Gawande said. Countries like Ghana now have oxygen generating capacity that can support up to 300,000 patients per day, per year. Gawande noted that the oxygen ecosystem includes liquid oxygen cylinders and concentrators, as well as the clinical engineering and technical assistance to use the technology. But expanding this initiative to other countries still needs more funding. Atul Gawande, USAID “As the Omicron variant abates, I think we’re all starting to feel that we can catch our breath. Oxygen demand may be lower right now. But it is the time that we have to make these investments to enable this kind of [sustainable] capacity.” Gawande said. Oxygen ‘natural security’ and ‘high-return’ health investment Leith Greenslade, Founder/CEO, JustActions & Coordinator, Every Breath Counts Coalition While the recent funding commitments are a positive sign, ‘it is not enough to fund protection’, said Leith Greenslade of the Every Breath Counts Coalition. “It took a pandemic of respiratory infection to wake up the world,” she pointed out. In the past year, about $700 million was invested into the ACT-A Oxygen Emergency Task Force, which has worked in LMICs to prevent oxygen shortages – jump-starting a more focused response. But so far, only a handful of governments – including the United States, Germany, Canada, and France – have borne the funding burden. “But most of the G-20 nations have not stepped up to invest in oxygen,” she charged. Greenslade appealed to donors to see oxygen as a high priority for three reasons: the moral obligation to flatten the COVID-19 curve; oxygen as a “national security” issue in moments of crisis; and finally, oxygen as a high-return health investment that will keep on saving lives beyond the pandemic. “When hospitals run out of oxygen, we have seen strikes and civil unrest in quite a few low- and middle-income countries,” she pointed out. “How many more deaths before this is over will largely depend on access to oxygen and critical care in the countries where the disease is greatest and the health systems are weakest,” she declared. Image Credits: Mstyslav Chernov/ Wikimedia Commons, UNICEF/Ralaivita, PATH, Every Breath Counts . Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. 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As Europe Moves to Improve Mental Health Services for Children, Experts Are Concerned About Men’s Mental State 21/03/2022 Kerry Cullinan Dr Hans Kluge Mental health practitioners worldwide are warning of a massive wave of pandemic-related mental health issues that many countries are ill-equipped to address. On Monday, the World Health Organization’s (WHO) Europe office and the government of Greece launched a new European programme to strengthen and improve the quality of mental health services for children and adolescents. WHO Europe Director Dr Hans Kluge told the launch that suicide was the leading cause of death in children and adolescents aged 10 to 19 living in low- and middle-income countries in the region and that over 4000 young people in this age group had killed themselves in 2015. 🔴Suicide is the leading cause of deathamong adolescents in low & middle income countries & 2nd in high income countries in the European Region Find guidance on how to approach child & adolescent #MentalHealth as a primary health care provider here👉 https://t.co/EUoragqO0q pic.twitter.com/AOvZRIY7HR — WHO/Europe (@WHO_Europe) March 21, 2022 “Ensuring that all children and adolescents in the region have access to quality mental health services is a moral imperative,” said Kluge, adding that this was as important as childhood vaccinations. The WHO Europe programme aims to work with member states to encourage them to share knowledge and expertise about how to boost the mental healthcare of children and adolescents, and to support member countries to develop their own strategies and frameworks. It will also “develop a package of tools to measure progress against evidence-based standards”, according to the regional office. Through this new programme, WHO/Europe will continue to help countries strengthen and improve #mentalhealth services for children and adolescents, as well as developing tools to measure progress pic.twitter.com/Fspx9hh2lN — WHO/Europe (@WHO_Europe) March 21, 2022 Mental health woes of COVID-19 COVID-19 has exacerbated mental health issues and, during the first year of the pandemic, there was a 25% increase in the global prevalence of anxiety and depression, according to a WHO brief published in early March. Approximately 140,000 children in the US have lost a parent or guardian to COVID, for example, and are likely to be struggling to come to terms with this loss. “One major explanation for the increase is the unprecedented stress caused by the social isolation resulting from the pandemic. Linked to this were constraints on people’s ability to work, seek support from loved ones and engage in their communities,” according to the WHO. “Loneliness, fear of infection, suffering and death for oneself and for loved ones, grief after bereavement and financial worries have also all been cited as stressors leading to anxiety and depression. Among health workers, exhaustion has been a major trigger for suicidal thinking,” it added. Calls to South Africa’s only mental health helpline, for example, have jumped exponentially during the pandemic – from around 400 to 600 calls a day before COVID-19 to over 2400 calls a day in 2021. Psychologist Zamo Mbele, a board member of the South African Depression and Anxiety Group (SADAG) that operates the helpline, said that his non-governmental organisation, which is wholly reliant on donations, had been struggling to keep up with demand. Psychologist Zamo Mbele, a board member of the South African Depression and Anxiety Group (SADAG) Male violence and mental health “One of the reasons we’ve seen an increase in our calls is because of COVID, but one of the other reasons is because people who would not previously access health are beginning to recognise that they need help,” said Mbele. He added that “toxic” manifestations of masculinity – seen in the country’s high levels of domestic violence, road rage and substance abuse – were indications that men, in particular, needed help. “It’s not as though men only recently starting to struggle with mental difficulties or emotional difficulties,” he added. “But they are just starting to see that the expression of their difficulties is no longer functional to them or to society. It’s no longer as socially acceptable to be violent in order to deal with your depression, or to have a big temper in order to deal irritability or anxiety – or to drink excessively or to spend copious amounts of hours at the gym. “Instead, we’re beginning to recognise that actually doing a lot of these things is masking a lot of symptoms.” https://twitter.com/SkosanaDr/status/1505834397391544323 Men and suicide In the vast majority of countries, men are far more likely to commit suicide than women, which mental health practitioners say is likely to be because men find it harder to ask for help. This is a worldwide trend, captured by the WHO’s Suicide Worldwide in 2019: Global Health Estimates. The report found that South Africa has the third-highest suicide rate on the African continent. Of the 13,774 suicides reported in South Africa, 10,681 were men in 2913 were women. Russia, South Korea, the US and Japan also have high suicide rates, particularly amongst men. However, while there has been an increase in suicidal thoughts during the pandemic, there has not been a global increase in actual suicides – with notable exceptions, such as Austria, and Japan (although there is very little information from LMICs). Mass Polio Vaccination Drive to Administer More Than 80 Million Doses to Southern African Children in Five Countries 18/03/2022 Raisa Santos Polio vaccinate campaign to target children under 5 across five southern African countries. Malawi is launching a mass vaccination campaign against wild poliovirus type 1, which is to extend to 23 million children across five southern African countries, WHO said on Friday. The campaign, to kick off Sunday, follows Malawi’s declaration of a polio outbreak on 17 February – three months after the first polio virus case in 30 years was identified in a young child in Lilongwe. The case was the first in Africa since the region was certified free of indigenous wild poliovirus in 2020. WHO said that the region’s certification as wild polio-free remains unchanged, as the wild poliovirus strain identified had been “imported” from Pakistan. So far, no clear explanation of how the Asian virus strain may have infected an African child who had never traveled outside of the country, has been provided by WHO or Malawi health authorities. Nor has there been any explanation of why it took three months between the time the child was diagnosed and the outbreak was formally declared by WHO. But the breadth of the new campaign makes it clear the incident has been perceived as a major threat to Africa’s wild polio virus free status – with risks of subtle, silent transmission of the virus much more widely, via contaminated water and sewage, food, or human-to-human contact. Malawi has since set up an environmental surveillance system for poliovirus in 11 cities across four sites, including the Lilongwe District that encompasses the capital Lilongwe, where the initial, and so far only reported case, was detected, WHO said. Asked by Health Policy Watch whether traces of the wild polio virus had also been identified in sewage sources, through the environmental surveillance, WHO did not reply as of publication time. Targeting children across four countries – then Zimbabwe More than 80 million doses will be administered to more than 23 million children under 5 years in a four-round vaccination campaign in five southern African countries, WHO said. The first phase of the campaign, beginning this month, will target 9.4 million children across Malawi, Mozambique, Tanzania, and Zambia. Three subsequent rounds – with Zimbabwe joining the campaign- are set for April, June, and July, and aim to reach more than 23 million children with more than 80 million doses of the bivalent Oral Polio Vaccine recommended by the World Health Organization (WHO). “Polio is a highly infectious and an untreatable disease that can result in permanent paralysis. In support of Malawi and its neighbours, we are acting fast to halt this outbreak and extinguish the threat through effective vaccinations,” said WHO Regional Director for Africa Dr Matshidiso Moeti. “The African region has already defeated wild poliovirus due to a monumental effort by countries. We have the know-how and are tirelessly working to ensure that every child lives and thrives in a continent free of polio.” Single case of polio in Malawi linked to Pakistan strain Pakistan is one of two countries where polio remains endemic. Laboratory analysis has linked the strain detected in Malawi to the one circulating in Pakistan’s Sindh Province in 2019. In addition to environmental surveillance, WHO has also been supporting the country to reinforce response measures including risk assessment, and preparations for the vaccination campaigns. A surge team from WHO is working with country-based counterparts, partner organizations, and the government to end the outbreak. The WHO team is a part of a broader multi-partner Global Polio Eradication Initiative to support the country. In an unrelated event, a vaccine-directed case of polio was also identified in February by Israeli authorities in Jerusalem, also for the first time in 30 years. The infected child is part of an ultra-orthodox Jewish community in which vaccination rates hover at around 50% or less. A vaccination drive also was launched in the city. Polio, a viral disease with no cure, can invade the nervous system and can cause total paralysis within hours, particular among children under 5 years. The virus is transmitted from person to person, mainly through contamination by fecal matter or, less frequently, through contaminated water or food, and multiplies in the intestine. While there is no cure for polio, the disease can be prevented through administration of a vaccine. Image Credits: Sanofi Pastuer/Flickr, Sanofi Pastuer/Flickr. UN Environment Programme Joins WHO Alliance to Advance One Health Approach 18/03/2022 Editorial team Safer and more sustainable food systems – from production to sales in food markets is key to a One-Health Approach. UN Environment has joined a three-way alliance with the Food and Agriculture Organization, the World Animal Health Organization (OIE), and WHO to advance “One-Health” solutions to both ecosystem degradation and pandemic threats, leaders of the four agencies said on Friday. The statement followed a meeting this week of the Tripartite FAO, WHO and OIE partnership – which now has become a “Quadripartite”. “The One Health approach aims to sustainably balance and optimize the health of people, animals, ecosystems and the wider environment,” said WHO in a press release. “It mobilizes multiple sectors, disciplines and communities to work together to foster well-being and tackle threats to health and ecosystems. And it addresses the collective need for clean water, energy and air, safe and nutritious food, action on climate change, and contributing to sustainable development.” The work of the newly expanded alliance will be focused on a One Health Joint Plan of Action, which includes six main action tracks: enhancing countries’ capacity to strengthen health systems under a One Health approach; reducing the risks from emerging or resurfacing zoonotic epidemics and pandemics; controlling and eliminating endemic zoonotic, neglected tropical or vector-borne diseases; strengthening the assessment, management and communication of food safety risks; curbing the silent pandemic of antimicrobial resistance (AMR) and better integrating the environment into the One Health approach. Increased awareness of One Health As the world enters the third year of the COVID-19 pandemic, with an estimated cost of $8 to 16 trillion, there is increased awareness and broad recognition