Africa to Expand COVID-19 Testing as it Waits for Vaccines to Arrive 27/09/2021 Kerry Cullinan Health workers in Cape Town, South Africa, getting vaccinated against COVID-19. As Africa waits for COVID-19 vaccines promised by the US and other countries to arrive, the continent’s Centers for Disease Control (CDC) plans to scale up antigen testing to identify and address pandemic hotspots. “We are only at 4% vaccination rate, which means we have to continue to advance basic public health tools at our disposition, including rapid antigen test scale-up and enhanced community work so that we can know exactly where the hotspots of this virus are and flush it out while waiting for vaccine coverage to increase,” said John Nkengasong, Africa CDC Director, late last week. He added that Africa CDC and partners would be launching its “2.0 response plan” in the coming weeks that aimed at scaling up testing, and expanding the outreach of community health workers. “There can be no doubt we need to test at scale, and we need to decentralise testing and put it in the hands of our community health care workers,” added Nkengasong in an address to an international audience organised by the US Ambassador to the African Union and the International Federation of the Red Cross and Red Crescent Societies (IFRC). He added that, over the past 18 months, over 18,000 community health care workers had been deployed in 38 countries to conduct about 2.6 million household visits. They had also conducted around 1.6 million tests to identify those who are infected, and their contacts. Nkengasong described community health care workers as the “nexus for universal health coverage and health security”, essential to fight the current pandemic and to prepare for subsequent disease outbreaks. Although there is an assumption that Africa has been comparatively less affected by COVID-19 infection than other regions, excess mortality figures of the few African countries that monitor these figures – notably Egypt and South Africa – indicate a huge under-estimation of the impact of the pandemic. A recent comparison of World Bank regions put the Middle East and North Africa as the third-worst affected region in the world after Latin America and South Asia. Meanwhile, Egypt outstrips a number of hard-hit countries including the US on excess mortality. There has been an increase in demand for COVID-19 vaccines across Africa in the past few weeks – from Zimbabwe to Morocco, according to Nkengasong. However, he acknowledged that in some countries, including Uganda, there had been a slowdown in demand. “We will be looking at those countries to understand why the uptake has slowed, and what can we do with the community and religious leaders to improve uptake of vaccines, and create champions – sport, celebrities, and local musicians – to promote vaccines. Image Credits: Western Cape government. Multilateralism Failed Africa; Regionalism May Work Better – Africa CDC Deputy Head at European Health Forum Gastein 27/09/2021 Elaine Ruth Fletcher Clockwise from left-right: Richard Hatchett, Coalition for Epidemic Preparedness Innovations, Clemens Martin Auer, President EHF-Gastein, Ahmed Ogwell Ouma, Africa CDC; Hans Kluge, Director, WHO European Region Multilateralism has “failed” to help Africa solve the COVID crisis and regional approaches to solving common problems could help the continent forge a “new public health order” said Africa Centers for Disease Control Deputy Director Ahmed Ogwell Ouma, speaking at the opening of the European Health Forum- Gastein. His statement at at the traditionally “Eurocentric” conference, palpably illustrated the way in which lack of access to COVID-19 vaccines and treatments is forcing leaders on the continent to look inward for new solutions – following the failure of international initiatives like the COVAX vaccine facility to bring adequate responses. The five-day European forum, which traditionally draws hundreds of participants from across the region to the Austrian spa town of Bad Gastein every autumn, is happening this year on an primarily virtual platform. But the conference, taking place under the slogan, “Rise Like a Phoenix” – Health at the Heart of a Resilient Future for Europe still includes the rich array of European and global health policymakers for which the forum has become known, including Stella Kyriakides, European Commissioner for Health and Food Safety, the European Medicines Agency’s Emer Cooke and WHO’s Director General Dr Tedros Adhanom Ghebreyesus. It also features a wide range of global health trend-setters, such as Michael Marmot, of University College London, who led WHO’s cutting edge work on the Social Determinants of Health a decade ago and Wellcome’s Sir Jeremy Farrar, who has been a leading voice on policy challenges around the pandemic. And there are dozens of experts presenting at, or attending, more specialised sessions covering topics ranging from brain health to marginalized groups, to a new “Oslo Medicines Initiative” which aims to foster new modes of public-private collaboration wider facilitating access to more affordable medicines. 🔔 Starting at 11:00 CET: ‘Oslo Medicines Initiative – A new vision for collaboration between the public and private sectors’ with @hans_kluge @natasha_azzmus @drsarahgarner @yann_eurordis @GiraudSylvain @kuiper_em & more! #EHFG2021 Organised by @WHO_Europe and @Legemiddelinfo pic.twitter.com/t5vuqP1CUJ — GasteinForum (@GasteinForum) September 27, 2021 New public health order should be part of ‘Pandemic Treaty’ Ahmed Ogwell Ouma, deputy director general, Africa CDC, at Gastein Forum But the kickoff sessions were a vivid reminder that Europe is not an island – and that the failures of regions like Africa to get access to critical COVID tools and treatments – are echoing in the global north and beyond. “Where we sit here at Africa CDC, indeed on the African continent, multilateralism has failed,” said Ouma, at a press briefing opening the conference’s first day, and just after WHO Regional Director Hans Kluge made a plea for European countries to share excess vaccine doses with low- and middle-income countries – in the spirit of multilateralism. “It [multilateralism] has been very successful in meeting rooms and webinars and probably some negotiating tables, but on the ground in Africa, it has failed,” retorted Ouma. “Going down the path of regionalism,” may be more effective now, Ouma remarked, “where neighbouring countries who share the same aspirations, countries who are willing to support each other during good times and bad times, can be able to come together and work towards a common good.” He said that Africa needs to aspire to a “new public health order, including four key pillars: Strengthened African health institutions at regional and country level; A stronger African health workforce; More reliable supply chains for medicines, vaccines and equipment, including more local manufacturing capacity; Global partnerships that are “respectful and action-oriented.” All of these elements should be incorporated into negotiations for a new Pandemic Treaty, or revisions in the existing WHO International Health Regulations, which current governing health emergency responses. “Is a new treaty necessary? We can discuss that if it captures these four points,” he said. “Is reviewing of the IHR necessary? Absolutely. We have seen a spectacular failure of the IHR. But we must tackle what is wrong and not just what is convenient to discuss.” Warns against regional competition Ilona Kickbusch, Founding Director of the Graduate Institute’s Global Health Centre in Geneva. At the same time, Ilona Kickbusch, founding director of the Geneva Graduate Institute’s Global Health Centre, said that regional solidarity should pave the way to more effective global cooperation. A stronger and better financed World Health Organization, and new collaborative frameworks such as a proposed ‘European Health Union’ consolidating national health agencies regionally, could help go beyond the rhetoric. “The pandemic has shown that there were at least three areas in which we cannot afford not to work together globally. That is global health, the environment, and the digital transformation,” said Kickbusch. “All three hang together to bring better health to people all around the world. “It has become clear that regional efforts are ever more important to bring countries together and to develop new initiatives,” she added. “However, regions should not compete with one another but rather work together at a multilateral level….. This is why we hope that the European-African partnership, that already exists, will be slowly strengthened through better financing and will lead to a new kind of global coalition that will be absolutely critical”. Kluge – On boosters & dose-sharing – 1.2 billion excess doses means there are enough “to do it all” The Austrian alpine setting which usually hosts hundreds of EHF-Gastein participants – this year was the setting only for a video clip and key conference organizers/ presenters. Touching on the controversial issue of COVID vaccine boosters, Kluge veered away from the line of his boss, Dr Tedros, who has repeatedly called for a booster moratorium, in order to free up more supplies to reach the global south. Instead, Kluge asserted that there should be enough vaccines to go around if they were used more efficiently – quoting United States Chief Medical Advisor Anthony Fauci who said in August that “we should do it all” – providing boosters to already-vaccinated groups in high-income countries – as well as vaccinating the world. “My principle has been, and this was the same principle as … Dr. Anthony Fauci whom I discussed this with in August, from my mission to Washington, is: “Do it all,” declared Kluge at the presser kicking off the first day’s proceedings. He pointed out that by end 2021, rich countries will have amassed an excess of 1.2 billion vaccine doses – if they don’t share them. “So the key issue is the political leadership and coordination to get them to those countries in need.” One key barrier to more efficient distribution, Kluge added out, has been that countries often prefer to share their excess doses “based on geopolitical considerations, instead of a need basis: “While I understand this, there has to be a bit of a balance.” Another obstacle, is that countries are “waiting too long to share their excess doses – too close to expiry dates, and then for the receiving countries, this is too difficult.” At the same time, he added that recent research has suggested that expiry dates may be extended under the right circumstances, noting a recent decision by Israeli authorities to extend the shelf life of Pfizer vaccines from a total of six to nine months. He also said that receiving countries need to do their part: “to do the homework to register the new products and the manufacturing sites” – although he did not elaborate as to what countries in the global south may have been slow to register new vaccines or manufacturing sites. Overall, however, the biggest problem is political leadership to unlock more massive quantities of excess doses, he stressed: “I mean, it’s nice that countries say 1 million, sharing, and 300 million sharing, but we should be sharing in terms of billions…And that’s what we need.” Image Credits: European Health Forum Gastein. WHO Academy in Lyon Will Promote Global Digital Learning for Health Workers 27/09/2021 Raisa Santos President of France Emmanuel Macron, speaking at the launch of the WHO Academy The World Health Organization (WHO) Director-General Dr Tedros Adhanom Gheybreyesus and French President Emmanuel Macron today broke ground at the launch of the first WHO Academy in the French city of Lyon. The Academy fulfills a commitment by the two leaders to make WHO training more widely available to member states, and more systematically offered across various new digital media channels. “The ambitions of the WHO Academy are not modest: to transform lifelong learning in health globally,” said Dr Tedros. “The COVID-19 pandemic is a powerful demonstration of the value of health workers, and why they need the most up-to-date information, competencies and tools to keep their communities healthy and safe. He added: “The WHO Academy is an investment in health, education, knowledge and technology, but ultimately it’s an investment in people, and in a healthier, safer, fairer future.” This initiative is one of a number of WHO projects in collaboration with major European countries in a new wave of science and diplomatic collaborations that notably coincide with France and Germany’s co-sponsoring of Tedros’ candidacy for re-election. Recently, the WHO and the German government launched a pandemic surveillance hub in Berlin. Training for those ‘on the ground’ From its campus in Lyon, the Academy will provide millions of people around the world with rapid access to health training tailored to meet the needs of those “on the ground”, Academy Executive Director Agnes Buzyn said during the launch event Monday. “We want to have a wealth of programs, we want to have a real portfolio, which will be relevant for a whole range of health care professionals and health care workers. “But of course this has to meet people’s needs, so out on the ground we need to really take stock of what those needs are so that we can adapt to them and provide the kind of skill and competences that it’s needed to improve healthcare worldwide.” The academy will be made available via desktop and mobile devices in low-bandwidth settings, ensuring a global and diverse cohort. Additionally, the academy will: harness new high-impact technologies such as virtual reality, augmented reality, artificial intelligence; formally recognize “digital credentials” to help participants advance their careers; and offer more than 100 major learning programs by 2023, with credentialled programs for COVID-19 vaccine Equity, Universal Health Coverage, Health Emergencies and Healthier Lives. COVID-19 – ‘Motor of Innovation’ for digital learning WHO Director-General Dr Tedros Adhanom Gheybreyesus The COVID-19 pandemic has disrupted in-person learning systems, generating a growing demand for digital learning, and may be a crucial step in advancing WHO guidance and health solidarity in low- and middle-income countries. “The guidance we give has not always delivered the impact as it should in countries. Too often it sits on the shelf or in an overworked health administrator’s inbox and isn’t fully implemented. The norms, the guidance we prepared – we need to find ways of making sure WHO guidance is applied faster and delivers results faster,” said Tedros. Emmanuel Macron also noted that this partnership would allow France to reach out to those in the African continent to train healthcare professionals in order to “have true health solidarity at a global level.” “You cannot emerge from an international crisis or pandemic without solidarity, and this crisis really was the motor of innovation.” Image Credits: WHO. US Centers for Disease Control Authorizes COVID-19 Boosters for Frontline Workers Aged 18-64 – Widening Access to Third Jab 24/09/2021 Madeleine Hoecklin US regulatory agencies established the populations eligible for the Pfizer/BioNTech booster shot this week, paving the way for the rollout of boosters nationwide. The Director of the US Centers for Disease Control and Prevention (CDC), Dr Rochelle Walensky, has authorized millions of frontline workers in health care and school settings to receive a third COVD-19 vaccine booster dose- opening the gates for a much wider wide swathe of Americans, ages 18-64, to receive the controversial booster shots. Her ruling late Thursday overruled that of a CDC’s Advisory Committee on Immunization Practices, which had endorsed Pfizer/BioNTech booster shots only for millions of older individuals and others at high risk of contracting the disease after a meeting on Thursday. However, the panel voted against allowing frontline workers aged 18 to 64 years from getting another jab. This had put the recommendations at odds with the Food and Drug Administration’s (FDA) decision to authorize Pfizer booster shots for workers at risk, on Wednesday. The FDA authorized the use of boosters at least six months after the completion of the primary vaccination series in individuals over the age of 65; those aged 18 to 64 at a high risk of severe COVID-19; and those aged 18 to 64 whose occupation puts them at a high risk of serious complications of COVID-19. Walensky’s decision to include adults working in high-risk settings, such as health care and school systems, aligned the CDC’s policy with the FDA. “As CDC Director, it is my job to recognize where our actions can have the greatest impact,” Walensky said at a meeting on Thursday. “At CDC, we are tasked with analyzing complex, often imperfect data to make concrete recommendations that optimize health. In a pandemic, even with uncertainty, we must take actions that we anticipate will do the greatest good.” Dr Rochelle Walensky, Director of the US Centers for Disease Control and Prevention (CDC). She said that providing boosters to healthcare workers would “best serve the nation’s public health needs.” Walensky’s decision will cover healthcare workers, teachers, and people living or working in institutional settings, such as prisons or homeless shelters. The panel attempted to limit those eligible for boosters, refusing to open jabs to healthy adults who aren’t at risk of severe illness. Members of the advisory committee wanted to avoid an all-adult booster campaign. Walensky’s decision was announced late on Thursday, demonstrating the complex decision making around the issue of boosters. The recommendations from the CDC and FDA still represent a considerable scale back on US President Joe Biden’s far reaching booster plan, which was designed to rollout the week of September 20. Some 20 million people are now eligible for a booster and in the coming months 40 million more people will become eligible, said Biden at a White House press briefing on Friday. Only Americans who already received two doses of the Pfizer/BioNTech vaccine will qualify for booster shots. FDA authorization of boosters for Moderna or Johnson & Johnson vaccines and the safety of allowing mixing-and-matching with boosters, has yet to be addressed. ‘Pandemic of the unvaccinated’ needs to be urgently addressed Despite the current focus on boosters, the priority of vaccinations should be on getting the unvaccinated their first shots, which is the leading cause of rising COVID cases and hospitalizations, American experts have stated, echoing the position of the World Health Organization and many other global health officials. “We can give boosters to people, but that’s not really the answer to this pandemic,” Dr. Helen Keipp Talbot, Professor of Medicine at Vanderbilt University, told NPR. “Hospitals are full because people are not vaccinated. We are declining care to people who deserve care because we are full of unvaccinated COVID-positive patients.” According to Walensky, the top goal “here in America and around the world” is to vaccinate the unvaccinated. Over 70 million have yet to get a single shot, said Biden. US President Joe Biden at a press conference on the COVID-19 Response and the Vaccination Program on Friday. “Listen to the voices of the unvaccinated Americans who are lying in hospital beds, taking their final breaths, saying…’If only I got vaccinated,'” Biden said. “People are dying and will die who don’t have to die.” Biden urged people to get vaccinated and announced his commitment to implement vaccination requirements wherever possible. Currently the vaccination mandates cover two thirds of all workers in the US. “We made so much progress during the past eight months of this pandemic, now we face a critical moment,” said Biden. “We have the tools, we have the plan, we just have to finish the job together as one nation. And I know we can…Please look out for your own self interest and health here. Get vaccinated.” Image Credits: Flickr – Province of British Columbia, International Monetary Fund/Ernesto Benavides, Centers for Disease Control and Prevention, White House. REGEN-COV Joins COVID-19 Treatment List; WHO and MSF Call for Lower Prices and Increased Access 24/09/2021 Raisa Santos Riviera Beach Fire Rescue starts REGEN-COV Infusion treatments within the city of Riviera Beach, Florida. REGEN-COV, the antibody cocktail made famous by Donald Trump when he became ill with COVID in 2020, was added Friday to WHO’s list of recommended drug treatments in updated COVID-19 clinical management guidelines, published Friday. At the same time, WHO and Médecins Sans Frontières/Doctors Without Borders (MSF) called on the US pharma firm Regeneron, which developed the cutting-edge drug treatment, to reduce the high prices for the drug and expand now-limited production of the medicine. “WHO calls on Regeneron to lower prices and distribute it equitably across all regions, especially in LMICs,” the WHO statement said, adding that Regeneron should also “transfer the technology” so that similar versions of the treatment may be created and easily accessed in lower-income settings. “It is simply not fair that people living in low- and middle-income countries cannot access new COVID-19 treatments that can decrease the risk of death because of pharmaceutical companies’ monopolies and wishes for high returns,” said Dr Elin Hoffmann Dahl, Infectious Disease Advisor for the MSF Access Campaign, in another statement from MSF. He also noted that the pharma company had benefited from significant public funding to develop the cocktail in the first place, with the US signing a US $450 million contract with Regeneron last year. Regeneron has ignored pressures by access groups to lower prices and widen access to cocktail Regeneron has so far ignored pressures by access groups for such concessions. It has priced the antiviral cocktail at US $820 in India, US $2,000 in Germany and US $2,100 in the US. The company also has filed patent applications in at least 11 more low- and middle-income countries (LMICs) – clearly demonstrating its intent to protect markets there against less expensive, biosimilar alternatives. The drug is the first to be recommended by WHO for use in patients with non-severe COVID-19, but at high risk of more severe disease progression. It’s also being recommended for people with severe infection, but lacking sufficient antibodies of their own. The antibody cocktail includes two monoclonal antibodies (mAbs), casirivimad/imdevimab, shown to have decreased the risks of hospitalization for non-severe COVID-19 patients with high risk of developing severe disease. The drug has also been shown to decrease the risk of death for COVID-19 patients already in severe condition, with their own antibody deficiencies. It was authorized for emergency use by the US Food and Drug Administration in November, and is now part of the “handful of authorised COVID-19 treatments [that] are becoming standard of care for COVID-19 patients,” according to International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) Director General Thomas Cueni, in a media briefing early September. “Monoclonal antibody treatments are beginning to offer promise as are novel antivirals,” said Cueni. MSF: ‘Price Should Reflect Cost of Production’ REGEN-COV is part of a drug class of monoclonal antibodies, or mAbs. The US has recently purchased an additional 1.4 million doses of REGEN-COV, to be provided at no cost to patients. Large scale production of monoclonal antibodies (the drug class casirivimab and imdevimab belong to) is estimated to be below $100/per gram, says the MSF statement. One dose of REGEN-COV is 1,200 mg, purchased from the US government at US $2,100 per dose. This price is 17 times the value of large-scale production of mAbs. Accordingly, Regeneron should “drop the price to reflect the cost of production”, MSF said. “Regeneron should instead set an example for all manufacturers of monoclonal antibodies by putting people’s lives before profits, immediately lower the price, stop pursuing monopolies and share the know-how and technology to produce casirivimab and imdevimab with manufacturers in low- and middle-income countries.” Scarcity of COVID-19 treatment ‘Unacceptable’ Monoclonal antibodies have long been used to treat other diseases, including cancers. There have been long standing problems with high prices and supply shortages for older mAbs used in other treatments as well, said former MSF Emergency Field Coordinator Joan Tubau, who described the situation as “unacceptable.” In light of that history, MSF’s concerns about REGEN-COV are particularly acute, he emphasized. “Access to new COVID-19 treatments must be ensured, especially in places where vaccine coverage is low and recurrent waves are inevitable, to prevent even more inequity in this deadly pandemic,” said Tubau. That’s particularly true in light of the history of high-income countries monopolizing COVID-19 vaccines, he said. “And yet, we’re seeing the same governments that bought up and stockpiled COVID-19 vaccines make similar advance purchases of COVID-19 treatments, leaving little supply for the rest of the world unless Regeneron allows other companies to help boost the global supply.” Additionally, REGEN-COV could play a particularly lifesaving role in countries with low vaccination rates. And yet, paradoxically, those same countries may be the last to be able to access the lifesaving antibody cocktails, she warned, thanks to the market dynamics of pharma sales. “In many countries where MSF works in Latin America and Africa, scarce access to hospital beds, insufficient numbers of health care workers to deal with the surge of patients, and lack of medical oxygen makes prevention of hospitalisation vital – an antiviral cocktail like casirivimab/imdevimab could be essential.” Image Credits: Riviera Beach Fire Rescue/Twitter, NHS Research Scotland/Twitter. New Zealand Appeals for Abolition of ‘Harmful’ Agricultural Subsidies at UN Food Summit 23/09/2021 Kerry Cullinan New Zealand’s Prime Minister Jacinda Ardern appealed for global cooperation to remove “environmentally harmful government agricultural subsidies”, particularly for fisheries, at the United Nations Food Systems Summit, which began on Thursday in New York. These subsidies led to “inefficient production, distorted trade environmental harm, and weakened food security”, Adern said. “We encourage constructive global cooperation to progress this aim, including during this year’s World Trade Organization (WTO) Ministerial Conference,” she added. The WTO has been negotiating over fisheries subsidies since 2001, battling to get consensus on subsidies that contribute to overcapacity and overfishing. Adern added that New Zealand would also be joining the indigenous peoples’ food systems coalition, announced earlier by Myrna Cunningham, President of the Fund for the Development of the Indigenous Peoples of Latin America and the Caribbean. “This means providing the significant role of Maori in our food sectors, and encouraging the growth of Maori agribusiness by removing barriers and empowering Maori leadership,” said Adern. War against nature The summit, which involved 18 months of consultations of over 100,000 people in 148 countries, strongly emphasized the importance of ‘traditional’ food to combat hunger and climate change. Two coalitions – on school meals and healthy diets from sustainable food systems – were also announced on Thursday. “We need food systems that support the health and well-being of all people,” said UN Secretary-General Antonio Guterres. “ Malnutrition, hunger and famine are not forces of nature. They are the result of the actions or inactions of all of us.” “Every day, hundreds of millions of people go to bed hungry. Children are starving. Three billion people cannot afford a healthy diet, two billion are overweight or obese, 462 million are underweight and nearly one-third of all food that is produced is lost or wasted,” said Guterres. “We are waging a war against nature and reaping the bitter harvest: ruined crops, dwindling incomes and failing food systems. Food systems also generate one-third of all greenhouse gas emissions, and they are responsible for up to 80% of biodiversity loss,” he added. UN Secretary General Antonio Guterres Boost ‘nature-based’ solutions Professor Joachim von Braun, head of the summit’s scientific group, said that four actions had been distilled from the consultations. The first involves achieving nourishment for all people: “Science says we actually can come close to ending hunger by 2030. Our modelling shows that it may cost an additional $40 to $50 billion per year until 2030 only,” said Von Braun. “Increased and sustainable production technologies, better markets, reduction of food waste and losses, and social protection, including school feeding and nutrition programmes are the central components of that investment,” he added. “Secondly, we must boost nature-based solutions and production. The global food system emits about 30% of global greenhouse gases, but it can and must become climate neutral,” he added. The third action involved advancing equitable livelihoods and decent work, including protecting the land rights of 500 million small scale producers. “The fourth area is to build resilience to vulnerabilities. The food climate and COVID crisis must be addressed jointly because they are closely linked. A One Health approach for resilience is called for,” he added. Climate-smart investments Samantha Power Elaborating on the $10 billion US commitment to food security announced by President Joe Biden in his address to the UN General Assembly on Wednesday, Head of USAID Samantha Power said half of this would be spent in the US. “The other half will be spent fighting global food insecurity, helping smallholder farmers and their families escape poverty,” said Power, adding that the money would be channeled through Feed the Future, America’s global hunger and food security initiative. “We’re going to revise our global food security strategy to make sure that money does more good in the world, that we focus more on inclusive agricultural growth, the lives of women, girls and marginalised communities,” said Power. “That we invest tens of millions of dollars in fortifying foods with critical vitamins and minerals to fight malnutrition, and that we double down on climate-smart investments like drought-tolerant seeds and carbon storage in soils, so the world can boost crop yields while cutting emissions.” “With new investments, and a new strategy, Feed the Future aims to contribute to a 20% reduction in poverty and stunting in target countries over the next five years,” said Power. School meals coalition Meanwhile, the WHO announced that it will support the coalitions on school meals and healthy diets from sustainable food systems. “The two coalitions are founded by and comprised of member states and other partners, including UN agencies,” said the WHO. “Healthy diets and sustainably produced, safe food for all is not an out-of-reach aspiration, but an unavoidable component of global development, a human right and an achievable goal which can be realised through clear, well established and aligned actions,” said Dr Francesco Branca, WHO Director of Nutrition and Food Safety. The School Meals Coalition wants to ensure that every child has the opportunity to receive a healthy, nutritious meal in school by 2030 by improving the quality of nationally owned school meal programmes and strengthening school meal systems globally. The Healthy Diets Coalition will tackle food supply, food environments, and valuing food by motivating people to eat healthy diets through “multi-dimensional education, information, demand generation, and behavior change support”, the WHO reported on Thursday. Germany Champions Tedros for Re-election as WHO Director General – At Deadline No Other Candidates Publicly Declared 23/09/2021 Elaine Ruth Fletcher WH0 Director General Dr Tedros Adhanom Ghebreyesus WHO Director General Dr Tedros Adhanom Ghebreyesus is now set to run for re-election as Germany’s nominee, backed by other European Union states, including France. And as nominations for the post closed today at 6 p.m. Geneva time on Thursday, it was appearing increasingly likely that the incumbent DG may run unopposed – with no other candidates visibly in the running. On Thursday evening, Germany made it official in a Tweet from its UN Mission in Geneva that stated: “Today September 23rd, France and Germany , in coordination with a group of EU states, nominated Dr Tedros Adhanom Ghebreyesus @DrTedros for the election of the @WHO Director-General to be held in May 2022.” Today September 23rd, France 🇫🇷 and Germany 🇩🇪, in coordination with a group of EU states 🇪🇺, nominated Dr Tedros Adhanom Ghebreyesus @DrTedros for the election of the @WHO Director-General to be held in May 2022. pic.twitter.com/Tx4dGZnrm1 — Germany UN Geneva 🇩🇪🇪🇺🇺🇦 (@GermanyUNGeneva) September 23, 2021 According to other reports, as many as a dozen or more EU countries were joining Germany in the nomination of Tedros – although the names of the actual candidates and their country sponsors will remain secret until early November, according to WHO election rules. “Yes [Germany is sponsoring] and at least 50-60% of EU countries have followed suit,” one diplomatic observer in Geneva told Health Policy Watch. No African country sponsors so far Paradoxically, however, while Tedros made history as the first African to be elected to head WHO in 2017, no African country had come forward publicly as of Thursday’s deadline to offer to co-sponsor his re-election bid, alongside Germany’s EU partners. That, despite the fact that Tedros is regarded as highly popular on the continent – thanks partly to his outspoken positions on health equity and access to vaccines during the COVID pandemic. Asked about the director general’s race at a press conference on Thursday, John Nkengasong, head of Africa Centers for Disease Control, demurred, saying “I work for the African Union, so I think it would be better to wait and see what the African Union position is, and we as staff would go with that.” Nominated by his home country, Ethiopia, for his successful 2017 election bid, Tedros has since fallen out with the ruling government in Addis Ababa over their war with Ethiopian’s Tigray minority community – of which Tedros is also a member. That left him without an obvious ”home” country to sponsor his re-election bid. Although Tedros has never publicly confirmed his desire to stand again – it has been widely assumed that he wants to remain for a second five-year term – which is the maximum allowed. Speaking at a press conference on Wednesday, he declined again to comment on his plans. Sino-American tensions make for rough political waters President Donald Trump discussing the US withdrawal from the WHO at a press conference in July 2020. Following the outbreak of COVID, Tedros has had to steer through the increasingly rough political waters of Sino-American rivalries, exacerbated by the outspoken positions of Donald Trump – who in spring 2020 repeatedly accused Tedros of being soft on China, and in the pockets of Beijing – before announcing in July 2020 that the US would withdraw from WHO membership. That decision was reversed right after the inauguration of US President Joe Biden in January 2021, and WHO relations with the United States have since warmed considerably – with Biden’s Chief Medical Advisor, Anthony Fauci, describing Tedros warmly as a trusted colleague and “dear friend“. Since that time, Tedros also began taking a much tougher line with China, sharply contrasting with the praise he bestowed in the pandemic’s early days. Tedros’ recent, explicit calls upon upon Beijing to be more transparent in the investigation of the origins of SARS-CoV2 have been closely aligned with European and US diplomatic views – who have also criticised the lack of access to critical data and information. The unresolved mysteries of the SARS virus origins, and its woefully incomplete investigation, is one of those issues that will surely shadow any second term in office, as Tedros continues to tread the fault lines between Beijing and the west. New alliances with European partners German Health Minister Jens Spahn appears on the same stage as Tedros at a WHO briefing in July 2021 during a high-profile visit to Geneva, underlining Germany’s support for WHO under Tedros’. But all the while, Tedros has been steadily cultivating a new set of bilateral relations with strong European partners, including Switzerland, Germany and the United Kingdom. In May, for instance, Tedros announced the creation of a new WHO Biohub facility, in collaboration with the Swiss Confederation, to investigate new pathogens of concern at a high-security laboratory in