Dr Jean Kaseya, Africa CDC Director General, accused the US of creating panic around Rwanda’s Marburg outbreak.

The Africa CDC has slammed the US government’s recent Level 3 travel advisory for Rwanda as unfair and baseless, arguing it undermines Rwanda’s proactive efforts to contain a Marburg outbreak. With rapid testing, vaccinations, and coordinated emergency response measures in place, Rwanda’s leaders insist the country poses no international threat and warn that travel restrictions could stoke panic and discourage transparency in future health crises.

Dr Jean Kaseya, Director General of Africa CDC, called the US decision “unfair” during a press briefing Thursday, accusing Washington of creating unnecessary panic. On October 7, state department increased the advisory level from 2 to 3, with the caveat to “reconsider travel in Rwanda due to an outbreak of Marburg Virus Disease”.

New US travel advisory on Rwanda, issued 7 October 2024.

Kaseya emphasized that Rwanda had taken a transparent and comprehensive approach to controlling the Marburg outbreak, which was declared on September 27.

“Rwanda collaborated with all partners, including the U.S., to show that there is no risk of spreading this disease,” he stated. He pointed to the country’s proactive measures, such as stringent screening processes at Kigali International Airport, effective contact tracing, and cross-border surveillance, as evidence of Rwanda’s commitment to preventing international transmission.

The press conference also featured remarks from Rwanda’s Minister of Health, Dr. Sabin Nsanzimana, who detailed the country’s rapid response efforts, which include intensive testing, vaccination campaigns targeting healthcare workers and high-risk groups, and the use of multiple therapeutic options. “We are working closely with partners across the world… although this is the most dangerous virus in the world, we came up stronger to respond,” said Nsanzimana.

Marburg outbreak, mapping both cases and location of contacts as of 2 October.

Rwanda has so far confirmed 58 cases of Marburg virus disease, with a case fatality rate (CFR) of 22%.  While that is four to five times higher than the average CFR of COVID in the first six months of the pandemic, it is significantly lower than the fatality rate of previous Marburg outbreaks in other parts of the Africa region, Nsanzimana contended.

Historically, the case fatality rate of Marburg has averaged 50%, according to WHO, although it has varied between 24-88% in different outbreak contexts.  The virus, which causes haemorrhagic fever, is in the same family as the virus that causes Ebola virus disease. Bats are regarded as a key virus reservoir.  

Rwanda’s use of advanced therapeutics and vaccine trials

Nsanzimana attributed the relatively low fatality rate to the country’s early detection of cases, rapid isolation protocols, and the administration of supportive treatments, such as antiviral drugs and monoclonal antibodies, administered to critically ill patients.

“The earlier you detect, the better the outcome,” he noted, underscoring the importance of prompt diagnosis and immediate response.

Marburg Rwanda
Rwandan Minister of Health, Sabin Nsanzimana speaking at the Africa CDC press briefing on Thursday.

Rwanda has also already administered over 200 doses of an investigational Marburg vaccine developed by the Sabin Vaccine Institute, he revealed. The vaccination campaign, which began this week, prioritizes healthcare workers and individuals in close contact with confirmed cases. The minister announced plans to expand the vaccination effort to additional high-risk groups in collaboration with international partners. “Our aim is to vaccinate as many people at risk as quickly as possible,” he added.

Despite the positive strides made, Nsanzimana acknowledged the need for more vaccine doses and indicated that Rwanda is actively working to secure additional supplies to protect healthcare workers and communities.

Rwanda has adopted an open-label approach to the vaccine trial to expedite protection for at-risk groups, Nsanzimana said. But due to the deadly nature of the disease, the initial protocol does not include a delayed-arm trial, but plans are in place to expand the study and consider alternative methodologies as more data becomes available.

“Our focus now is on saving lives and preventing transmission. We can explore more complex trial designs as we move forward,” he said.

Criticism of travel bans

Amid growing concerns about travel restrictions, both Kaseya and Nsanzimana argued that imposing travel bans is counterproductive during outbreaks, as they may deter transparency and international collaboration. “Let us be guided by facts and science,” Nsanzimana stated, pointing out that Rwanda’s efforts to contain the virus should be viewed as a model rather than grounds for punitive measures. Kaseya added that the country’s centralized emergency response system and comprehensive cross-border surveillance demonstrate its preparedness and should be encouraged, not penalized.