of the importance of One Health as a long-term, viable and sustainable approach. The G7, G20 and UN Food Systems Summit have all given a nod to the approach, along with the increased references by WHO and its partners. But the hard work of reforming food systems, from production to markets, as well as halting related deforestation and ecosystem destruction, are much more formidable challenges that the organisations have barely begun to face. Last year saw the Tripartite implement a number of initial initiatives, including on antimicrobial resistance, a One Health High-Level Expert Panel, and guidance on better management – but not the banning – of wild animal sales in markets – in the wake of the COVID pandemic, whose origins may have emerged from the capture, transport and slaughter of SARS-CoV2 infected wild animals at the Wuhan, China market. Plan implementation the key challenge “Now the challenge is implementation: how do we translate our work on the ground to support our Members? And how do we mobilize funding and financing mechanisms to support the Joint Plan for Action?” said FAO Director QU Dongyu, handing over the chair of the Secretariat to WHO. WHO Director-General Tedros Adhanom Ghebreyesus, said: “We need to build a more comprehensive and coordinated One Health governance structure at global level. We need a strong workforce, committed political will, and sustained financial investment. We need to develop a more proactive way of communicating and engaging across sectors, disciplines and communities to elicit the change we need.” (WHO) Image Credits: Michael Casmir/Pierce Mill Media. Healthy Mouths, Healthy Planet 18/03/2022 Ihsane Ben Yahya, Nicolas Martin & Steven Mulligan Dental procedures produce a hefty amount of carbon emissions. In honour of World Oral Health Day, 20 March, three leading voices from the World Dental Federation highlight the unexpected linkages between the health of your mouth and that of the planet. It will come as a surprise to most people that the healthcare sector has a significant environmental impact. Healthcare systems are responsible for around 5% of global greenhouse gas emissions, of which oral healthcare is an important contributor. Indeed, if the healthcare sector was a country, it would be the fifth largest greenhouse gas emitter on the planet. Oral healthcare contributes to this environmental burden with air pollution arising from the release of CO2 associated with travel and transport, the incineration of waste, the greenhouse gas impact of anesthetic gases such as nitrous oxide and the high consumption of water. Specific to dentistry, the most routine procedures, all come with a hefty carbon price tag. Tooth-coloured fillings for instance, produce around 15 kilograms of CO2eq (carbon dioxide equivalent) per procedure, according to Public Health England, whose National Health Service has done some of the most extensive carbon footprint modeling of healthcare delivery in the world. A single root canal treatment, meanwhile, produces 23 kilograms of CO2eq, dentures between 58 and 71 kilograms CO2eq. Use of the anesthetic gas nitrous oxide (laughing gas), in a procedure, meanwhile, is responsible for 119 kilograms CO2eq. Nitrous oxide N2O, the most commonly used inhalation dental anesthetic, is a greenhouse gas with far more climate warming potential than CO2. Just one kilogram of nitrous oxide is equivalent to 298 kilogrammes of CO2 and 25 kilograms of methane – another powerful greenhouse gas. Meanwhile, silver amalgam fillings contain mercury. While more and more rarely used today, and still considered safe for dental treatments, there is an environmental impact through the release of residual mercury into sewage during procedures, as well as throughout its life cycle. Prevention is better than cure Ways to maintain good oral health. The dental industry has a collective responsibility to reduce these impacts – while also expanding access to oral healthcare. How can we do both? One simple solution is to look at how we can best minimize what we might label as “avoidable” oral procedures. Prevention is always better than cure and it is the most impactful and practical way of reducing the need for clinical interventions and their associated environmental impacts. This is best achieved through the promotion of good oral hygiene, a healthy diet and the avoidance of smoking. When treatment is required, oral healthcare also should focus on the provision of durable fillings, using high quality products and materials that will last longer and/or require fewer replacements. Legislation around water fluoridation for instance, complemented by targeted public health policies can help prevent tooth decay (caries) and ultimately cavities. The recent banning of TV and online advertising of junk food in the UK before 9pm is an indirect example of encouraging better diet. So too the campaign by UK footballer Marcus Rashford to promote healthier school lunches. At the same time, while many dental problems such as caries and periodontal (gum) disease are common preventable diseases, no amount of prevention can make them go away entirely. There will always be a need for accessible dental check-ups and treatments to facilitate good oral health. And it remains important to expand access to such treatments among disadvantaged groups as well as in many low- and middle-income countries so as to reduce inequalities in healthcare provision. Less trips to the dentist would also mean less travel and water consumption Dental procedures require a lot of water, which can be reduced by practicing good oral healthcare. Oral healthcare has higher levels of patient and staff transport than other medical specializations and this is partly due to the need for regular oral health maintenance, whereas other specializations tend only to treat illness. In the UK for instance, staff and patient commuting and travel accounts for approximately two thirds of all emissions from the oral healthcare sector and about eight per cent of the total UK NHS air pollution attributable to travel. This can be reduced significantly, through the maintenance of good oral health, that requires fewer interventions and consequently fewer trips to the dentist. Simple transport habit changes can have a great impact. For example, in October 2021 the Sustainability Committee at Harvard School of Dental Medicine (HSDM) implemented a `Step Challenge´ that encouraged staff, students and faculty to walk, or take public transport rather than drive during that month. They amassed over one million steps in total, preventing the release of approximately 0.28 metric tons of CO2. The practice of dentistry and personal oral healthcare is a significant consumer of water. As a conservative estimate, a bathroom tap delivers about four litres/minute. If we estimate that half the world population cleans their teeth once a day and runs the tap for one minute, the daily global water usage equates to 6,400 Olympic swimming pools. This figure is in addition to undocumented water consumption up and down the oral healthcare manufacturing and distribution supply chain. Reducing dental use of single use plastics and packaging Measures to reduce carbon footprint in dental offices. So what measures can be taken at the dentist office to reduce the carbon footprint of dentistry procedures that are nonetheless essential to good oral health? The use and consequent disposal of single use plastics for many procedures is one of the biggest contributors to the environmental footprint of healthcare generally – and that holds true for dentistry as well. Among single-use plastics, in fact it is the packaging in which the needles, gloves and other oral healthcare products are encased that is the single largest contributor to such waste in the dental industry, with over 90 % ending its life cycle in an incinerator or a landfill. A more thoughtful approach to the design of such packaging – from the plastics content, manufacture and transport, to the potential for reuse, recycling or biodegradability, is therefore one obvious starting point in reducing the carbon footprint of the typical dentist’s office. This is particularly important because packaging, as such, is not “contaminated” biomedical waste that needs special treatment, post-procedure. This requires greater engagement with consumers and waste management companies to segregate, collect and recycle uncontaminated clinical single use plastics (SUPs) as a valuable commodity. It also involves the design and development of more plastic items made from mono-polymer plastics that can be readily recycled. The Flexible Plastics Consortium which represents 34 European companies looking for better plastics content and design solutions for packaging is a good example of how this might work in practice. The United Kingdom’s Plastics Pact is another good example: it has set targets with the goal of 100% of plastic packaging to be reused, recycled or compostable by 2025. Major challenges in managing single use plastic waste from oral healthcare Many single use dental items end up in the waste bin, including gloves, aprons, masks. Once the box is opened, many of the everyday products used in dentistry are only briefly used and then end up in the waste bin. These single-use plastic (SUP) items range from personal protective equipment (aprons, gloves and masks) and other disposable sundries (the mouth-rinse cup or the dental suction tube). SUP biomedical waste requires more specialized management – since these are contaminated with blood and other bodily fluids from oral health procedures. The high safety and quality requirements for these products to be legally compliant, is often incompatible with recycling and materials recovery. The complex nature of items assembled from different plastics also makes recycling difficult, as does the prevailing view that plastic is simply waste and is not considered a valuable resource. Still there are many attempts at finding solutions around the world. These include incentivization schemes and professional education courses that can help manufacturers to design products that can be safely treated and reprocessed, as well as sensitizing dental practitioners to different waste streams, and the treatment they require. Initiatives like the development of a competency-based dental waste management course being undertaken at the Copperbelt University in Zambia are a step in the right direction. Even so, the lack of good technological solutions for the appropriate collection, disinfection/sterilization and subsequent recovery or reprocessing of single use plastics used in biomedical procedures remains an ongoing barrier. We need product research to come up with safe, sustainable solutions for a circular economy, including in the healthcare sector, and governments to adopt supportive policies. Assessing the environmental impacts of oral healthcare as a first step It is important to understand the environmental impacts of materials used in healthcare. A better understanding of the environmental impacts of products and materials used in healthcare systems, from procurement to disposal, is key to any of these measures. Solutions proposed have included more life cycle analysis for all materials used in the healthcare supply chain and the development of a credible ‘sustainability index’ to inform medical supply purchasers about the sustainability credentials of a product. The index could potentially include information on environmental sourcing, ethical manufacturing, supply chain distribution and procurement. This World Oral Health Day we can celebrate the fact that the oral health sector has recognised that it has a vital role to play in healthcare-related climate change mitigation. That is the first step. The next ones will be more challenging and will need ‘teeth’. The FDI World Dental Federation´s Code of Good Practice, which is to be launched later this year, following an extensive consultation with the sector, will be a good starting point for ensuring healthy mouths also help to produce a healthier planet. Steven Mulligan Nicolas Martin Ihsane Ben Yahya Ihsane Ben Yahya is the President of the FDI World Dental Federation and professor at the Dental University in Casablanca, Morocco. Nicolas Martin is the Chair of the FDI Sustainability in Dentistry Task Team. He is also Clinical Professor in Restorative Dentistry in the School of Clinical Dentistry, at the University of Sheffield, UK. Steven Mulligan is a Member of the FDI Sustainability in Dentistry Task Team. He is also a Clinical Lecturer in Restorative Dentistry in the School of Clinical Dentistry, at the University of Sheffield, UK. Image Credits: Mass Communication Specialist Seaman Apprentice Brian H. Abel/Flickr, FDI World Dental Federation , Jan Fidler/Flickr, World Dental Federation , Mass Communication Specialist 3rd Class Everett Allen/Flickr. From COVID to Humanitarian Crises – Medical Oxygen Needs More Prioritization for its Lifesaving Capacities 17/03/2022 Raisa Santos Lifesaving oxygen flows into the lungs of a COVID patient in Chernivtsi, southwest Ukraine before the start of the recent Russian invasion. Whether its due to COVID or conflict, oxygen supplies fall short in many parts of the world. From patients lying in the parking lots of hospitals, in the back seats of cars suffocating as their family members searched frantically for oxygen in India during its second wave of COVID last year, to the inability to receive emergency care amidst constant bombing and shelling in current war-torn Ukraine, global health experts and leaders are desperately searching for ways of improving the global oxygen supply. At a media briefing on the issue Thursday, speakers emphasized the need for both access to oxygen on the ground and more funding to the WHO co-sponsored Access to COVID-19 Tools Accelerator (ACT-A), which is attempting to beef up oxygen supplies in low and middle-income countries. “Oxygen has been treated for too long like a commodity, treated as something that must be delivered,” said WHO Executive Director of Health Emergencies Programme Dr Mike Ryan, speaking at the briefing, cosponsored by the