Spiez. Appearing in Berlin on 1 September, Tedros launched a new WHO Hub for Pandemic and Research Intelligence in collaboration with the German government, to be headed by a noted Nigerian scientist, Dr Chikwe Ihekweazu. And earlier this week, Tedros named former UK Ambassador Gordon Brown as WHO’s “Ambassador for Global Health Financing“. The series of adroit political moves have added to his credit among high-income donor countries upon which WHO depends heavily for its budget resources. This, in an era when voluntary contributions by rich countries now far outweigh the fixed, annual assessments to WHO’s 194 member states. And achieving a more sustainable finance base is yet another thorny issue with which Tedros will have to grapple if elected to a second term at the 75th World Health Asssembly in May 2022. In the meantime , if other candidates do emerge, the intervening period will also be marked by electioneering, including “candidates forums” with member states. For the moment, however, a certain amount of suspense will remain as the names of the candidates to the WHO director general post will not be revealed for another month – only after a series of WHO regional meetings with member states are concluded, according to the re-election rules posted by WHO. Asked why there should be such secrecy around the names of the candidates even after nominations formally closed, a WHO spokesperson refused to elaborate, saying only that it is a “well established” process. However, one former senior WHO official, disagreed: “Such a delay in announcing the candidate(s) is a new development in my recollection and I don’t understand why they need to wait for the end of the regional committees if the deadline is going to expire now. I am puzzled. If I remember correctly, both for [former WHO Director General Margaret] Chan’s reelection and Tedros’s [2017] election, the names of the candidates were published shortly after the expiry of the deadline.” Updated 24 September Image Credits: WHO, C-Span. Afghan Health System in Danger of Collapse, WHO Concerned About Female Patients and Health Workers 22/09/2021 Editorial team WHO’s recent mission to Afghanistan Afghanistan’s health system is on the brink of collapse and the country faces “an imminent humanitarian catastrophe,” the World Health Organization (WHO) warned on Wednesday. Only 17% of the facilities of the country’s largest health project, Sehetmandi, are still fully functional as they have run out of funds for supplies and salaries for health staff. “This breakdown in health services is having a rippling effect on the availability of basic and essential health care, as well as on emergency response, polio eradication, and COVID-19 vaccination efforts,” the WHO said. Nine of 37 COVID-19 hospitals have already closed, and “all aspects of the COVID-19 response have dropped, including surveillance, testing, and vaccination”. It warned that 1.8 million COVID-19 vaccine doses in the country remain unused. “Swift action is needed to use these doses in the coming weeks and work towards reaching the goal of vaccinating at least 20% of the population by the end of the year based on national targets.” The WHO recently completed a high-level mission to Kabul in Afghanistan headed by Director-General Dr Tedros Adhanom Ghebreyesus where it met with Taliban leaders, UN partners, health care workers and patients. “WHO particularly emphasizes the need for women to maintain access to education, health care, and to the health workforce,” the global body stated. “With fewer health facilities operational and fewer female health workers reporting to work, female patients are hesitant to seek care. We are committed to working with partners to invest in the health education of girls and women, as well as continue training female health workers.” Polio is still endemic in Afghanistan, while measles is on the increase. Can the UN Food Summit Make a Difference to a World Overpowered by Junk Food? 21/09/2021 Kerry Cullinan Around 70% of primary school children in rural Mexican had a sugary drink for breakfast in 2012. Many children in the global south are drinking more sugary drinks than milk – thanks to the aggressive promotion of ultra-processed food to low and middle-income countries (LMICs) in the past two decades. Global obesity and diabetes rates have exploded as a result of dietary changes, and these conditions have made people far more vulnerable to severe COVID-19 illness – and not a single country has been able to reverse their obesity trends. Thursday’s United Nations Food Systems Summit (UNFSS) aims to “build a global conversation on the way in which we produce, process, and consume food, and galvanize global actions and commitments to change our food systems to provide safe, nutritious food for all within our planetary boundaries”, according to the UN. But summit preparation has been rocky. Its organisers have been accused of lacking transparency and giving big food, alcohol and tobacco companies a seat at the table, according to a letter signed by internationally renowned food policy academics and international NGOs including the Non-Communicable Diseases (NCD) Alliance. Meanwhile, a number of organisations – particularly representing small farmers and indigenous people – boycotted its pre-summit in Rome in July, citing unhappiness with the dominance of agribusiness. Boycotts and controversy “The issue of landlessness and land grabbing is not on the agenda of the UNFSS. Nowhere in its so-called Action Tracks do discussions highlight critical trends such as on land concentration and reconcentration in the hands of big agribusiness firms and their network of local landlords and compradors, nor on the massive displacement of rural communities to give way to big private investments and large development projects,” said Chennaiah Poguri, chairperson of the Asian Peasant Coalition (APC). Nonetheless, at least 85 heads of state are expected to share their commitments to addressing the global food crisis, according to a UNFSS media release on Monday. “After 18 long months, the world is on the brink of a summit that aims to change the trajectory of global progress, uniting everyone in a shared commitment to deliver the Sustainable Development Goals and the fundamental human rights at their core,” said Agnes Kalibata, the UN Secretary-General’s Special Envoy for the summit. However, the appointment of Kalibata, a former minister of agriculture in Rwanda, has also been controversial. Critics accuse the organisation she heads, the Alliance for a Green Revolution in Africa (AGRA), of opening African markets to “corporate monopolies controlling commercial seeds, genetically modified crops, fossil fuel-heavy synthetic fertilizers and polluting pesticides”, and asked the UN to revoke her appointment. Food policy activists protest against ultr-processed food in South Africa. Desperate need for food policy change Despite the controversies, the need for a change in global food policy is urgent. Around eight million people die annually due to poor diets, according to the Bloomberg Philanthropies’ Food Policy Program, which has committed over $435 million to help public health advocates to promote healthier diets through policy change. “In almost every country, traditional diets are being rapidly displaced by low-quality, nutrient-deficient diets,” says Trish Cotter, Senior Policy and Communication Advisor at Vital Strategies’ Food Policy Program. Obesity has almost tripled since the mid-1970s, with over 1.9 billion adults and more than 370 million children and adolescents now overweight or obese, according to the World Health Organization, while the prevalence of type 2 diabetes has doubled since 1980, affecting about 420 million people. “The most plausible explanation for this change? The rapid rise in consumption of ultra-processed foods and beverages – products that have been chemically or physically transformed using industrial processes,” adds Cotter, who is also part of the Bloomberg program. Leading food policy academics writing in the BMJ recently described ultra-processed foods as products arising from “industrial processes that convert food commodities such as wheat, soy, corn, oils and sugar, into chemically or physically transformed food substances, formulated with various classes of additives”. Transnational corporations “use their power to formulate, mass manufacture, distribute and aggressively market their products worldwide” and also “shape scientific findings by funding in-house and university-based research, so as to defend and promote ultra-processed foods”, according to the academics, who include Carlos Monteiro, Professor of Nutrition at Sao Paulo University, Marion Nestle, Emeritus Professor of Nutrition at New York University and the University of North Carolina’s Professor Barry Popkin. Taxes, warning labels and marketing restrictions Warning labels on food products in Chile nudge customers away from unhealthy foods – top-left: “high in calories”; top-right: “high in sugars”; bottom-left: “high in sodium”; bottom-right: “high in saturated fats” They urge the summit to encourage global dietary guidelines that favour fresh or minimally processed foods and “fiscal measures” including taxes, marketing regulations, mandatory front-of-pack warning labels on ultra-processed foods. Cotter, who has worked on international communication campaigns aimed at encouraging healthy eating, says that “ultra-processed products have crept into our lives under the guise of convenience backed up by some extremely clever and consistent marketing”. “We cannot simply place the onus on individuals to change lifestyles or make healthier choices when there often is little choice available for healthier products or consumers are swamped by alluringly marketed, ready-to-eat, convenient and tasty products advertised by Big Food,” she adds. “There’s no question that these products must be regulated and taxed to reduce consumption. But without the support of government policy, this task—of avoiding the health consequences of populations consuming ultra-processed products—is nigh impossible. The onus is on governments to act, and to act now.” Most Mexican kids had sodas for breakfast Mexico was the first country to tax sugary drinks in 2014, as it struggled to address the strain on its health system stemming from almost three-quarters of its population being overweight. Prior to the tax, Mexico had one of the highest consumption rates of sugary drinks in the world, and 70% of rural primary school children and 80% of high school students had one for breakfast every day. A year after it had implemented a 10% soda tax, sugary drinks purchases declined by 9% among the poorest third of the population. South Africa implemented a sugary drinks tax of around 10% in 2018 and has cut consumption by 28%, welcome news in a country where nine and 10- year-olds drink almost three times the global average of Coca-Colas every year. Chile has cut sugary drink purchasing by 24% through a comprehensive policy approach that includes warning labels on bottles. Recently, Brazil and Colombia have also passed legislation requiring warning labels on ultra-processed food. These warnings are important, says Cotter, because most shoppers spend less than 10 seconds choosing each food and beverage item. “Front-of-package warning labels can help consumers to quickly identify unhealthy products and encourage them to make healthy choices.” Safe, nutritious food for all UN Envoy Kalibata says that summit has five interconnected objectives. These are to ensure access to safe, nutritious food for all; shift to sustainable consumption by reducing waste and creating demand for healthy diets; boost “nature-positive production,” (entailing reduced emissions and protection of ecosystems), advance equitable livelihoods; and build resilience to vulnerabilities and shocks. Despite its controversies, Lucy Westerman, Policy and Campaigns Manager for the NCD Alliance, says that the summit “has succeeded in getting more people talking about food systems and the complexity of them”. “We would really like to see this summit shift from promises and pledges to actual action and investment. It would be truly game-changing for those whose priorities lie in the health of people and planet to invest in what we know works at scale, without the interference of those with harmful interests,” adds Westerman. She also appealed for the summit to be “one part of a much bigger conversation” and that includes the UN Climate Change Conference of the Parties (COP26) starting on 31 October and Nutrition For Growth to address malnutrition in December. Meanwhile, Monteiro and colleagues want the summit to “urge member states to implement multiple policy interventions to reduce ultra-processed food production, distribution and consumption, while simultaneously making fresh or minimally processed foods more available, accessible and affordable”. Whatever the outcome of the summit, it is evident that the world needs much more innovation to stop ultra-processed food and the twin epidemics of obesity and diabetes that it is fueling. Image Credits: Unsplash, Kerry Cullinan, Vital Strategies, Michael Casmir/Pierce Mill Media. Long Working Hours Kill More Workers Than Injuries 18/09/2021 Kerry Cullinan The biggest killers of working people are strokes and heart disease associated with long working hours – over 55 hours a week. This is according to a joint report from the World Health Organization (WHO) and International Labour Organization (ILO), the first global comparative risk assessment of the work-related burden of disease, which was released on Friday. Diseases associated with long working hours accounted for almost 40% of global deaths in 2016, some 750,000 deaths. People from South East Asia and Western Pacific, men and those over 54 were most at risk. Workplace injuries were the next biggest cause of worker deaths, accounting for 19.4% of deaths (360,000 deaths) – around half the deaths caused by long working hours. Workers most in danger of injuries were those in the construction, transport, manufacturing and agricultural sectors. Workplace exposure to air pollution (particulate matter, gases and fumes) was responsible for 450,000 deaths. Meanwhile, asbestos exposure caused 11.1% deaths, causing a variety of cancers. According to the report, 81% of deaths in 2016 were caused by non-communicable diseases (NCDs), the most common being chronic obstructive pulmonary disease (450,000 deaths); stroke (400,000 deaths) and ischaemic heart disease (350,000 deaths). “It’s shocking to see so many people literally being killed by their jobs,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Our report is a wake-up call to countries and businesses to improve and protect the health and safety of workers by honouring their commitments to provide universal coverage of occupational health and safety services.” Healthy limits This report will enable policymakers to track work-related health loss at country, regional and global levels, according to the two bodies. “These estimates provide important information on the work-related burden of disease, and this information can help to shape policies and practices to create healthier and safer workplaces,” said Guy Ryder, ILO Director-General. Each risk factor has a unique set of preventive actions, which are outlined in the monitoring report to guide governments, in consultation with employers and workers. Preventing long working hours requires agreement on healthy maximum limits on working time, for example. To reduce workplace exposure to air pollution, dust control, ventilation, and personal protective equipment is recommended. “These almost 2 million premature deaths are preventable. Action needs to be taken based on the research available to target the evolving nature of work-related health threats,” said Dr. Maria Neira, Director of the Department of Environment, Climate Change and Health at WHO. The report notes that total work-related burden of disease is likely substantially larger, as health loss from several other occupational risk factors must still be quantified in the future. Moreover, the effects of the COVID-19 pandemic will add another dimension to this burden to be captured in future estimates. 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Multilateralism Failed Africa; Regionalism May Work Better – Africa CDC Deputy Head at European Health Forum Gastein 27/09/2021 Elaine Ruth Fletcher Clockwise from left-right: Richard Hatchett, Coalition for Epidemic Preparedness Innovations, Clemens Martin Auer, President EHF-Gastein, Ahmed Ogwell Ouma, Africa CDC; Hans Kluge, Director, WHO European Region Multilateralism has “failed” to help Africa solve the COVID crisis and regional approaches to solving common problems could help the continent forge a “new public health order” said Africa Centers for Disease Control Deputy Director Ahmed Ogwell Ouma, speaking at the opening of the European Health Forum- Gastein. His statement at at the traditionally “Eurocentric” conference, palpably illustrated the way in which lack of access to COVID-19 vaccines and treatments is forcing leaders on the continent to look inward for new solutions – following the failure of international initiatives like the COVAX vaccine facility to bring adequate responses. The five-day European forum, which traditionally draws hundreds of participants from across the region to the Austrian spa town of Bad Gastein every autumn, is happening this year on an primarily virtual platform. But the conference, taking place under the slogan, “Rise Like a Phoenix” – Health at the Heart of a Resilient Future for Europe still includes the rich array of European and global health policymakers for which the forum has become known, including Stella Kyriakides, European Commissioner for Health and Food Safety, the European Medicines Agency’s Emer Cooke and WHO’s Director General Dr Tedros Adhanom Ghebreyesus. It also features a wide range of global health trend-setters, such as Michael Marmot, of University College London, who led WHO’s cutting edge work on the Social Determinants of Health a decade ago and Wellcome’s Sir Jeremy Farrar, who has been a leading voice on policy challenges around the pandemic. And there are dozens of experts presenting at, or attending, more specialised sessions covering topics ranging from brain health to marginalized groups, to a new “Oslo Medicines Initiative” which aims to foster new modes of public-private collaboration wider facilitating access to more affordable medicines. 🔔 Starting at 11:00 CET: ‘Oslo Medicines Initiative – A new vision for collaboration between the public and private sectors’ with @hans_kluge @natasha_azzmus @drsarahgarner @yann_eurordis @GiraudSylvain @kuiper_em & more! #EHFG2021 Organised by @WHO_Europe and @Legemiddelinfo pic.twitter.com/t5vuqP1CUJ — GasteinForum (@GasteinForum) September 27, 2021 New public health order should be part of ‘Pandemic Treaty’ Ahmed Ogwell Ouma, deputy director general, Africa CDC, at Gastein Forum But the kickoff sessions were a vivid reminder that Europe is not an island – and that the failures of regions like Africa to get access to critical COVID tools and treatments – are echoing in the global north and beyond. “Where we sit here at Africa CDC, indeed on the African continent, multilateralism has failed,” said Ouma, at a press briefing opening the conference’s first day, and just after WHO Regional Director Hans Kluge made a plea for European countries to share excess vaccine doses with low- and middle-income countries – in the spirit of multilateralism. “It [multilateralism] has been very successful in meeting rooms and webinars and probably some negotiating tables, but on the ground in Africa, it has failed,” retorted Ouma. “Going down the path of regionalism,” may be more effective now, Ouma remarked, “where neighbouring countries who share the same aspirations, countries who are willing to support each other during good times and bad times, can be able to come together and work towards a common good.” He said that Africa needs to aspire to a “new public health order, including four key pillars: Strengthened African health institutions at regional and country level; A stronger African health workforce; More reliable supply chains for medicines, vaccines and equipment, including more local manufacturing capacity; Global partnerships that are “respectful and action-oriented.” All of these elements should be incorporated into negotiations for a new Pandemic Treaty, or revisions in the existing WHO International Health Regulations, which current governing health emergency responses. “Is a new treaty necessary? We can discuss that if it captures these four points,” he said. “Is reviewing of the IHR necessary? Absolutely. We have seen a spectacular failure of the IHR. But we must tackle what is wrong and not just what is convenient to discuss.” Warns against regional competition Ilona Kickbusch, Founding Director of the Graduate Institute’s Global Health Centre in Geneva. At the same time, Ilona Kickbusch, founding director of the Geneva Graduate Institute’s Global Health Centre, said that regional solidarity should pave the way to more effective global cooperation. A stronger and better financed World Health Organization, and new collaborative frameworks such as a proposed ‘European Health Union’ consolidating national health agencies regionally, could help go beyond the rhetoric. “The pandemic has shown that there were at least three areas in which we cannot afford not to work together globally. That is global health, the environment, and the digital transformation,” said Kickbusch. “All three hang together to bring better health to people all around the world. “It has become clear that regional efforts are ever more important to bring countries together and to develop new initiatives,” she added. “However, regions should not compete with one another but rather work together at a multilateral level….. This is why we hope that the European-African partnership, that already exists, will be slowly strengthened through better financing and will lead to a new kind of global coalition that will be absolutely critical”. Kluge – On boosters & dose-sharing – 1.2 billion excess doses means there are enough “to do it all” The Austrian alpine setting which usually hosts hundreds of EHF-Gastein participants – this year was the setting only for a video clip and key conference organizers/ presenters. Touching on the controversial issue of COVID vaccine boosters, Kluge veered away from the line of his boss, Dr Tedros, who has repeatedly called for a booster moratorium, in order to free up more supplies to reach the global south. Instead, Kluge asserted that there should be enough vaccines to go around if they were used more efficiently – quoting United States Chief Medical Advisor Anthony Fauci who said in August that “we should do it all” – providing boosters to already-vaccinated groups in high-income countries – as well as vaccinating the world. “My principle has been, and this was the same principle as … Dr. Anthony Fauci whom I discussed this with in August, from my mission to Washington, is: “Do it all,” declared Kluge at the presser kicking off the first day’s proceedings. He pointed out that by end 2021, rich countries will have amassed an excess of 1.2 billion vaccine doses – if they don’t share them. “So the key issue is the political leadership and coordination to get them to those countries in need.” One key barrier to more efficient distribution, Kluge added out, has been that countries often prefer to share their excess doses “based on geopolitical considerations, instead of a need basis: “While I understand this, there has to be a bit of a balance.” Another obstacle, is that countries are “waiting too long to share their excess doses – too close to expiry dates, and then for the receiving countries, this is too difficult.” At the same time, he added that recent research has suggested that expiry dates may be extended under the right circumstances, noting a recent decision by Israeli authorities to extend the shelf life of Pfizer vaccines from a total of six to nine months. He also said that receiving countries need to do their part: “to do the homework to register the new products and the manufacturing sites” – although he did not elaborate as to what countries in the global south may have been slow to register new vaccines or manufacturing sites. Overall, however, the biggest problem is political leadership to unlock more massive quantities of excess doses, he stressed: “I mean, it’s nice that countries say 1 million, sharing, and 300 million sharing, but we should be sharing in terms of billions…And that’s what we need.” Image Credits: European Health Forum Gastein. WHO Academy in Lyon Will Promote Global Digital Learning for Health Workers 27/09/2021 Raisa Santos President of France Emmanuel Macron, speaking at the launch of the WHO Academy The World Health Organization (WHO) Director-General Dr Tedros Adhanom Gheybreyesus and French President Emmanuel Macron today broke ground at the launch of the first WHO Academy in the French city of Lyon. The Academy fulfills a commitment by the two leaders to make WHO training more widely available to member states, and more systematically offered across various new digital media channels. “The ambitions of the WHO Academy are not modest: to transform lifelong learning in health globally,” said Dr Tedros. “The COVID-19 pandemic is a powerful demonstration of the value of health workers, and why they need the most up-to-date information, competencies and tools to keep their communities healthy and safe. He added: “The WHO Academy is an investment in health, education, knowledge and technology, but ultimately it’s an investment in people, and in a healthier, safer, fairer future.” This initiative is one of a number of WHO projects in collaboration with major European countries in a new wave of science and diplomatic collaborations that notably coincide with France and Germany’s co-sponsoring of Tedros’ candidacy for re-election. Recently, the WHO and the German government launched a pandemic surveillance hub in Berlin. Training for those ‘on the ground’ From its campus in Lyon, the Academy will provide millions of people around the world with rapid access to health training tailored to meet the needs of those “on the ground”, Academy Executive Director Agnes Buzyn said during the launch event Monday. “We want to have a wealth of programs, we want to have a real portfolio, which will be relevant for a whole range of health care professionals and health care workers. “But of course this has to meet people’s needs, so out on the ground we need to really take stock of what those needs are so that we can adapt to them and provide the kind of skill and competences that it’s needed to improve healthcare worldwide.” The academy will be made available via desktop and mobile devices in low-bandwidth settings, ensuring a global and diverse cohort. Additionally, the academy will: harness new high-impact technologies such as virtual reality, augmented reality, artificial intelligence; formally recognize “digital credentials” to help participants advance their careers; and offer more than 100 major learning programs by 2023, with credentialled programs for COVID-19 vaccine Equity, Universal Health Coverage, Health Emergencies and Healthier Lives. COVID-19 – ‘Motor of Innovation’ for digital learning WHO Director-General Dr Tedros Adhanom Gheybreyesus The COVID-19 pandemic has disrupted in-person learning systems, generating a growing demand for digital learning, and may be a crucial step in advancing WHO guidance and health solidarity in low- and middle-income countries. “The guidance we give has not always delivered the impact as it should in countries. Too often it sits on the shelf or in an overworked health administrator’s inbox and isn’t fully implemented. The norms, the guidance we prepared – we need to find ways of making sure WHO guidance is applied faster and delivers results faster,” said Tedros. Emmanuel Macron also noted that this partnership would allow France to reach out to those in the African continent to train healthcare professionals in order to “have true health solidarity at a global level.” “You cannot emerge from an international crisis or pandemic without solidarity, and this crisis really was the motor of innovation.” Image Credits: WHO. US Centers for Disease Control Authorizes COVID-19 Boosters for Frontline Workers Aged 18-64 – Widening Access to Third Jab 24/09/2021 Madeleine Hoecklin US regulatory agencies established the populations eligible for the Pfizer/BioNTech booster shot this week, paving the way for the rollout of boosters nationwide. The Director of the US Centers for Disease Control and Prevention (CDC), Dr Rochelle Walensky, has authorized millions of frontline workers in health care and school settings to receive a third COVD-19 vaccine booster dose- opening the gates for a much wider wide swathe of Americans, ages 18-64, to receive the controversial booster shots. Her ruling late Thursday overruled that of a CDC’s Advisory Committee on Immunization Practices, which had endorsed Pfizer/BioNTech booster shots only for millions of older individuals and others at high risk of contracting the disease after a meeting on Thursday. However, the panel voted against allowing frontline workers aged 18 to 64 years from getting another jab. This had put the recommendations at odds with the Food and Drug Administration’s (FDA) decision to authorize Pfizer booster shots for workers at risk, on Wednesday. The FDA authorized the use of boosters at least six months after the completion of the primary vaccination series in individuals over the age of 65; those aged 18 to 64 at a high risk of severe COVID-19; and those aged 18 to 64 whose occupation puts them at a high risk of serious complications of COVID-19. Walensky’s decision to include adults working in high-risk settings, such as health care and school systems, aligned the CDC’s policy with the FDA. “As CDC Director, it is my job to recognize where our actions can have the greatest impact,” Walensky said at a meeting on Thursday. “At CDC, we are tasked with analyzing complex, often imperfect data to make concrete recommendations that optimize health. In a pandemic, even with uncertainty, we must take actions that we anticipate will do the greatest good.” Dr Rochelle Walensky, Director of the US Centers for Disease Control and Prevention (CDC). She said that providing boosters to healthcare workers would “best serve the nation’s public health needs.” Walensky’s decision will cover healthcare workers, teachers, and people living or working in institutional settings, such as prisons or homeless shelters. The panel attempted to limit those eligible for boosters, refusing to open jabs to healthy adults who aren’t at risk of severe illness. Members of the advisory committee wanted to avoid an all-adult booster campaign. Walensky’s decision was announced late on Thursday, demonstrating the complex decision making around the issue of boosters. The recommendations from the CDC and FDA still represent a considerable scale back on US President Joe Biden’s far reaching booster plan, which was designed to rollout the week of September 20. Some 20 million people are now eligible for a booster and in the coming months 40 million more people will become eligible, said Biden at a White House press briefing on Friday. Only Americans who already received two doses of the Pfizer/BioNTech vaccine will qualify for booster shots. FDA authorization of boosters for Moderna or Johnson & Johnson vaccines and the safety of allowing mixing-and-matching with boosters, has yet to be addressed. ‘Pandemic of the unvaccinated’ needs to be urgently addressed Despite the current focus on boosters, the priority of vaccinations should be on getting the unvaccinated their first shots, which is the leading cause of rising COVID cases and hospitalizations, American experts have stated, echoing the position of the World Health Organization and many other global health officials. “We can give boosters to people, but that’s not really the answer to this pandemic,” Dr. Helen Keipp Talbot, Professor of Medicine at Vanderbilt University, told NPR. “Hospitals are full because people are not vaccinated. We are declining care to people who deserve care because we are full of unvaccinated COVID-positive patients.” According to Walensky, the top goal “here in America and around the world” is to vaccinate the unvaccinated. Over 70 million have yet to get a single shot, said Biden. US President Joe Biden at a press conference on the COVID-19 Response and the Vaccination Program on Friday. “Listen to the voices of the unvaccinated Americans who are lying in hospital beds, taking their final breaths, saying…’If only I got vaccinated,'” Biden said. “People are dying and will die who don’t have to die.” Biden urged people to get vaccinated and announced his commitment to implement vaccination requirements wherever possible. Currently the vaccination mandates cover two thirds of all workers in the US. “We made so much progress during the past eight months of this pandemic, now we face a critical moment,” said Biden. “We have the tools, we have the plan, we just have to finish the job together as one nation. And I know we can…Please look out for your own self interest and health here. Get vaccinated.” Image Credits: Flickr – Province of British Columbia, International Monetary Fund/Ernesto Benavides, Centers for Disease Control and Prevention, White House. REGEN-COV Joins COVID-19 Treatment List; WHO and MSF Call for Lower Prices and Increased Access 24/09/2021 Raisa Santos Riviera Beach Fire Rescue starts REGEN-COV Infusion treatments within the city of Riviera Beach, Florida. REGEN-COV, the antibody cocktail made famous by Donald Trump when he became ill with COVID in 2020, was added Friday to WHO’s list of recommended drug treatments in updated COVID-19 clinical management guidelines, published Friday. At the same time, WHO and Médecins Sans Frontières/Doctors Without Borders (MSF) called on the US pharma firm Regeneron, which developed the cutting-edge drug treatment, to reduce the high prices for the drug and expand now-limited production of the medicine. “WHO calls on Regeneron to lower prices and distribute it equitably across all regions, especially in LMICs,” the WHO statement said, adding that Regeneron should also “transfer the technology” so that similar versions of the treatment may be created and easily accessed in lower-income settings. “It is simply not fair that people living in low- and middle-income countries cannot access new COVID-19 treatments that can decrease the risk of death because of pharmaceutical companies’ monopolies and wishes for high returns,” said Dr Elin Hoffmann Dahl, Infectious Disease Advisor for the MSF Access Campaign, in another statement from MSF. He also noted that the pharma company had benefited from significant public funding to develop the cocktail in the first place, with the US signing a US $450 million contract with Regeneron last year. Regeneron has ignored pressures by access groups to lower prices and widen access to cocktail Regeneron has so far ignored pressures by access groups for such concessions. It has priced the antiviral cocktail at US $820 in India, US $2,000 in Germany and US $2,100 in the US. The company also has filed patent applications in at least 11 more low- and middle-income countries (LMICs) – clearly demonstrating its intent to protect markets there against less expensive, biosimilar alternatives. The drug is the first to be recommended by WHO for use in patients with non-severe COVID-19, but at high risk of more severe disease progression. It’s also being recommended for people with severe infection, but lacking sufficient antibodies of their own. The antibody cocktail includes two monoclonal antibodies (mAbs), casirivimad/imdevimab, shown to have decreased the risks of hospitalization for non-severe COVID-19 patients with high risk of developing severe disease. The drug has also been shown to decrease the risk of death for COVID-19 patients already in severe condition, with their own antibody deficiencies. It was authorized for emergency use by the US Food and Drug Administration in November, and is now part of the “handful of authorised COVID-19 treatments [that] are becoming standard of care for COVID-19 patients,” according to International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) Director General Thomas Cueni, in a media briefing early September. “Monoclonal antibody treatments are beginning to offer promise as are novel antivirals,” said Cueni. MSF: ‘Price Should Reflect Cost of Production’ REGEN-COV is part of a drug class of monoclonal antibodies, or mAbs. The US has recently purchased