The Africa CDC chief emphasized that travel advisories based on limited evidence could harm not only the affected country but also the global community by discouraging other nations from reporting outbreaks in a timely manner. He disclosed that following discussions, the U.S. government had agreed to consult with Africa CDC before issuing any future travel-related advisories regarding the continent. “We need to ensure that decisions are based on evidence and consultation with local health authorities,” Kaseya said.  US officials have also praised Rwanda’s rapid outbreak response, in comments like one from Rwanda’s US Amassador Eric Kneedler on X, who called it a “model” for the region. 

Strengthening cross-border cooperation and surveillance

Kaseya and Nsanzimana also highlighted the need for cross-border cooperation and surveillance efforts aimed at containing the Marburg virus and preventing regional spread. Kaseya announced that Africa CDC is deploying rapid diagnostic testing and bolstering surveillance capabilities in neighboring countries to ensure that any potential cases are quickly identified and isolated. He revealed that more than 5,000 test kits have already been distributed to high-risk areas, and plans are underway to establish rapid testing stations at key border points.

Rwanda also revealed it has set up a centralized emergency response center that integrates all relevant services, including health workers, the military, police, and ambulance services. This coordinated approach, the minister said, allows for rapid deployment of medical personnel and other resources across the country. “The mechanism they put in place is impressive,” Kaseya said. “When a call comes in, they can locate an ambulance anywhere in the country, not just in Kigali, and deploy personnel quickly.”

Ongoing mpox outbreak: a public health concern

Roundup of mpox cases in the African region.

At the briefing, Kaseya also stressed that the ongoing mpox outbreak remains a significant public health issue across the continent, with 3,186 new cases and 53 deaths recorded during the last week of September across Africa. The Democratic Republic of Congo (DRC), Nigeria, Uganda, and other nations are grappling with the virus, which continues to spread due to limited testing capabilities and low vaccination rates. Neighboring Republic of Congo, reported its first mpox case in the capital of Brazzavile, after six weeks of no case reports.. 

The lack of sufficient laboratory infrastructure was highlighted as a major challenge in countries like Liberia and the DRC, where low testing rates hinder accurate tracking of the outbreak. “The outbreak is still there, still increasing, and we need to stay focused to stop it,” Kaseya warned, urging affected countries to prioritize improving laboratory capacity and access to diagnostics.

Mpox vaccination campaigns underway in DRC

During the briefing, officials provided updates on the mpox vaccination rollout in the DRC, where a campaign targeting high-risk regions commenced on October 5. The first phase has seen 1,654 individuals vaccinated in DRC’s eastern regions such as North Kivu, South Kivu, where M23 militias control much of the territory. Kaseya acknowledged the logistical challenges faced during the rollout, particularly the distribution of vaccines to remote and conflict-prone regions. He commended the DRC government for prioritizing vaccination in areas with the highest burden of cases and reiterated Africa CDC’s commitment to supporting similar efforts in other affected countries, including Nigeria and the Central African Republic.

Calls for solidarity

Calling for greater regional and global solidarity in the fight against disease outbreaks, Kaseya and Nsanzimana both emphasized that health crises in one region can quickly affect others. 

In addition to pressing the US to lift its Level 3 travel advisory, the Africa CDC director repeated his commitment to working with the WHO and other partners to strengthen outbreak response systems across the continent.

This includes pushing for the finalization of a global pandemic agreement that would accelerate knowledge transfer, ease intellectual property restrictions on developing countries’ use of new and patented drug formulations, and facilitate local manufacturing of vaccines and therapeutics in Africa.

“The travel ban is not a solution,” Kaseya stated, calling for continued collaboration and evidence-based decision-making. “Let us continue to work in solidarity. We are one planet, and we must face these challenges together.”

Image Credits: Africa CDC, US State Department , WHO, Africa CDC .

A traditional brick factory in Tozeur, southern Tunisia. In Africa and South Asia brick making and waste burning are major sources of air pollution.

Governments worldwide allocated almost $700 million (15%) more international development aid to fossil fuel expansion in 2022 than to projects improving better air quality – which typically also promote green energy and reduce climate emissions, according to a new report from the Clean Air Fund.