Act Acccelerator and Unitaid. But “oxygen is a capability, not a commodity,” he stressed. Rethinking oxygen’s lifesaving capacities Mike Ryan, Executive Director, Health Emergencies Programme; World Health Organization Ryan and others made the case for rethinking oxygen as a health tool that requires not only a sustainable supply at a country level, but an entire ecosystem of supply and maintenance technology and infrastructure. Its role – and the chronic lack of capacity in many countries – has been underscored by COVID – and again in the very different setting of the Ukraine crisis – where the lack of access for people ranging from COVID patients to mothers in birth and children with pneumonia has prompted widespread alarm. Oxygen remains a critical component of the global COVID-19 response – 75% of patients hospitalized for COVID-19 can be treated with oxygen alone – without any further advanced care. Yet the current global supply of oxygen does not meet needs for both COVID-19 and other serious illnesses. “COVID didn’t cause [the oxygen shortage], COVID uncovered this. COVID laid bare, tore away the bandages from some very old wounds,” said Ryan. UNITAID Commits $56 million to boost access to global medical oxygen supply Robert Matiru, Chair, ACT-A Oxygen Emergency Taskforce & Director Programmes, Unitaid The ACT-A Strategic Plan and Budget for 2022 has identified a funding deficit of $1 billion for oxygen supplies worldwide for this year alone. As a first step to closing that gap, Unitaid has announced that it will invest $56 million to increase access to medical oxygen both for short-term needs related to COVID-19 as well as for the longer term – as a critical foundation for fighting future pandemics. The Unitaid pledge builds on the $50 million USAID has committed in funding for oxygen as pledged at US President Joe Biden’s Global COVID-19 Summit in September 2021. Four Unitaid-funded projects, designed to address global inequities in oxygen access, will be implemented by The Alliance for International Medical Action (ALIMA), the Clinton Health Access Initiative (CHAI), Partners in Health (PIH), and the WHO Health Emergencies Programme. These will also support the work of the ACT-A Oxygen Emergency Task Force by ensuring access to more affordable oxygen solutions such as bulk liquid oxygen, oxygen generation systems, and other important oxygen equipment. Unitaid called on donors, including governments, foundations, and private sector partners to join in the efforts. “Our call here is not just for the present, for this pandemic, but to recognize that donors and funders that come forward and step forward, over and above the generous contributors to date, will help drive a more sustainable ecosystem and [deliver] essential medicines to countries that are lacking it,” said Robert Matiru, Chair of the ACT-A Oxygen Emergency Taskforce and Director of Programmes at Unitaid. Children with pneumonia unrecognized victims – 40% of hospitals in some African countries lack oxygen Numerous countries are facing oxygen shortages, while readily available oxygen products are in short supply. Children are among the unrecognized victims of the lack of oxygen supplies – with childhood pneumonia still one of the biggest killers of under-fives. Accounting for almost a million deaths a year, the highest burden is in sub-Saharan African and South-East Asian countries where children face a double whammy of disease from both the lack of preventive treatments, like vaccinations, along with exposure to heavy indoor air pollution from the open burning of coal, biomass and other such fuels. But an estimated 20 to 40% of these deaths are preventable with increased availability of oxygen therapy. The shortage is particularly acute in low-income sub-Saharan African countries such as Tanzania, Sierra Leone, Liberia, and Gambia, where 40% of health facilities had no access to oxygen and other basic life saving supplies, said Atul Gawande of the United States Agency for International Development (USAID). COVID has led to big surges in needs Daily medical oxygen need for COVID-19 as of 16 March 2022 Along with the chronic shortages, COVID led to a major surge in oxygen needs. Low and middle-income countries (LMICs) need at least 23 million cubic meters of oxygen every day, just to treat COVID patients alone, according to the PATH COVID-19 Oxygen Needs Tracker. On the brighter side, the pandemic has brought a long-ignored aspect of health capacity in LMICs more to the forefront. USAID is currently working in 11 countries to build ‘oxygen ecosystems’ to support oxygen therapy for pneumonia patients, COVID patients, and others, Gawande said. Countries like Ghana now have oxygen generating capacity that can support up to 300,000 patients per day, per year. Gawande noted that the oxygen ecosystem includes liquid oxygen cylinders and concentrators, as well as the clinical engineering and technical assistance to use the technology. But expanding this initiative to other countries still needs more funding. Atul Gawande, USAID “As the Omicron variant abates, I think we’re all starting to feel that we can catch our breath. Oxygen demand may be lower right now. But it is the time that we have to make these investments to enable this kind of [sustainable] capacity.” Gawande said. Oxygen ‘natural security’ and ‘high-return’ health investment Leith Greenslade, Founder/CEO, JustActions & Coordinator, Every Breath Counts Coalition While the recent funding commitments are a positive sign, ‘it is not enough to fund protection’, said Leith Greenslade of the Every Breath Counts Coalition. “It took a pandemic of respiratory infection to wake up the world,” she pointed out. In the past year, about $700 million was invested into the ACT-A Oxygen Emergency Task Force, which has worked in LMICs to prevent oxygen shortages – jump-starting a more focused response. But so far, only a handful of governments – including the United States, Germany, Canada, and France – have borne the funding burden. “But most of the G-20 nations have not stepped up to invest in oxygen,” she charged. Greenslade appealed to donors to see oxygen as a high priority for three reasons: the moral obligation to flatten the COVID-19 curve; oxygen as a “national security” issue in moments of crisis; and finally, oxygen as a high-return health investment that will keep on saving lives beyond the pandemic. “When hospitals run out of oxygen, we have seen strikes and civil unrest in quite a few low- and middle-income countries,” she pointed out. “How many more deaths before this is over will largely depend on access to oxygen and critical care in the countries where the disease is greatest and the health systems are weakest,” she declared. Image Credits: Mstyslav Chernov/ Wikimedia Commons, UNICEF/Ralaivita, PATH, Every Breath Counts . Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. 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Mass Polio Vaccination Drive to Administer More Than 80 Million Doses to Southern African Children in Five Countries 18/03/2022 Raisa Santos Polio vaccinate campaign to target children under 5 across five southern African countries. Malawi is launching a mass vaccination campaign against wild poliovirus type 1, which is to extend to 23 million children across five southern African countries, WHO said on Friday. The campaign, to kick off Sunday, follows Malawi’s declaration of a polio outbreak on 17 February – three months after the first polio virus case in 30 years was identified in a young child in Lilongwe. The case was the first in Africa since the region was certified free of indigenous wild poliovirus in 2020. WHO said that the region’s certification as wild polio-free remains unchanged, as the wild poliovirus strain identified had been “imported” from Pakistan. So far, no clear explanation of how the Asian virus strain may have infected an African child who had never traveled outside of the country, has been provided by WHO or Malawi health authorities. Nor has there been any explanation of why it took three months between the time the child was diagnosed and the outbreak was formally declared by WHO. But the breadth of the new campaign makes it clear the incident has been perceived as a major threat to Africa’s wild polio virus free status – with risks of subtle, silent transmission of the virus much more widely, via contaminated water and sewage, food, or human-to-human contact. Malawi has since set up an environmental surveillance system for poliovirus in 11 cities across four sites, including the Lilongwe District that encompasses the capital Lilongwe, where the initial, and so far only reported case, was detected, WHO said. Asked by Health Policy Watch whether traces of the wild polio virus had also been identified in sewage sources, through the environmental surveillance, WHO did not reply as of publication time. Targeting children across four countries – then Zimbabwe More than 80 million doses will be administered to more than 23 million children under 5 years in a four-round vaccination campaign in five southern African countries, WHO said. The first phase of the campaign, beginning this month, will target 9.4 million children across Malawi, Mozambique, Tanzania, and Zambia. Three subsequent rounds – with Zimbabwe joining the campaign- are set for April, June, and July, and aim to reach more than 23 million children with more than 80 million doses of the bivalent Oral Polio Vaccine recommended by the World Health Organization (WHO). “Polio is a highly infectious and an untreatable disease that can result in permanent paralysis. In support of Malawi and its neighbours, we are acting fast to halt this outbreak and extinguish the threat through effective vaccinations,” said WHO Regional Director for Africa Dr Matshidiso Moeti. “The African region has already defeated wild poliovirus due to a monumental effort by countries. We have the know-how and are tirelessly working to ensure that every child lives and thrives in a continent free of polio.” Single case of polio in Malawi linked to Pakistan strain Pakistan is one of two countries where polio remains endemic. Laboratory analysis has linked the strain detected in Malawi to the one circulating in Pakistan’s Sindh Province in 2019. In addition to environmental surveillance, WHO has also been supporting the country to reinforce response measures including risk assessment, and preparations for the vaccination campaigns. A surge team from WHO is working with country-based counterparts, partner organizations, and the government to end the outbreak. The WHO team is a part of a broader multi-partner Global Polio Eradication Initiative to support the country. In an unrelated event, a vaccine-directed case of polio was also identified in February by Israeli authorities in Jerusalem, also for the first time in 30 years. The infected child is part of an ultra-orthodox Jewish community in which vaccination rates hover at around 50% or less. A vaccination drive also was launched in the city. Polio, a viral disease with no cure, can invade the nervous system and can cause total paralysis within hours, particular among children under 5 years. The virus is transmitted from person to person, mainly through contamination by fecal matter or, less frequently, through contaminated water or food, and multiplies in the intestine. While there is no cure for polio, the disease can be prevented through administration of a vaccine. Image Credits: Sanofi Pastuer/Flickr, Sanofi Pastuer/Flickr. UN Environment Programme Joins WHO Alliance to Advance One Health Approach 18/03/2022 Editorial team Safer and more sustainable food systems – from production to sales in food markets is key to a One-Health Approach. UN Environment has joined a three-way alliance with the Food and Agriculture Organization, the World Animal Health Organization (OIE), and WHO to advance “One-Health” solutions to both ecosystem degradation and pandemic threats, leaders of the four agencies said on Friday. The statement followed a meeting this week of the Tripartite FAO, WHO and OIE partnership – which now has become a “Quadripartite”. “The One Health approach aims to sustainably balance and optimize the health of people, animals, ecosystems and the wider environment,” said WHO in a press release. “It mobilizes multiple sectors, disciplines and communities to work together to foster well-being and tackle threats to health and ecosystems. And it addresses the collective need for clean water, energy and air, safe and nutritious food, action on climate change, and contributing to sustainable development.” The work of the newly expanded alliance will be focused on a One Health Joint Plan of Action, which includes six main action tracks: enhancing countries’ capacity to strengthen health systems under a One Health approach; reducing the risks from emerging or resurfacing zoonotic epidemics and pandemics; controlling and eliminating endemic zoonotic, neglected tropical or vector-borne diseases; strengthening the assessment, management and communication of food safety risks; curbing the silent pandemic of antimicrobial resistance (AMR) and better integrating the environment into the One Health approach. Increased awareness of One Health As the world enters the third year of the COVID-19 pandemic, with an estimated cost of $8 to 16 trillion, there is increased awareness and broad recognition of the importance of One Health as a long-term, viable and sustainable approach. The G7, G20 and UN Food Systems Summit have all given a nod to the approach, along with the increased references by WHO and its partners. But the hard work of reforming food systems, from production to markets, as well as halting related deforestation and ecosystem destruction, are much more formidable challenges that the organisations have barely begun to face. Last year saw the Tripartite implement a number of initial initiatives, including on antimicrobial resistance, a One Health High-Level Expert Panel, and guidance on better management – but not the banning – of wild animal sales in markets – in the wake of the COVID pandemic, whose origins may have emerged from the