an additional 1.4 million doses of REGEN-COV, to be provided at no cost to patients. Large scale production of monoclonal antibodies (the drug class casirivimab and imdevimab belong to) is estimated to be below $100/per gram, says the MSF statement. One dose of REGEN-COV is 1,200 mg, purchased from the US government at US $2,100 per dose. This price is 17 times the value of large-scale production of mAbs. Accordingly, Regeneron should “drop the price to reflect the cost of production”, MSF said. “Regeneron should instead set an example for all manufacturers of monoclonal antibodies by putting people’s lives before profits, immediately lower the price, stop pursuing monopolies and share the know-how and technology to produce casirivimab and imdevimab with manufacturers in low- and middle-income countries.” Scarcity of COVID-19 treatment ‘Unacceptable’ Monoclonal antibodies have long been used to treat other diseases, including cancers. There have been long standing problems with high prices and supply shortages for older mAbs used in other treatments as well, said former MSF Emergency Field Coordinator Joan Tubau, who described the situation as “unacceptable.” In light of that history, MSF’s concerns about REGEN-COV are particularly acute, he emphasized. “Access to new COVID-19 treatments must be ensured, especially in places where vaccine coverage is low and recurrent waves are inevitable, to prevent even more inequity in this deadly pandemic,” said Tubau. That’s particularly true in light of the history of high-income countries monopolizing COVID-19 vaccines, he said. “And yet, we’re seeing the same governments that bought up and stockpiled COVID-19 vaccines make similar advance purchases of COVID-19 treatments, leaving little supply for the rest of the world unless Regeneron allows other companies to help boost the global supply.” Additionally, REGEN-COV could play a particularly lifesaving role in countries with low vaccination rates. And yet, paradoxically, those same countries may be the last to be able to access the lifesaving antibody cocktails, she warned, thanks to the market dynamics of pharma sales. “In many countries where MSF works in Latin America and Africa, scarce access to hospital beds, insufficient numbers of health care workers to deal with the surge of patients, and lack of medical oxygen makes prevention of hospitalisation vital – an antiviral cocktail like casirivimab/imdevimab could be essential.” Image Credits: Riviera Beach Fire Rescue/Twitter, NHS Research Scotland/Twitter. New Zealand Appeals for Abolition of ‘Harmful’ Agricultural Subsidies at UN Food Summit 23/09/2021 Kerry Cullinan New Zealand’s Prime Minister Jacinda Ardern appealed for global cooperation to remove “environmentally harmful government agricultural subsidies”, particularly for fisheries, at the United Nations Food Systems Summit, which began on Thursday in New York. These subsidies led to “inefficient production, distorted trade environmental harm, and weakened food security”, Adern said. “We encourage constructive global cooperation to progress this aim, including during this year’s World Trade Organization (WTO) Ministerial Conference,” she added. The WTO has been negotiating over fisheries subsidies since 2001, battling to get consensus on subsidies that contribute to overcapacity and overfishing. Adern added that New Zealand would also be joining the indigenous peoples’ food systems coalition, announced earlier by Myrna Cunningham, President of the Fund for the Development of the Indigenous Peoples of Latin America and the Caribbean. “This means providing the significant role of Maori in our food sectors, and encouraging the growth of Maori agribusiness by removing barriers and empowering Maori leadership,” said Adern. War against nature The summit, which involved 18 months of consultations of over 100,000 people in 148 countries, strongly emphasized the importance of ‘traditional’ food to combat hunger and climate change. Two coalitions – on school meals and healthy diets from sustainable food systems – were also announced on Thursday. “We need food systems that support the health and well-being of all people,” said UN Secretary-General Antonio Guterres. “ Malnutrition, hunger and famine are not forces of nature. They are the result of the actions or inactions of all of us.” “Every day, hundreds of millions of people go to bed hungry. Children are starving. Three billion people cannot afford a healthy diet, two billion are overweight or obese, 462 million are underweight and nearly one-third of all food that is produced is lost or wasted,” said Guterres. “We are waging a war against nature and reaping the bitter harvest: ruined crops, dwindling incomes and failing food systems. Food systems also generate one-third of all greenhouse gas emissions, and they are responsible for up to 80% of biodiversity loss,” he added. UN Secretary General Antonio Guterres Boost ‘nature-based’ solutions Professor Joachim von Braun, head of the summit’s scientific group, said that four actions had been distilled from the consultations. The first involves achieving nourishment for all people: “Science says we actually can come close to ending hunger by 2030. Our modelling shows that it may cost an additional $40 to $50 billion per year until 2030 only,” said Von Braun. “Increased and sustainable production technologies, better markets, reduction of food waste and losses, and social protection, including school feeding and nutrition programmes are the central components of that investment,” he added. “Secondly, we must boost nature-based solutions and production. The global food system emits about 30% of global greenhouse gases, but it can and must become climate neutral,” he added. The third action involved advancing equitable livelihoods and decent work, including protecting the land rights of 500 million small scale producers. “The fourth area is to build resilience to vulnerabilities. The food climate and COVID crisis must be addressed jointly because they are closely linked. A One Health approach for resilience is called for,” he added. Climate-smart investments Samantha Power Elaborating on the $10 billion US commitment to food security announced by President Joe Biden in his address to the UN General Assembly on Wednesday, Head of USAID Samantha Power said half of this would be spent in the US. “The other half will be spent fighting global food insecurity, helping smallholder farmers and their families escape poverty,” said Power, adding that the money would be channeled through Feed the Future, America’s global hunger and food security initiative. “We’re going to revise our global food security strategy to make sure that money does more good in the world, that we focus more on inclusive agricultural growth, the lives of women, girls and marginalised communities,” said Power. “That we invest tens of millions of dollars in fortifying foods with critical vitamins and minerals to fight malnutrition, and that we double down on climate-smart investments like drought-tolerant seeds and carbon storage in soils, so the world can boost crop yields while cutting emissions.” “With new investments, and a new strategy, Feed the Future aims to contribute to a 20% reduction in poverty and stunting in target countries over the next five years,” said Power. School meals coalition Meanwhile, the WHO announced that it will support the coalitions on school meals and healthy diets from sustainable food systems. “The two coalitions are founded by and comprised of member states and other partners, including UN agencies,” said the WHO. “Healthy diets and sustainably produced, safe food for all is not an out-of-reach aspiration, but an unavoidable component of global development, a human right and an achievable goal which can be realised through clear, well established and aligned actions,” said Dr Francesco Branca, WHO Director of Nutrition and Food Safety. The School Meals Coalition wants to ensure that every child has the opportunity to receive a healthy, nutritious meal in school by 2030 by improving the quality of nationally owned school meal programmes and strengthening school meal systems globally. The Healthy Diets Coalition will tackle food supply, food environments, and valuing food by motivating people to eat healthy diets through “multi-dimensional education, information, demand generation, and behavior change support”, the WHO reported on Thursday. Germany Champions Tedros for Re-election as WHO Director General – At Deadline No Other Candidates Publicly Declared 23/09/2021 Elaine Ruth Fletcher WH0 Director General Dr Tedros Adhanom Ghebreyesus WHO Director General Dr Tedros Adhanom Ghebreyesus is now set to run for re-election as Germany’s nominee, backed by other European Union states, including France. And as nominations for the post closed today at 6 p.m. Geneva time on Thursday, it was appearing increasingly likely that the incumbent DG may run unopposed – with no other candidates visibly in the running. On Thursday evening, Germany made it official in a Tweet from its UN Mission in Geneva that stated: “Today September 23rd, France and Germany , in coordination with a group of EU states, nominated Dr Tedros Adhanom Ghebreyesus @DrTedros for the election of the @WHO Director-General to be held in May 2022.” Today September 23rd, France 🇫🇷 and Germany 🇩🇪, in coordination with a group of EU states 🇪🇺, nominated Dr Tedros Adhanom Ghebreyesus @DrTedros for the election of the @WHO Director-General to be held in May 2022. pic.twitter.com/Tx4dGZnrm1 — Germany UN Geneva 🇩🇪🇪🇺🇺🇦 (@GermanyUNGeneva) September 23, 2021 According to other reports, as many as a dozen or more EU countries were joining Germany in the nomination of Tedros – although the names of the actual candidates and their country sponsors will remain secret until early November, according to WHO election rules. “Yes [Germany is sponsoring] and at least 50-60% of EU countries have followed suit,” one diplomatic observer in Geneva told Health Policy Watch. No African country sponsors so far Paradoxically, however, while Tedros made history as the first African to be elected to head WHO in 2017, no African country had come forward publicly as of Thursday’s deadline to offer to co-sponsor his re-election bid, alongside Germany’s EU partners. That, despite the fact that Tedros is regarded as highly popular on the continent – thanks partly to his outspoken positions on health equity and access to vaccines during the COVID pandemic. Asked about the director general’s race at a press conference on Thursday, John Nkengasong, head of Africa Centers for Disease Control, demurred, saying “I work for the African Union, so I think it would be better to wait and see what the African Union position is, and we as staff would go with that.” Nominated by his home country, Ethiopia, for his successful 2017 election bid, Tedros has since fallen out with the ruling government in Addis Ababa over their war with Ethiopian’s Tigray minority community – of which Tedros is also a member. That left him without an obvious ”home” country to sponsor his re-election bid. Although Tedros has never publicly confirmed his desire to stand again – it has been widely assumed that he wants to remain for a second five-year term – which is the maximum allowed. Speaking at a press conference on Wednesday, he declined again to comment on his plans. Sino-American tensions make for rough political waters President Donald Trump discussing the US withdrawal from the WHO at a press conference in July 2020. Following the outbreak of COVID, Tedros has had to steer through the increasingly rough political waters of Sino-American rivalries, exacerbated by the outspoken positions of Donald Trump – who in spring 2020 repeatedly accused Tedros of being soft on China, and in the pockets of Beijing – before announcing in July 2020 that the US would withdraw from WHO membership. That decision was reversed right after the inauguration of US President Joe Biden in January 2021, and WHO relations with the United States have since warmed considerably – with Biden’s Chief Medical Advisor, Anthony Fauci, describing Tedros warmly as a trusted colleague and “dear friend“. Since that time, Tedros also began taking a much tougher line with China, sharply contrasting with the praise he bestowed in the pandemic’s early days. Tedros’ recent, explicit calls upon upon Beijing to be more transparent in the investigation of the origins of SARS-CoV2 have been closely aligned with European and US diplomatic views – who have also criticised the lack of access to critical data and information. The unresolved mysteries of the SARS virus origins, and its woefully incomplete investigation, is one of those issues that will surely shadow any second term in office, as Tedros continues to tread the fault lines between Beijing and the west. New alliances with European partners German Health Minister Jens Spahn appears on the same stage as Tedros at a WHO briefing in July 2021 during a high-profile visit to Geneva, underlining Germany’s support for WHO under Tedros’. But all the while, Tedros has been steadily cultivating a new set of bilateral relations with strong European partners, including Switzerland, Germany and the United Kingdom. In May, for instance, Tedros announced the creation of a new WHO Biohub facility, in collaboration with the Swiss Confederation, to investigate new pathogens of concern at a high-security laboratory in Spiez. Appearing in Berlin on 1 September, Tedros launched a new WHO Hub for Pandemic and Research Intelligence in collaboration with the German government, to be headed by a noted Nigerian scientist, Dr Chikwe Ihekweazu. And earlier this week, Tedros named former UK Ambassador Gordon Brown as WHO’s “Ambassador for Global Health Financing“. The series of adroit political moves have added to his credit among high-income donor countries upon which WHO depends heavily for its budget resources. This, in an era when voluntary contributions by rich countries now far outweigh the fixed, annual assessments to WHO’s 194 member states. And achieving a more sustainable finance base is yet another thorny issue with which Tedros will have to grapple if elected to a second term at the 75th World Health Asssembly in May 2022. In the meantime , if other candidates do emerge, the intervening period will also be marked by electioneering, including “candidates forums” with member states. For the moment, however, a certain amount of suspense will remain as the names of the candidates to the WHO director general post will not be revealed for another month – only after a series of WHO regional meetings with member states are concluded, according to the re-election rules posted by WHO. Asked why there should be such secrecy around the names of the candidates even after nominations formally closed, a WHO spokesperson refused to elaborate, saying only that it is a “well established” process. However, one former senior WHO official, disagreed: “Such a delay in announcing the candidate(s) is a new development in my recollection and I don’t understand why they need to wait for the end of the regional committees if the deadline is going to expire now. I am puzzled. If I remember correctly, both for [former WHO Director General Margaret] Chan’s reelection and Tedros’s [2017] election, the names of the candidates were published shortly after the expiry of the deadline.” Updated 24 September Image Credits: WHO, C-Span. Afghan Health System in Danger of Collapse, WHO Concerned About Female Patients and Health Workers 22/09/2021 Editorial team WHO’s recent mission to Afghanistan Afghanistan’s health system is on the brink of collapse and the country faces “an imminent humanitarian catastrophe,” the World Health Organization (WHO) warned on Wednesday. Only 17% of the facilities of the country’s largest health project, Sehetmandi, are still fully functional as they have run out of funds for supplies and salaries for health staff. “This breakdown in health services is having a rippling effect on the availability of basic and essential health care, as well as on emergency response, polio eradication, and COVID-19 vaccination efforts,” the WHO said. Nine of 37 COVID-19 hospitals have already closed, and “all aspects of the COVID-19 response have dropped, including surveillance, testing, and vaccination”. It warned that 1.8 million COVID-19 vaccine doses in the country remain unused. “Swift action is needed to use these doses in the coming weeks and work towards reaching the goal of vaccinating at least 20% of the population by the end of the year based on national targets.” The WHO recently completed a high-level mission to Kabul in Afghanistan headed by Director-General Dr Tedros Adhanom Ghebreyesus where it met with Taliban leaders, UN partners, health care workers and patients. “WHO particularly emphasizes the need for women to maintain access to education, health care, and to the health workforce,” the global body stated. “With fewer health facilities operational and fewer female health workers reporting to work, female patients are hesitant to seek care. We are committed to working with partners to invest in the health education of girls and women, as well as continue training female health workers.” Polio is still endemic in Afghanistan, while measles is on the increase. Can the UN Food Summit Make a Difference to a World Overpowered by Junk Food? 21/09/2021 Kerry Cullinan Around 70% of primary school children in rural Mexican had a sugary drink for breakfast in 2012. Many children in the global south are drinking more sugary drinks than milk – thanks to the aggressive promotion of ultra-processed food to low and middle-income countries (LMICs) in the past two decades. Global obesity and diabetes rates have exploded as a result of dietary changes, and these conditions have made people far more vulnerable to severe COVID-19 illness – and not a single country has been able to reverse their obesity trends. Thursday’s United Nations Food Systems Summit (UNFSS) aims to “build a global conversation on the way in which we produce, process, and consume food, and galvanize global actions and commitments to change our food systems to provide safe, nutritious food for all within our planetary boundaries”, according to the UN. But summit preparation has been rocky. Its organisers have been accused of lacking transparency and giving big food, alcohol and tobacco companies a seat at the table, according to a letter signed by internationally renowned food policy academics and international NGOs including the Non-Communicable Diseases (NCD) Alliance. Meanwhile, a number of organisations – particularly representing small farmers and indigenous people – boycotted its pre-summit in Rome in July, citing unhappiness with the dominance of agribusiness. Boycotts and controversy “The issue of landlessness and land grabbing is not on the agenda of the UNFSS. Nowhere in its so-called Action Tracks do discussions highlight critical trends such as on land concentration and reconcentration in the hands of big agribusiness firms and their network of local landlords and compradors, nor on the massive displacement of rural communities to give way to big private investments and large development projects,” said Chennaiah Poguri, chairperson of the Asian Peasant Coalition (APC). Nonetheless, at least 85 heads of state are expected to share their commitments to addressing the global food crisis, according to a UNFSS media release on Monday. “After 18 long months, the world is on the brink of a summit that aims to change the trajectory of global progress, uniting everyone in a shared commitment to deliver the Sustainable Development Goals and the fundamental human rights at their core,” said Agnes Kalibata, the UN Secretary-General’s Special Envoy for the summit. However, the appointment of Kalibata, a former minister of agriculture in Rwanda, has also been controversial. Critics accuse the organisation she heads, the Alliance for a Green Revolution in Africa (AGRA), of opening African markets to “corporate monopolies controlling commercial seeds, genetically modified crops, fossil fuel-heavy synthetic fertilizers and polluting pesticides”, and asked the UN to revoke her appointment. Food policy activists protest against ultr-processed food in South Africa. Desperate need for food policy change Despite the controversies, the need for a change in global food policy is urgent. Around eight million people die annually due to poor diets, according to the Bloomberg Philanthropies’ Food Policy Program, which has committed over $435 million to help public health advocates to promote healthier diets through policy change. “In almost every country, traditional diets are being rapidly displaced by low-quality, nutrient-deficient diets,” says Trish Cotter, Senior Policy and Communication Advisor at Vital Strategies’ Food Policy Program. Obesity has almost tripled since the mid-1970s, with over 1.9 billion adults and more than 370 million children and adolescents now overweight or obese, according to the World Health Organization, while the prevalence of type 2 diabetes has doubled since 1980, affecting about 420 million people. “The most plausible explanation for this change? The rapid rise in consumption of ultra-processed foods and beverages – products that have been chemically or physically transformed using industrial processes,” adds Cotter, who is also part of the Bloomberg program. Leading food policy academics writing in the BMJ recently described ultra-processed foods as products arising from “industrial processes that convert food commodities such as wheat, soy, corn, oils and sugar, into chemically or physically transformed food substances, formulated with various classes of additives”. Transnational corporations “use their power to formulate, mass manufacture, distribute and aggressively market their products worldwide” and also “shape scientific findings by funding in-house and university-based research, so as to defend and promote ultra-processed foods”, according to the academics, who include Carlos Monteiro, Professor of Nutrition at Sao Paulo University, Marion Nestle, Emeritus Professor of Nutrition at New York University and the University of North Carolina’s Professor Barry Popkin. Taxes, warning labels and marketing restrictions Warning labels on food products in Chile nudge customers away from unhealthy foods – top-left: “high in calories”; top-right: “high in sugars”; bottom-left: “high in sodium”; bottom-right: “high in saturated fats” They urge the summit to encourage global dietary guidelines that favour fresh or minimally processed foods and “fiscal measures” including taxes, marketing regulations, mandatory front-of-pack warning labels on ultra-processed foods. Cotter, who has worked on international communication campaigns aimed at encouraging healthy eating, says that “ultra-processed products have crept into our lives under the guise of convenience backed up by some extremely clever and consistent marketing”. “We cannot simply place the onus on individuals to change lifestyles or make healthier choices when there often is little choice available for healthier products or consumers are swamped by alluringly marketed, ready-to-eat, convenient and tasty products advertised by Big Food,” she adds. “There’s no question that these products must be regulated and taxed to reduce consumption. But without the support of government policy, this task—of avoiding the health consequences of populations consuming ultra-processed products—is nigh impossible. The onus is on governments to act, and to act now.” Most Mexican kids had sodas for breakfast Mexico was the first country to tax sugary drinks in 2014, as it struggled to address the strain on its health system stemming from almost three-quarters of its population being overweight. Prior to the tax, Mexico had one of the highest consumption rates of sugary drinks in the world, and 70% of rural primary school children and 80% of high school students had one for breakfast every day. A year after it had implemented a 10% soda tax, sugary drinks purchases declined by 9% among the poorest third of the population. South Africa implemented a sugary drinks tax of around 10% in 2018 and has cut consumption by 28%, welcome news in a country where nine and 10- year-olds drink almost three times the global average of Coca-Colas every year. Chile has cut sugary drink purchasing by 24% through a comprehensive policy approach that includes warning labels on bottles. Recently, Brazil and Colombia have also passed legislation requiring warning labels on ultra-processed food. These warnings are important, says Cotter, because most shoppers spend less than 10 seconds choosing each food and beverage item. “Front-of-package warning labels can help consumers to quickly identify unhealthy products and encourage them to make healthy choices.” Safe, nutritious food for all UN Envoy Kalibata says that summit has five interconnected objectives. These are to ensure access to safe, nutritious food for all; shift to sustainable consumption by reducing waste and creating demand for healthy diets; boost “nature-positive production,” (entailing reduced emissions and protection of ecosystems), advance equitable livelihoods; and build resilience to vulnerabilities and shocks. Despite its controversies, Lucy Westerman, Policy and Campaigns Manager for the NCD Alliance, says that the summit “has succeeded in getting more people talking about food systems and the complexity of them”. “We would really like to see this summit shift from promises and pledges to actual action and investment. It would be truly game-changing for those whose priorities lie in the health of people and planet to invest in what we know works at scale, without the interference of those with harmful interests,” adds Westerman. She also appealed for the summit to be “one part of a much bigger conversation” and that includes the UN Climate Change Conference of the Parties (COP26) starting on 31 October and Nutrition For Growth to address malnutrition in December. Meanwhile, Monteiro and colleagues want the summit to “urge member states to implement multiple policy interventions to reduce ultra-processed food production, distribution and consumption, while simultaneously making fresh or minimally processed foods more available, accessible and affordable”. Whatever the outcome of the summit, it is evident that the world needs much more innovation to stop ultra-processed food and the twin epidemics of obesity and diabetes that it is fueling. Image Credits: Unsplash, Kerry Cullinan, Vital Strategies, Michael Casmir/Pierce Mill Media. Long Working Hours Kill More Workers Than Injuries 18/09/2021 Kerry Cullinan The biggest killers of working people are strokes and heart disease associated with long working hours – over 55 hours a week. This is according to a joint report from the World Health Organization (WHO) and International Labour Organization (ILO), the first global comparative risk assessment of the work-related burden of disease, which was released on Friday. Diseases associated with long working hours accounted for almost 40% of global deaths in 2016, some 750,000 deaths. People from South East Asia and Western Pacific, men and those over 54 were most at risk. Workplace injuries were the next biggest cause of worker deaths, accounting for 19.4% of deaths (360,000 deaths) – around half the deaths caused by long working hours. Workers most in danger of injuries were those in the construction, transport, manufacturing and agricultural sectors. Workplace exposure to air pollution (particulate matter, gases and fumes) was responsible for 450,000 deaths. Meanwhile, asbestos exposure caused 11.1% deaths, causing a variety of cancers. According to the report, 81% of deaths in 2016 were caused by non-communicable diseases (NCDs), the most common being chronic obstructive pulmonary disease (450,000 deaths); stroke (400,000 deaths) and ischaemic heart disease (350,000 deaths). “It’s shocking to see so many people literally being killed by their jobs,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Our report is a wake-up call to countries and businesses to improve and protect the health and safety of workers by honouring their commitments to provide universal coverage of occupational health and safety services.” Healthy limits This report will enable policymakers to track work-related health loss at country, regional and global levels, according to the two bodies. “These estimates provide important information on the work-related burden of disease, and this information can help to shape policies and practices to create healthier and safer workplaces,” said Guy Ryder, ILO Director-General. Each risk factor has a unique set of preventive actions, which are outlined in the monitoring report to guide governments, in consultation with employers and workers. Preventing long working hours requires agreement on healthy maximum limits on working time, for example. To reduce workplace exposure to air pollution, dust control, ventilation, and personal protective equipment is recommended. “These almost 2 million premature deaths are preventable. Action needs to be taken based on the research available to target the evolving nature of work-related health threats,” said Dr. Maria Neira, Director of the Department of Environment, Climate Change and Health at WHO. The report notes that total work-related burden of disease is likely substantially larger, as health loss from several other occupational risk factors must still be quantified in the future. Moreover, the effects of the COVID-19 pandemic will add another dimension to this burden to be captured in future estimates. 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WHO Academy in Lyon Will Promote Global Digital Learning for Health Workers 27/09/2021 Raisa Santos President of France Emmanuel Macron, speaking at the launch of the WHO Academy The World Health Organization (WHO) Director-General Dr Tedros Adhanom Gheybreyesus and French President Emmanuel Macron today broke ground at the launch of the first WHO Academy in the French city of Lyon. The Academy fulfills a commitment by the two leaders to make WHO training more widely available to member states, and more systematically offered across various new digital media channels. “The ambitions of the WHO Academy are not modest: to transform lifelong learning in health globally,” said Dr Tedros. “The COVID-19 pandemic is a powerful demonstration of the value of health workers, and why they need the most up-to-date information, competencies and tools to keep their communities healthy and safe. He added: “The WHO Academy is an investment in health, education, knowledge and technology, but ultimately it’s an investment in people, and in a healthier, safer, fairer future.” This initiative is one of a number of WHO projects in collaboration with major European countries in a new wave of science and diplomatic collaborations that notably coincide with France and Germany’s co-sponsoring of Tedros’ candidacy for re-election. Recently, the WHO and the German government launched a pandemic surveillance hub in Berlin. Training for those ‘on the ground’ From its campus in Lyon, the Academy will provide millions of people around the world with rapid access to health training tailored to meet the needs of those “on the ground”, Academy Executive Director Agnes Buzyn said during the launch event Monday. “We want to have a wealth of programs, we want to have a real portfolio, which will be relevant for a whole range of health care professionals and health care workers. “But of course this has to meet people’s needs, so out on the ground we need to really take stock of what those needs are so that we can adapt to them and provide the kind of skill and competences that it’s needed to improve healthcare worldwide.” The academy will be made available via desktop and mobile devices in low-bandwidth settings, ensuring a global and diverse cohort. Additionally, the academy will: harness new high-impact technologies such as virtual reality, augmented reality, artificial intelligence; formally recognize “digital credentials” to help participants advance their careers; and offer more than 100 major learning programs by 2023, with credentialled programs for COVID-19 vaccine Equity, Universal Health Coverage, Health Emergencies and Healthier Lives. COVID-19 – ‘Motor of Innovation’ for digital learning WHO Director-General Dr Tedros Adhanom Gheybreyesus The COVID-19 pandemic has disrupted in-person learning systems, generating a growing demand for digital learning, and may be a crucial step in advancing WHO guidance and health solidarity in low- and middle-income countries. “The guidance we give has not always delivered the impact as it should in countries. Too often it sits on the shelf or in an overworked health administrator’s inbox and isn’t fully implemented. The norms, the guidance we prepared – we need to find ways of making sure WHO guidance is applied faster and delivers results faster,” said Tedros. Emmanuel Macron also noted that this partnership would allow France to reach out to those in the African continent to train healthcare professionals in order to “have true health solidarity at a global level.” “You cannot emerge from an international crisis or pandemic without solidarity, and this crisis really was the motor of innovation.” Image Credits: WHO. US Centers for Disease Control Authorizes COVID-19 Boosters for Frontline Workers Aged 18-64 – Widening Access to Third Jab 24/09/2021 Madeleine Hoecklin US regulatory agencies established the populations eligible for the Pfizer/BioNTech booster shot this week, paving the way for the rollout of boosters nationwide. The Director of the US Centers for Disease Control and Prevention (CDC), Dr Rochelle Walensky, has authorized millions of frontline workers in health care and school settings to receive a third COVD-19 vaccine booster dose- opening the gates for a much wider wide swathe of Americans, ages 18-64, to receive the controversial booster shots. Her ruling late Thursday overruled that of a CDC’s Advisory Committee on Immunization Practices, which had endorsed Pfizer/BioNTech booster shots only for millions of older individuals and others at high risk of contracting the disease after a meeting on Thursday. However, the panel voted against allowing frontline workers aged 18 to 64 years from getting another jab. This had put the recommendations at odds with the Food and Drug Administration’s (FDA) decision to authorize Pfizer booster shots for workers at risk, on Wednesday. The FDA authorized the use of boosters at least six months after the completion of the primary vaccination series in individuals over the age of 65; those aged 18 to 64 at a high risk of severe COVID-19; and those aged 18 to 64 whose occupation puts them at a high risk of serious complications of COVID-19. Walensky’s decision to include adults working in high-risk settings, such as health care and school systems, aligned the CDC’s policy with the FDA. “As CDC Director, it is my job to recognize where our actions can have the greatest impact,” Walensky said at a meeting on Thursday. “At CDC, we are tasked with analyzing complex, often imperfect data to make concrete recommendations that optimize health. In a pandemic, even with uncertainty, we must take actions that we anticipate will do the greatest good.” Dr Rochelle Walensky, Director of the US Centers for Disease Control and Prevention (CDC). She said that providing boosters to healthcare workers would “best serve the nation’s public health needs.” Walensky’s decision will cover healthcare workers, teachers, and people living or working in institutional settings, such as prisons or homeless shelters. The panel attempted to limit those eligible for boosters, refusing to open jabs to healthy adults who aren’t at risk of severe illness. Members of the advisory committee wanted to avoid an all-adult booster campaign. Walensky’s decision was announced late on Thursday, demonstrating the complex decision making around the issue of boosters. The recommendations from the CDC and FDA still represent a considerable scale back on US President Joe Biden’s far reaching booster plan, which was designed to rollout the week of September 20. Some 20 million people are now eligible for a booster and in the coming months 40 million more people will become eligible, said Biden at a White House press briefing on Friday. Only Americans who already received two doses of the Pfizer/BioNTech vaccine will qualify for booster shots. FDA authorization of boosters for Moderna or Johnson & Johnson vaccines and the safety of allowing mixing-and-matching with boosters, has yet to be addressed. ‘Pandemic of the unvaccinated’ needs to be urgently addressed Despite the current focus on boosters, the priority of vaccinations