This marks a sharp reversal from 2021 when international aid from governments, bilateral development agencies, and multilateral development banks for clean air initiatives briefly overtook the investments in fossil fuel development.

The latest data also shows aid for fossil fuel expansion has more than quadrupled, rising from $1.2 billion to $5.4 billion in just one year.  Although investments in clean air projects nearly doubled, from $2.4 to $4.7 billion, the net result was that fossil fuel investments regained the historic lead once more – in terms of global development priorities. 

International aid for fossil fuel development as compared to projects that improve air quality over five years.

The new CAF analysis hones in on international aid funding that is targeted to addressing outdoor air pollution in comparison to fossil-fuel prolonging investments, says Merel Krediet, one of the report’s authors. “This outdoor air quality funding hones in on projects that explicitly target air pollution,” she said.

A separate analysis looks at climate investments in clean energy and transport systems that may  have implicit air quality co-benefits – even though air quality is not cited as a project objective.  On a brighter note, this latter category may in fact be quite large, amounting to as much as $27 billion in 2022, and $94 billion between 2018-2022, according to the CAF analysis. The assessment was based on review of an OECD investment data base, and other climate investment data.

Even so, Jane Burston, CEO of the Clean Air Fund (CAF), described the “shocking increase in aid funding to fossil fuels” as  “a wake-up call”. 

“The world cannot continue down this path of propping up polluting practices at the expense of global health and climate stability. We need to see a drastic shift towards supporting clean air initiatives and debt-free aid to communities who need it most,” said Burston.

CAF warns that the problem is compounded by the structure of the clean air aid, with 92% of funding towards air quality initiatives provided as loans, while only 6% is allocated as grants. 

“This loan-heavy model would place an unsustainable burden on low-income, heavily polluted countries that cannot afford to take on additional debt,” said CAF in a statement on Thursday.
“This stands in stark contrast with other areas of international development funding  such as healthcare and education. On average, 63% of official development assistance is funded as grants.”

Significant proportion of deaths from air pollution are attributable to fossil fuel emissions

Smoking chimneys air pollution
Power plant running on fossil fuels emits air pollution over a city skyline. A large proportion of air pollution-related deaths are due to fossil fuel emissions.

A significant proportion of the estimated 8.3 million annual deaths caused by outdoor air pollution globally are attributable to fossil fuel emissions – and over half according to some of the most recent estimates. Despite this, governments continue to channel aid into fossil fuel prolonging and expanding projects, while clean air initiatives receive less than 1% of available ODA funding, overall. 

Toxic air also carries immense economic costs, with the combined impact of premature deaths, lost productivity, and healthcare expenses for diseases like cancer, heart disease, and dementia running into trillions of dollars each year. The World Bank estimates this “dirty air tax” drains around 6.1% of global annual GDP.

Report on ‘dirty air’ ODA investments come ahead of COP29 discussion of new goals for climate finance

These findings come just ahead of the upcoming UN Climate Conference (COP29) in Baku, 11-22 November, where negotiators are expected to focus significant attention on climate finance goals.  At the conference, leaders and negotiators will reassess international funding strategies and attempt to hammer out a “New Collective Quantified Goal (NCQG)” for accelerating climate finance. 

CAF and other clean air advocates want to seize the moment to secure commitments on increased air quality funding –  with an emphasis on providing grants instead of loans to already heavily-indebted low- and middle income countries.”

There is also a need to address the significant inequalities seen in funding for low-income countries, particularly in sun-rich regions of Africa and the Middle East, and some middle- or upper-middle-income states in Asia, Europe and Latin America.

“There are wide ‘funding deserts’ because funding is spread unevenly across regions,” the report states. For example, outdoor air quality funding for every country in Africa and the Middle East was only a third of the funding channelled to one Asian country, the Philippines ($1.5 billion versus $4.7 billion from 2018 – 2022).”

Over the same period, low-income countries such as Chad and Somalia receive much less funding than upper middle-income countries such as Serbia and Costa Rica: $2 versus $73 of overall air quality funding per capita.

 “Even as countries pledge to reduce their emissions, increase their climate change ambitions and transition away from fossil fuels, the figures tell a different story,” said Adalberto Maluf, National Secretary of Urban Environment and Environmental Quality in Brazil,” in a comment on the report’s findings. 