capture, transport and slaughter of SARS-CoV2 infected wild animals at the Wuhan, China market. Plan implementation the key challenge “Now the challenge is implementation: how do we translate our work on the ground to support our Members? And how do we mobilize funding and financing mechanisms to support the Joint Plan for Action?” said FAO Director QU Dongyu, handing over the chair of the Secretariat to WHO. WHO Director-General Tedros Adhanom Ghebreyesus, said: “We need to build a more comprehensive and coordinated One Health governance structure at global level. We need a strong workforce, committed political will, and sustained financial investment. We need to develop a more proactive way of communicating and engaging across sectors, disciplines and communities to elicit the change we need.” (WHO) Image Credits: Michael Casmir/Pierce Mill Media. Healthy Mouths, Healthy Planet 18/03/2022 Ihsane Ben Yahya, Nicolas Martin & Steven Mulligan Dental procedures produce a hefty amount of carbon emissions. In honour of World Oral Health Day, 20 March, three leading voices from the World Dental Federation highlight the unexpected linkages between the health of your mouth and that of the planet. It will come as a surprise to most people that the healthcare sector has a significant environmental impact. Healthcare systems are responsible for around 5% of global greenhouse gas emissions, of which oral healthcare is an important contributor. Indeed, if the healthcare sector was a country, it would be the fifth largest greenhouse gas emitter on the planet. Oral healthcare contributes to this environmental burden with air pollution arising from the release of CO2 associated with travel and transport, the incineration of waste, the greenhouse gas impact of anesthetic gases such as nitrous oxide and the high consumption of water. Specific to dentistry, the most routine procedures, all come with a hefty carbon price tag. Tooth-coloured fillings for instance, produce around 15 kilograms of CO2eq (carbon dioxide equivalent) per procedure, according to Public Health England, whose National Health Service has done some of the most extensive carbon footprint modeling of healthcare delivery in the world. A single root canal treatment, meanwhile, produces 23 kilograms of CO2eq, dentures between 58 and 71 kilograms CO2eq. Use of the anesthetic gas nitrous oxide (laughing gas), in a procedure, meanwhile, is responsible for 119 kilograms CO2eq. Nitrous oxide N2O, the most commonly used inhalation dental anesthetic, is a greenhouse gas with far more climate warming potential than CO2. Just one kilogram of nitrous oxide is equivalent to 298 kilogrammes of CO2 and 25 kilograms of methane – another powerful greenhouse gas. Meanwhile, silver amalgam fillings contain mercury. While more and more rarely used today, and still considered safe for dental treatments, there is an environmental impact through the release of residual mercury into sewage during procedures, as well as throughout its life cycle. Prevention is better than cure Ways to maintain good oral health. The dental industry has a collective responsibility to reduce these impacts – while also expanding access to oral healthcare. How can we do both? One simple solution is to look at how we can best minimize what we might label as “avoidable” oral procedures. Prevention is always better than cure and it is the most impactful and practical way of reducing the need for clinical interventions and their associated environmental impacts. This is best achieved through the promotion of good oral hygiene, a healthy diet and the avoidance of smoking. When treatment is required, oral healthcare also should focus on the provision of durable fillings, using high quality products and materials that will last longer and/or require fewer replacements. Legislation around water fluoridation for instance, complemented by targeted public health policies can help prevent tooth decay (caries) and ultimately cavities. The recent banning of TV and online advertising of junk food in the UK before 9pm is an indirect example of encouraging better diet. So too the campaign by UK footballer Marcus Rashford to promote healthier school lunches. At the same time, while many dental problems such as caries and periodontal (gum) disease are common preventable diseases, no amount of prevention can make them go away entirely. There will always be a need for accessible dental check-ups and treatments to facilitate good oral health. And it remains important to expand access to such treatments among disadvantaged groups as well as in many low- and middle-income countries so as to reduce inequalities in healthcare provision. Less trips to the dentist would also mean less travel and water consumption Dental procedures require a lot of water, which can be reduced by practicing good oral healthcare. Oral healthcare has higher levels of patient and staff transport than other medical specializations and this is partly due to the need for regular oral health maintenance, whereas other specializations tend only to treat illness. In the UK for instance, staff and patient commuting and travel accounts for approximately two thirds of all emissions from the oral healthcare sector and about eight per cent of the total UK NHS air pollution attributable to travel. This can be reduced significantly, through the maintenance of good oral health, that requires fewer interventions and consequently fewer trips to the dentist. Simple transport habit changes can have a great impact. For example, in October 2021 the Sustainability Committee at Harvard School of Dental Medicine (HSDM) implemented a `Step Challenge´ that encouraged staff, students and faculty to walk, or take public transport rather than drive during that month. They amassed over one million steps in total, preventing the release of approximately 0.28 metric tons of CO2. The practice of dentistry and personal oral healthcare is a significant consumer of water. As a conservative estimate, a bathroom tap delivers about four litres/minute. If we estimate that half the world population cleans their teeth once a day and runs the tap for one minute, the daily global water usage equates to 6,400 Olympic swimming pools. This figure is in addition to undocumented water consumption up and down the oral healthcare manufacturing and distribution supply chain. Reducing dental use of single use plastics and packaging Measures to reduce carbon footprint in dental offices. So what measures can be taken at the dentist office to reduce the carbon footprint of dentistry procedures that are nonetheless essential to good oral health? The use and consequent disposal of single use plastics for many procedures is one of the biggest contributors to the environmental footprint of healthcare generally – and that holds true for dentistry as well. Among single-use plastics, in fact it is the packaging in which the needles, gloves and other oral healthcare products are encased that is the single largest contributor to such waste in the dental industry, with over 90 % ending its life cycle in an incinerator or a landfill. A more thoughtful approach to the design of such packaging – from the plastics content, manufacture and transport, to the potential for reuse, recycling or biodegradability, is therefore one obvious starting point in reducing the carbon footprint of the typical dentist’s office. This is particularly important because packaging, as such, is not “contaminated” biomedical waste that needs special treatment, post-procedure. This requires greater engagement with consumers and waste management companies to segregate, collect and recycle uncontaminated clinical single use plastics (SUPs) as a valuable commodity. It also involves the design and development of more plastic items made from mono-polymer plastics that can be readily recycled. The Flexible Plastics Consortium which represents 34 European companies looking for better plastics content and design solutions for packaging is a good example of how this might work in practice. The United Kingdom’s Plastics Pact is another good example: it has set targets with the goal of 100% of plastic packaging to be reused, recycled or compostable by 2025. Major challenges in managing single use plastic waste from oral healthcare Many single use dental items end up in the waste bin, including gloves, aprons, masks. Once the box is opened, many of the everyday products used in dentistry are only briefly used and then end up in the waste bin. These single-use plastic (SUP) items range from personal protective equipment (aprons, gloves and masks) and other disposable sundries (the mouth-rinse cup or the dental suction tube). SUP biomedical waste requires more specialized management – since these are contaminated with blood and other bodily fluids from oral health procedures. The high safety and quality requirements for these products to be legally compliant, is often incompatible with recycling and materials recovery. The complex nature of items assembled from different plastics also makes recycling difficult, as does the prevailing view that plastic is simply waste and is not considered a valuable resource. Still there are many attempts at finding solutions around the world. These include incentivization schemes and professional education courses that can help manufacturers to design products that can be safely treated and reprocessed, as well as sensitizing dental practitioners to different waste streams, and the treatment they require. Initiatives like the development of a competency-based dental waste management course being undertaken at the Copperbelt University in Zambia are a step in the right direction. Even so, the lack of good technological solutions for the appropriate collection, disinfection/sterilization and subsequent recovery or reprocessing of single use plastics used in biomedical procedures remains an ongoing barrier. We need product research to come up with safe, sustainable solutions for a circular economy, including in the healthcare sector, and governments to adopt supportive policies. Assessing the environmental impacts of oral healthcare as a first step It is important to understand the environmental impacts of materials used in healthcare. A better understanding of the environmental impacts of products and materials used in healthcare systems, from procurement to disposal, is key to any of these measures. Solutions proposed have included more life cycle analysis for all materials used in the healthcare supply chain and the development of a credible ‘sustainability index’ to inform medical supply purchasers about the sustainability credentials of a product. The index could potentially include information on environmental sourcing, ethical manufacturing, supply chain distribution and procurement. This World Oral Health Day we can celebrate the fact that the oral health sector has recognised that it has a vital role to play in healthcare-related climate change mitigation. That is the first step. The next ones will be more challenging and will need ‘teeth’. The FDI World Dental Federation´s Code of Good Practice, which is to be launched later this year, following an extensive consultation with the sector, will be a good starting point for ensuring healthy mouths also help to produce a healthier planet. Steven Mulligan Nicolas Martin Ihsane Ben Yahya Ihsane Ben Yahya is the President of the FDI World Dental Federation and professor at the Dental University in Casablanca, Morocco. Nicolas Martin is the Chair of the FDI Sustainability in Dentistry Task Team. He is also Clinical Professor in Restorative Dentistry in the School of Clinical Dentistry, at the University of Sheffield, UK. Steven Mulligan is a Member of the FDI Sustainability in Dentistry Task Team. He is also a Clinical Lecturer in Restorative Dentistry in the School of Clinical Dentistry, at the University of Sheffield, UK. Image Credits: Mass Communication Specialist Seaman Apprentice Brian H. Abel/Flickr, FDI World Dental Federation , Jan Fidler/Flickr, World Dental Federation , Mass Communication Specialist 3rd Class Everett Allen/Flickr. From COVID to Humanitarian Crises – Medical Oxygen Needs More Prioritization for its Lifesaving Capacities 17/03/2022 Raisa Santos Lifesaving oxygen flows into the lungs of a COVID patient in Chernivtsi, southwest Ukraine before the start of the recent Russian invasion. Whether its due to COVID or conflict, oxygen supplies fall short in many parts of the world. From patients lying in the parking lots of hospitals, in the back seats of cars suffocating as their family members searched frantically for oxygen in India during its second wave of COVID last year, to the inability to receive emergency care amidst constant bombing and shelling in current war-torn Ukraine, global health experts and leaders are desperately searching for ways of improving the global oxygen supply. At a media briefing on the issue Thursday, speakers emphasized the need for both access to oxygen on the ground and more funding to the WHO co-sponsored Access to COVID-19 Tools Accelerator (ACT-A), which is attempting to beef up oxygen supplies in low and middle-income countries. “Oxygen has been treated for too long like a commodity, treated as something that must be delivered,” said WHO Executive Director of Health Emergencies Programme Dr Mike Ryan, speaking at the briefing, cosponsored by the Act Acccelerator and Unitaid. But “oxygen is a capability, not a commodity,” he stressed. Rethinking oxygen’s lifesaving capacities Mike Ryan, Executive Director, Health Emergencies Programme; World Health Organization Ryan and others made the case for rethinking oxygen as a health tool that requires not only a sustainable supply at a country level, but an entire ecosystem of supply and maintenance technology and infrastructure. Its role – and the chronic lack of capacity in many countries – has been underscored by COVID – and again in the very different setting of the Ukraine crisis – where the lack of access for people ranging from COVID patients to mothers in birth and children with pneumonia has prompted widespread alarm. Oxygen remains a critical component of