should be on getting the unvaccinated their first shots, which is the leading cause of rising COVID cases and hospitalizations, American experts have stated, echoing the position of the World Health Organization and many other global health officials. “We can give boosters to people, but that’s not really the answer to this pandemic,” Dr. Helen Keipp Talbot, Professor of Medicine at Vanderbilt University, told NPR. “Hospitals are full because people are not vaccinated. We are declining care to people who deserve care because we are full of unvaccinated COVID-positive patients.” According to Walensky, the top goal “here in America and around the world” is to vaccinate the unvaccinated. Over 70 million have yet to get a single shot, said Biden. US President Joe Biden at a press conference on the COVID-19 Response and the Vaccination Program on Friday. “Listen to the voices of the unvaccinated Americans who are lying in hospital beds, taking their final breaths, saying…’If only I got vaccinated,'” Biden said. “People are dying and will die who don’t have to die.” Biden urged people to get vaccinated and announced his commitment to implement vaccination requirements wherever possible. Currently the vaccination mandates cover two thirds of all workers in the US. “We made so much progress during the past eight months of this pandemic, now we face a critical moment,” said Biden. “We have the tools, we have the plan, we just have to finish the job together as one nation. And I know we can…Please look out for your own self interest and health here. Get vaccinated.” Image Credits: Flickr – Province of British Columbia, International Monetary Fund/Ernesto Benavides, Centers for Disease Control and Prevention, White House. REGEN-COV Joins COVID-19 Treatment List; WHO and MSF Call for Lower Prices and Increased Access 24/09/2021 Raisa Santos Riviera Beach Fire Rescue starts REGEN-COV Infusion treatments within the city of Riviera Beach, Florida. REGEN-COV, the antibody cocktail made famous by Donald Trump when he became ill with COVID in 2020, was added Friday to WHO’s list of recommended drug treatments in updated COVID-19 clinical management guidelines, published Friday. At the same time, WHO and Médecins Sans Frontières/Doctors Without Borders (MSF) called on the US pharma firm Regeneron, which developed the cutting-edge drug treatment, to reduce the high prices for the drug and expand now-limited production of the medicine. “WHO calls on Regeneron to lower prices and distribute it equitably across all regions, especially in LMICs,” the WHO statement said, adding that Regeneron should also “transfer the technology” so that similar versions of the treatment may be created and easily accessed in lower-income settings. “It is simply not fair that people living in low- and middle-income countries cannot access new COVID-19 treatments that can decrease the risk of death because of pharmaceutical companies’ monopolies and wishes for high returns,” said Dr Elin Hoffmann Dahl, Infectious Disease Advisor for the MSF Access Campaign, in another statement from MSF. He also noted that the pharma company had benefited from significant public funding to develop the cocktail in the first place, with the US signing a US $450 million contract with Regeneron last year. Regeneron has ignored pressures by access groups to lower prices and widen access to cocktail Regeneron has so far ignored pressures by access groups for such concessions. It has priced the antiviral cocktail at US $820 in India, US $2,000 in Germany and US $2,100 in the US. The company also has filed patent applications in at least 11 more low- and middle-income countries (LMICs) – clearly demonstrating its intent to protect markets there against less expensive, biosimilar alternatives. The drug is the first to be recommended by WHO for use in patients with non-severe COVID-19, but at high risk of more severe disease progression. It’s also being recommended for people with severe infection, but lacking sufficient antibodies of their own. The antibody cocktail includes two monoclonal antibodies (mAbs), casirivimad/imdevimab, shown to have decreased the risks of hospitalization for non-severe COVID-19 patients with high risk of developing severe disease. The drug has also been shown to decrease the risk of death for COVID-19 patients already in severe condition, with their own antibody deficiencies. It was authorized for emergency use by the US Food and Drug Administration in November, and is now part of the “handful of authorised COVID-19 treatments [that] are becoming standard of care for COVID-19 patients,” according to International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) Director General Thomas Cueni, in a media briefing early September. “Monoclonal antibody treatments are beginning to offer promise as are novel antivirals,” said Cueni. MSF: ‘Price Should Reflect Cost of Production’ REGEN-COV is part of a drug class of monoclonal antibodies, or mAbs. The US has recently purchased an additional 1.4 million doses of REGEN-COV, to be provided at no cost to patients. Large scale production of monoclonal antibodies (the drug class casirivimab and imdevimab belong to) is estimated to be below $100/per gram, says the MSF statement. One dose of REGEN-COV is 1,200 mg, purchased from the US government at US $2,100 per dose. This price is 17 times the value of large-scale production of mAbs. Accordingly, Regeneron should “drop the price to reflect the cost of production”, MSF said. “Regeneron should instead set an example for all manufacturers of monoclonal antibodies by putting people’s lives before profits, immediately lower the price, stop pursuing monopolies and share the know-how and technology to produce casirivimab and imdevimab with manufacturers in low- and middle-income countries.” Scarcity of COVID-19 treatment ‘Unacceptable’ Monoclonal antibodies have long been used to treat other diseases, including cancers. There have been long standing problems with high prices and supply shortages for older mAbs used in other treatments as well, said former MSF Emergency Field Coordinator Joan Tubau, who described the situation as “unacceptable.” In light of that history, MSF’s concerns about REGEN-COV are particularly acute, he emphasized. “Access to new COVID-19 treatments must be ensured, especially in places where vaccine coverage is low and recurrent waves are inevitable, to prevent even more inequity in this deadly pandemic,” said Tubau. That’s particularly true in light of the history of high-income countries monopolizing COVID-19 vaccines, he said. “And yet, we’re seeing the same governments that bought up and stockpiled COVID-19 vaccines make similar advance purchases of COVID-19 treatments, leaving little supply for the rest of the world unless Regeneron allows other companies to help boost the global supply.” Additionally, REGEN-COV could play a particularly lifesaving role in countries with low vaccination rates. And yet, paradoxically, those same countries may be the last to be able to access the lifesaving antibody cocktails, she warned, thanks to the market dynamics of pharma sales. “In many countries where MSF works in Latin America and Africa, scarce access to hospital beds, insufficient numbers of health care workers to deal with the surge of patients, and lack of medical oxygen makes prevention of hospitalisation vital – an antiviral cocktail like casirivimab/imdevimab could be essential.” Image Credits: Riviera Beach Fire Rescue/Twitter, NHS Research Scotland/Twitter. New Zealand Appeals for Abolition of ‘Harmful’ Agricultural Subsidies at UN Food Summit 23/09/2021 Kerry Cullinan New Zealand’s Prime Minister Jacinda Ardern appealed for global cooperation to remove “environmentally harmful government agricultural subsidies”, particularly for fisheries, at the United Nations Food Systems Summit, which began on Thursday in New York. These subsidies led to “inefficient production, distorted trade environmental harm, and weakened food security”, Adern said. “We encourage constructive global cooperation to progress this aim, including during this year’s World Trade Organization (WTO) Ministerial Conference,” she added. The WTO has been negotiating over fisheries subsidies since 2001, battling to get consensus on subsidies that contribute to overcapacity and overfishing. Adern added that New Zealand would also be joining the indigenous peoples’ food systems coalition, announced earlier by Myrna Cunningham, President of the Fund for the Development of the Indigenous Peoples of Latin America and the Caribbean. “This means providing the significant role of Maori in our food sectors, and encouraging the growth of Maori agribusiness by removing barriers and empowering Maori leadership,” said Adern. War against nature The summit, which involved 18 months of consultations of over 100,000 people in 148 countries, strongly emphasized the importance of ‘traditional’ food to combat hunger and climate change. Two coalitions – on school meals and healthy diets from sustainable food systems – were also announced on Thursday. “We need food systems that support the health and well-being of all people,” said UN Secretary-General Antonio Guterres. “ Malnutrition, hunger and famine are not forces of nature. They are the result of the actions or inactions of all of us.” “Every day, hundreds of millions of people go to bed hungry. Children are starving. Three billion people cannot afford a healthy diet, two billion are overweight or obese, 462 million are underweight and nearly one-third of all food that is produced is lost or wasted,” said Guterres. “We are waging a war against nature and reaping the bitter harvest: ruined crops, dwindling incomes and failing food systems. Food systems also generate one-third of all greenhouse gas emissions, and they are responsible for up to 80% of biodiversity loss,” he added. UN Secretary General Antonio Guterres Boost ‘nature-based’ solutions Professor Joachim von Braun, head of the summit’s scientific group, said that four actions had been distilled from the consultations. The first involves achieving nourishment for all people: “Science says we actually can come close to ending hunger by 2030. Our modelling shows that it may cost an additional $40 to $50 billion per year until 2030 only,” said Von Braun. “Increased and sustainable production technologies, better markets, reduction of food waste and losses, and social protection, including school feeding and nutrition programmes are the central components of that investment,” he added. “Secondly, we must boost nature-based solutions and production. The global food system emits about 30% of global greenhouse gases, but it can and must become climate neutral,” he added. The third action involved advancing equitable livelihoods and decent work, including protecting the land rights of 500 million small scale producers. “The fourth area is to build resilience to vulnerabilities. The food climate and COVID crisis must be addressed jointly because they are closely linked. A One Health approach for resilience is called for,” he added. Climate-smart investments Samantha Power Elaborating on the $10 billion US commitment to food security announced by President Joe Biden in his address to the UN General Assembly on Wednesday, Head of USAID Samantha Power said half of this would be spent in the US. “The other half will be spent fighting global food insecurity, helping smallholder farmers and their families escape poverty,” said Power, adding that the money would be channeled through Feed the Future, America’s global hunger and food security initiative. “We’re going to revise our global food security strategy to make sure that money does more good in the world, that we focus more on inclusive agricultural growth, the lives of women, girls and marginalised communities,” said Power. “That we invest tens of millions of dollars in fortifying foods with critical vitamins and minerals to fight malnutrition, and that we double down on climate-smart investments like drought-tolerant seeds and carbon storage in soils, so the world can boost crop yields while cutting emissions.” “With new investments, and a new strategy, Feed the Future aims to contribute to a 20% reduction in poverty and stunting in target countries over the next five years,” said Power. School meals coalition Meanwhile, the WHO announced that it will support the coalitions on school meals and healthy diets from sustainable food systems. “The two coalitions are founded by and comprised of member states and other partners, including UN agencies,” said the WHO. “Healthy diets and sustainably produced, safe food for all is not an out-of-reach aspiration, but an unavoidable component of global development, a human right and an achievable goal which can be realised through clear, well established and aligned actions,” said Dr Francesco Branca, WHO Director of Nutrition and Food Safety. The School Meals Coalition wants to ensure that every child has the opportunity to receive a healthy, nutritious meal in school by 2030 by improving the quality of nationally owned school meal programmes and strengthening school meal systems globally. The Healthy Diets Coalition will tackle food supply, food environments, and valuing food by motivating people to eat healthy diets through “multi-dimensional education, information, demand generation, and behavior change support”, the WHO reported on Thursday. Germany Champions Tedros for Re-election as WHO Director General – At Deadline No Other Candidates Publicly Declared 23/09/2021 Elaine Ruth Fletcher WH0 Director General Dr Tedros Adhanom Ghebreyesus WHO Director General Dr Tedros Adhanom Ghebreyesus is now set to run for re-election as Germany’s nominee, backed by other European Union states, including France. And as nominations for the post closed today at 6 p.m. Geneva time on Thursday, it was appearing increasingly likely that the incumbent DG may run unopposed – with no other candidates visibly in the running. On Thursday evening, Germany made it official in a Tweet from its UN Mission in Geneva that stated: “Today September 23rd, France and Germany , in coordination with a group of EU states, nominated Dr Tedros Adhanom Ghebreyesus @DrTedros for the election of the @WHO Director-General to be held in May 2022.” Today September 23rd, France 🇫🇷 and Germany 🇩🇪, in coordination with a group of EU states 🇪🇺, nominated Dr Tedros Adhanom Ghebreyesus @DrTedros for the election of the @WHO Director-General to be held in May 2022. pic.twitter.com/Tx4dGZnrm1 — Germany UN Geneva 🇩🇪🇪🇺🇺🇦 (@GermanyUNGeneva) September 23, 2021 According to other reports, as many as a dozen or more EU countries were joining Germany in the nomination of Tedros – although the names of the actual candidates and their country sponsors will remain secret until early November, according to WHO election rules. “Yes [Germany is sponsoring] and at least 50-60% of EU countries have followed suit,” one diplomatic observer in Geneva told Health Policy Watch. No African country sponsors so far Paradoxically, however, while Tedros made history as the first African to be elected to head WHO in 2017, no African country had come forward publicly as of Thursday’s deadline to offer to co-sponsor his re-election bid, alongside Germany’s EU partners. That, despite the fact that Tedros is regarded as highly popular on the continent – thanks partly to his outspoken positions on health equity and access to vaccines during the COVID pandemic. Asked about the director general’s race at a press conference on Thursday, John Nkengasong, head of Africa Centers for Disease Control, demurred, saying “I work for the African Union, so I think it would be better to wait and see what the African Union position is, and we as staff would go with that.” Nominated by his home country, Ethiopia, for his successful 2017 election bid, Tedros has since fallen out with the ruling government in Addis Ababa over their war with Ethiopian’s Tigray minority community – of which Tedros is also a member. That left him without an obvious ”home” country to sponsor his re-election bid. Although Tedros has never publicly confirmed his desire to stand again – it has been widely assumed that he wants to remain for a second five-year term – which is the maximum allowed. Speaking at a press conference on Wednesday, he declined again to comment on his plans. Sino-American tensions make for rough political waters President Donald Trump discussing the US withdrawal from the WHO at a press conference in July 2020. Following the outbreak of COVID, Tedros has had to steer through the increasingly rough political waters of Sino-American rivalries, exacerbated by the outspoken positions of Donald Trump – who in spring 2020 repeatedly accused Tedros of being soft on China, and in the pockets of Beijing – before announcing in July 2020 that the US would withdraw from WHO membership. That decision was reversed right after the inauguration of US President Joe Biden in January 2021, and WHO relations with the United States have since warmed considerably – with Biden’s Chief Medical Advisor, Anthony Fauci, describing Tedros warmly as a trusted colleague and “dear friend“. Since that time, Tedros also began taking a much tougher line with China, sharply contrasting with the praise he bestowed in the pandemic’s early days. Tedros’ recent, explicit calls upon upon Beijing to be more transparent in the investigation of the origins of SARS-CoV2 have been closely aligned with European and US diplomatic views – who have also criticised the lack of access to critical data and information. The unresolved mysteries of the SARS virus origins, and its woefully incomplete investigation, is one of those issues that will surely shadow any second term in office, as Tedros continues to tread the fault lines between Beijing and the west. New alliances with European partners German Health Minister Jens Spahn appears on the same stage as Tedros at a WHO briefing in July 2021 during a high-profile visit to Geneva, underlining Germany’s support for WHO under Tedros’. But all the while, Tedros has been steadily cultivating a new set of bilateral relations with strong European partners, including Switzerland, Germany and the United Kingdom. In May, for instance, Tedros announced the creation of a new WHO Biohub facility, in collaboration with the Swiss Confederation, to investigate new pathogens of concern at a high-security laboratory in Spiez. Appearing in Berlin on 1 September, Tedros launched a new WHO Hub for Pandemic and Research Intelligence in collaboration with the German government, to be headed by a noted Nigerian scientist, Dr Chikwe Ihekweazu. And earlier this week, Tedros named former UK Ambassador Gordon Brown as WHO’s “Ambassador for Global Health Financing“. The series of adroit political moves have added to his credit among high-income donor countries upon which WHO depends heavily for its budget resources. This, in an era when voluntary contributions by rich countries now far outweigh the fixed, annual assessments to WHO’s 194 member states. And achieving a more sustainable finance base is yet another thorny issue with which Tedros will have to grapple if elected to a second term at the 75th World Health Asssembly in May 2022. In the meantime , if other candidates do emerge, the intervening period will also be marked by electioneering, including “candidates forums” with member states. For the moment, however, a certain amount of suspense will remain as the names of the candidates to the WHO director general post will not be revealed for another month – only after a series of WHO regional meetings with member states are concluded, according to the re-election rules posted by WHO. Asked why there should be such secrecy around the names of the candidates even after nominations formally closed, a WHO spokesperson refused to elaborate, saying only that it is a “well established” process. However, one former senior WHO official, disagreed: “Such a delay in announcing the candidate(s) is a new development in my recollection and I don’t understand why they need to wait for the end of the regional committees if the deadline is going to expire now. I am puzzled. If I remember correctly, both for [former WHO Director General Margaret] Chan’s reelection and Tedros’s [2017] election, the names of the candidates were published shortly after the expiry of the deadline.” Updated 24 September Image Credits: WHO, C-Span. Afghan Health System in Danger of Collapse, WHO Concerned About Female Patients and Health Workers 22/09/2021 Editorial team WHO’s recent mission to Afghanistan Afghanistan’s health system is on the brink of collapse and the country faces “an imminent humanitarian catastrophe,” the World Health Organization (WHO) warned on Wednesday. Only 17% of the facilities of the country’s largest health project, Sehetmandi, are still fully functional as they have run out of funds for supplies and salaries for health staff. “This breakdown in health services is having a rippling effect on the availability of basic and essential health care, as well as on emergency response, polio eradication, and COVID-19 vaccination efforts,” the WHO said. Nine of 37 COVID-19 hospitals have already closed, and “all aspects of the COVID-19 response have dropped, including surveillance, testing, and vaccination”. It warned that 1.8 million COVID-19 vaccine doses in the country remain unused. “Swift action is needed to use these doses in the coming weeks and work towards reaching the goal of vaccinating at least 20% of the population by the end of the year based on national targets.” The WHO recently completed a high-level mission to Kabul in Afghanistan headed by Director-General Dr Tedros Adhanom Ghebreyesus where it met with Taliban leaders, UN partners, health care workers and patients. “WHO particularly emphasizes the need for women to maintain access to education, health care, and to the health workforce,” the global body stated. “With fewer health facilities operational and fewer female health workers reporting to work, female patients are hesitant to seek care. We are committed to working with partners to invest in the health education of girls and women, as well as continue training female health workers.” Polio is still endemic in Afghanistan, while measles is on the increase. Can the UN Food Summit Make a Difference to a World Overpowered by Junk Food? 21/09/2021 Kerry Cullinan Around 70% of primary school children in rural Mexican had a sugary drink for breakfast in 2012. Many children in the global south are drinking more sugary drinks than milk – thanks to the aggressive promotion of ultra-processed food to low and middle-income countries (LMICs) in the past two decades. Global obesity and diabetes rates have exploded as a result of dietary changes, and these conditions have made people far more vulnerable to severe COVID-19 illness – and not a single country has been able to reverse their obesity trends. Thursday’s United Nations Food Systems Summit (UNFSS) aims to “build a global conversation on the way in which we produce, process, and consume food, and galvanize global actions and commitments to change our food systems to provide safe, nutritious food for all within our planetary boundaries”, according to the UN. But summit preparation has been rocky. Its organisers have been accused of lacking transparency and giving big food, alcohol and tobacco companies a seat at the table, according to a letter signed by internationally renowned food policy academics and international NGOs including the Non-Communicable Diseases (NCD) Alliance. Meanwhile, a number of organisations – particularly representing small farmers and indigenous people – boycotted its pre-summit in Rome in July, citing unhappiness with the dominance of agribusiness. Boycotts and controversy “The issue of landlessness and land grabbing is not on the agenda of the UNFSS. Nowhere in its so-called Action Tracks do discussions highlight critical trends such as on land concentration and reconcentration in the hands of big agribusiness firms and their network of local landlords and compradors, nor on the massive displacement of rural communities to give way to big private investments and large development projects,” said Chennaiah Poguri, chairperson of the Asian Peasant Coalition (APC). Nonetheless, at least 85 heads of state are expected to share their commitments to addressing the global food crisis, according to a UNFSS media release on Monday. “After 18 long months, the world is on the brink of a summit that aims to change the trajectory of global progress, uniting everyone in a shared commitment to deliver the Sustainable Development Goals and the fundamental human rights at their core,” said Agnes Kalibata, the UN Secretary-General’s Special Envoy for the summit. However, the appointment of Kalibata, a former minister of agriculture in Rwanda, has also been controversial. Critics accuse the organisation she heads, the Alliance for a Green Revolution in Africa (AGRA), of opening African markets to “corporate monopolies controlling commercial seeds, genetically modified crops, fossil fuel-heavy synthetic fertilizers and polluting pesticides”, and asked the UN to revoke her appointment. Food policy activists protest against ultr-processed food in South Africa. Desperate need for food policy change Despite the controversies, the need for a change in global food policy is urgent. Around eight million people die annually due to poor diets, according to the Bloomberg Philanthropies’ Food Policy Program, which has committed over $435 million to help public health advocates to promote healthier diets through policy change. “In almost every country, traditional diets are being rapidly displaced by low-quality, nutrient-deficient diets,” says Trish Cotter, Senior Policy and Communication Advisor at Vital Strategies’ Food Policy Program. Obesity has almost tripled since the mid-1970s, with over 1.9 billion adults and more than 370 million children and adolescents now overweight or obese, according to the World Health Organization, while the prevalence of type 2 diabetes has doubled since 1980, affecting about 420 million people. “The most plausible explanation for this change? The rapid rise in consumption of ultra-processed foods and beverages – products that have been chemically or physically transformed using industrial processes,” adds Cotter, who is also part of the Bloomberg program. Leading food policy academics writing in the BMJ recently described ultra-processed foods as products arising from “industrial processes that convert food commodities such as wheat, soy, corn, oils and sugar, into chemically or physically transformed food substances, formulated with various classes of additives”. Transnational corporations “use their power to formulate, mass manufacture, distribute and aggressively market their products worldwide” and also “shape scientific findings by funding in-house and university-based research, so as to defend and promote ultra-processed foods”, according to the academics, who include Carlos Monteiro, Professor of Nutrition at Sao Paulo University, Marion Nestle, Emeritus Professor of Nutrition at New York University and the University of North Carolina’s Professor Barry Popkin. Taxes, warning labels and marketing restrictions Warning labels on food products in Chile nudge customers away from unhealthy foods – top-left: “high in calories”; top-right: “high in sugars”; bottom-left: “high in sodium”; bottom-right: “high in saturated fats” They urge the summit to encourage global dietary guidelines that favour fresh or minimally processed foods and “fiscal measures” including taxes, marketing regulations, mandatory front-of-pack warning labels on ultra-processed foods. Cotter, who has worked on international communication campaigns aimed at encouraging healthy eating, says that “ultra-processed products have crept into our lives under the guise of convenience backed up by some extremely clever and consistent marketing”. “We cannot simply place the onus on individuals to change lifestyles or make healthier choices when there often is little choice available for healthier products or consumers are swamped by alluringly marketed, ready-to-eat, convenient and tasty products advertised by Big Food,” she adds. “There’s no question that these products must be regulated and taxed to reduce consumption. But without the support of government policy, this task—of avoiding the health consequences of populations consuming ultra-processed products—is nigh impossible. The onus is on governments to act, and to act now.” Most Mexican kids had sodas for breakfast Mexico was the first country to tax sugary drinks in 2014, as it struggled to address the strain on its health system stemming from almost three-quarters of its population being overweight. Prior to the tax, Mexico had one of the highest consumption rates of sugary drinks in the world, and 70% of rural primary school children and 80% of high school students had one for breakfast every day. A year after it had implemented a 10% soda tax, sugary drinks purchases declined by 9% among the poorest third of the population. South Africa implemented a sugary drinks tax of around 10% in 2018 and has cut consumption by 28%, welcome news in a country where nine and 10- year-olds drink almost three times the global average of Coca-Colas every year. Chile has cut sugary drink purchasing by 24% through a comprehensive policy approach that includes warning labels on bottles. Recently, Brazil and Colombia have also passed legislation requiring warning labels on ultra-processed food. These warnings are important, says Cotter, because most shoppers spend less than 10 seconds choosing each food and beverage item. “Front-of-package warning labels can help consumers to quickly identify unhealthy products and encourage them to make healthy choices.” Safe, nutritious food for all UN Envoy Kalibata says that summit has five interconnected objectives. These are to ensure access to safe, nutritious food for all; shift to sustainable consumption by reducing waste and creating demand for healthy diets; boost “nature-positive production,” (entailing reduced emissions and protection of ecosystems), advance equitable livelihoods; and build resilience to vulnerabilities and shocks. Despite its controversies, Lucy Westerman, Policy and Campaigns Manager for the NCD Alliance, says that the summit “has succeeded in getting more people talking about food systems and the complexity of them”. “We would really like to see this summit shift from promises and pledges to actual action and investment. It would be truly game-changing for those whose priorities lie in the health of people and planet to invest in what we know works at scale, without the interference of those with harmful interests,” adds Westerman. She also appealed for the summit to be “one part of a much bigger conversation” and that includes the UN Climate Change Conference of the Parties (COP26) starting on 31 October and Nutrition For Growth to address malnutrition in December. Meanwhile, Monteiro and colleagues want the summit to “urge member states to implement multiple policy interventions to reduce ultra-processed food production, distribution and consumption, while simultaneously making fresh or minimally processed foods more available, accessible and affordable”. Whatever the outcome of the summit, it is evident that the world needs much more innovation to stop ultra-processed food and the twin epidemics of obesity and diabetes that it is fueling. Image Credits: Unsplash, Kerry Cullinan, Vital Strategies, Michael Casmir/Pierce Mill Media. Long Working Hours Kill More Workers Than Injuries 18/09/2021 Kerry Cullinan The biggest killers of working people are strokes and heart disease associated with long working hours – over 55 hours a week. This is according to a joint report from the World Health Organization (WHO) and International Labour Organization (ILO), the first global comparative risk assessment of the work-related burden of disease, which was released on Friday. Diseases associated with long working hours accounted for almost 40% of global deaths in 2016, some 750,000 deaths. People from South East Asia and Western Pacific, men and those over 54 were most at risk. Workplace injuries were the next biggest cause of worker deaths, accounting for 19.4% of deaths (360,000 deaths) – around half the deaths caused by long working hours. Workers most in danger of injuries were those in the construction, transport, manufacturing and agricultural sectors. Workplace exposure to air pollution (particulate matter, gases and fumes) was responsible for 450,000 deaths. Meanwhile, asbestos exposure caused 11.1% deaths, causing a variety of cancers. According to the report, 81% of deaths in 2016 were caused by non-communicable diseases (NCDs), the most common being chronic obstructive pulmonary disease (450,000 deaths); stroke (400,000 deaths) and ischaemic heart disease (350,000 deaths). “It’s shocking to see so many people literally being killed by their jobs,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Our report is a wake-up call to countries and businesses to improve and protect the health and safety of workers by honouring their commitments to provide universal coverage of occupational health and safety services.” Healthy limits This report will enable policymakers to track work-related health loss at country, regional and global levels, according to the two bodies. “These estimates provide important information on the work-related burden of disease, and this information can help to shape policies and practices to create healthier and safer workplaces,” said Guy Ryder, ILO Director-General. Each risk factor has a unique set of preventive actions, which are outlined in the monitoring report to guide governments, in consultation with employers and workers. Preventing long working hours requires agreement on healthy maximum limits on working time, for example. To reduce workplace exposure to air pollution, dust control, ventilation, and personal protective equipment is recommended. “These almost 2 million premature deaths are preventable. Action needs to be taken based on the research available to target the evolving nature of work-related health threats,” said Dr. Maria Neira, Director of the Department of Environment, Climate Change and Health at WHO. The report notes that total work-related burden of disease is likely substantially larger, as health loss from several other occupational risk factors must still be quantified in the future. Moreover, the effects of the COVID-19 pandemic will add another dimension to this burden to be captured in future estimates. 