the global COVID-19 response – 75% of patients hospitalized for COVID-19 can be treated with oxygen alone – without any further advanced care. Yet the current global supply of oxygen does not meet needs for both COVID-19 and other serious illnesses. “COVID didn’t cause [the oxygen shortage], COVID uncovered this. COVID laid bare, tore away the bandages from some very old wounds,” said Ryan. UNITAID Commits $56 million to boost access to global medical oxygen supply Robert Matiru, Chair, ACT-A Oxygen Emergency Taskforce & Director Programmes, Unitaid The ACT-A Strategic Plan and Budget for 2022 has identified a funding deficit of $1 billion for oxygen supplies worldwide for this year alone. As a first step to closing that gap, Unitaid has announced that it will invest $56 million to increase access to medical oxygen both for short-term needs related to COVID-19 as well as for the longer term – as a critical foundation for fighting future pandemics. The Unitaid pledge builds on the $50 million USAID has committed in funding for oxygen as pledged at US President Joe Biden’s Global COVID-19 Summit in September 2021. Four Unitaid-funded projects, designed to address global inequities in oxygen access, will be implemented by The Alliance for International Medical Action (ALIMA), the Clinton Health Access Initiative (CHAI), Partners in Health (PIH), and the WHO Health Emergencies Programme. These will also support the work of the ACT-A Oxygen Emergency Task Force by ensuring access to more affordable oxygen solutions such as bulk liquid oxygen, oxygen generation systems, and other important oxygen equipment. Unitaid called on donors, including governments, foundations, and private sector partners to join in the efforts. “Our call here is not just for the present, for this pandemic, but to recognize that donors and funders that come forward and step forward, over and above the generous contributors to date, will help drive a more sustainable ecosystem and [deliver] essential medicines to countries that are lacking it,” said Robert Matiru, Chair of the ACT-A Oxygen Emergency Taskforce and Director of Programmes at Unitaid. Children with pneumonia unrecognized victims – 40% of hospitals in some African countries lack oxygen Numerous countries are facing oxygen shortages, while readily available oxygen products are in short supply. Children are among the unrecognized victims of the lack of oxygen supplies – with childhood pneumonia still one of the biggest killers of under-fives. Accounting for almost a million deaths a year, the highest burden is in sub-Saharan African and South-East Asian countries where children face a double whammy of disease from both the lack of preventive treatments, like vaccinations, along with exposure to heavy indoor air pollution from the open burning of coal, biomass and other such fuels. But an estimated 20 to 40% of these deaths are preventable with increased availability of oxygen therapy. The shortage is particularly acute in low-income sub-Saharan African countries such as Tanzania, Sierra Leone, Liberia, and Gambia, where 40% of health facilities had no access to oxygen and other basic life saving supplies, said Atul Gawande of the United States Agency for International Development (USAID). COVID has led to big surges in needs Daily medical oxygen need for COVID-19 as of 16 March 2022 Along with the chronic shortages, COVID led to a major surge in oxygen needs. Low and middle-income countries (LMICs) need at least 23 million cubic meters of oxygen every day, just to treat COVID patients alone, according to the PATH COVID-19 Oxygen Needs Tracker. On the brighter side, the pandemic has brought a long-ignored aspect of health capacity in LMICs more to the forefront. USAID is currently working in 11 countries to build ‘oxygen ecosystems’ to support oxygen therapy for pneumonia patients, COVID patients, and others, Gawande said. Countries like Ghana now have oxygen generating capacity that can support up to 300,000 patients per day, per year. Gawande noted that the oxygen ecosystem includes liquid oxygen cylinders and concentrators, as well as the clinical engineering and technical assistance to use the technology. But expanding this initiative to other countries still needs more funding. Atul Gawande, USAID “As the Omicron variant abates, I think we’re all starting to feel that we can catch our breath. Oxygen demand may be lower right now. But it is the time that we have to make these investments to enable this kind of [sustainable] capacity.” Gawande said. Oxygen ‘natural security’ and ‘high-return’ health investment Leith Greenslade, Founder/CEO, JustActions & Coordinator, Every Breath Counts Coalition While the recent funding commitments are a positive sign, ‘it is not enough to fund protection’, said Leith Greenslade of the Every Breath Counts Coalition. “It took a pandemic of respiratory infection to wake up the world,” she pointed out. In the past year, about $700 million was invested into the ACT-A Oxygen Emergency Task Force, which has worked in LMICs to prevent oxygen shortages – jump-starting a more focused response. But so far, only a handful of governments – including the United States, Germany, Canada, and France – have borne the funding burden. “But most of the G-20 nations have not stepped up to invest in oxygen,” she charged. Greenslade appealed to donors to see oxygen as a high priority for three reasons: the moral obligation to flatten the COVID-19 curve; oxygen as a “national security” issue in moments of crisis; and finally, oxygen as a high-return health investment that will keep on saving lives beyond the pandemic. “When hospitals run out of oxygen, we have seen strikes and civil unrest in quite a few low- and middle-income countries,” she pointed out. “How many more deaths before this is over will largely depend on access to oxygen and critical care in the countries where the disease is greatest and the health systems are weakest,” she declared. Image Credits: Mstyslav Chernov/ Wikimedia Commons, UNICEF/Ralaivita, PATH, Every Breath Counts . Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
UN Environment Programme Joins WHO Alliance to Advance One Health Approach 18/03/2022 Editorial team Safer and more sustainable food systems – from production to sales in food markets is key to a One-Health Approach. UN Environment has joined a three-way alliance with the Food and Agriculture Organization, the World Animal Health Organization (OIE), and WHO to advance “One-Health” solutions to both ecosystem degradation and pandemic threats, leaders of the four agencies said on Friday. The statement followed a meeting this week of the Tripartite FAO, WHO and OIE partnership – which now has become a “Quadripartite”. “The One Health approach aims to sustainably balance and optimize the health of people, animals, ecosystems and the wider environment,” said WHO in a press release. “It mobilizes multiple sectors, disciplines and communities to work together to foster well-being and tackle threats to health and ecosystems. And it addresses the collective need for clean water, energy and air, safe and nutritious food, action on climate change, and contributing to sustainable development.” The work of the newly expanded alliance will be focused on a One Health Joint Plan of Action, which includes six main action tracks: enhancing countries’ capacity to strengthen health systems under a One Health approach; reducing the risks from emerging or resurfacing zoonotic epidemics and pandemics; controlling and eliminating endemic zoonotic, neglected tropical or vector-borne diseases; strengthening the assessment, management and communication of food safety risks; curbing the silent pandemic of antimicrobial resistance (AMR) and better integrating the environment into the One Health approach. Increased awareness of One Health As the world enters the third year of the COVID-19 pandemic, with an estimated cost of $8 to 16 trillion, there is increased awareness and broad recognition of the importance of One Health as a long-term, viable and sustainable approach. The G7, G20 and UN Food Systems Summit have all given a nod to the approach, along with the increased references by WHO and its partners. But the hard work of reforming food systems, from production to markets, as well as halting related deforestation and ecosystem destruction, are much more formidable challenges that the organisations have barely begun to face. Last year saw the Tripartite implement a number of initial initiatives, including on antimicrobial resistance, a One Health High-Level Expert Panel, and guidance on better management – but not the banning – of wild animal sales in markets – in the wake of the COVID pandemic, whose origins may have emerged from the capture, transport and slaughter of SARS-CoV2 infected wild animals at the Wuhan, China market. Plan implementation the key challenge “Now the challenge is implementation: how do we translate our work on the ground to support our Members? And how do we mobilize funding and financing mechanisms to support the Joint Plan for Action?” said FAO Director QU Dongyu, handing over the chair of the Secretariat to WHO. WHO Director-General Tedros Adhanom Ghebreyesus, said: “We need to build a more comprehensive and coordinated One Health governance structure at global level. We need a strong workforce, committed political will, and sustained financial investment. We need to develop a more proactive way of communicating and engaging across sectors, disciplines and communities to elicit the change we need.” (WHO) Image Credits: Michael Casmir/Pierce Mill Media. Healthy Mouths, Healthy Planet 18/03/2022 Ihsane Ben Yahya, Nicolas Martin & Steven Mulligan Dental procedures produce a hefty amount of carbon emissions. In honour of World Oral Health Day, 20 March, three leading voices from the World Dental Federation highlight the unexpected linkages between the health of your mouth and that of the planet. It will come as a surprise to most people that the healthcare sector has a significant environmental impact. Healthcare systems are responsible for around 5% of global greenhouse gas emissions, of which oral healthcare is an important contributor. Indeed, if the healthcare sector was a country, it would be the fifth largest greenhouse gas emitter on the planet. Oral healthcare contributes to this environmental burden with air pollution arising from the release of CO2 associated with travel and transport, the incineration of waste, the greenhouse gas impact of anesthetic gases such as nitrous oxide and the high consumption of water. Specific to dentistry, the most routine procedures, all come with a hefty carbon price tag. Tooth-coloured fillings for instance, produce around 15 kilograms of CO2eq (carbon dioxide equivalent) per procedure, according to Public Health England, whose National Health Service has done some of the most extensive carbon footprint modeling of healthcare delivery in the world. A single root canal treatment, meanwhile, produces 23 kilograms of CO2eq, dentures between 58 and 71 kilograms CO2eq. Use of the anesthetic gas nitrous oxide (laughing gas), in a procedure, meanwhile, is responsible for 119 kilograms CO2eq. Nitrous oxide N2O, the most commonly used inhalation dental anesthetic, is a greenhouse gas with far more climate warming potential than CO2. Just one kilogram of nitrous oxide is equivalent to 298 kilogrammes of CO2 and 25 kilograms of methane – another powerful greenhouse gas. Meanwhile, silver amalgam fillings contain mercury. While more and more rarely used today, and still considered safe for dental treatments, there is an environmental impact through the release of residual mercury into sewage during procedures, as well as throughout its life cycle. Prevention is better than cure Ways to maintain good oral health. The dental industry has a collective responsibility to reduce these impacts – while also expanding access to oral healthcare. How can we do both? One simple solution is to look at how we can best minimize what we might label as “avoidable” oral procedures. Prevention is always better than cure and it is the most impactful and practical way of reducing the need for clinical interventions and their associated environmental impacts. This is best achieved through the promotion of good oral hygiene, a healthy diet and the avoidance of smoking. When treatment is required, oral healthcare also should focus on the provision of durable fillings, using high quality products and materials that will last longer and/or require fewer replacements. Legislation around water fluoridation for instance, complemented by targeted public health policies can help prevent tooth decay (caries) and ultimately cavities. The recent banning of TV and online advertising of junk food in the UK before 9pm is an indirect example of encouraging better diet. So too the campaign by UK footballer Marcus Rashford to promote healthier school lunches. At the same time, while many dental problems such as caries and periodontal (gum) disease are common preventable diseases, no amount of prevention can make them go away entirely. There will always be a need for accessible dental check-ups and treatments to facilitate good oral health. And it remains important to expand access to such treatments among disadvantaged groups as well as in many low- and middle-income countries so as to reduce inequalities in healthcare provision. Less trips to the dentist would also mean less travel and water consumption Dental procedures require a lot of water, which can be reduced by practicing good oral healthcare. Oral healthcare has higher levels of patient and staff transport than other medical specializations and this is partly due to the need for regular oral health maintenance, whereas other specializations tend only to treat illness. In the UK for instance, staff and patient commuting and travel accounts for approximately two thirds of all emissions from the oral healthcare sector and about eight per cent of the total UK NHS air pollution attributable to travel. This can be reduced significantly, through the maintenance of good oral health, that requires fewer interventions and consequently fewer trips to the dentist. Simple transport habit changes can have a great impact. For example, in October 2021 the Sustainability Committee at Harvard School of Dental Medicine (HSDM) implemented a `Step Challenge´ that encouraged staff, students and faculty to walk, or take public transport rather than drive during that month. They amassed over one million steps in total, preventing the release of approximately 0.28 metric tons of CO2. The practice of dentistry and personal oral healthcare is a significant consumer of water. As a conservative estimate, a bathroom tap delivers about four litres/minute. If we estimate that half the world population cleans their teeth once a day and runs the tap for one minute, the daily global water usage equates to 6,400 Olympic swimming pools. This figure is in addition to undocumented water consumption up and down the oral healthcare manufacturing and distribution supply chain. Reducing dental use of single use plastics and packaging Measures to reduce carbon footprint in dental offices. So what measures can be taken at the dentist office to reduce the carbon footprint of dentistry procedures that are nonetheless essential to good oral health? The use and consequent disposal of single use plastics for many procedures is one of the biggest contributors to the environmental footprint of healthcare generally – and that holds true for dentistry as well. Among single-use plastics, in fact it is the packaging in which the needles, gloves and other oral healthcare products are encased that is the single largest contributor to such waste in the dental industry, with over 90 % ending its life cycle in an incinerator or a landfill. A more thoughtful approach to the design of such packaging – from the plastics content, manufacture and transport, to the potential for reuse, recycling or biodegradability, is therefore one obvious starting point in reducing the carbon footprint of the typical dentist’s office. This is particularly important because packaging, as such, is not “contaminated” biomedical waste that needs special treatment, post-procedure. This requires greater engagement with consumers and waste management companies to segregate, collect and recycle uncontaminated clinical single use plastics (SUPs) as a valuable commodity. It also involves the design and development of more plastic items made from mono-polymer plastics that can be readily recycled. The Flexible Plastics Consortium which represents 34 European companies looking for better plastics content and design solutions for packaging is a good example of how this might work in practice. The United Kingdom’s Plastics Pact is another good example: it has set targets with the goal of 100% of plastic packaging to be reused, recycled or compostable by 2025. Major challenges in managing single use plastic waste from oral healthcare Many single use dental items end up in the waste bin, including gloves, aprons, masks. Once the box is opened, many of the everyday products used in dentistry are only briefly used and then end up in the waste bin. These single-use plastic (SUP) items range from personal protective equipment (aprons, gloves and masks) and other disposable sundries (the mouth-rinse cup or the dental suction tube). SUP biomedical waste requires more specialized management – since these are contaminated with blood and other bodily fluids from oral health procedures. The high safety and quality requirements for these products to be legally compliant, is often incompatible with recycling and materials recovery. The complex nature of items assembled from different plastics also makes recycling difficult, as does the prevailing view that plastic is simply waste and is not considered a valuable resource. Still there are many attempts at finding solutions around the world. These include incentivization schemes and professional education courses that can help manufacturers to design products that can be safely treated and reprocessed, as well as sensitizing dental practitioners to different waste streams, and the treatment they require. Initiatives like the development of a competency-based dental waste management course being undertaken at the Copperbelt University in Zambia are a step in the right direction. Even so, the lack of good technological solutions for the appropriate collection, disinfection/sterilization and subsequent recovery or reprocessing of single use plastics used in biomedical procedures remains an ongoing barrier. We need product research to come up with safe, sustainable solutions for a circular economy, including in the healthcare sector, and governments to adopt supportive policies. Assessing the environmental impacts of oral healthcare as a first step It is important to understand the environmental impacts of materials used in healthcare. A better understanding of the environmental impacts of products and materials used in healthcare systems, from procurement to disposal, is key to any of these measures. Solutions proposed have included more life cycle analysis for all materials used in the healthcare supply chain and the development of a credible ‘sustainability index’ to inform medical supply purchasers about the sustainability credentials of a product. The index could potentially include information on environmental sourcing, ethical manufacturing, supply chain distribution and procurement. This World Oral Health Day we can celebrate the fact that the oral health sector has recognised that it has a vital role to play in healthcare-related climate change mitigation. That is the first step. The next ones will be more challenging and will need ‘teeth’. The FDI World Dental Federation´s Code of Good Practice, which is to be launched later this year, following an extensive consultation with the sector, will be a good starting point for ensuring healthy mouths also help to produce a healthier planet. Steven Mulligan Nicolas Martin Ihsane Ben Yahya Ihsane Ben Yahya is the President of the FDI World Dental Federation and professor at the Dental University in Casablanca, Morocco. Nicolas Martin is the Chair of the FDI Sustainability in Dentistry Task Team. He is also Clinical Professor in Restorative Dentistry in the School of Clinical Dentistry, at the University of Sheffield, UK. Steven Mulligan is a Member of the FDI Sustainability in Dentistry Task Team. He is also a Clinical Lecturer in Restorative Dentistry in the School of Clinical Dentistry, at the University of Sheffield, UK. Image Credits: Mass Communication Specialist Seaman Apprentice Brian H. Abel/Flickr, FDI World Dental Federation , Jan Fidler/Flickr, World Dental Federation , Mass Communication Specialist 3rd Class Everett Allen/Flickr. From COVID to Humanitarian Crises – Medical Oxygen Needs More Prioritization for its Lifesaving Capacities 17/03/2022 Raisa Santos Lifesaving oxygen flows into the lungs of a COVID patient in Chernivtsi, southwest Ukraine before the start of the recent Russian invasion. Whether its due to COVID or conflict, oxygen supplies fall short in many parts of the world. From patients lying in the parking lots of hospitals, in the back seats of cars suffocating as their family members searched frantically for oxygen in India during its second wave of COVID last year, to the inability to receive emergency care amidst constant bombing and shelling in current war-torn Ukraine, global health experts and leaders are desperately searching for ways of improving the global oxygen supply. At a media briefing on the issue Thursday, speakers emphasized the need for both access to oxygen on the ground and more funding to the WHO co-sponsored Access to COVID-19 Tools Accelerator (ACT-A), which is attempting to beef up oxygen supplies in low and middle-income countries. “Oxygen has been treated for too long like a commodity, treated as something that must be delivered,” said WHO Executive Director of Health Emergencies Programme Dr Mike Ryan, speaking at the briefing, cosponsored by the Act Acccelerator and Unitaid. But “oxygen is a capability, not a commodity,” he stressed. Rethinking oxygen’s lifesaving capacities Mike Ryan, Executive Director, Health Emergencies Programme; World Health Organization Ryan and others made the case for rethinking oxygen as a health tool that requires not only a sustainable supply at a country level, but an entire ecosystem of supply and maintenance technology and infrastructure. Its role – and the chronic lack of capacity in many countries – has been underscored by COVID – and again in the very different setting of the Ukraine crisis – where the lack of access for people ranging from COVID patients to mothers in birth and children with pneumonia has prompted widespread alarm. Oxygen remains a critical component of the global COVID-19 response – 75% of patients hospitalized for COVID-19 can be treated with oxygen alone – without any further advanced care. Yet the current global supply of oxygen does not meet needs for both COVID-19 and other serious illnesses. “COVID didn’t cause [the oxygen shortage], COVID uncovered this. COVID laid bare, tore away the bandages from some very old wounds,” said Ryan. UNITAID Commits $56 million to boost access to global medical oxygen supply Robert Matiru, Chair, ACT-A Oxygen Emergency Taskforce & Director Programmes, Unitaid The ACT-A Strategic Plan and Budget for 2022 has identified a funding deficit of $1 billion for oxygen supplies worldwide for this year alone. As a first step to closing that gap, Unitaid has announced that it will invest $56 million to increase access to medical oxygen both for short-term needs related to COVID-19 as well as for the longer term – as a critical foundation for fighting future pandemics. The Unitaid pledge builds on the $50 million USAID has committed in funding for oxygen as pledged at US President Joe Biden’s Global COVID-19 Summit in September 2021. Four Unitaid-funded projects, designed to address global inequities in oxygen access, will be implemented by The Alliance for International Medical Action (ALIMA), the Clinton Health Access Initiative (CHAI), Partners in Health (PIH), and the WHO Health Emergencies Programme. These will also support the work of the ACT-A Oxygen Emergency Task Force by ensuring access to more affordable oxygen solutions such as bulk liquid oxygen, oxygen generation systems, and other important oxygen equipment. Unitaid called on donors, including governments, foundations, and private sector partners to join in the efforts. “Our call here is not just for the present, for this pandemic, but to recognize that donors and funders that come forward and step forward, over and above the generous contributors to date, will help drive a more sustainable ecosystem and [deliver] essential medicines to countries that are lacking it,” said Robert Matiru, Chair of the ACT-A Oxygen Emergency Taskforce and Director of Programmes at Unitaid. Children with pneumonia unrecognized victims – 40% of hospitals in some African countries lack oxygen Numerous countries are facing oxygen shortages, while readily available oxygen products are in short supply. Children are among the unrecognized victims of the lack of oxygen supplies – with childhood pneumonia still one of the biggest killers of under-fives. Accounting for almost a million deaths a year, the highest burden is in sub-Saharan African and South-East Asian countries where children face a double whammy of disease from both the lack of preventive treatments, like vaccinations, along with exposure to heavy indoor air pollution from the open burning of coal, biomass and other such fuels. But an estimated 20 to 40% of these deaths are preventable with increased availability of oxygen therapy. The shortage is particularly acute in low-income sub-Saharan African countries such as Tanzania, Sierra Leone, Liberia, and Gambia, where 40% of health facilities had no access to oxygen and other basic life saving supplies, said Atul Gawande of the United States Agency for International Development (USAID). COVID has led to big surges in needs Daily medical oxygen need for COVID-19 as of 16 March 2022 Along with the chronic shortages, COVID led to a major surge in oxygen needs. Low and middle-income countries (LMICs) need at least 23 million cubic meters of oxygen every day, just to treat COVID patients alone, according to the PATH COVID-19 Oxygen Needs Tracker. On the brighter side, the pandemic has brought a long-ignored aspect of health capacity in LMICs more to the forefront. USAID is currently working in 11 countries to build ‘oxygen ecosystems’ to support oxygen therapy for pneumonia patients, COVID patients, and others, Gawande said. Countries like Ghana now have oxygen generating capacity that can support up to 300,000 patients per day, per year. Gawande noted that the oxygen ecosystem includes liquid oxygen cylinders and concentrators, as well as the clinical engineering and technical assistance to use the technology. But expanding this initiative to other countries still needs more funding. Atul Gawande, USAID “As the Omicron variant abates, I think we’re all starting to feel that we can catch our breath. Oxygen demand may be lower right now. But it is the time that we have to make these investments to enable this kind of [sustainable] capacity.” Gawande said. Oxygen ‘natural security’ and ‘high-return’ health investment Leith Greenslade, Founder/CEO, JustActions & Coordinator, Every Breath Counts Coalition While the recent funding commitments are a positive sign, ‘it is not enough to fund protection’, said Leith Greenslade of the Every Breath Counts Coalition. “It took a pandemic of respiratory infection to wake up the world,” she pointed out. In the past year, about $700 million was invested into the ACT-A Oxygen Emergency Task Force, which has worked in LMICs to prevent oxygen shortages – jump-starting a more focused response. But so far, only a handful of governments – including the United States, Germany, Canada, and France – have borne the funding burden. “But most of the G-20 nations have not stepped up to invest in oxygen,” she charged. Greenslade appealed to donors to see oxygen as a high priority for three reasons: the moral obligation to flatten the COVID-19 curve; oxygen as a “national security” issue in moments of crisis; and finally, oxygen as a high-return health investment that will keep on saving lives beyond the pandemic. “When hospitals run out of oxygen, we have seen strikes and civil unrest in quite a few low- and middle-income countries,” she pointed out. “How many more deaths before this is over will largely depend on access to oxygen and critical care in the countries where the disease is greatest and the health systems are weakest,” she declared. Image Credits: Mstyslav Chernov/ Wikimedia Commons, UNICEF/Ralaivita, PATH, Every Breath Counts . Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