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US Centers for Disease Control Authorizes COVID-19 Boosters for Frontline Workers Aged 18-64 – Widening Access to Third Jab 24/09/2021 Madeleine Hoecklin US regulatory agencies established the populations eligible for the Pfizer/BioNTech booster shot this week, paving the way for the rollout of boosters nationwide. The Director of the US Centers for Disease Control and Prevention (CDC), Dr Rochelle Walensky, has authorized millions of frontline workers in health care and school settings to receive a third COVD-19 vaccine booster dose- opening the gates for a much wider wide swathe of Americans, ages 18-64, to receive the controversial booster shots. Her ruling late Thursday overruled that of a CDC’s Advisory Committee on Immunization Practices, which had endorsed Pfizer/BioNTech booster shots only for millions of older individuals and others at high risk of contracting the disease after a meeting on Thursday. However, the panel voted against allowing frontline workers aged 18 to 64 years from getting another jab. This had put the recommendations at odds with the Food and Drug Administration’s (FDA) decision to authorize Pfizer booster shots for workers at risk, on Wednesday. The FDA authorized the use of boosters at least six months after the completion of the primary vaccination series in individuals over the age of 65; those aged 18 to 64 at a high risk of severe COVID-19; and those aged 18 to 64 whose occupation puts them at a high risk of serious complications of COVID-19. Walensky’s decision to include adults working in high-risk settings, such as health care and school systems, aligned the CDC’s policy with the FDA. “As CDC Director, it is my job to recognize where our actions can have the greatest impact,” Walensky said at a meeting on Thursday. “At CDC, we are tasked with analyzing complex, often imperfect data to make concrete recommendations that optimize health. In a pandemic, even with uncertainty, we must take actions that we anticipate will do the greatest good.” Dr Rochelle Walensky, Director of the US Centers for Disease Control and Prevention (CDC). She said that providing boosters to healthcare workers would “best serve the nation’s public health needs.” Walensky’s decision will cover healthcare workers, teachers, and people living or working in institutional settings, such as prisons or homeless shelters. The panel attempted to limit those eligible for boosters, refusing to open jabs to healthy adults who aren’t at risk of severe illness. Members of the advisory committee wanted to avoid an all-adult booster campaign. Walensky’s decision was announced late on Thursday, demonstrating the complex decision making around the issue of boosters. The recommendations from the CDC and FDA still represent a considerable scale back on US President Joe Biden’s far reaching booster plan, which was designed to rollout the week of September 20. Some 20 million people are now eligible for a booster and in the coming months 40 million more people will become eligible, said Biden at a White House press briefing on Friday. Only Americans who already received two doses of the Pfizer/BioNTech vaccine will qualify for booster shots. FDA authorization of boosters for Moderna or Johnson & Johnson vaccines and the safety of allowing mixing-and-matching with boosters, has yet to be addressed. ‘Pandemic of the unvaccinated’ needs to be urgently addressed Despite the current focus on boosters, the priority of vaccinations should be on getting the unvaccinated their first shots, which is the leading cause of rising COVID cases and hospitalizations, American experts have stated, echoing the position of the World Health Organization and many other global health officials. “We can give boosters to people, but that’s not really the answer to this pandemic,” Dr. Helen Keipp Talbot, Professor of Medicine at Vanderbilt University, told NPR. “Hospitals are full because people are not vaccinated. We are declining care to people who deserve care because we are full of unvaccinated COVID-positive patients.” According to Walensky, the top goal “here in America and around the world” is to vaccinate the unvaccinated. Over 70 million have yet to get a single shot, said Biden. US President Joe Biden at a press conference on the COVID-19 Response and the Vaccination Program on Friday. “Listen to the voices of the unvaccinated Americans who are lying in hospital beds, taking their final breaths, saying…’If only I got vaccinated,'” Biden said. “People are dying and will die who don’t have to die.” Biden urged people to get vaccinated and announced his commitment to implement vaccination requirements wherever possible. Currently the vaccination mandates cover two thirds of all workers in the US. “We made so much progress during the past eight months of this pandemic, now we face a critical moment,” said Biden. “We have the tools, we have the plan, we just have to finish the job together as one nation. And I know we can…Please look out for your own self interest and health here. Get vaccinated.” Image Credits: Flickr – Province of British Columbia, International Monetary Fund/Ernesto Benavides, Centers for Disease Control and Prevention, White House. REGEN-COV Joins COVID-19 Treatment List; WHO and MSF Call for Lower Prices and Increased Access 24/09/2021 Raisa Santos Riviera Beach Fire Rescue starts REGEN-COV Infusion treatments within the city of Riviera Beach, Florida. REGEN-COV, the antibody cocktail made famous by Donald Trump when he became ill with COVID in 2020, was added Friday to WHO’s list of recommended drug treatments in updated COVID-19 clinical management guidelines, published Friday. At the same time, WHO and Médecins Sans Frontières/Doctors Without Borders (MSF) called on the US pharma firm Regeneron, which developed the cutting-edge drug treatment, to reduce the high prices for the drug and expand now-limited production of the medicine. “WHO calls on Regeneron to lower prices and distribute it equitably across all regions, especially in LMICs,” the WHO statement said, adding that Regeneron should also “transfer the technology” so that similar versions of the treatment may be created and easily accessed in lower-income settings. “It is simply not fair that people living in low- and middle-income countries cannot access new COVID-19 treatments that can decrease the risk of death because of pharmaceutical companies’ monopolies and wishes for high returns,” said Dr Elin Hoffmann Dahl, Infectious Disease Advisor for the MSF Access Campaign, in another statement from MSF. He also noted that the pharma company had benefited from significant public funding to develop the cocktail in the first place, with the US signing a US $450 million contract with Regeneron last year. Regeneron has ignored pressures by access groups to lower prices and widen access to cocktail Regeneron has so far ignored pressures by access groups for such concessions. It has priced the antiviral cocktail at US $820 in India, US $2,000 in Germany and US $2,100 in the US. The company also has filed patent applications in at least 11 more low- and middle-income countries (LMICs) – clearly demonstrating its intent to protect markets there against less expensive, biosimilar alternatives. The drug is the first to be recommended by WHO for use in patients with non-severe COVID-19, but at high risk of more severe disease progression. It’s also being recommended for people with severe infection, but lacking sufficient antibodies of their own. The antibody cocktail includes two monoclonal antibodies (mAbs), casirivimad/imdevimab, shown to have decreased the risks of hospitalization for non-severe COVID-19 patients with high risk of developing severe disease. The drug has also been shown to decrease the risk of death for COVID-19 patients already in severe condition, with their own antibody deficiencies. It was authorized for emergency use by the US Food and Drug Administration in November, and is now part of the “handful of authorised COVID-19 treatments [that] are becoming standard of care for COVID-19 patients,” according to International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) Director General Thomas Cueni, in a media briefing early September. “Monoclonal antibody treatments are beginning to offer promise as are novel antivirals,” said Cueni. MSF: ‘Price Should Reflect Cost of Production’ REGEN-COV is part of a drug class of monoclonal antibodies, or mAbs. The US has recently purchased an additional 1.4 million doses of REGEN-COV, to be provided at no cost to patients. Large scale production of monoclonal antibodies (the drug class casirivimab and imdevimab belong to) is estimated to be below $100/per gram, says the MSF statement. One dose of REGEN-COV is 1,200 mg, purchased from the US government at US $2,100 per dose. This price is 17 times the value of large-scale production of mAbs. Accordingly, Regeneron should “drop the price to reflect the cost of production”, MSF said. “Regeneron should instead set an example for all manufacturers of monoclonal antibodies by putting people’s lives before profits, immediately lower the price, stop pursuing monopolies and share the know-how and technology to produce casirivimab and imdevimab with manufacturers in low- and middle-income countries.” Scarcity of COVID-19 treatment ‘Unacceptable’ Monoclonal antibodies have long been used to treat other diseases, including cancers. There have been long standing problems with high prices and supply shortages for older mAbs used in other treatments as well, said former MSF Emergency Field Coordinator Joan Tubau, who described the situation as “unacceptable.” In light of that history, MSF’s concerns about REGEN-COV are particularly acute, he emphasized. “Access to new COVID-19 treatments must be ensured, especially in places where vaccine coverage is low and recurrent waves are inevitable, to prevent even more inequity in this deadly pandemic,” said Tubau. That’s particularly true in light of the history of high-income countries monopolizing COVID-19 vaccines, he said. “And yet, we’re seeing the same governments that bought up and stockpiled COVID-19 vaccines make similar advance purchases of COVID-19 treatments, leaving little supply for the rest of the world unless Regeneron allows other companies to help boost the global supply.” Additionally, REGEN-COV could play a particularly lifesaving role in countries with low vaccination rates. And yet, paradoxically, those same countries may be the last to be able to access the lifesaving antibody cocktails, she warned, thanks to the market dynamics of pharma sales. “In many countries where MSF works in Latin America and Africa, scarce access to hospital beds, insufficient numbers of health care workers to deal with the surge of patients, and lack of medical oxygen makes prevention of hospitalisation vital – an antiviral cocktail like casirivimab/imdevimab could be essential.” Image Credits: Riviera Beach Fire Rescue/Twitter, NHS Research Scotland/Twitter. New Zealand Appeals for Abolition of ‘Harmful’ Agricultural Subsidies at UN Food Summit 23/09/2021 Kerry Cullinan New Zealand’s Prime Minister Jacinda Ardern appealed for global cooperation to remove “environmentally harmful government agricultural subsidies”, particularly for fisheries, at the United Nations Food Systems Summit, which began on Thursday in New York. These subsidies led to “inefficient production, distorted trade environmental harm, and weakened food security”, Adern said. “We encourage constructive global cooperation to progress this aim, including during this year’s World Trade Organization (WTO) Ministerial Conference,” she added. The WTO has been negotiating over fisheries subsidies since 2001, battling to get consensus on subsidies that contribute to overcapacity and overfishing. Adern added that New Zealand would also be joining the indigenous peoples’ food systems coalition, announced earlier by Myrna Cunningham, President of the Fund for the Development of the Indigenous Peoples of Latin America and the Caribbean. “This means providing the significant role of Maori in our food sectors, and encouraging the growth of Maori agribusiness by removing barriers and empowering Maori leadership,” said Adern. War against nature The summit, which involved 18 months of consultations of over 100,000 people in 148 countries, strongly emphasized the importance of ‘traditional’ food to combat hunger and climate change. Two coalitions – on school meals and healthy diets from sustainable food systems – were also announced on Thursday. “We need food systems that support the health and well-being of all people,” said UN Secretary-General Antonio Guterres. “ Malnutrition, hunger and famine are not forces of nature. They are the result of the actions or inactions of all of us.” “Every day, hundreds of millions of people go to bed hungry. Children are starving. Three billion people cannot afford a healthy diet, two billion are overweight or obese, 462 million are underweight and nearly one-third of all food that is produced is lost or wasted,” said Guterres. “We are waging a war against nature and reaping the bitter harvest: ruined crops, dwindling incomes and failing food systems. Food systems also generate one-third of all greenhouse gas emissions, and they are responsible for up to 80% of biodiversity loss,” he added. UN Secretary General Antonio Guterres Boost ‘nature-based’ solutions Professor Joachim von Braun, head of the summit’s scientific group, said that four actions had been distilled from the consultations. The first involves achieving nourishment for all people: “Science says we actually can come close to ending hunger by 2030. Our modelling shows that it may cost an additional $40 to $50 billion per year until 2030 only,” said Von Braun. “Increased and sustainable production technologies, better markets, reduction of food waste and losses, and social protection, including school feeding and nutrition programmes are the central components of that investment,” he added. “Secondly, we must boost nature-based solutions and production. The global food system emits about 30% of global greenhouse gases, but it can and must become climate neutral,” he added. The third action involved advancing equitable livelihoods and decent work, including protecting the land rights of 500 million small scale producers. “The fourth area is to build resilience to vulnerabilities. The food climate and COVID crisis must be addressed jointly because they are closely linked. A One Health approach for resilience is called for,” he added. Climate-smart investments Samantha Power Elaborating on the $10 billion US commitment to food security announced by President Joe Biden in his address to the UN General Assembly on Wednesday, Head of USAID Samantha Power said half of this would be spent in the US. “The other half will be spent fighting global food insecurity, helping smallholder farmers and their families escape poverty,” said Power, adding that the money would be channeled through Feed the Future, America’s global hunger and food security initiative. “We’re going to revise our global food security strategy to make sure that money does more good in the world, that we focus more on inclusive agricultural growth, the lives of women, girls and marginalised communities,” said Power. “That we invest tens of millions of dollars in fortifying foods with critical vitamins and minerals to fight malnutrition, and that we double down on climate-smart investments like drought-tolerant seeds and carbon storage in soils, so the world can boost crop yields while cutting emissions.” “With new investments, and a new strategy, Feed the Future aims to contribute to a 20% reduction in poverty and stunting in target countries over the next five years,” said Power. School meals coalition Meanwhile, the WHO announced that it will support the coalitions on school meals and healthy diets from sustainable food systems. “The two coalitions are founded by and comprised of member states and other partners, including UN agencies,” said the WHO. “Healthy diets and sustainably produced, safe food for all is not an out-of-reach aspiration, but an unavoidable component of global development, a human right and an achievable goal which can be realised through clear, well established and aligned actions,” said Dr Francesco Branca, WHO Director of Nutrition and Food Safety. The School Meals Coalition wants to ensure that every child has the opportunity to receive a healthy, nutritious meal in school by 2030 by improving the quality of nationally owned school meal programmes and strengthening school meal systems globally. The Healthy Diets Coalition will tackle food supply, food environments, and valuing food by motivating people to eat healthy diets through “multi-dimensional education, information, demand generation, and behavior change support”, the WHO reported on Thursday. Germany Champions Tedros for Re-election as WHO Director General – At Deadline No Other Candidates Publicly Declared 23/09/2021 Elaine Ruth Fletcher WH0 Director General Dr Tedros Adhanom Ghebreyesus WHO Director General Dr Tedros Adhanom Ghebreyesus is now set to run for re-election as Germany’s nominee, backed by other European Union states, including France. And as nominations for the post closed today at 6 p.m. Geneva time on Thursday, it was appearing increasingly likely that the incumbent DG may run unopposed – with no other candidates visibly in the running. On Thursday evening, Germany made it official in a Tweet from its UN Mission in Geneva that stated: “Today September 23rd, France and Germany , in coordination with a group of EU states, nominated Dr Tedros Adhanom Ghebreyesus @DrTedros for the election of the @WHO Director-General to be held in May 2022.” Today September 23rd, France 🇫🇷 and Germany 🇩🇪, in coordination with a group of EU states 🇪🇺, nominated Dr Tedros Adhanom Ghebreyesus @DrTedros for the election of the @WHO Director-General to be held in May 2022. pic.twitter.com/Tx4dGZnrm1 — Germany UN Geneva 🇩🇪🇪🇺🇺🇦 (@GermanyUNGeneva) September 23, 2021 According to other reports, as many as a dozen or more EU countries were joining Germany in the nomination of Tedros – although the names of the actual candidates and their country sponsors will remain secret until early November, according to WHO election rules. “Yes [Germany is sponsoring] and at least 50-60% of EU countries have followed suit,” one diplomatic observer in Geneva told Health Policy Watch. No African country sponsors so far Paradoxically, however, while Tedros made history as the first African to be elected to head WHO in 2017, no African country had come forward publicly as of Thursday’s deadline to offer to co-sponsor his re-election bid, alongside Germany’s EU partners. That, despite the fact that Tedros is regarded as highly popular on the continent – thanks partly to his outspoken positions on health equity and access to vaccines during the COVID pandemic. Asked about the director general’s race at a press conference on Thursday, John Nkengasong, head of Africa Centers for Disease Control, demurred, saying “I work for the African Union, so I think it would be better to wait and see what the African Union position is, and we as staff would go with that.” Nominated by his home country, Ethiopia, for his successful 2017 election bid, Tedros has since fallen out with the ruling government in Addis Ababa over their war with Ethiopian’s Tigray minority community – of which Tedros is also a member. That left him without an obvious ”home” country to sponsor his re-election bid. Although Tedros has never publicly confirmed his desire to stand again – it has been widely assumed that he wants to remain for a second five-year term – which is the maximum allowed. Speaking at a press conference on Wednesday, he declined again to comment on his plans. Sino-American tensions make for rough political waters President Donald Trump discussing the US withdrawal from the WHO at a press conference in July 2020. Following the outbreak of COVID, Tedros has had to steer through the increasingly rough political waters of Sino-American rivalries, exacerbated by the outspoken positions of Donald Trump – who in spring 2020 repeatedly accused Tedros of being soft on China, and in the pockets of Beijing – before announcing in July 2020 that the US would withdraw from WHO membership. That decision was reversed right after the inauguration of US President Joe Biden in January 2021, and WHO relations with the United States have since warmed considerably – with Biden’s Chief Medical Advisor, Anthony Fauci, describing Tedros warmly as a trusted colleague and “dear friend“. Since that time, Tedros also began taking a much tougher line with China, sharply contrasting with the praise he bestowed in the pandemic’s early days. Tedros’ recent, explicit calls upon upon Beijing to be more transparent in the investigation of the origins of SARS-CoV2 have been closely aligned with European and US diplomatic views – who have also criticised the lack of access to critical data and information. The unresolved mysteries of the SARS virus origins, and its woefully incomplete investigation, is one of those issues that will surely shadow any second term in office, as Tedros continues to tread the fault lines between Beijing and the west. New alliances with European partners German Health Minister Jens Spahn appears on the same stage as Tedros at a WHO briefing in July 2021 during a high-profile visit to Geneva, underlining Germany’s support for WHO under Tedros’. But all the while, Tedros has been steadily cultivating a new set of bilateral relations with strong European partners, including Switzerland, Germany and the United Kingdom. In May, for instance, Tedros announced the creation of a new WHO Biohub facility, in collaboration with the Swiss Confederation, to investigate new pathogens of concern at a high-security laboratory in Spiez. Appearing in Berlin on 1 September, Tedros launched a new WHO Hub for Pandemic and Research Intelligence in collaboration with the German government, to be headed by a noted Nigerian scientist, Dr Chikwe Ihekweazu. And earlier this week, Tedros named former UK Ambassador Gordon Brown as WHO’s “Ambassador for Global Health Financing“. The series of adroit political moves have added to his credit among high-income donor countries upon which WHO depends heavily for its budget resources. This, in an era when voluntary contributions by rich countries now far outweigh the fixed, annual assessments to WHO’s 194 member states. And achieving a more sustainable finance base is yet another thorny issue with which Tedros will have to grapple if elected to a second term at the 75th World Health Asssembly in May 2022. In the meantime , if other candidates do emerge, the intervening period will also be marked by electioneering, including “candidates forums” with member states. For the moment, however, a certain amount of suspense will remain as the names of the candidates to the WHO director general post will not be revealed for another month – only after a series of WHO regional meetings with member states are concluded, according to the re-election rules posted by WHO. Asked why there should be such secrecy around the names of the candidates even after nominations formally closed, a WHO spokesperson refused to elaborate, saying only that it is a “well established” process. However, one former senior WHO official, disagreed: “Such a delay in announcing the candidate(s) is a new development in my recollection and I don’t understand why they need to wait for the end of the regional committees if the deadline is going to expire now. I am puzzled. If I remember correctly, both for [former WHO Director General Margaret] Chan’s reelection and Tedros’s [2017] election, the names of the candidates were published shortly after the expiry of the deadline.” Updated 24 September Image Credits: WHO, C-Span. Afghan Health System in Danger of Collapse, WHO Concerned About Female Patients and Health Workers 22/09/2021 Editorial team WHO’s recent mission to Afghanistan Afghanistan’s health system is on the brink of collapse and the country faces “an imminent humanitarian catastrophe,” the World Health Organization (WHO) warned on Wednesday. Only 17% of the facilities of the country’s largest health project, Sehetmandi, are still fully functional as they have run out of funds for supplies and salaries for health staff. “This breakdown in health services is having a rippling effect on the availability of basic and essential health care, as well as on emergency response, polio eradication, and COVID-19 vaccination efforts,” the WHO said. Nine of 37 COVID-19 hospitals have already closed, and “all aspects of the COVID-19 response have dropped, including surveillance, testing, and vaccination”. It warned that 1.8 million COVID-19 vaccine doses in the country remain unused. “Swift action is needed to use these doses in the coming weeks and work towards reaching the goal of vaccinating at least 20% of the population by the end of the year based on national targets.” The WHO recently completed a high-level mission to Kabul in Afghanistan headed by Director-General Dr Tedros Adhanom Ghebreyesus where it met with Taliban leaders, UN partners, health care workers and patients. “WHO particularly emphasizes the need for women to maintain access to education, health care, and to the health workforce,” the global body stated. “With fewer health facilities operational and fewer female health workers reporting to work, female patients are hesitant to seek care. We are committed to working with partners to invest in the health education of girls and women, as well as continue training female health workers.” Polio is still endemic in Afghanistan, while measles is on the increase. Can the UN Food Summit Make a Difference to a World Overpowered by Junk Food? 21/09/2021 Kerry Cullinan Around 70% of primary school children in rural Mexican had a sugary drink for breakfast in 2012. Many children in the global south are drinking more sugary drinks than milk – thanks to the aggressive promotion of ultra-processed food to low and middle-income countries (LMICs) in the past two decades. Global obesity and diabetes rates have exploded as a result of dietary changes, and these conditions have made people far more vulnerable to severe COVID-19 illness – and not a single country has been able to reverse their obesity trends. Thursday’s United Nations Food Systems Summit (UNFSS) aims to “build a global conversation on the way in which we produce, process, and consume food, and galvanize global actions and commitments to change our food systems to provide safe, nutritious food for all within our planetary boundaries”, according to the UN. But summit preparation has been rocky. Its organisers have been accused of lacking transparency and giving big food, alcohol and tobacco companies a seat at the table, according to a letter signed by internationally renowned food policy academics and international NGOs including the Non-Communicable Diseases (NCD) Alliance. Meanwhile, a number of organisations – particularly representing small farmers and indigenous people – boycotted its pre-summit in Rome in July, citing unhappiness with the dominance of agribusiness. Boycotts and controversy “The issue of landlessness and land grabbing is not on the agenda of the UNFSS. Nowhere in its so-called Action Tracks do discussions highlight critical trends such as on land concentration and reconcentration in the hands of big agribusiness firms and their network of local landlords and compradors, nor on the massive displacement of rural communities to give way to big private investments and large development projects,” said Chennaiah Poguri, chairperson of the Asian Peasant Coalition (APC). Nonetheless, at least 85 heads of state are expected to share their commitments to addressing the global food crisis, according to a UNFSS media release on Monday. “After 18 long months, the world is on the brink of a summit that aims to change the trajectory of global progress, uniting everyone in a shared commitment to deliver the Sustainable Development Goals and the fundamental human rights at their core,” said Agnes Kalibata, the UN Secretary-General’s Special Envoy for the summit. However, the appointment of Kalibata, a former minister of agriculture in Rwanda, has also been controversial. Critics accuse the organisation she heads, the Alliance for a Green Revolution in Africa (AGRA), of opening African markets to “corporate monopolies controlling commercial seeds, genetically modified crops, fossil fuel-heavy synthetic fertilizers and polluting pesticides”, and asked the UN to revoke her appointment. Food policy activists protest against ultr-processed food in South Africa. Desperate need for food policy change Despite the controversies, the need for a change in global food policy is urgent. Around eight million people die annually due to poor diets, according to the Bloomberg Philanthropies’ Food Policy Program, which has committed over $435 million to help public health advocates to promote healthier diets through policy change. “In almost every country, traditional diets are being rapidly displaced by low-quality, nutrient-deficient diets,” says Trish Cotter, Senior Policy and Communication Advisor at Vital Strategies’ Food Policy Program. Obesity has almost tripled since the mid-1970s, with over 1.9 billion adults and more than 370 million children and adolescents now overweight or obese, according to the World Health Organization, while the prevalence of type 2 diabetes has doubled since 1980, affecting about 420 million people. “The most plausible explanation for this change? The rapid rise in consumption of ultra-processed foods and beverages – products that have been chemically or physically transformed using industrial processes,” adds Cotter, who is also part of the Bloomberg program. Leading food policy academics writing in the BMJ recently described ultra-processed foods as products arising from “industrial processes that convert food commodities such as wheat, soy, corn, oils and sugar, into chemically or physically transformed food substances, formulated with various classes of additives”. Transnational corporations “use their power to formulate, mass manufacture, distribute and aggressively market their products worldwide” and also “shape scientific findings by funding in-house and university-based research, so as to defend and promote ultra-processed foods”, according to the academics, who include Carlos Monteiro, Professor of Nutrition at Sao Paulo University, Marion Nestle, Emeritus Professor of Nutrition at New York University and the University of North Carolina’s Professor Barry Popkin. Taxes, warning labels and marketing restrictions Warning labels on food products in Chile nudge customers away from unhealthy foods – top-left: “high in calories”; top-right: “high in sugars”; bottom-left: “high in sodium”; bottom-right: “high in saturated fats” They urge the summit to encourage global dietary guidelines that favour fresh or minimally processed foods and “fiscal measures” including taxes, marketing regulations, mandatory front-of-pack warning labels on ultra-processed foods. Cotter, who has worked on international communication campaigns aimed at encouraging healthy eating, says that “ultra-processed products have crept into our lives under the guise of convenience backed up by some extremely clever and consistent marketing”. “We cannot simply place the onus on individuals to change lifestyles or make healthier choices when there often is little choice available for healthier products or consumers are swamped by alluringly marketed, ready-to-eat, convenient and tasty products advertised by Big Food,” she adds. “There’s no question that these products must be regulated and taxed to reduce consumption. But without the support of government policy, this task—of avoiding the health consequences of populations consuming ultra-processed products—is nigh impossible. The onus is on governments to act, and to act now.” Most Mexican kids had sodas for breakfast Mexico was the first country to tax sugary drinks in 2014, as it struggled to address the strain on its health system stemming from almost three-quarters of its population being overweight. Prior to the tax, Mexico had one of the highest consumption rates of sugary drinks in the world, and 70% of rural primary school children and 80% of high school students had one for breakfast every day. A year after it had implemented a 10% soda tax, sugary drinks purchases declined by 9% among the poorest third of the population. South Africa implemented a sugary drinks tax of around 10% in 2018 and has cut consumption by 28%, welcome news in a country where nine and 10- year-olds drink almost three times the global average of Coca-Colas every year. Chile has cut sugary drink purchasing by 24% through a comprehensive policy approach that includes warning labels on bottles. Recently, Brazil and Colombia have also passed legislation requiring warning labels on ultra-processed food. These warnings are important, says Cotter, because most shoppers spend less than 10 seconds choosing each food and beverage item. “Front-of-package warning labels can help consumers to quickly identify unhealthy products and encourage them to make healthy choices.” Safe, nutritious food for all UN Envoy Kalibata says that summit has five interconnected objectives. These are to ensure access to safe, nutritious food for all; shift to sustainable consumption by reducing waste and creating demand for healthy diets; boost “nature-positive production,” (entailing reduced emissions and protection of ecosystems), advance equitable livelihoods; and build resilience to vulnerabilities and shocks. Despite its controversies, Lucy Westerman, Policy and Campaigns Manager for the NCD Alliance, says that the summit “has succeeded in getting more people talking about food systems and the complexity of them”. “We would really like to see this summit shift from promises and pledges to actual action and investment. It would be truly game-changing for those whose priorities lie in the health of people and planet to invest in what we know works at scale, without the interference of those with harmful interests,” adds Westerman. She also appealed for the summit to be “one part of a much bigger conversation” and that includes the UN Climate Change Conference of the Parties (COP26) starting on 31 October and Nutrition For Growth to address malnutrition in December. Meanwhile, Monteiro and colleagues want the summit to “urge member states to implement multiple policy interventions to reduce ultra-processed food production, distribution and consumption, while simultaneously making fresh or minimally processed foods more available, accessible and affordable”. Whatever the outcome of the summit, it is evident that the world needs much more innovation to stop ultra-processed food and the twin epidemics of obesity and diabetes that it is fueling. Image Credits: Unsplash, Kerry Cullinan, Vital Strategies, Michael Casmir/Pierce Mill Media. Long Working Hours Kill More Workers Than Injuries 18/09/2021 Kerry Cullinan The biggest killers of working people are strokes and heart disease associated with long working hours – over 55 hours a week. This is according to a joint report from the World Health Organization (WHO) and International Labour Organization (ILO), the first global comparative risk assessment of the work-related burden of disease, which was released on Friday. Diseases associated with long working hours accounted for almost 40% of global deaths in 2016, some 750,000 deaths. People from South East Asia and Western Pacific, men and those over 54 were most at risk. Workplace injuries were the next biggest cause of worker deaths, accounting for 19.4% of deaths (360,000 deaths) – around half the deaths caused by long working hours. Workers most in danger of injuries were those in the construction, transport, manufacturing and agricultural sectors. Workplace exposure to air pollution (particulate matter, gases and fumes) was responsible for 450,000 deaths. Meanwhile, asbestos exposure caused 11.1% deaths, causing a variety of cancers. According to the report, 81% of deaths in 2016 were caused by non-communicable diseases (NCDs), the most common being chronic obstructive pulmonary disease (450,000 deaths); stroke (400,000 deaths) and ischaemic heart disease (350,000 deaths). “It’s shocking to see so many people literally being killed by their jobs,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Our report is a wake-up call to countries and businesses to improve and protect the health and safety of workers by honouring their commitments to provide universal coverage of occupational health and safety services.” Healthy limits This report will enable policymakers to track work-related health loss at country, regional and global levels, according to the two bodies. “These estimates provide important information on the work-related burden of disease, and this information can help to shape policies and practices to create healthier and safer workplaces,” said Guy Ryder, ILO Director-General. Each risk factor has a unique set of preventive actions, which are outlined in the monitoring report to guide governments, in consultation with employers and workers. Preventing long working hours requires agreement on healthy maximum limits on working time, for example. To reduce workplace exposure to air pollution, dust control, ventilation, and personal protective equipment is recommended. “These almost 2 million premature deaths are preventable. Action needs to be taken based on the research available to target the evolving nature of work-related health threats,” said Dr. Maria Neira, Director of the Department of Environment, Climate Change and Health at WHO. The report notes that total work-related burden of disease is likely substantially larger, as health loss from several other occupational risk factors must still be quantified in the future. Moreover, the effects of the COVID-19 pandemic will add another dimension to this burden to be captured in future estimates. 