Healthy Mouths, Healthy Planet 18/03/2022 Ihsane Ben Yahya, Nicolas Martin & Steven Mulligan Dental procedures produce a hefty amount of carbon emissions. In honour of World Oral Health Day, 20 March, three leading voices from the World Dental Federation highlight the unexpected linkages between the health of your mouth and that of the planet. It will come as a surprise to most people that the healthcare sector has a significant environmental impact. Healthcare systems are responsible for around 5% of global greenhouse gas emissions, of which oral healthcare is an important contributor. Indeed, if the healthcare sector was a country, it would be the fifth largest greenhouse gas emitter on the planet. Oral healthcare contributes to this environmental burden with air pollution arising from the release of CO2 associated with travel and transport, the incineration of waste, the greenhouse gas impact of anesthetic gases such as nitrous oxide and the high consumption of water. Specific to dentistry, the most routine procedures, all come with a hefty carbon price tag. Tooth-coloured fillings for instance, produce around 15 kilograms of CO2eq (carbon dioxide equivalent) per procedure, according to Public Health England, whose National Health Service has done some of the most extensive carbon footprint modeling of healthcare delivery in the world. A single root canal treatment, meanwhile, produces 23 kilograms of CO2eq, dentures between 58 and 71 kilograms CO2eq. Use of the anesthetic gas nitrous oxide (laughing gas), in a procedure, meanwhile, is responsible for 119 kilograms CO2eq. Nitrous oxide N2O, the most commonly used inhalation dental anesthetic, is a greenhouse gas with far more climate warming potential than CO2. Just one kilogram of nitrous oxide is equivalent to 298 kilogrammes of CO2 and 25 kilograms of methane – another powerful greenhouse gas. Meanwhile, silver amalgam fillings contain mercury. While more and more rarely used today, and still considered safe for dental treatments, there is an environmental impact through the release of residual mercury into sewage during procedures, as well as throughout its life cycle. Prevention is better than cure Ways to maintain good oral health. The dental industry has a collective responsibility to reduce these impacts – while also expanding access to oral healthcare. How can we do both? One simple solution is to look at how we can best minimize what we might label as “avoidable” oral procedures. Prevention is always better than cure and it is the most impactful and practical way of reducing the need for clinical interventions and their associated environmental impacts. This is best achieved through the promotion of good oral hygiene, a healthy diet and the avoidance of smoking. When treatment is required, oral healthcare also should focus on the provision of durable fillings, using high quality products and materials that will last longer and/or require fewer replacements. Legislation around water fluoridation for instance, complemented by targeted public health policies can help prevent tooth decay (caries) and ultimately cavities. The recent banning of TV and online advertising of junk food in the UK before 9pm is an indirect example of encouraging better diet. So too the campaign by UK footballer Marcus Rashford to promote healthier school lunches. At the same time, while many dental problems such as caries and periodontal (gum) disease are common preventable diseases, no amount of prevention can make them go away entirely. There will always be a need for accessible dental check-ups and treatments to facilitate good oral health. And it remains important to expand access to such treatments among disadvantaged groups as well as in many low- and middle-income countries so as to reduce inequalities in healthcare provision. Less trips to the dentist would also mean less travel and water consumption Dental procedures require a lot of water, which can be reduced by practicing good oral healthcare. Oral healthcare has higher levels of patient and staff transport than other medical specializations and this is partly due to the need for regular oral health maintenance, whereas other specializations tend only to treat illness. In the UK for instance, staff and patient commuting and travel accounts for approximately two thirds of all emissions from the oral healthcare sector and about eight per cent of the total UK NHS air pollution attributable to travel. This can be reduced significantly, through the maintenance of good oral health, that requires fewer interventions and consequently fewer trips to the dentist. Simple transport habit changes can have a great impact. For example, in October 2021 the Sustainability Committee at Harvard School of Dental Medicine (HSDM) implemented a `Step Challenge´ that encouraged staff, students and faculty to walk, or take public transport rather than drive during that month. They amassed over one million steps in total, preventing the release of approximately 0.28 metric tons of CO2. The practice of dentistry and personal oral healthcare is a significant consumer of water. As a conservative estimate, a bathroom tap delivers about four litres/minute. If we estimate that half the world population cleans their teeth once a day and runs the tap for one minute, the daily global water usage equates to 6,400 Olympic swimming pools. This figure is in addition to undocumented water consumption up and down the oral healthcare manufacturing and distribution supply chain. Reducing dental use of single use plastics and packaging Measures to reduce carbon footprint in dental offices. So what measures can be taken at the dentist office to reduce the carbon footprint of dentistry procedures that are nonetheless essential to good oral health? The use and consequent disposal of single use plastics for many procedures is one of the biggest contributors to the environmental footprint of healthcare generally – and that holds true for dentistry as well. Among single-use plastics, in fact it is the packaging in which the needles, gloves and other oral healthcare products are encased that is the single largest contributor to such waste in the dental industry, with over 90 % ending its life cycle in an incinerator or a landfill. A more thoughtful approach to the design of such packaging – from the plastics content, manufacture and transport, to the potential for reuse, recycling or biodegradability, is therefore one obvious starting point in reducing the carbon footprint of the typical dentist’s office. This is particularly important because packaging, as such, is not “contaminated” biomedical waste that needs special treatment, post-procedure. This requires greater engagement with consumers and waste management companies to segregate, collect and recycle uncontaminated clinical single use plastics (SUPs) as a valuable commodity. It also involves the design and development of more plastic items made from mono-polymer plastics that can be readily recycled. The Flexible Plastics Consortium which represents 34 European companies looking for better plastics content and design solutions for packaging is a good example of how this might work in practice. The United Kingdom’s Plastics Pact is another good example: it has set targets with the goal of 100% of plastic packaging to be reused, recycled or compostable by 2025. Major challenges in managing single use plastic waste from oral healthcare Many single use dental items end up in the waste bin, including gloves, aprons, masks. Once the box is opened, many of the everyday products used in dentistry are only briefly used and then end up in the waste bin. These single-use plastic (SUP) items range from personal protective equipment (aprons, gloves and masks) and other disposable sundries (the mouth-rinse cup or the dental suction tube). SUP biomedical waste requires more specialized management – since these are contaminated with blood and other bodily fluids from oral health procedures. The high safety and quality requirements for these products to be legally compliant, is often incompatible with recycling and materials recovery. The complex nature of items assembled from different plastics also makes recycling difficult, as does the prevailing view that plastic is simply waste and is not considered a valuable resource. Still there are many attempts at finding solutions around the world. These include incentivization schemes and professional education courses that can help manufacturers to design products that can be safely treated and reprocessed, as well as sensitizing dental practitioners to different waste streams, and the treatment they require. Initiatives like the development of a competency-based dental waste management course being undertaken at the Copperbelt University in Zambia are a step in the right direction. Even so, the lack of good technological solutions for the appropriate collection, disinfection/sterilization and subsequent recovery or reprocessing of single use plastics used in biomedical procedures remains an ongoing barrier. We need product research to come up with safe, sustainable solutions for a circular economy, including in the healthcare sector, and governments to adopt supportive policies. Assessing the environmental impacts of oral healthcare as a first step It is important to understand the environmental impacts of materials used in healthcare. A better understanding of the environmental impacts of products and materials used in healthcare systems, from procurement to disposal, is key to any of these measures. Solutions proposed have included more life cycle analysis for all materials used in the healthcare supply chain and the development of a credible ‘sustainability index’ to inform medical supply purchasers about the sustainability credentials of a product. The index could potentially include information on environmental sourcing, ethical manufacturing, supply chain distribution and procurement. This World Oral Health Day we can celebrate the fact that the oral health sector has recognised that it has a vital role to play in healthcare-related climate change mitigation. That is the first step. The next ones will be more challenging and will need ‘teeth’. The FDI World Dental Federation´s Code of Good Practice, which is to be launched later this year, following an extensive consultation with the sector, will be a good starting point for ensuring healthy mouths also help to produce a healthier planet. Steven Mulligan Nicolas Martin Ihsane Ben Yahya Ihsane Ben Yahya is the President of the FDI World Dental Federation and professor at the Dental University in Casablanca, Morocco. Nicolas Martin is the Chair of the FDI Sustainability in Dentistry Task Team. He is also Clinical Professor in Restorative Dentistry in the School of Clinical Dentistry, at the University of Sheffield, UK. Steven Mulligan is a Member of the FDI Sustainability in Dentistry Task Team. He is also a Clinical Lecturer in Restorative Dentistry in the School of Clinical Dentistry, at the University of Sheffield, UK. Image Credits: Mass Communication Specialist Seaman Apprentice Brian H. Abel/Flickr, FDI World Dental Federation , Jan Fidler/Flickr, World Dental Federation , Mass Communication Specialist 3rd Class Everett Allen/Flickr. From COVID to Humanitarian Crises – Medical Oxygen Needs More Prioritization for its Lifesaving Capacities 17/03/2022 Raisa Santos Lifesaving oxygen flows into the lungs of a COVID patient in Chernivtsi, southwest Ukraine before the start of the recent Russian invasion. Whether its due to COVID or conflict, oxygen supplies fall short in many parts of the world. From patients lying in the parking lots of hospitals, in the back seats of cars suffocating as their family members searched frantically for oxygen in India during its second wave of COVID last year, to the inability to receive emergency care amidst constant bombing and shelling in current war-torn Ukraine, global health experts and leaders are desperately searching for ways of improving the global oxygen supply. At a media briefing on the issue Thursday, speakers emphasized the need for both access to oxygen on the ground and more funding to the WHO co-sponsored Access to COVID-19 Tools Accelerator (ACT-A), which is attempting to beef up oxygen supplies in low and middle-income countries. “Oxygen has been treated for too long like a commodity, treated as something that must be delivered,” said WHO Executive Director of Health Emergencies Programme Dr Mike Ryan, speaking at the briefing, cosponsored by the Act Acccelerator and Unitaid. But “oxygen is a capability, not a commodity,” he stressed. Rethinking oxygen’s lifesaving capacities Mike Ryan, Executive Director, Health Emergencies Programme; World Health Organization Ryan and others made the case for rethinking oxygen as a health tool that requires not only a sustainable supply at a country level, but an entire ecosystem of supply and maintenance technology and infrastructure. Its role – and the chronic lack of capacity in many countries – has been underscored by COVID – and again in the very different setting of the Ukraine crisis – where the lack of access for people ranging from COVID patients to mothers in birth and children with pneumonia has prompted widespread alarm. Oxygen remains a critical component of the global COVID-19 response – 75% of patients hospitalized for COVID-19 can be treated with oxygen alone – without any further advanced care. Yet