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REGEN-COV Joins COVID-19 Treatment List; WHO and MSF Call for Lower Prices and Increased Access 24/09/2021 Raisa Santos Riviera Beach Fire Rescue starts REGEN-COV Infusion treatments within the city of Riviera Beach, Florida. REGEN-COV, the antibody cocktail made famous by Donald Trump when he became ill with COVID in 2020, was added Friday to WHO’s list of recommended drug treatments in updated COVID-19 clinical management guidelines, published Friday. At the same time, WHO and Médecins Sans Frontières/Doctors Without Borders (MSF) called on the US pharma firm Regeneron, which developed the cutting-edge drug treatment, to reduce the high prices for the drug and expand now-limited production of the medicine. “WHO calls on Regeneron to lower prices and distribute it equitably across all regions, especially in LMICs,” the WHO statement said, adding that Regeneron should also “transfer the technology” so that similar versions of the treatment may be created and easily accessed in lower-income settings. “It is simply not fair that people living in low- and middle-income countries cannot access new COVID-19 treatments that can decrease the risk of death because of pharmaceutical companies’ monopolies and wishes for high returns,” said Dr Elin Hoffmann Dahl, Infectious Disease Advisor for the MSF Access Campaign, in another statement from MSF. He also noted that the pharma company had benefited from significant public funding to develop the cocktail in the first place, with the US signing a US $450 million contract with Regeneron last year. Regeneron has ignored pressures by access groups to lower prices and widen access to cocktail Regeneron has so far ignored pressures by access groups for such concessions. It has priced the antiviral cocktail at US $820 in India, US $2,000 in Germany and US $2,100 in the US. The company also has filed patent applications in at least 11 more low- and middle-income countries (LMICs) – clearly demonstrating its intent to protect markets there against less expensive, biosimilar alternatives. The drug is the first to be recommended by WHO for use in patients with non-severe COVID-19, but at high risk of more severe disease progression. It’s also being recommended for people with severe infection, but lacking sufficient antibodies of their own. The antibody cocktail includes two monoclonal antibodies (mAbs), casirivimad/imdevimab, shown to have decreased the risks of hospitalization for non-severe COVID-19 patients with high risk of developing severe disease. The drug has also been shown to decrease the risk of death for COVID-19 patients already in severe condition, with their own antibody deficiencies. It was authorized for emergency use by the US Food and Drug Administration in November, and is now part of the “handful of authorised COVID-19 treatments [that] are becoming standard of care for COVID-19 patients,” according to International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) Director General Thomas Cueni, in a media briefing early September. “Monoclonal antibody treatments are beginning to offer promise as are novel antivirals,” said Cueni. MSF: ‘Price Should Reflect Cost of Production’ REGEN-COV is part of a drug class of monoclonal antibodies, or mAbs. The US has recently purchased an additional 1.4 million doses of REGEN-COV, to be provided at no cost to patients. Large scale production of monoclonal antibodies (the drug class casirivimab and imdevimab belong to) is estimated to be below $100/per gram, says the MSF statement. One dose of REGEN-COV is 1,200 mg, purchased from the US government at US $2,100 per dose. This price is 17 times the value of large-scale production of mAbs. Accordingly, Regeneron should “drop the price to reflect the cost of production”, MSF said. “Regeneron should instead set an example for all manufacturers of monoclonal antibodies by putting people’s lives before profits, immediately lower the price, stop pursuing monopolies and share the know-how and technology to produce casirivimab and imdevimab with manufacturers in low- and middle-income countries.” Scarcity of COVID-19 treatment ‘Unacceptable’ Monoclonal antibodies have long been used to treat other diseases, including cancers. There have been long standing problems with high prices and supply shortages for older mAbs used in other treatments as well, said former MSF Emergency Field Coordinator Joan Tubau, who described the situation as “unacceptable.” In light of that history, MSF’s concerns about REGEN-COV are particularly acute, he emphasized. “Access to new COVID-19 treatments must be ensured, especially in places where vaccine coverage is low and recurrent waves are inevitable, to prevent even more inequity in this deadly pandemic,” said Tubau. That’s particularly true in light of the history of high-income countries monopolizing COVID-19 vaccines, he said. “And yet, we’re seeing the same governments that bought up and stockpiled COVID-19 vaccines make similar advance purchases of COVID-19 treatments, leaving little supply for the rest of the world unless Regeneron allows other companies to help boost the global supply.” Additionally, REGEN-COV could play a particularly lifesaving role in countries with low vaccination rates. And yet, paradoxically, those same countries may be the last to be able to access the lifesaving antibody cocktails, she warned, thanks to the market dynamics of pharma sales. “In many countries where MSF works in Latin America and Africa, scarce access to hospital beds, insufficient numbers of health care workers to deal with the surge of patients, and lack of medical oxygen makes prevention of hospitalisation vital – an antiviral cocktail like casirivimab/imdevimab could be essential.” Image Credits: Riviera Beach Fire Rescue/Twitter, NHS Research Scotland/Twitter. New Zealand Appeals for Abolition of ‘Harmful’ Agricultural Subsidies at UN Food Summit 23/09/2021 Kerry Cullinan New Zealand’s Prime Minister Jacinda Ardern appealed for global cooperation to remove “environmentally harmful government agricultural subsidies”, particularly for fisheries, at the United Nations Food Systems Summit, which began on Thursday in New York. These subsidies led to “inefficient production, distorted trade environmental harm, and weakened food security”, Adern said. “We encourage constructive global cooperation to progress this aim, including during this year’s World Trade Organization (WTO) Ministerial Conference,” she added. The WTO has been negotiating over fisheries subsidies since 2001, battling to get consensus on subsidies that contribute to overcapacity and overfishing. Adern added that New Zealand would also be joining the indigenous peoples’ food systems coalition, announced earlier by Myrna Cunningham, President of the Fund for the Development of the Indigenous Peoples of Latin America and the Caribbean. “This means providing the significant role of Maori in our food sectors, and encouraging the growth of Maori agribusiness by removing barriers and empowering Maori leadership,” said Adern. War against nature The summit, which involved 18 months of consultations of over 100,000 people in 148 countries, strongly emphasized the importance of ‘traditional’ food to combat hunger and climate change. Two coalitions – on school meals and healthy diets from sustainable food systems – were also announced on Thursday. “We need food systems that support the health and well-being of all people,” said UN Secretary-General Antonio Guterres. “ Malnutrition, hunger and famine are not forces of nature. They are the result of the actions or inactions of all of us.” “Every day, hundreds of millions of people go to bed hungry. Children are starving. Three billion people cannot afford a healthy diet, two billion are overweight or obese, 462 million are underweight and nearly one-third of all food that is produced is lost or wasted,” said Guterres. “We are waging a war against nature and reaping the bitter harvest: ruined crops, dwindling incomes and failing food systems. Food systems also generate one-third of all greenhouse gas emissions, and they are responsible for up to 80% of biodiversity loss,” he added. UN Secretary General Antonio Guterres Boost ‘nature-based’ solutions Professor Joachim von Braun, head of the summit’s scientific group, said that four actions had been distilled from the consultations. The first involves achieving nourishment for all people: “Science says we actually can come close to ending hunger by 2030. Our modelling shows that it may cost an additional $40 to $50 billion per year until 2030 only,” said Von Braun. “Increased and sustainable production technologies, better markets, reduction of food waste and losses, and social protection, including school feeding and nutrition programmes are the central components of that investment,” he added. “Secondly, we must boost nature-based solutions and production. The global food system emits about 30% of global greenhouse gases, but it can and must become climate neutral,” he added. The third action involved advancing equitable livelihoods and decent work, including protecting the land rights of 500 million small scale producers. “The fourth area is to build resilience to vulnerabilities. The food climate and COVID crisis must be addressed jointly because they are closely linked. A One Health approach for resilience is called for,” he added. Climate-smart investments Samantha Power Elaborating on the $10 billion US commitment to food security announced by President Joe Biden in his address to the UN General Assembly on Wednesday, Head of USAID Samantha Power said half of this would be spent in the US. “The other half will be spent fighting global food insecurity, helping smallholder farmers and their families escape poverty,” said Power, adding that the money would be channeled through Feed the Future, America’s global hunger and food security initiative. “We’re going to revise our global food security strategy to make sure that money does more good in the world, that we focus more on inclusive agricultural growth, the lives of women, girls and marginalised communities,” said Power. “That we invest tens of millions of dollars in fortifying foods with critical vitamins and minerals to fight malnutrition, and that we double down on climate-smart investments like drought-tolerant seeds and carbon storage in soils, so the world can boost crop yields while cutting emissions.” “With new investments, and a new strategy, Feed the Future aims to contribute to a 20% reduction in poverty and stunting in target countries over the next five years,” said Power. School meals coalition Meanwhile, the WHO announced that it will support the coalitions on school meals and healthy diets from sustainable food systems. “The two coalitions are founded by and comprised of member states and other partners, including UN agencies,” said the WHO. “Healthy diets and sustainably produced, safe food for all is not an out-of-reach aspiration, but an unavoidable component of global development, a human right and an achievable goal which can be realised through clear, well established and aligned actions,” said Dr Francesco Branca, WHO Director of Nutrition and Food Safety. The School Meals Coalition wants to ensure that every child has the opportunity to receive a healthy, nutritious meal in school by 2030 by improving the quality of nationally owned school meal programmes and strengthening school meal systems globally. The Healthy Diets Coalition will tackle food supply, food environments, and valuing food by motivating people to eat healthy diets through “multi-dimensional education, information, demand generation, and behavior change support”, the WHO reported on Thursday. Germany Champions Tedros for Re-election as WHO Director General – At Deadline No Other Candidates Publicly Declared 23/09/2021 Elaine Ruth Fletcher WH0 Director General Dr Tedros Adhanom Ghebreyesus WHO Director General Dr Tedros Adhanom Ghebreyesus is now set to run for re-election as Germany’s nominee, backed by other European Union states, including France. And as nominations for the post closed today at 6 p.m. Geneva time on Thursday, it was appearing increasingly likely that the incumbent DG may run unopposed – with no other candidates visibly in the running. On Thursday evening, Germany made it official in a Tweet from its UN Mission in Geneva that stated: “Today September 23rd, France and Germany , in coordination with a group of EU states, nominated Dr Tedros Adhanom Ghebreyesus @DrTedros for the election of the @WHO Director-General to be held in May 2022.” Today September 23rd, France 🇫🇷 and Germany 🇩🇪, in coordination with a group of EU states 🇪🇺, nominated Dr Tedros Adhanom Ghebreyesus @DrTedros for the election of the @WHO Director-General to be held in May 2022. pic.twitter.com/Tx4dGZnrm1 — Germany UN Geneva 🇩🇪🇪🇺🇺🇦 (@GermanyUNGeneva) September 23, 2021 According to other reports, as many as a dozen or more EU countries were joining Germany in the nomination of Tedros – although the names of the actual candidates and their country sponsors will remain secret until early November, according to WHO election rules. “Yes [Germany is sponsoring] and at least 50-60% of EU countries have followed suit,” one diplomatic observer in Geneva told Health Policy Watch. No African country sponsors so far Paradoxically, however, while Tedros made history as the first African to be elected to head WHO in 2017, no African country had come forward publicly as of Thursday’s deadline to offer to co-sponsor his re-election bid, alongside Germany’s EU partners. That, despite the fact that Tedros is regarded as highly popular on the continent – thanks partly to his outspoken positions on health equity and access to vaccines during the COVID pandemic. Asked about the director general’s race at a press conference on Thursday, John Nkengasong, head of Africa Centers for Disease Control, demurred, saying “I work for the African Union, so I think it would be better to wait and see what the African Union position is, and we as staff would go with that.” Nominated by his home country, Ethiopia, for his successful 2017 election bid, Tedros has since fallen out with the ruling government in Addis Ababa over their war with Ethiopian’s Tigray minority community – of which Tedros is also a member. That left him without an obvious ”home” country to sponsor his re-election bid. Although Tedros has never publicly confirmed his desire to stand again – it has been widely assumed that he wants to remain for a second five-year term – which is the maximum allowed. Speaking at a press conference on Wednesday, he declined again to comment on his plans. Sino-American tensions make for rough political waters President Donald Trump discussing the US withdrawal from the WHO at a press conference in July 2020. Following the outbreak of COVID, Tedros has had to steer through the increasingly rough political waters of Sino-American rivalries, exacerbated by the outspoken positions of Donald Trump – who in spring 2020 repeatedly accused Tedros of being soft on China, and in the pockets of Beijing – before announcing in July 2020 that the US would withdraw from WHO membership. That decision was reversed right after the inauguration of US President Joe Biden in January 2021, and WHO relations with the United States have since warmed considerably – with Biden’s Chief Medical Advisor, Anthony Fauci, describing Tedros warmly as a trusted colleague and “dear friend“. Since that time, Tedros also began taking a much tougher line with China, sharply contrasting with the praise he bestowed in the pandemic’s early days. Tedros’ recent, explicit calls upon upon Beijing to be more transparent in the investigation of the origins of SARS-CoV2 have been closely aligned with European and US diplomatic views – who have also criticised the lack of access to critical data and information. The unresolved mysteries of the SARS virus origins, and its woefully incomplete investigation, is one of those issues that will surely shadow any second term in office, as Tedros continues to tread the fault lines between Beijing and the west. New alliances with European partners German Health Minister Jens Spahn appears on the same stage as Tedros at a WHO briefing in July 2021 during a high-profile visit to Geneva, underlining Germany’s support for WHO under Tedros’. But all the while, Tedros has been steadily cultivating a new set of bilateral relations with strong European partners, including Switzerland, Germany and the United Kingdom. In May, for instance, Tedros announced the creation of a new WHO Biohub facility, in collaboration with the Swiss Confederation, to investigate new pathogens of concern at a high-security laboratory in Spiez. Appearing in Berlin on 1 September, Tedros launched a new WHO Hub for Pandemic and Research Intelligence in collaboration with the German government, to be headed by a noted Nigerian scientist, Dr Chikwe Ihekweazu. And earlier this week, Tedros named former UK Ambassador Gordon Brown as WHO’s “Ambassador for Global Health Financing“. The series of adroit political moves have added to his credit among high-income donor countries upon which WHO depends heavily for its budget resources. This, in an era when voluntary contributions by rich countries now far outweigh the fixed, annual assessments to WHO’s 194 member states. And achieving a more sustainable finance base is yet another thorny issue with which Tedros will have to grapple if elected to a second term at the 75th World Health Asssembly in May 2022. In the meantime , if other candidates do emerge, the intervening period will also be marked by electioneering, including “candidates forums” with member states. For the moment, however, a certain amount of suspense will remain as the names of the candidates to the WHO director general post will not be revealed for another month – only after a series of WHO regional meetings with member states are concluded, according to the re-election rules posted by WHO. Asked why there should be such secrecy around the names of the candidates even after nominations formally closed, a WHO spokesperson refused to elaborate, saying only that it is a “well established” process. However, one former senior WHO official, disagreed: “Such a delay in announcing the candidate(s) is a new development in my recollection and I don’t understand why they need to wait for the end of the regional committees if the deadline is going to expire now. I am puzzled. If I remember correctly, both for [former WHO Director General Margaret] Chan’s reelection and Tedros’s [2017] election, the names of the candidates were published shortly after the expiry of the deadline.” Updated 24 September Image Credits: WHO, C-Span. Afghan Health System in Danger of Collapse, WHO Concerned About Female Patients and Health Workers 22/09/2021 Editorial team WHO’s recent mission to Afghanistan Afghanistan’s health system is on the brink of collapse and the country faces “an imminent humanitarian catastrophe,” the World Health Organization (WHO) warned on Wednesday. Only 17% of the facilities of the country’s largest health project, Sehetmandi, are still fully functional as they have run out of funds for supplies and salaries for health staff. “This breakdown in health services is having a rippling effect on the availability of basic and essential health care, as well as on emergency response, polio eradication, and COVID-19 vaccination efforts,” the WHO said. Nine of 37 COVID-19 hospitals have already closed, and “all aspects of the COVID-19 response have dropped, including surveillance, testing, and vaccination”. It warned that 1.8 million COVID-19 vaccine doses in the country remain unused. “Swift action is needed to use these doses in the coming weeks and work towards reaching the goal of vaccinating at least 20% of the population by the end of the year based on national targets.” The WHO recently completed a high-level mission to Kabul in Afghanistan headed by Director-General Dr Tedros Adhanom Ghebreyesus where it met with Taliban leaders, UN partners, health care workers and patients. “WHO particularly emphasizes the need for women to maintain access to education, health care, and to the health workforce,” the global body stated. “With fewer health facilities operational and fewer female health workers reporting to work, female patients are hesitant to seek care. We are committed to working with partners to invest in the health education of girls and women, as well as continue training female health workers.” Polio is still endemic in Afghanistan, while measles is on the increase. Can the UN Food Summit Make a Difference to a World Overpowered by Junk Food? 21/09/2021 Kerry Cullinan Around 70% of primary school children in rural Mexican had a sugary drink for breakfast in 2012. Many children in the global south are drinking more sugary drinks than milk – thanks to the aggressive promotion of ultra-processed food to low and middle-income countries (LMICs) in the past two decades. Global obesity and diabetes rates have exploded as a result of dietary changes, and these conditions have made people far more vulnerable to severe COVID-19 illness – and not a single country has been able to reverse their obesity trends. Thursday’s United Nations Food Systems Summit (UNFSS) aims to “build a global conversation on the way in which we produce, process, and consume food, and galvanize global actions and commitments to change our food systems to provide safe, nutritious food for all within our planetary boundaries”, according to the UN. But summit preparation has been rocky. Its organisers have been accused of lacking transparency and giving big food, alcohol and tobacco companies a seat at the table, according to a letter signed by internationally renowned food policy academics and international NGOs including the Non-Communicable Diseases (NCD) Alliance. Meanwhile, a number of organisations – particularly representing small farmers and indigenous people – boycotted its pre-summit in Rome in July, citing unhappiness with the dominance of agribusiness. Boycotts and controversy “The issue of landlessness and land grabbing is not on the agenda of the UNFSS. Nowhere in its so-called Action Tracks do discussions highlight critical trends such as on land concentration and reconcentration in the hands of big agribusiness firms and their network of local landlords and compradors, nor on the massive displacement of rural communities to give way to big private investments and large development projects,” said Chennaiah Poguri, chairperson of the Asian Peasant Coalition (APC). Nonetheless, at least 85 heads of state are expected to share their commitments to addressing the global food crisis, according to a UNFSS media release on Monday. “After 18 long months, the world is on the brink of a summit that aims to change the trajectory of global progress, uniting everyone in a shared commitment to deliver the Sustainable Development Goals and the fundamental human rights at their core,” said Agnes Kalibata, the UN Secretary-General’s Special Envoy for the summit. However, the appointment of Kalibata, a former minister of agriculture in Rwanda, has also been controversial. Critics accuse the organisation she heads, the Alliance for a Green Revolution in Africa (AGRA), of opening African markets to “corporate monopolies controlling commercial seeds, genetically modified crops, fossil fuel-heavy synthetic fertilizers and polluting pesticides”, and asked the UN to revoke her appointment. Food policy activists protest against ultr-processed food in South Africa. Desperate need for food policy change Despite the controversies, the need for a change in global food policy is urgent. Around eight million people die annually due to poor diets, according to the Bloomberg Philanthropies’ Food Policy Program, which has committed over $435 million to help public health advocates to promote healthier diets through policy change. “In almost every country, traditional diets are being rapidly displaced by low-quality, nutrient-deficient diets,” says Trish Cotter, Senior Policy and Communication Advisor at Vital Strategies’ Food Policy Program. Obesity has almost tripled since the mid-1970s, with over 1.9 billion adults and more than 370 million children and adolescents now overweight or obese, according to the World Health Organization, while the prevalence of type 2 diabetes has doubled since 1980, affecting about 420 million people. “The most plausible explanation for this change? The rapid rise in consumption of ultra-processed foods and beverages – products that have been chemically or physically transformed using industrial processes,” adds Cotter, who is also part of the Bloomberg program. Leading food policy academics writing in the BMJ recently described ultra-processed foods as products arising from “industrial processes that convert food commodities such as wheat, soy, corn, oils and sugar, into chemically or physically transformed food substances, formulated with various classes of additives”. Transnational corporations “use their power to formulate, mass manufacture, distribute and aggressively market their products worldwide” and also “shape scientific findings by funding in-house and university-based research, so as to defend and promote ultra-processed foods”, according to the academics, who include Carlos Monteiro, Professor of Nutrition at Sao Paulo University, Marion Nestle, Emeritus Professor of Nutrition at New York University and the University of North Carolina’s Professor Barry Popkin. Taxes, warning labels and marketing restrictions Warning labels on food products in Chile nudge customers away from unhealthy foods – top-left: “high in calories”; top-right: “high in sugars”; bottom-left: “high in sodium”; bottom-right: “high in saturated fats” They urge the summit to encourage global dietary guidelines that favour fresh or minimally processed foods and “fiscal measures” including taxes, marketing regulations, mandatory front-of-pack warning labels on ultra-processed foods. Cotter, who has worked on international communication campaigns aimed at encouraging healthy eating, says that “ultra-processed products have crept into our lives under the guise of convenience backed up by some extremely clever and consistent marketing”. “We cannot simply place the onus on individuals to change lifestyles or make healthier choices when there often is little choice available for healthier products or consumers are swamped by alluringly marketed, ready-to-eat, convenient and tasty products advertised by Big Food,” she adds. “There’s no question that these products must be regulated and taxed to reduce consumption. But without the support of government policy, this task—of avoiding the health consequences of populations consuming ultra-processed products—is nigh impossible. The onus is on governments to act, and to act now.” Most Mexican kids had sodas for breakfast Mexico was the first country to tax sugary drinks in 2014, as it struggled to address the strain on its health system stemming from almost three-quarters of its population being overweight. Prior to the tax, Mexico had one of the highest consumption rates of sugary drinks in the world, and 70% of rural primary school children and 80% of high school students had one for breakfast every day. A year after it had implemented a 10% soda tax, sugary drinks purchases declined by 9% among the poorest third of the population. South Africa implemented a sugary drinks tax of around 10% in 2018 and has cut consumption by 28%, welcome news in a country where nine and 10- year-olds drink almost three times the global average of Coca-Colas every year. Chile has cut sugary drink purchasing by 24% through a comprehensive policy approach that includes warning labels on bottles. Recently, Brazil and Colombia have also passed legislation requiring warning labels on ultra-processed food. These warnings are important, says Cotter, because most shoppers spend less than 10 seconds choosing each food and beverage item. “Front-of-package warning labels can help consumers to quickly identify unhealthy products and encourage them to make healthy choices.” Safe, nutritious food for all UN Envoy Kalibata says that summit has five interconnected objectives. These are to ensure access to safe, nutritious food for all; shift to sustainable consumption by reducing waste and creating demand for healthy diets; boost “nature-positive production,” (entailing reduced emissions and protection of ecosystems), advance equitable livelihoods; and build resilience to vulnerabilities and shocks. Despite its controversies, Lucy Westerman, Policy and Campaigns Manager for the NCD Alliance, says that the summit “has succeeded in getting more people talking about food systems and the complexity of them”. “We would really like to see this summit shift from promises and pledges to actual action and investment. It would be truly game-changing for those whose priorities lie in the health of people and planet to invest in what we know works at scale, without the interference of those with harmful interests,” adds Westerman. She also appealed for the summit to be “one part of a much bigger conversation” and that includes the UN Climate Change Conference of the Parties (COP26) starting on 31 October and Nutrition For Growth to address malnutrition in December. Meanwhile, Monteiro and colleagues want the summit to “urge member states to implement multiple policy interventions to reduce ultra-processed food production, distribution and consumption, while simultaneously making fresh or minimally processed foods more available, accessible and affordable”. Whatever the outcome of the summit, it is evident that the world needs much more innovation to stop ultra-processed food and the twin epidemics of obesity and diabetes that it is fueling. Image Credits: Unsplash, Kerry Cullinan, Vital Strategies, Michael Casmir/Pierce Mill Media. Long Working Hours Kill More Workers Than Injuries 18/09/2021 Kerry Cullinan The biggest killers of working people are strokes and heart disease associated with long working hours – over 55 hours a week. This is according to a joint report from the World Health Organization (WHO) and International Labour Organization (ILO), the first global comparative risk assessment of the work-related burden of disease, which was released on Friday. Diseases associated with long working hours accounted for almost 40% of global deaths in 2016, some 750,000 deaths. People from South East Asia and Western Pacific, men and those over 54 were most at risk. Workplace injuries were the next biggest cause of worker deaths, accounting for 19.4% of deaths (360,000 deaths) – around half the deaths caused by long working hours. Workers most in danger of injuries were those in the construction, transport, manufacturing and agricultural sectors. Workplace exposure to air pollution (particulate matter, gases and fumes) was responsible for 450,000 deaths. Meanwhile, asbestos exposure caused 11.1% deaths, causing a variety of cancers. According to the report, 81% of deaths in 2016 were caused by non-communicable diseases (NCDs), the most common being chronic obstructive pulmonary disease (450,000 deaths); stroke (400,000 deaths) and ischaemic heart disease (350,000 deaths). “It’s shocking to see so many people literally being killed by their jobs,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Our report is a wake-up call to countries and businesses to improve and protect the health and safety of workers by honouring their commitments to provide universal coverage of occupational health and safety services.” Healthy limits This report will enable policymakers to track work-related health loss at country, regional and global levels, according to the two bodies. “These estimates provide important information on the work-related burden of disease, and this information can help to shape policies and practices to create healthier and safer workplaces,” said Guy Ryder, ILO Director-General. Each risk factor has a unique set of preventive actions, which are outlined in the monitoring report to guide governments, in consultation with employers and workers. Preventing long working hours requires agreement on healthy maximum limits on working time, for example. To reduce workplace exposure to air pollution, dust control, ventilation, and personal protective equipment is recommended. “These almost 2 million premature deaths are preventable. Action needs to be taken based on the research available to target the evolving nature of work-related health threats,” said Dr. Maria Neira, Director of the Department of Environment, Climate Change and Health at WHO. The report notes that total work-related burden of disease is likely substantially larger, as health loss from several other occupational risk factors must still be quantified in the future. Moreover, the effects of the COVID-19 pandemic will add another dimension to this burden to be captured in future estimates. 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New Zealand Appeals for Abolition of ‘Harmful’ Agricultural Subsidies at UN Food Summit 23/09/2021 Kerry Cullinan New Zealand’s Prime Minister Jacinda Ardern appealed for global cooperation to remove “environmentally harmful government agricultural subsidies”, particularly for fisheries, at the United Nations Food Systems Summit, which began on Thursday in New York. These subsidies led to “inefficient production, distorted trade environmental harm, and weakened food security”, Adern said. “We encourage constructive global cooperation to progress this aim, including during this year’s World Trade Organization (WTO) Ministerial Conference,” she added. The WTO has been negotiating over fisheries subsidies since 2001, battling to get consensus on subsidies that contribute to overcapacity and overfishing. Adern added that New Zealand would also be joining the indigenous peoples’ food systems coalition, announced earlier by Myrna Cunningham, President of the Fund for the Development of the Indigenous Peoples of Latin America and the Caribbean. “This means providing the significant role of Maori in our food sectors, and encouraging the growth of Maori agribusiness by removing barriers and empowering Maori leadership,” said Adern. War against nature The summit, which involved 18 months of consultations of over 100,000 people in 148 countries, strongly emphasized the importance of ‘traditional’ food to combat hunger and climate change. Two coalitions – on school meals and healthy diets from sustainable food systems – were also announced on Thursday. “We need food systems that support the health and well-being of all people,” said UN Secretary-General Antonio Guterres. “ Malnutrition, hunger and famine are not forces of nature. They are the result of the actions or inactions of all of us.” “Every day, hundreds of millions of people go to bed hungry. Children are starving. Three billion people cannot afford a healthy diet, two billion are overweight or obese, 462 million are underweight and nearly one-third of all food that is produced is lost or wasted,” said Guterres. “We are waging a war against nature and reaping the bitter harvest: ruined crops, dwindling incomes and failing food systems. Food systems also generate one-third of all greenhouse gas emissions, and they are responsible for up to 80% of biodiversity loss,” he added. UN Secretary General Antonio Guterres Boost ‘nature-based’ solutions Professor Joachim von Braun, head of the summit’s scientific group, said that four actions had been distilled from the consultations. The first involves achieving nourishment for all people: “Science says we actually can come close to ending hunger by 2030. Our modelling shows that it may cost an additional $40 to $50 billion per year until 2030 only,” said Von Braun. “Increased and sustainable production technologies, better markets, reduction of food waste and losses, and social protection, including school feeding and nutrition programmes are the central components of that investment,” he added. “Secondly, we must boost nature-based solutions and production. The global food system emits about 30% of global greenhouse gases, but it can and must become climate neutral,” he added. The third action involved advancing equitable livelihoods and decent work, including protecting the land rights of 500 million small scale producers. “The fourth area is to build resilience to vulnerabilities. The food climate and COVID crisis must be addressed jointly because they are closely linked. A One Health approach for resilience is called for,” he added. Climate-smart investments Samantha Power Elaborating on the $10 billion US commitment to food security announced by President Joe Biden in his address to the UN General Assembly on Wednesday, Head of USAID Samantha Power said half of this would be spent in the US. “The other half will be spent fighting global food insecurity, helping smallholder farmers and their families escape poverty,” said Power, adding that the money would be channeled through Feed the Future, America’s global hunger and food security initiative. “We’re going to revise our global food security strategy to make sure that money does more good in the world, that we focus more on inclusive agricultural growth, the lives of women, girls and marginalised communities,” said Power. “That we invest tens of millions of dollars in fortifying foods with critical vitamins and minerals to fight malnutrition, and that we double down on climate-smart investments like drought-tolerant seeds and carbon storage in soils, so the world can boost crop yields while cutting emissions.” “With new investments, and a new strategy, Feed the Future aims to contribute to a 20% reduction in poverty and stunting in target countries over the next five years,” said Power. School meals coalition Meanwhile, the WHO announced that it will support the coalitions on school meals and healthy diets from sustainable food systems. “The two coalitions are founded by and comprised of member states and other partners, including UN agencies,” said the WHO. “Healthy diets and sustainably produced, safe food for all is not an out-of-reach aspiration, but an unavoidable component of global development, a human right and an achievable goal which can be realised through clear, well established and aligned actions,” said Dr Francesco Branca, WHO Director of Nutrition and Food Safety. The School Meals Coalition wants to ensure that every child has the opportunity to receive a healthy, nutritious meal in school by 2030 by improving the quality of nationally owned school meal programmes and strengthening school meal systems globally. The Healthy Diets Coalition will tackle food supply, food environments, and valuing food by motivating people to eat healthy diets through “multi-dimensional education, information, demand generation, and behavior change support”, the WHO reported on Thursday. Germany Champions Tedros for Re-election as WHO Director General – At Deadline No Other Candidates Publicly Declared 23/09/2021 Elaine Ruth Fletcher WH0 Director General Dr Tedros Adhanom Ghebreyesus WHO Director General Dr Tedros Adhanom Ghebreyesus is now set to run for re-election as Germany’s nominee, backed by other European Union states, including France. And as nominations for the post closed today at 6 p.m. Geneva time on Thursday, it was appearing increasingly likely that the incumbent DG may run unopposed – with no other candidates visibly in the running. On Thursday evening, Germany made it official in a Tweet from its UN Mission in Geneva that stated: “Today September 23rd, France and Germany , in coordination with a group of EU states, nominated Dr Tedros Adhanom Ghebreyesus @DrTedros for the election of the @WHO Director-General to be held in May 2022.” Today September 23rd, France 🇫🇷 and Germany 🇩🇪, in coordination with a group of EU states 🇪🇺, nominated Dr Tedros Adhanom Ghebreyesus @DrTedros for the election of the @WHO Director-General to be held in May 2022. pic.twitter.com/Tx4dGZnrm1 — Germany UN Geneva 🇩🇪🇪🇺🇺🇦 (@GermanyUNGeneva) September 23, 2021 According to other reports, as many as a dozen or more EU countries were joining Germany in the nomination of Tedros – although the names of the actual candidates and their country sponsors will remain secret until early November, according to WHO election rules. “Yes [Germany is sponsoring] and at least 50-60% of EU countries have followed suit,” one diplomatic observer in Geneva told Health Policy Watch. No African country sponsors so far Paradoxically, however, while Tedros made history as the first African to be elected to head WHO in 2017, no African country had come forward publicly as of Thursday’s deadline to offer to co-sponsor his re-election bid, alongside Germany’s EU partners. That, despite the fact that Tedros is regarded as highly popular on the continent – thanks partly to his outspoken positions on health equity and access to vaccines during the COVID pandemic. Asked about the director general’s race at a press conference on Thursday, John Nkengasong, head of Africa Centers for Disease Control, demurred, saying “I work for the African Union, so I think it would be better to wait and see what the African Union position is, and we as staff would go with that.” Nominated by his home country, Ethiopia, for his successful 2017 election bid, Tedros has since fallen out with the ruling government in Addis Ababa over their war with Ethiopian’s Tigray minority community – of which Tedros is also a member. That left him without an obvious ”home” country to sponsor his re-election bid. Although Tedros has never publicly confirmed his desire to stand again – it has been widely assumed that he wants to remain for a second five-year term – which is the maximum allowed. Speaking at a press conference on Wednesday, he declined again to comment on his plans. Sino-American tensions make for rough political waters President Donald Trump discussing the US withdrawal from the WHO at a press conference in July 2020. Following the outbreak of COVID, Tedros has had to steer through the increasingly rough political waters of Sino-American rivalries, exacerbated by the outspoken positions of Donald Trump – who in spring 2020 repeatedly accused Tedros of being soft on China, and in the pockets of Beijing – before announcing in July 2020 that the US would withdraw from WHO membership. That decision was reversed right after the inauguration of US President Joe Biden in January 2021, and WHO relations with the United States have since warmed considerably – with Biden’s Chief Medical Advisor, Anthony Fauci, describing Tedros warmly as a trusted colleague and “dear friend“. Since that time, Tedros also began taking a much tougher line with China, sharply contrasting with the praise he bestowed in the pandemic’s early days. Tedros’ recent, explicit calls upon upon Beijing to be more transparent in the investigation of the origins of SARS-CoV2 have been closely aligned with European and US diplomatic views – who have also criticised the lack of access to critical data and information. The unresolved mysteries of the SARS virus origins, and its woefully incomplete investigation, is one of those issues that will surely shadow any second term in office, as Tedros continues to tread the fault lines between Beijing and the west. New alliances with European partners German Health Minister Jens Spahn appears on the same stage as Tedros at a WHO briefing in July 2021 during a high-profile visit to Geneva, underlining Germany’s support for WHO under Tedros’. But all the while, Tedros has been steadily cultivating a new set of bilateral relations with strong European partners, including Switzerland, Germany and the United Kingdom. In May, for instance, Tedros announced the creation of a new WHO Biohub facility, in collaboration with the Swiss Confederation, to investigate new pathogens of concern at a high-security laboratory in Spiez. Appearing in Berlin on 1 September, Tedros launched a new WHO Hub for Pandemic and Research Intelligence in collaboration with the German government, to be headed by a noted Nigerian scientist, Dr Chikwe Ihekweazu. And earlier this week, Tedros named former UK Ambassador Gordon Brown as WHO’s “Ambassador for Global Health Financing“. The series of adroit political moves have added to his credit among high-income donor countries upon which WHO depends heavily for its budget resources. This, in an era when voluntary contributions by rich countries now far outweigh the fixed, annual assessments to WHO’s 194 member states. And achieving a more sustainable finance base is yet another thorny issue with which Tedros will have to grapple if elected to a second term at the 75th World Health Asssembly in May 2022. In the meantime , if other candidates do emerge, the intervening period will also be marked by electioneering, including “candidates forums” with member states. For the moment, however, a certain amount of suspense will remain as the names of the candidates to the WHO director general post will not be revealed for another month – only after a series of WHO regional meetings with member states are concluded, according to the re-election rules posted by WHO. Asked why there should be such secrecy around the names of the candidates even after nominations formally closed, a WHO spokesperson refused to elaborate, saying only that it is a “well established” process. However, one former senior WHO official, disagreed: “Such a delay in announcing the candidate(s) is a new development in my recollection and I don’t understand why they need to wait for the end of the regional committees if the deadline is going to expire now. I am puzzled. If I remember correctly, both for [former WHO Director General Margaret] Chan’s reelection and Tedros’s [2017] election, the names of the candidates were published shortly after the expiry of the deadline.” Updated 24 September Image Credits: WHO, C-Span. Afghan Health System in Danger of Collapse, WHO Concerned About Female Patients and Health Workers 22/09/2021 Editorial team WHO’s recent mission to Afghanistan Afghanistan’s health system is on the brink of collapse and the country faces “an imminent humanitarian catastrophe,” the World Health Organization (WHO) warned on Wednesday. Only 17% of the facilities of the country’s largest health project, Sehetmandi, are still fully functional as they have run out of funds for supplies and salaries for health staff. “This breakdown in health services is having a rippling effect on the availability of basic and essential health care, as well as on emergency response, polio eradication, and COVID-19 vaccination efforts,” the WHO said. Nine of 37 COVID-19 hospitals have already closed, and “all aspects of the COVID-19 response have dropped, including surveillance, testing, and vaccination”. It warned that 1.8 million COVID-19 vaccine doses in the country remain unused. “Swift action is needed to use these doses in the coming weeks and work towards reaching the goal of vaccinating at least 20% of the population by the end of the year based on national targets.” The WHO recently completed a high-level mission to Kabul in Afghanistan headed by Director-General Dr Tedros Adhanom Ghebreyesus where it met with Taliban leaders, UN partners, health care workers and patients. “WHO particularly emphasizes the need for women to maintain access to education, health care, and to the health workforce,” the global body stated. “With fewer health facilities operational and fewer female health workers reporting to work, female patients are hesitant to seek care. We are committed to working with partners to invest in the health education of girls and women, as well as continue training female health workers.” Polio is still endemic in Afghanistan, while measles is on the increase. Can the UN Food Summit Make a Difference to a World Overpowered by Junk Food? 21/09/2021 Kerry Cullinan Around 70% of primary school children in rural Mexican had a sugary drink for breakfast in 2012. Many children in the global south are drinking more sugary drinks than milk – thanks to the aggressive promotion of ultra-processed food to low and middle-income countries (LMICs) in the past two decades. Global obesity and diabetes rates have exploded as a result of dietary changes, and these conditions have made people far more vulnerable to severe COVID-19 illness – and not a single country has been able to reverse their obesity trends. Thursday’s United Nations Food Systems Summit (UNFSS) aims to “build a global conversation on the way in which we produce, process, and consume food, and galvanize global actions and commitments to change our food systems to provide safe, nutritious food for all within our planetary boundaries”, according to the UN. But summit preparation has been rocky. Its organisers have been accused of lacking transparency and giving big food, alcohol and tobacco companies a seat at the table, according to a letter signed by internationally renowned food policy academics and international NGOs including the Non-Communicable Diseases (NCD) Alliance. Meanwhile, a number of organisations – particularly representing small farmers and indigenous people – boycotted its pre-summit in Rome in July, citing unhappiness with the dominance of agribusiness. Boycotts and controversy “The issue of landlessness and land grabbing is not on the agenda of the UNFSS. Nowhere in its so-called Action Tracks do discussions highlight critical trends such as on land concentration and reconcentration in the hands of big agribusiness firms and their network of local landlords and compradors, nor on the massive displacement of rural communities to give way to big private investments and large development projects,” said Chennaiah Poguri, chairperson of the Asian Peasant Coalition (APC). Nonetheless, at least 85 heads of state are expected to share their commitments to addressing the global food crisis, according to a UNFSS media release on Monday. “After 18 long months, the world is on the brink of a summit that aims to change the trajectory of global progress, uniting everyone in a shared commitment to deliver the Sustainable Development Goals and the fundamental human rights at their core,” said Agnes Kalibata, the UN Secretary-General’s Special Envoy for the summit. However, the appointment of Kalibata, a former minister of agriculture in Rwanda, has also been controversial. Critics accuse the organisation she heads, the Alliance for a Green Revolution in Africa (AGRA), of opening African markets to “corporate monopolies controlling commercial seeds, genetically modified crops, fossil fuel-heavy synthetic fertilizers and polluting pesticides”, and asked the UN to revoke her appointment. Food policy activists protest against ultr-processed food in South Africa. Desperate need for food policy change Despite the controversies, the need for a change in global food policy is urgent. Around eight million people die annually due to poor diets, according to the Bloomberg Philanthropies’ Food Policy Program, which has committed over $435 million to help public health advocates to promote healthier diets through policy change. “In almost every country, traditional diets are being rapidly displaced by low-quality, nutrient-deficient diets,” says Trish Cotter, Senior Policy and Communication Advisor at Vital Strategies’ Food Policy Program. Obesity has almost tripled since the mid-1970s, with over 1.9 billion adults and more than 370 million children and adolescents now overweight or obese, according to the World Health Organization, while the prevalence of type 2 diabetes has doubled since 1980, affecting about 420 million people. “The most plausible explanation for this change? The rapid rise in consumption of ultra-processed foods and beverages – products that have been chemically or physically transformed using industrial processes,” adds Cotter, who is also part of the Bloomberg program. Leading food policy academics writing in the BMJ recently described ultra-processed foods as products arising from “industrial processes that convert food commodities such as wheat, soy, corn, oils and sugar, into chemically or physically transformed food substances, formulated with various classes of additives”. Transnational corporations “use their power to formulate, mass manufacture, distribute and aggressively market their products worldwide” and also “shape scientific findings by funding in-house and university-based research, so as to defend and promote ultra-processed foods”, according to the academics, who include Carlos Monteiro, Professor of Nutrition at Sao Paulo University, Marion Nestle, Emeritus Professor of Nutrition at New York University and the University of North Carolina’s Professor Barry Popkin. Taxes, warning labels and marketing restrictions Warning labels on food products in Chile nudge customers away from unhealthy foods – top-left: “high in calories”; top-right: “high in sugars”; bottom-left: “high in sodium”; bottom-right: “high in saturated fats” They urge the summit to encourage global dietary guidelines that favour fresh or minimally processed foods and “fiscal measures” including taxes, marketing regulations, mandatory front-of-pack warning labels on ultra-processed foods. Cotter, who has worked on international communication campaigns aimed at encouraging healthy eating, says that “ultra-processed products have crept into our lives under the guise of convenience backed up by some extremely clever and consistent marketing”. “We cannot simply place the onus on individuals to change lifestyles or make healthier choices when there often is little choice available for healthier products or consumers are swamped by alluringly marketed, ready-to-eat, convenient and tasty products advertised by Big Food,” she adds. “There’s no question that these products must be regulated and taxed to reduce consumption. But without the support of government policy, this task—of avoiding the health consequences of populations consuming ultra-processed products—is nigh impossible. The onus is on governments to act, and to act now.” Most Mexican kids had sodas for breakfast Mexico was the first country to tax sugary drinks in 2014, as it struggled to address the strain on its health system stemming from almost three-quarters of its population being overweight. Prior to the tax, Mexico had one of the highest consumption rates of sugary drinks in the world, and 70% of rural primary school children and 80% of high school students had one for breakfast every day. A year after it had implemented a 10% soda tax, sugary drinks purchases declined by 9% among the poorest third of the population. South Africa implemented a sugary drinks tax of around 10% in 2018 and has cut consumption by 28%, welcome news in a country where nine and 10- year-olds drink almost three times the global average of Coca-Colas every year. Chile has cut sugary drink purchasing by 24% through a comprehensive policy approach that includes warning labels on bottles. Recently, Brazil and Colombia have also passed legislation requiring warning labels on ultra-processed food. These warnings are important, says Cotter, because most shoppers spend less than 10 seconds choosing each food and beverage item. “Front-of-package warning labels can help consumers to quickly identify unhealthy products and encourage them to make healthy choices.” Safe, nutritious food for all UN Envoy Kalibata says that summit has five interconnected objectives. These are to ensure access to safe, nutritious food for all; shift to sustainable consumption by reducing waste and creating demand for healthy diets; boost “nature-positive production,” (entailing reduced emissions and protection of ecosystems), advance equitable livelihoods; and build resilience to vulnerabilities and shocks. Despite its controversies, Lucy Westerman, Policy and Campaigns Manager for the NCD Alliance, says that the summit “has succeeded in getting more people talking about food systems and the complexity of them”. “We would really like to see this summit shift from promises and pledges to actual action and investment. It would be truly game-changing for those whose priorities lie in the health of people and planet to invest in what we know works at scale, without the interference of those with harmful interests,” adds Westerman. She also appealed for the summit to be “one part of a much bigger conversation” and that includes the UN Climate Change Conference of the Parties (COP26) starting on 31 October and Nutrition For Growth to address malnutrition in December. Meanwhile, Monteiro and colleagues want the summit to “urge member states to implement multiple policy interventions to reduce ultra-processed food production, distribution and consumption, while simultaneously making fresh or minimally processed foods more available, accessible and affordable”. Whatever the outcome of the summit, it is evident that the world needs much more innovation to stop ultra-processed food and the twin epidemics of obesity and diabetes that it is fueling. Image Credits: Unsplash, Kerry Cullinan, Vital Strategies, Michael Casmir/Pierce Mill Media. Long Working Hours Kill More Workers Than Injuries 18/09/2021 Kerry Cullinan The biggest killers of working people are strokes and heart disease associated with long working hours – over 55 hours a week. This is according to a joint report from the World Health Organization (WHO) and International Labour Organization (ILO), the first global comparative risk assessment of the work-related burden of disease, which was released on Friday. Diseases associated with long working hours accounted for almost 40% of global deaths in 2016, some 750,000 deaths. People from South East Asia and Western Pacific, men and those over 54 were most at risk. Workplace injuries were the next biggest cause of worker deaths, accounting for 19.4% of deaths (360,000 deaths) – around half the deaths caused by long working hours. Workers most in danger of injuries were those in the construction, transport, manufacturing and agricultural sectors. Workplace exposure to air pollution (particulate matter, gases and fumes) was responsible for 450,000 deaths. Meanwhile, asbestos exposure caused 11.1% deaths, causing a variety of cancers. According to the report, 81% of deaths in 2016 were caused by non-communicable diseases (NCDs), the most common being chronic obstructive pulmonary disease (450,000 deaths); stroke (400,000 deaths) and ischaemic heart disease (350,000 deaths). “It’s shocking to see so many people literally being killed by their jobs,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Our report is a wake-up call to countries and businesses to improve and protect the health and safety of workers by honouring their commitments to provide universal coverage of occupational health and safety services.” Healthy limits This report will enable policymakers to track work-related health loss at country, regional and global levels, according to the two bodies. “These estimates provide important information on the work-related burden of disease, and this information can help to shape policies and practices to create healthier and safer workplaces,” said Guy Ryder, ILO Director-General. Each risk factor has a unique set of preventive actions, which are outlined in the monitoring report to guide governments, in consultation with employers and workers. Preventing long working hours requires agreement on healthy maximum limits on working time, for example. To reduce workplace exposure to air pollution, dust control, ventilation, and personal protective equipment is recommended. “These almost 2 million premature deaths are preventable. Action needs to be taken based on the research available to target the evolving nature of work-related health threats,” said Dr. Maria Neira, Director of the Department of Environment, Climate Change and Health at WHO. The report notes that total work-related burden of disease is likely substantially larger, as health loss from several other occupational risk factors must still be quantified in the future. Moreover, the effects of the COVID-19 pandemic will add another dimension to this burden to be captured in future estimates. 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Germany Champions Tedros for Re-election as WHO Director General – At Deadline No Other Candidates Publicly Declared 23/09/2021 Elaine Ruth Fletcher WH0 Director General Dr Tedros Adhanom Ghebreyesus WHO Director General Dr Tedros Adhanom Ghebreyesus is now set to run for re-election as Germany’s nominee, backed by other European Union states, including France. And as nominations for the post closed today at 6 p.m. Geneva time on Thursday, it was appearing increasingly likely that the incumbent DG may run unopposed – with no other candidates visibly in the running. On Thursday evening, Germany made it official in a Tweet from its UN Mission in Geneva that stated: “Today September 23rd, France and Germany , in coordination with a group of EU states, nominated Dr Tedros Adhanom Ghebreyesus @DrTedros for the election of the @WHO Director-General to be held in May 2022.” Today September 23rd, France 🇫🇷 and Germany 🇩🇪, in coordination with a group of EU states 🇪🇺, nominated Dr Tedros Adhanom Ghebreyesus @DrTedros for the election of the @WHO Director-General to be held in May 2022. pic.twitter.com/Tx4dGZnrm1 — Germany UN Geneva 🇩🇪🇪🇺🇺🇦 (@GermanyUNGeneva) September 23, 2021 According to other reports, as many as a dozen or more EU countries were joining Germany in the nomination of Tedros – although the names of the actual candidates and their country sponsors will remain secret until early November, according to WHO election rules. “Yes [Germany is sponsoring] and at least 50-60% of EU countries have followed suit,” one diplomatic observer in Geneva told Health Policy Watch. No African country sponsors so far Paradoxically, however, while Tedros made history as the first African to be elected to head WHO in 2017, no African country had come forward publicly as of Thursday’s deadline to offer to co-sponsor his re-election bid, alongside Germany’s EU partners. That, despite the fact that Tedros is regarded as highly popular on the continent – thanks partly to his outspoken positions on health equity and access to vaccines during the COVID pandemic. Asked about the director general’s race at a press conference on Thursday, John Nkengasong, head of Africa Centers for Disease Control, demurred, saying “I work for the African Union, so I think it would be better to wait and see what the African Union position is, and we as staff would go with that.” Nominated by his home country, Ethiopia, for his successful 2017 election bid, Tedros has since fallen out with the ruling government in Addis Ababa over their war with Ethiopian’s Tigray minority community – of which Tedros is also a member. That left him without an obvious ”home” country to sponsor his re-election bid. Although Tedros has never publicly confirmed his desire to stand again – it has been widely assumed that he wants to remain for a second five-year term – which is the maximum allowed. Speaking at a press conference on Wednesday, he declined again to comment on his plans. Sino-American tensions make for rough political waters President Donald Trump discussing the US withdrawal from the WHO at a press conference in July 2020. Following the outbreak of COVID, Tedros has had to steer through the increasingly rough political waters of Sino-American rivalries, exacerbated by the outspoken positions of Donald Trump – who in spring 2020 repeatedly accused Tedros of being soft on China, and in the pockets of Beijing – before announcing in July 2020 that the US would withdraw from WHO membership. That decision was reversed right after the inauguration of US President Joe Biden in January 2021, and WHO relations with the United States have since warmed considerably – with Biden’s Chief Medical Advisor, Anthony Fauci, describing Tedros warmly as a trusted colleague and “dear friend“. Since that time, Tedros also began taking a much tougher line with China, sharply contrasting with the praise he bestowed in the pandemic’s early days. Tedros’ recent, explicit calls upon upon Beijing to be more transparent in the investigation of the origins of SARS-CoV2 have been closely aligned with European and US diplomatic views – who have also criticised the lack of access to critical data and information. The unresolved mysteries of the SARS virus origins, and its woefully incomplete investigation, is one of those issues that will surely shadow any second term in office, as Tedros continues to tread the fault lines between Beijing and the west. New alliances with European partners German Health Minister Jens Spahn appears on the same stage as Tedros at a WHO briefing in July 2021 during a high-profile visit to Geneva, underlining Germany’s support for WHO under Tedros’. But all the while, Tedros has been steadily cultivating a new set of bilateral relations with strong European partners, including Switzerland, Germany and the United Kingdom. In May, for instance, Tedros announced the creation of a new WHO Biohub facility, in collaboration with the Swiss Confederation, to investigate new pathogens of concern at a high-security laboratory in Spiez. Appearing in Berlin on 1 September, Tedros launched a new WHO Hub for Pandemic and Research Intelligence in collaboration with the German government, to be headed by a noted Nigerian scientist, Dr Chikwe Ihekweazu. And earlier this week, Tedros named former UK Ambassador Gordon Brown as WHO’s “Ambassador for Global Health Financing“. The series of adroit political moves have added to his credit among high-income donor countries upon which WHO depends heavily for its budget resources. This, in an era when voluntary contributions by rich countries now far outweigh the fixed, annual assessments to WHO’s 194 member states. And achieving a more sustainable finance base is yet another thorny issue with which Tedros will have to grapple if elected to a second term at the 75th World Health Asssembly in May 2022. In the meantime , if other candidates do emerge, the intervening period will also be marked by electioneering, including “candidates forums” with member states. For the moment, however, a certain amount of suspense will remain as the names of the candidates to the WHO director general post will not be revealed for another month – only after a series of WHO regional meetings with member states are concluded, according to the re-election rules posted by WHO. Asked why there should be such secrecy around the names of the candidates even after nominations formally closed, a WHO spokesperson refused to elaborate, saying only that it is a “well established” process. However, one former senior WHO official, disagreed: “Such a delay in announcing the candidate(s) is a new development in my recollection and I don’t understand why they need to wait for the end of the regional committees if the deadline is going to expire now. I am puzzled. If I remember correctly, both for [former WHO Director General Margaret] Chan’s reelection and Tedros’s [2017] election, the names of the candidates were published shortly after the expiry of the deadline.” Updated 24 September Image Credits: WHO, C-Span. Afghan Health System in Danger of Collapse, WHO Concerned About Female Patients and Health Workers 22/09/2021 Editorial team WHO’s recent mission to Afghanistan Afghanistan’s health system is on the brink of collapse and the country faces “an imminent humanitarian catastrophe,” the World Health Organization (WHO) warned on Wednesday. Only 17% of the facilities of the country’s largest health project, Sehetmandi, are still fully functional as they have run out of funds for supplies and salaries for health staff. “This breakdown in health services is having a rippling effect on the availability of basic and essential health care, as well as on emergency response, polio eradication, and COVID-19 vaccination efforts,” the WHO said. Nine of 37 COVID-19 hospitals have already closed, and “all aspects of the COVID-19 response have dropped, including surveillance, testing, and vaccination”. It warned that 1.8 million COVID-19 vaccine doses in the country remain unused. “Swift action is needed to use these doses in the coming weeks and work towards reaching the goal of vaccinating at least 20% of the population by the end of the year based on national targets.” The WHO recently completed a high-level mission to Kabul in Afghanistan headed by Director-General Dr Tedros Adhanom Ghebreyesus where it met with Taliban leaders, UN partners, health care workers and patients. “WHO particularly emphasizes the need for women to maintain access to education, health care, and to the health workforce,” the global body stated. “With fewer health facilities operational and fewer female health workers reporting to work, female patients are hesitant to seek care. We are committed to working with partners to invest in the health education of girls and women, as well as continue training female health workers.” Polio is still endemic in Afghanistan, while measles is on the increase. Can the UN Food Summit Make a Difference to a World Overpowered by Junk Food? 21/09/2021 Kerry Cullinan Around 70% of primary school children in rural Mexican had a sugary drink for breakfast in 2012. Many children in the global south are drinking more sugary drinks than milk – thanks to the aggressive promotion of ultra-processed food to low and middle-income countries (LMICs) in the past two decades. Global obesity and diabetes rates have exploded as a result of dietary changes, and these conditions have made people far more vulnerable to severe COVID-19 illness – and not a single country has been able to reverse their obesity trends. Thursday’s United Nations Food Systems Summit (UNFSS) aims to “build a global conversation on the way in which we produce, process, and consume food, and galvanize global actions and commitments to change our food systems to provide safe, nutritious food for all within our planetary boundaries”, according to the UN. But summit preparation has been rocky. Its organisers have been accused of lacking transparency and giving big food, alcohol and tobacco companies a seat at the table, according to a letter signed by internationally renowned food policy academics and international NGOs including the Non-Communicable Diseases (NCD) Alliance. Meanwhile, a number of organisations – particularly representing small farmers and indigenous people – boycotted its pre-summit in Rome in July, citing unhappiness with the dominance of agribusiness. Boycotts and controversy “The issue of landlessness and land grabbing is not on the agenda of the UNFSS. Nowhere in its so-called Action Tracks do discussions highlight critical trends such as on land concentration and reconcentration in the hands of big agribusiness firms and their network of local landlords and compradors, nor on the massive displacement of rural communities to give way to big private investments and large development projects,” said Chennaiah Poguri, chairperson of the Asian Peasant Coalition (APC). Nonetheless, at least 85 heads of state are expected to share their commitments to addressing the global food crisis, according to a UNFSS media release on Monday. “After 18 long months, the world is on the brink of a summit that aims to change the trajectory of global progress, uniting everyone in a shared commitment to deliver the Sustainable Development Goals and the fundamental human rights at their core,” said Agnes Kalibata, the UN Secretary-General’s Special Envoy for the summit. However, the appointment of Kalibata, a former minister of agriculture in Rwanda, has also been controversial. Critics accuse the organisation she heads, the Alliance for a Green Revolution in Africa (AGRA), of opening African markets to “corporate monopolies controlling commercial seeds, genetically modified crops, fossil fuel-heavy synthetic fertilizers and polluting pesticides”, and asked the UN to revoke her appointment. Food policy activists protest against ultr-processed food in South Africa. Desperate need for food policy change Despite the controversies, the need for a change in global food policy is urgent. Around eight million people die annually due to poor diets, according to the Bloomberg Philanthropies’ Food Policy Program, which has committed over $435 million to help public health advocates to promote healthier diets through policy change. “In almost every country, traditional diets are being rapidly displaced by low-quality, nutrient-deficient diets,” says Trish Cotter, Senior Policy and Communication Advisor at Vital Strategies’ Food Policy Program. Obesity has almost tripled since the mid-1970s, with over 1.9 billion adults and more than 370 million children and adolescents now overweight or obese, according to the World Health Organization, while the prevalence of type 2 diabetes has doubled since 1980, affecting about 420 million people. “The most plausible explanation for this change? The rapid rise in consumption of ultra-processed foods and beverages – products that have been chemically or physically transformed using industrial processes,” adds Cotter, who is also part of the Bloomberg program. Leading food policy academics writing in the BMJ recently described ultra-processed foods as products arising from “industrial processes that convert food commodities such as wheat, soy, corn, oils and sugar, into chemically or physically transformed food substances, formulated with various classes of additives”. Transnational corporations “use their power to formulate, mass manufacture, distribute and aggressively market their products worldwide” and also “shape scientific findings by funding in-house and university-based research, so as to defend and promote ultra-processed foods”, according to the academics, who include Carlos Monteiro, Professor of Nutrition at Sao Paulo University, Marion Nestle, Emeritus Professor of Nutrition at New York University and the University of North Carolina’s Professor Barry Popkin. Taxes, warning labels and marketing restrictions Warning labels on food products in Chile nudge customers away from unhealthy foods – top-left: “high in calories”; top-right: “high in sugars”; bottom-left: “high in sodium”; bottom-right: “high in saturated fats” They urge the summit to encourage global dietary guidelines that favour fresh or minimally processed foods and “fiscal measures” including taxes, marketing regulations, mandatory front-of-pack warning labels on