the current global supply of oxygen does not meet needs for both COVID-19 and other serious illnesses. “COVID didn’t cause [the oxygen shortage], COVID uncovered this. COVID laid bare, tore away the bandages from some very old wounds,” said Ryan. UNITAID Commits $56 million to boost access to global medical oxygen supply Robert Matiru, Chair, ACT-A Oxygen Emergency Taskforce & Director Programmes, Unitaid The ACT-A Strategic Plan and Budget for 2022 has identified a funding deficit of $1 billion for oxygen supplies worldwide for this year alone. As a first step to closing that gap, Unitaid has announced that it will invest $56 million to increase access to medical oxygen both for short-term needs related to COVID-19 as well as for the longer term – as a critical foundation for fighting future pandemics. The Unitaid pledge builds on the $50 million USAID has committed in funding for oxygen as pledged at US President Joe Biden’s Global COVID-19 Summit in September 2021. Four Unitaid-funded projects, designed to address global inequities in oxygen access, will be implemented by The Alliance for International Medical Action (ALIMA), the Clinton Health Access Initiative (CHAI), Partners in Health (PIH), and the WHO Health Emergencies Programme. These will also support the work of the ACT-A Oxygen Emergency Task Force by ensuring access to more affordable oxygen solutions such as bulk liquid oxygen, oxygen generation systems, and other important oxygen equipment. Unitaid called on donors, including governments, foundations, and private sector partners to join in the efforts. “Our call here is not just for the present, for this pandemic, but to recognize that donors and funders that come forward and step forward, over and above the generous contributors to date, will help drive a more sustainable ecosystem and [deliver] essential medicines to countries that are lacking it,” said Robert Matiru, Chair of the ACT-A Oxygen Emergency Taskforce and Director of Programmes at Unitaid. Children with pneumonia unrecognized victims – 40% of hospitals in some African countries lack oxygen Numerous countries are facing oxygen shortages, while readily available oxygen products are in short supply. Children are among the unrecognized victims of the lack of oxygen supplies – with childhood pneumonia still one of the biggest killers of under-fives. Accounting for almost a million deaths a year, the highest burden is in sub-Saharan African and South-East Asian countries where children face a double whammy of disease from both the lack of preventive treatments, like vaccinations, along with exposure to heavy indoor air pollution from the open burning of coal, biomass and other such fuels. But an estimated 20 to 40% of these deaths are preventable with increased availability of oxygen therapy. The shortage is particularly acute in low-income sub-Saharan African countries such as Tanzania, Sierra Leone, Liberia, and Gambia, where 40% of health facilities had no access to oxygen and other basic life saving supplies, said Atul Gawande of the United States Agency for International Development (USAID). COVID has led to big surges in needs Daily medical oxygen need for COVID-19 as of 16 March 2022 Along with the chronic shortages, COVID led to a major surge in oxygen needs. Low and middle-income countries (LMICs) need at least 23 million cubic meters of oxygen every day, just to treat COVID patients alone, according to the PATH COVID-19 Oxygen Needs Tracker. On the brighter side, the pandemic has brought a long-ignored aspect of health capacity in LMICs more to the forefront. USAID is currently working in 11 countries to build ‘oxygen ecosystems’ to support oxygen therapy for pneumonia patients, COVID patients, and others, Gawande said. Countries like Ghana now have oxygen generating capacity that can support up to 300,000 patients per day, per year. Gawande noted that the oxygen ecosystem includes liquid oxygen cylinders and concentrators, as well as the clinical engineering and technical assistance to use the technology. But expanding this initiative to other countries still needs more funding. Atul Gawande, USAID “As the Omicron variant abates, I think we’re all starting to feel that we can catch our breath. Oxygen demand may be lower right now. But it is the time that we have to make these investments to enable this kind of [sustainable] capacity.” Gawande said. Oxygen ‘natural security’ and ‘high-return’ health investment Leith Greenslade, Founder/CEO, JustActions & Coordinator, Every Breath Counts Coalition While the recent funding commitments are a positive sign, ‘it is not enough to fund protection’, said Leith Greenslade of the Every Breath Counts Coalition. “It took a pandemic of respiratory infection to wake up the world,” she pointed out. In the past year, about $700 million was invested into the ACT-A Oxygen Emergency Task Force, which has worked in LMICs to prevent oxygen shortages – jump-starting a more focused response. But so far, only a handful of governments – including the United States, Germany, Canada, and France – have borne the funding burden. “But most of the G-20 nations have not stepped up to invest in oxygen,” she charged. Greenslade appealed to donors to see oxygen as a high priority for three reasons: the moral obligation to flatten the COVID-19 curve; oxygen as a “national security” issue in moments of crisis; and finally, oxygen as a high-return health investment that will keep on saving lives beyond the pandemic. “When hospitals run out of oxygen, we have seen strikes and civil unrest in quite a few low- and middle-income countries,” she pointed out. “How many more deaths before this is over will largely depend on access to oxygen and critical care in the countries where the disease is greatest and the health systems are weakest,” she declared. Image Credits: Mstyslav Chernov/ Wikimedia Commons, UNICEF/Ralaivita, PATH, Every Breath Counts . Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. 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From COVID to Humanitarian Crises – Medical Oxygen Needs More Prioritization for its Lifesaving Capacities 17/03/2022 Raisa Santos Lifesaving oxygen flows into the lungs of a COVID patient in Chernivtsi, southwest Ukraine before the start of the recent Russian invasion. Whether its due to COVID or conflict, oxygen supplies fall short in many parts of the world. From patients lying in the parking lots of hospitals, in the back seats of cars suffocating as their family members searched frantically for oxygen in India during its second wave of COVID last year, to the inability to receive emergency care amidst constant bombing and shelling in current war-torn Ukraine, global health experts and leaders are desperately searching for ways of improving the global oxygen supply. At a media briefing on the issue Thursday, speakers emphasized the need for both access to oxygen on the ground and more funding to the WHO co-sponsored Access to COVID-19 Tools Accelerator (ACT-A), which is attempting to beef up oxygen supplies in low and middle-income countries. “Oxygen has been treated for too long like a commodity, treated as something that must be delivered,” said WHO Executive Director of Health Emergencies Programme Dr Mike Ryan, speaking at the briefing, cosponsored by the Act Acccelerator and Unitaid. But “oxygen is a capability, not a commodity,” he stressed. Rethinking oxygen’s lifesaving capacities Mike Ryan, Executive Director, Health Emergencies Programme; World Health Organization Ryan and others made the case for rethinking oxygen as a health tool that requires not only a sustainable supply at a country level, but an entire ecosystem of supply and maintenance technology and infrastructure. Its role – and the chronic lack of capacity in many countries – has been underscored by COVID – and again in the very different setting of the Ukraine crisis – where the lack of access for people ranging from COVID patients to mothers in birth and children with pneumonia has prompted widespread alarm. Oxygen remains a critical component of the global COVID-19 response – 75% of patients hospitalized for COVID-19 can be treated with oxygen alone – without any further advanced care. Yet the current global supply of oxygen does not meet needs for both COVID-19 and other serious illnesses. “COVID didn’t cause [the oxygen shortage], COVID uncovered this. COVID laid bare, tore away the bandages from some very old wounds,” said Ryan. UNITAID Commits $56 million to boost access to global medical oxygen supply Robert Matiru, Chair, ACT-A Oxygen Emergency Taskforce & Director Programmes, Unitaid The ACT-A Strategic Plan and Budget for 2022 has identified a funding deficit of $1 billion for oxygen supplies worldwide for this year alone. As a first step to closing that gap, Unitaid has announced that it will invest $56 million to increase access to medical oxygen both for short-term needs related to COVID-19 as well as for the longer term – as a critical foundation for fighting future pandemics. The Unitaid pledge builds on the $50 million USAID has committed in funding for oxygen as pledged at US President Joe Biden’s Global COVID-19 Summit in September 2021. Four Unitaid-funded projects, designed to address global inequities in oxygen access, will be implemented by The Alliance for International Medical Action (ALIMA), the Clinton Health Access Initiative (CHAI), Partners in Health (PIH), and the WHO Health Emergencies Programme. These will also support the work of the ACT-A Oxygen Emergency Task Force by ensuring access to more affordable oxygen solutions such as bulk liquid oxygen, oxygen generation systems, and other important oxygen equipment. Unitaid called on donors, including governments, foundations, and private sector partners to join in the efforts. “Our call here is not just for the present, for this pandemic, but to recognize that donors and funders that come forward and step forward, over and above the generous contributors to date, will help drive a more sustainable ecosystem and [deliver] essential medicines to countries that are lacking it,” said Robert Matiru, Chair of the ACT-A Oxygen Emergency Taskforce and Director of Programmes at Unitaid. Children with pneumonia unrecognized victims – 40% of hospitals in some African countries lack oxygen Numerous countries are facing oxygen shortages, while readily available oxygen products are in short supply. Children are among the unrecognized victims of the lack of oxygen supplies – with childhood pneumonia still one of the biggest killers of under-fives. Accounting for almost a million deaths a year, the highest burden is in sub-Saharan African and South-East Asian countries where children face a double whammy of disease from both the lack of preventive treatments, like vaccinations, along with exposure to heavy indoor air pollution from the open burning of coal, biomass and other such fuels. But an estimated 20 to 40% of these deaths are preventable with increased availability of oxygen therapy. The shortage is particularly acute in low-income sub-Saharan African countries such as Tanzania, Sierra Leone, Liberia, and Gambia, where 40% of health facilities had no access to oxygen and other basic life saving supplies, said Atul Gawande of the United States Agency for International Development (USAID). COVID has led to big surges in needs Daily medical oxygen need for COVID-19 as of 16 March 2022 Along with the chronic shortages, COVID led to a major surge in oxygen needs. Low and middle-income countries (LMICs) need at least 23 million cubic meters of oxygen every day, just to treat COVID patients alone, according to the PATH COVID-19 Oxygen Needs Tracker. On the brighter side, the pandemic has brought a long-ignored aspect of health capacity in LMICs more to the forefront. USAID is currently working in 11 countries to build ‘oxygen ecosystems’ to support oxygen therapy for pneumonia patients, COVID patients, and others, Gawande said. Countries like Ghana now have oxygen generating capacity that can support up to 300,000 patients per day, per year. Gawande noted that the oxygen ecosystem includes liquid oxygen cylinders and concentrators, as well as the clinical engineering and technical assistance to use the technology. But expanding this initiative to other countries still needs more funding. Atul Gawande, USAID “As the Omicron variant abates, I think we’re all starting to feel that we can catch our breath. Oxygen demand may be lower right now. But it is the time that we have to make these investments to enable this kind of [sustainable] capacity.” Gawande said. Oxygen ‘natural security’ and ‘high-return’ health investment Leith Greenslade, Founder/CEO, JustActions & Coordinator, Every Breath Counts Coalition While the recent funding commitments are a positive sign, ‘it is not enough to fund protection’, said Leith Greenslade of the Every Breath Counts Coalition. “It took a pandemic of respiratory infection to wake up the world,” she pointed out. In the past year, about $700 million was invested into the ACT-A Oxygen Emergency Task Force, which has worked in LMICs to prevent oxygen shortages – jump-starting a more focused response. But so far, only a handful of governments – including the United States, Germany, Canada, and France – have borne the funding burden. “But most of the G-20 nations have not stepped up to invest in oxygen,” she charged. Greenslade appealed to donors to see oxygen as a high priority for three reasons: the moral obligation to flatten the COVID-19 curve; oxygen as a “national security” issue in moments of crisis; and finally, oxygen as a high-return health investment that will keep on saving lives beyond the pandemic. “When hospitals run out of oxygen, we have seen strikes and civil unrest in quite a few low- and middle-income countries,” she pointed out. “How many more deaths before this is over will largely depend on access to oxygen and critical care in the countries where the disease is greatest and the health systems are weakest,” she declared. Image Credits: Mstyslav Chernov/ Wikimedia Commons, UNICEF/Ralaivita, PATH, Every Breath Counts . Posts navigation Older postsNewer posts