ultra-processed foods. Cotter, who has worked on international communication campaigns aimed at encouraging healthy eating, says that “ultra-processed products have crept into our lives under the guise of convenience backed up by some extremely clever and consistent marketing”. “We cannot simply place the onus on individuals to change lifestyles or make healthier choices when there often is little choice available for healthier products or consumers are swamped by alluringly marketed, ready-to-eat, convenient and tasty products advertised by Big Food,” she adds. “There’s no question that these products must be regulated and taxed to reduce consumption. But without the support of government policy, this task—of avoiding the health consequences of populations consuming ultra-processed products—is nigh impossible. The onus is on governments to act, and to act now.” Most Mexican kids had sodas for breakfast Mexico was the first country to tax sugary drinks in 2014, as it struggled to address the strain on its health system stemming from almost three-quarters of its population being overweight. Prior to the tax, Mexico had one of the highest consumption rates of sugary drinks in the world, and 70% of rural primary school children and 80% of high school students had one for breakfast every day. A year after it had implemented a 10% soda tax, sugary drinks purchases declined by 9% among the poorest third of the population. South Africa implemented a sugary drinks tax of around 10% in 2018 and has cut consumption by 28%, welcome news in a country where nine and 10- year-olds drink almost three times the global average of Coca-Colas every year. Chile has cut sugary drink purchasing by 24% through a comprehensive policy approach that includes warning labels on bottles. Recently, Brazil and Colombia have also passed legislation requiring warning labels on ultra-processed food. These warnings are important, says Cotter, because most shoppers spend less than 10 seconds choosing each food and beverage item. “Front-of-package warning labels can help consumers to quickly identify unhealthy products and encourage them to make healthy choices.” Safe, nutritious food for all UN Envoy Kalibata says that summit has five interconnected objectives. These are to ensure access to safe, nutritious food for all; shift to sustainable consumption by reducing waste and creating demand for healthy diets; boost “nature-positive production,” (entailing reduced emissions and protection of ecosystems), advance equitable livelihoods; and build resilience to vulnerabilities and shocks. Despite its controversies, Lucy Westerman, Policy and Campaigns Manager for the NCD Alliance, says that the summit “has succeeded in getting more people talking about food systems and the complexity of them”. “We would really like to see this summit shift from promises and pledges to actual action and investment. It would be truly game-changing for those whose priorities lie in the health of people and planet to invest in what we know works at scale, without the interference of those with harmful interests,” adds Westerman. She also appealed for the summit to be “one part of a much bigger conversation” and that includes the UN Climate Change Conference of the Parties (COP26) starting on 31 October and Nutrition For Growth to address malnutrition in December. Meanwhile, Monteiro and colleagues want the summit to “urge member states to implement multiple policy interventions to reduce ultra-processed food production, distribution and consumption, while simultaneously making fresh or minimally processed foods more available, accessible and affordable”. Whatever the outcome of the summit, it is evident that the world needs much more innovation to stop ultra-processed food and the twin epidemics of obesity and diabetes that it is fueling. Image Credits: Unsplash, Kerry Cullinan, Vital Strategies, Michael Casmir/Pierce Mill Media. Long Working Hours Kill More Workers Than Injuries 18/09/2021 Kerry Cullinan The biggest killers of working people are strokes and heart disease associated with long working hours – over 55 hours a week. This is according to a joint report from the World Health Organization (WHO) and International Labour Organization (ILO), the first global comparative risk assessment of the work-related burden of disease, which was released on Friday. Diseases associated with long working hours accounted for almost 40% of global deaths in 2016, some 750,000 deaths. People from South East Asia and Western Pacific, men and those over 54 were most at risk. Workplace injuries were the next biggest cause of worker deaths, accounting for 19.4% of deaths (360,000 deaths) – around half the deaths caused by long working hours. Workers most in danger of injuries were those in the construction, transport, manufacturing and agricultural sectors. Workplace exposure to air pollution (particulate matter, gases and fumes) was responsible for 450,000 deaths. Meanwhile, asbestos exposure caused 11.1% deaths, causing a variety of cancers. According to the report, 81% of deaths in 2016 were caused by non-communicable diseases (NCDs), the most common being chronic obstructive pulmonary disease (450,000 deaths); stroke (400,000 deaths) and ischaemic heart disease (350,000 deaths). “It’s shocking to see so many people literally being killed by their jobs,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Our report is a wake-up call to countries and businesses to improve and protect the health and safety of workers by honouring their commitments to provide universal coverage of occupational health and safety services.” Healthy limits This report will enable policymakers to track work-related health loss at country, regional and global levels, according to the two bodies. “These estimates provide important information on the work-related burden of disease, and this information can help to shape policies and practices to create healthier and safer workplaces,” said Guy Ryder, ILO Director-General. Each risk factor has a unique set of preventive actions, which are outlined in the monitoring report to guide governments, in consultation with employers and workers. Preventing long working hours requires agreement on healthy maximum limits on working time, for example. To reduce workplace exposure to air pollution, dust control, ventilation, and personal protective equipment is recommended. “These almost 2 million premature deaths are preventable. Action needs to be taken based on the research available to target the evolving nature of work-related health threats,” said Dr. Maria Neira, Director of the Department of Environment, Climate Change and Health at WHO. The report notes that total work-related burden of disease is likely substantially larger, as health loss from several other occupational risk factors must still be quantified in the future. Moreover, the effects of the COVID-19 pandemic will add another dimension to this burden to be captured in future estimates. 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.
Afghan Health System in Danger of Collapse, WHO Concerned About Female Patients and Health Workers 22/09/2021 Editorial team WHO’s recent mission to Afghanistan Afghanistan’s health system is on the brink of collapse and the country faces “an imminent humanitarian catastrophe,” the World Health Organization (WHO) warned on Wednesday. Only 17% of the facilities of the country’s largest health project, Sehetmandi, are still fully functional as they have run out of funds for supplies and salaries for health staff. “This breakdown in health services is having a rippling effect on the availability of basic and essential health care, as well as on emergency response, polio eradication, and COVID-19 vaccination efforts,” the WHO said. Nine of 37 COVID-19 hospitals have already closed, and “all aspects of the COVID-19 response have dropped, including surveillance, testing, and vaccination”. It warned that 1.8 million COVID-19 vaccine doses in the country remain unused. “Swift action is needed to use these doses in the coming weeks and work towards reaching the goal of vaccinating at least 20% of the population by the end of the year based on national targets.” The WHO recently completed a high-level mission to Kabul in Afghanistan headed by Director-General Dr Tedros Adhanom Ghebreyesus where it met with Taliban leaders, UN partners, health care workers and patients. “WHO particularly emphasizes the need for women to maintain access to education, health care, and to the health workforce,” the global body stated. “With fewer health facilities operational and fewer female health workers reporting to work, female patients are hesitant to seek care. We are committed to working with partners to invest in the health education of girls and women, as well as continue training female health workers.” Polio is still endemic in Afghanistan, while measles is on the increase. Can the UN Food Summit Make a Difference to a World Overpowered by Junk Food? 21/09/2021 Kerry Cullinan Around 70% of primary school children in rural Mexican had a sugary drink for breakfast in 2012. Many children in the global south are drinking more sugary drinks than milk – thanks to the aggressive promotion of ultra-processed food to low and middle-income countries (LMICs) in the past two decades. Global obesity and diabetes rates have exploded as a result of dietary changes, and these conditions have made people far more vulnerable to severe COVID-19 illness – and not a single country has been able to reverse their obesity trends. Thursday’s United Nations Food Systems Summit (UNFSS) aims to “build a global conversation on the way in which we produce, process, and consume food, and galvanize global actions and commitments to change our food systems to provide safe, nutritious food for all within our planetary boundaries”, according to the UN. But summit preparation has been rocky. Its organisers have been accused of lacking transparency and giving big food, alcohol and tobacco companies a seat at the table, according to a letter signed by internationally renowned food policy academics and international NGOs including the Non-Communicable Diseases (NCD) Alliance. Meanwhile, a number of organisations – particularly representing small farmers and indigenous people – boycotted its pre-summit in Rome in July, citing unhappiness with the dominance of agribusiness. Boycotts and controversy “The issue of landlessness and land grabbing is not on the agenda of the UNFSS. Nowhere in its so-called Action Tracks do discussions highlight critical trends such as on land concentration and reconcentration in the hands of big agribusiness firms and their network of local landlords and compradors, nor on the massive displacement of rural communities to give way to big private investments and large development projects,” said Chennaiah Poguri, chairperson of the Asian Peasant Coalition (APC). Nonetheless, at least 85 heads of state are expected to share their commitments to addressing the global food crisis, according to a UNFSS media release on Monday. “After 18 long months, the world is on the brink of a summit that aims to change the trajectory of global progress, uniting everyone in a shared commitment to deliver the Sustainable Development Goals and the fundamental human rights at their core,” said Agnes Kalibata, the UN Secretary-General’s Special Envoy for the summit. However, the appointment of Kalibata, a former minister of agriculture in Rwanda, has also been controversial. Critics accuse the organisation she heads, the Alliance for a Green Revolution in Africa (AGRA), of opening African markets to “corporate monopolies controlling commercial seeds, genetically modified crops, fossil fuel-heavy synthetic fertilizers and polluting pesticides”, and asked the UN to revoke her appointment. Food policy activists protest against ultr-processed food in South Africa. Desperate need for food policy change Despite the controversies, the need for a change in global food policy is urgent. Around eight million people die annually due to poor diets, according to the Bloomberg Philanthropies’ Food Policy Program, which has committed over $435 million to help public health advocates to promote healthier diets through policy change. “In almost every country, traditional diets are being rapidly displaced by low-quality, nutrient-deficient diets,” says Trish Cotter, Senior Policy and Communication Advisor at Vital Strategies’ Food Policy Program. Obesity has almost tripled since the mid-1970s, with over 1.9 billion adults and more than 370 million children and adolescents now overweight or obese, according to the World Health Organization, while the prevalence of type 2 diabetes has doubled since 1980, affecting about 420 million people. “The most plausible explanation for this change? The rapid rise in consumption of ultra-processed foods and beverages – products that have been chemically or physically transformed using industrial processes,” adds Cotter, who is also part of the Bloomberg program. Leading food policy academics writing in the BMJ recently described ultra-processed foods as products arising from “industrial processes that convert food commodities such as wheat, soy, corn, oils and sugar, into chemically or physically transformed food substances, formulated with various classes of additives”. Transnational corporations “use their power to formulate, mass manufacture, distribute and aggressively market their products worldwide” and also “shape scientific findings by funding in-house and university-based research, so as to defend and promote ultra-processed foods”, according to the academics, who include Carlos Monteiro, Professor of Nutrition at Sao Paulo University, Marion Nestle, Emeritus Professor of Nutrition at New York University and the University of North Carolina’s Professor Barry Popkin. Taxes, warning labels and marketing restrictions Warning labels on food products in Chile nudge customers away from unhealthy foods – top-left: “high in calories”; top-right: “high in sugars”; bottom-left: “high in sodium”; bottom-right: “high in saturated fats” They urge the summit to encourage global dietary guidelines that favour fresh or minimally processed foods and “fiscal measures” including taxes, marketing regulations, mandatory front-of-pack warning labels on ultra-processed foods. Cotter, who has worked on international communication campaigns aimed at encouraging healthy eating, says that “ultra-processed products have crept into our lives under the guise of convenience backed up by some extremely clever and consistent marketing”. “We cannot simply place the onus on individuals to change lifestyles or make healthier choices when there often is little choice available for healthier products or consumers are swamped by alluringly marketed, ready-to-eat, convenient and tasty products advertised by Big Food,” she adds. “There’s no question that these products must be regulated and taxed to reduce consumption. But without the support of government policy, this task—of avoiding the health consequences of populations consuming ultra-processed products—is nigh impossible. The onus is on governments to act, and to act now.” Most Mexican kids had sodas for breakfast Mexico was the first country to tax sugary drinks in 2014, as it struggled to address the strain on its health system stemming from almost three-quarters of its population being overweight. Prior to the tax, Mexico had one of the highest consumption rates of sugary drinks in the world, and 70% of rural primary school children and 80% of high school students had one for breakfast every day. A year after it had implemented a 10% soda tax, sugary drinks purchases declined by 9% among the poorest third of the population. South Africa implemented a sugary drinks tax of around 10% in 2018 and has cut consumption by 28%, welcome news in a country where nine and 10- year-olds drink almost three times the global average of Coca-Colas every year. Chile has cut sugary drink purchasing by 24% through a comprehensive policy approach that includes warning labels on bottles. Recently, Brazil and Colombia have also passed legislation requiring warning labels on ultra-processed food. These warnings are important, says Cotter, because most shoppers spend less than 10 seconds choosing each food and beverage item. “Front-of-package warning labels can help consumers to quickly identify unhealthy products and encourage them to make healthy choices.” Safe, nutritious food for all UN Envoy Kalibata says that summit has five interconnected objectives. These are to ensure access to safe, nutritious food for all; shift to sustainable consumption by reducing waste and creating demand for healthy diets; boost “nature-positive production,” (entailing reduced emissions and protection of ecosystems), advance equitable livelihoods; and build resilience to vulnerabilities and shocks. Despite its controversies, Lucy Westerman, Policy and Campaigns Manager for the NCD Alliance, says that the summit “has succeeded in getting more people talking about food systems and the complexity of them”. “We would really like to see this summit shift from promises and pledges to actual action and investment. It would be truly game-changing for those whose priorities lie in the health of people and planet to invest in what we know works at scale, without the interference of those with harmful interests,” adds Westerman. She also appealed for the summit to be “one part of a much bigger conversation” and that includes the UN Climate Change Conference of the Parties (COP26) starting on 31 October and Nutrition For Growth to address malnutrition in December. Meanwhile, Monteiro and colleagues want the summit to “urge member states to implement multiple policy interventions to reduce ultra-processed food production, distribution and consumption, while simultaneously making fresh or minimally processed foods more available, accessible and affordable”. Whatever the outcome of the summit, it is evident that the world needs much more innovation to stop ultra-processed food and the twin epidemics of obesity and diabetes that it is fueling. Image Credits: Unsplash, Kerry Cullinan, Vital Strategies, Michael Casmir/Pierce Mill Media. Long Working Hours Kill More Workers Than Injuries 18/09/2021 Kerry Cullinan The biggest killers of working people are strokes and heart disease associated with long working hours – over 55 hours a week. This is according to a joint report from the World Health Organization (WHO) and International Labour Organization (ILO), the first global comparative risk assessment of the work-related burden of disease, which was released on Friday. Diseases associated with long working hours accounted for almost 40% of global deaths in 2016, some 750,000 deaths. People from South East Asia and Western Pacific, men and those over 54 were most at risk. Workplace injuries were the next biggest cause of worker deaths, accounting for 19.4% of deaths (360,000 deaths) – around half the deaths caused by long working hours. Workers most in danger of injuries were those in the construction, transport, manufacturing and agricultural sectors. Workplace exposure to air pollution (particulate matter, gases and fumes) was responsible for 450,000 deaths. Meanwhile, asbestos exposure caused 11.1% deaths, causing a variety of cancers. According to the report, 81% of deaths in 2016 were caused by non-communicable diseases (NCDs), the most common being chronic obstructive pulmonary disease (450,000 deaths); stroke (400,000 deaths) and ischaemic heart disease (350,000 deaths). “It’s shocking to see so many people literally being killed by their jobs,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Our report is a wake-up call to countries and businesses to improve and protect the health and safety of workers by honouring their commitments to provide universal coverage of occupational health and safety services.” Healthy limits This report will enable policymakers to track work-related health loss at country, regional and global levels, according to the two bodies. “These estimates provide important information on the work-related burden of disease, and this information can help to shape policies and practices to create healthier and safer workplaces,” said Guy Ryder, ILO Director-General. Each risk factor has a unique set of preventive actions, which are outlined in the monitoring report to guide governments, in consultation with employers and workers. Preventing long working hours requires agreement on healthy maximum limits on working time, for example. To reduce workplace exposure to air pollution, dust control, ventilation, and personal protective equipment is recommended. “These almost 2 million premature deaths are preventable. Action needs to be taken based on the research available to target the evolving nature of work-related health threats,” said Dr. Maria Neira, Director of the Department of Environment, Climate Change and Health at WHO. The report notes that total work-related burden of disease is likely substantially larger, as health loss from several other occupational risk factors must still be quantified in the future. Moreover, the effects of the COVID-19 pandemic will add another dimension to this burden to be captured in future estimates. 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.
Can the UN Food Summit Make a Difference to a World Overpowered by Junk Food? 21/09/2021 Kerry Cullinan Around 70% of primary school children in rural Mexican had a sugary drink for breakfast in 2012. Many children in the global south are drinking more sugary drinks than milk – thanks to the aggressive promotion of ultra-processed food to low and middle-income countries (LMICs) in the past two decades. Global obesity and diabetes rates have exploded as a result of dietary changes, and these conditions have made people far more vulnerable to severe COVID-19 illness – and not a single country has been able to reverse their obesity trends. Thursday’s United Nations Food Systems Summit (UNFSS) aims to “build a global conversation on the way in which we produce, process, and consume food, and galvanize global actions and commitments to change our food systems to provide safe, nutritious food for all within our planetary boundaries”, according to the UN. But summit preparation has been rocky. Its organisers have been accused of lacking transparency and giving big food, alcohol and tobacco companies a seat at the table, according to a letter signed by internationally renowned food policy academics and international NGOs including the Non-Communicable Diseases (NCD) Alliance. Meanwhile, a number of organisations – particularly representing small farmers and indigenous people – boycotted its pre-summit in Rome in July, citing unhappiness with the dominance of agribusiness. Boycotts and controversy “The issue of landlessness and land grabbing is not on the agenda of the UNFSS. Nowhere in its so-called Action Tracks do discussions highlight critical trends such as on land concentration and reconcentration in the hands of big agribusiness firms and their network of local landlords and compradors, nor on the massive displacement of rural communities to give way to big private investments and large development projects,” said Chennaiah Poguri, chairperson of the Asian Peasant Coalition (APC). Nonetheless, at least 85 heads of state are expected to share their commitments to addressing the global food crisis, according to a UNFSS media release on Monday. “After 18 long months, the world is on the brink of a summit that aims to change the trajectory of global progress, uniting everyone in a shared commitment to deliver the Sustainable Development Goals and the fundamental human rights at their core,” said Agnes Kalibata, the UN Secretary-General’s Special Envoy for the summit. However, the appointment of Kalibata, a former minister of agriculture in Rwanda, has also been controversial. Critics accuse the organisation she heads, the Alliance for a Green Revolution in Africa (AGRA), of opening African markets to “corporate monopolies controlling commercial seeds, genetically modified crops, fossil fuel-heavy synthetic fertilizers and polluting pesticides”, and asked the UN to revoke her appointment. Food policy activists protest against ultr-processed food in South Africa. Desperate need for food policy change Despite the controversies, the need for a change in global food policy is urgent. Around eight million people die annually due to poor diets, according to the Bloomberg Philanthropies’ Food Policy Program, which has committed over $435 million to help public health advocates to promote healthier diets through policy change. “In almost every country, traditional diets are being rapidly displaced by low-quality, nutrient-deficient diets,” says Trish Cotter, Senior Policy and Communication Advisor at Vital Strategies’ Food Policy Program. Obesity has almost tripled since the mid-1970s, with over 1.9 billion adults and more than 370 million children and adolescents now overweight or obese, according to the World Health Organization, while the prevalence of type 2 diabetes has doubled since 1980, affecting about 420 million people. “The most plausible explanation for this change? The rapid rise in consumption of ultra-processed foods and beverages – products that have been chemically or physically transformed using industrial processes,” adds Cotter, who is also part of the Bloomberg program. Leading food policy academics writing in the BMJ recently described ultra-processed foods as products arising from “industrial processes that convert food commodities such as wheat, soy, corn, oils and sugar, into chemically or physically transformed food substances, formulated with various classes of additives”. Transnational corporations “use their power to formulate, mass manufacture, distribute and aggressively market their products worldwide” and also “shape scientific findings by funding in-house and university-based research, so as to defend and promote ultra-processed foods”, according to the academics, who include Carlos Monteiro, Professor of Nutrition at Sao Paulo University, Marion Nestle, Emeritus Professor of Nutrition at New York University and the University of North Carolina’s Professor Barry Popkin. Taxes, warning labels and marketing restrictions Warning labels on food products in Chile nudge customers away from unhealthy foods – top-left: “high in calories”; top-right: “high in sugars”; bottom-left: “high in sodium”; bottom-right: “high in saturated fats” They urge the summit to encourage global dietary guidelines that favour fresh or minimally processed foods and “fiscal measures” including taxes, marketing regulations, mandatory front-of-pack warning labels on ultra-processed foods. Cotter, who has worked on international communication campaigns aimed at encouraging healthy eating, says that “ultra-processed products have crept into our lives under the guise of convenience backed up by some extremely clever and consistent marketing”. “We cannot simply place the onus on individuals to change lifestyles or make healthier choices when there often is little choice available for healthier products or consumers are swamped by alluringly marketed, ready-to-eat, convenient and tasty products advertised by Big Food,” she adds. “There’s no question that these products must be regulated and taxed to reduce consumption. But without the support of government policy, this task—of avoiding the health consequences of populations consuming ultra-processed products—is nigh impossible. The onus is on governments to act, and to act now.” Most Mexican kids had sodas for breakfast Mexico was the first country to tax sugary drinks in 2014, as it struggled to address the strain on its health system stemming from almost three-quarters of its population being overweight. Prior to the tax, Mexico had one of the highest consumption rates of sugary drinks in the world, and 70% of rural primary school children and 80% of high school students had one for breakfast every day. A year after it had implemented a 10% soda tax, sugary drinks purchases declined by 9% among the poorest third of the population. South Africa implemented a sugary drinks tax of around 10% in 2018 and has cut consumption by 28%, welcome news in a country where nine and 10- year-olds drink almost three times the global average of Coca-Colas every year. Chile has cut sugary drink purchasing by 24% through a comprehensive policy approach that includes warning labels on bottles. Recently, Brazil and Colombia have also passed legislation requiring warning labels on ultra-processed food. These warnings are important, says Cotter, because most shoppers spend less than 10 seconds choosing each food and beverage item. “Front-of-package warning labels can help consumers to quickly identify unhealthy products and encourage them to make healthy choices.” Safe, nutritious food for all UN Envoy Kalibata says that summit has five interconnected objectives. These are to ensure access to safe, nutritious food for all; shift to sustainable consumption by reducing waste and creating demand for healthy diets; boost “nature-positive production,” (entailing reduced emissions and protection of ecosystems), advance equitable livelihoods; and build resilience to vulnerabilities and shocks. Despite its controversies, Lucy Westerman, Policy and Campaigns Manager for the NCD Alliance, says that the summit “has succeeded in getting more people talking about food systems and the complexity of them”. “We would really like to see this summit shift from promises and pledges to actual action and investment. It would be truly game-changing for those whose priorities lie in the health of people and planet to invest in what we know works at scale, without the interference of those with harmful interests,” adds Westerman. She also appealed for the summit to be “one part of a much bigger conversation” and that includes the UN Climate Change Conference of the Parties (COP26) starting on 31 October and Nutrition For Growth to address malnutrition in December. Meanwhile, Monteiro and colleagues want the summit to “urge member states to implement multiple policy interventions to reduce ultra-processed food production, distribution and consumption, while simultaneously making fresh or minimally processed foods more available, accessible and affordable”. Whatever the outcome of the summit, it is evident that the world needs much more innovation to stop ultra-processed food and the twin epidemics of obesity and diabetes that it is fueling. Image Credits: Unsplash, Kerry Cullinan, Vital Strategies, Michael Casmir/Pierce Mill Media. Long Working Hours Kill More Workers Than Injuries 18/09/2021 Kerry Cullinan The biggest killers of working people are strokes and heart disease associated with long working hours – over 55 hours a week. This is according to a joint report from the World Health Organization (WHO) and International Labour Organization (ILO), the first global comparative risk assessment of the work-related burden of disease, which was released on Friday. Diseases associated with long working hours accounted for almost 40% of global deaths in 2016, some 750,000 deaths. People from South East Asia and Western Pacific, men and those over 54 were most at risk. Workplace injuries were the next biggest cause of worker deaths, accounting for 19.4% of deaths (360,000 deaths) – around half the deaths caused by long working hours. Workers most in danger of injuries were those in the construction, transport, manufacturing and agricultural sectors. Workplace exposure to air pollution (particulate matter, gases and fumes) was responsible for 450,000 deaths. Meanwhile, asbestos exposure caused 11.1% deaths, causing a variety of cancers. According to the report, 81% of deaths in 2016 were caused by non-communicable diseases (NCDs), the most common being chronic obstructive pulmonary disease (450,000 deaths); stroke (400,000 deaths) and ischaemic heart disease (350,000 deaths). “It’s shocking to see so many people literally being killed by their jobs,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Our report is a wake-up call to countries and businesses to improve and protect the health and safety of workers by honouring their commitments to provide universal coverage of occupational health and safety services.” Healthy limits This report will enable policymakers to track work-related health loss at country, regional and global levels, according to the two bodies. “These estimates provide important information on the work-related burden of disease, and this information can help to shape policies and practices to create healthier and safer workplaces,” said Guy Ryder, ILO Director-General. Each risk factor has a unique set of preventive actions, which are outlined in the monitoring report to guide governments, in consultation with employers and workers. Preventing long working hours requires agreement on healthy maximum limits on working time, for example. To reduce workplace exposure to air pollution, dust control, ventilation, and personal protective equipment is recommended. “These almost 2 million premature deaths are preventable. Action needs to be taken based on the research available to target the evolving nature of work-related health threats,” said Dr. Maria Neira, Director of the Department of Environment, Climate Change and Health at WHO. The report notes that total work-related burden of disease is likely substantially larger, as health loss from several other occupational risk factors must still be quantified in the future. Moreover, the effects of the COVID-19 pandemic will add another dimension to this burden to be captured in future estimates. 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
Long Working Hours Kill More Workers Than Injuries 18/09/2021 Kerry Cullinan The biggest killers of working people are strokes and heart disease associated with long working hours – over 55 hours a week. This is according to a joint report from the World Health Organization (WHO) and International Labour Organization (ILO), the first global comparative risk assessment of the work-related burden of disease, which was released on Friday. Diseases associated with long working hours accounted for almost 40% of global deaths in 2016, some 750,000 deaths. People from South East Asia and Western Pacific, men and those over 54 were most at risk. Workplace injuries were the next biggest cause of worker deaths, accounting for 19.4% of deaths (360,000 deaths) – around half the deaths caused by long working hours. Workers most in danger of injuries were those in the construction, transport, manufacturing and agricultural sectors. Workplace exposure to air pollution (particulate matter, gases and fumes) was responsible for 450,000 deaths. Meanwhile, asbestos exposure caused 11.1% deaths, causing a variety of cancers. According to the report, 81% of deaths in 2016 were caused by non-communicable diseases (NCDs), the most common being chronic obstructive pulmonary disease (450,000 deaths); stroke (400,000 deaths) and ischaemic heart disease (350,000 deaths). “It’s shocking to see so many people literally being killed by their jobs,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Our report is a wake-up call to countries and businesses to improve and protect the health and safety of workers by honouring their commitments to provide universal coverage of occupational health and safety services.” Healthy limits This report will enable policymakers to track work-related health loss at country, regional and global levels, according to the two bodies. “These estimates provide important information on the work-related burden of disease, and this information can help to shape policies and practices to create healthier and safer workplaces,” said Guy Ryder, ILO Director-General. Each risk factor has a unique set of preventive actions, which are outlined in the monitoring report to guide governments, in consultation with employers and workers. Preventing long working hours requires agreement on healthy maximum limits on working time, for example. To reduce workplace exposure to air pollution, dust control, ventilation, and personal protective equipment is recommended. “These almost 2 million premature deaths are preventable. Action needs to be taken based on the research available to target the evolving nature of work-related health threats,” said Dr. Maria Neira, Director of the Department of Environment, Climate Change and Health at WHO. The report notes that total work-related burden of disease is likely substantially larger, as health loss from several other occupational risk factors must still be quantified in the future. Moreover, the effects of the COVID-19 pandemic will add another dimension to this burden to be captured in future estimates. Posts navigation Older postsNewer posts