“International public funding does not come close to meeting the scale of the challenge or unlocking the significant opportunity of investment in air quality. What funding exists often does not reach the most affected geographies, communities and vulnerable people. It doesn’t have to be this way. 

“Brazil, as G20 chair and the incoming COP Presidency, is proud to be championing another vision for the planet: one where humans and nature co-exist in harmony, where we respect the environment we are blessed with, and where economic prosperity doesn’t come at the expense of our health and wellbeing.”

Barbara Buchner, Global Managing Director of Climate Policy Initiative, which co-authored the report, said: “Air pollution and climate change are driven by the same root causes, and share the same solutions. Directing limited public funds towards fossil fuel projects and subsidies is locking in harmful emissions for decades to come. International aid and climate finance should prioritize initiatives that improve air quality, delivering significant health, economic, and climate benefits.”

  • Elaine Ruth Fletcher contributed reporting to this story.

Image Credits: INGImage, WHO/Diego Rodriguez, Clean Air Fund.

(L-R) WHO’s Yvan J-F. Hutin, Mateusz Hasso-Agopsowicz and Martin Friede, launch new report quantifying how vaccines could reduce deaths from drug resistant pathogens.

Better use of existing pneumonia and typhoid vaccines as well as new TB and pneumonia vaccines that are currently in clinical trials, could save over half a million deaths annually from drug resistant pathogens that don’t respond to antibiotics, according to a new WHO report on how vaccine strategies can reduce antimicrobial resistance (AMR).

And over a longer term, better use of existing vaccines as well as the development of new vaccines against 24 deadly pathogens could reduce the number of antibiotics needed by 22% or 2.5 billion defined daily doses globally every year, supporting worldwide efforts to address AMR, according to the report, published on Thursday.

“Antimicrobial resistance in reality, is a sort of a race between the microbes or the bugs that are getting smarter to evade the antimicrobials, with the antibiotics and the new medicines,” said Yvan J-F. Hutin, Director of Surveillance, Prevention and Control, AMR Division, WHO, at a press conference on Thursday discussing the report.

Along with more judicious use of available drugs, preventing diseases from ever occurring is a critical AMR strategy, he added. And along with better water, sanitation and hygiene, vaccination is an important, but oft-overlooked AMR prevention tool.

“Within the prevention pillar, vaccination is really important,” Hutin said. That means, “using the vaccines that we have today to increase the coverage, and pushing the vaccines that are close to the finish line, in terms of research and development, like TB, and having the vision to say that for certain pathogens, certain microbes, we don’t have the vaccine yet, but it would make a lot of sense to have this these vaccines.”

Prioritizing vaccine development to prevent AMR deaths, as well as deaths from the disease

Guatemalan infant immunized against Haemeophilus influenze (Hib) – wider Hib vaccination can help combat development of AMR down the road.

“We’ve known for many years that vaccines could play a role in controlling or contributing to the control of antimicrobial resistance, but we haven’t, up until today, been able to say which vaccines and what the impact really could be,” added Martin Friede, Head of the Product & Delivery Research team, within WHO’s Department of Immunization, Vaccines and Biologicals.

“Vaccines have been developed for the last 50 years based on the prioritization,.. of deaths that happened due to that pathogen,” he added.  But that ignored the ancillary effect of pathogen drug resistance when people became ill, and antibiotic treatments failed. “This latest report, however, adds in the element of avoidable deaths from drug resistant pathogens. So now we have a new metric against which we can incorporate into our prioritization methodologies and say, well, not only can we prevent deaths due to the pathogen, but we can prevent antibiotic use.

“We have a good start citing point which to say, these are the vaccines, these are the pathogens where we would have the greatest impact,” on reducing AMR.

There are an estimated 1.13 million deaths annually due to drug resistant pathogens – and more than five million deaths overall are attributable directly indirectly to AMR, according to the latest WHO research.

The report estimates that wider use of already available vaccines against Haemophilus influenzae type B (Hib), a bacteria causing both pneumonia and meningitis, as well as typhoid vaccines could avert up to 106 000 of the deaths annually associated with the development of AMR from antibiotic use when unvaccinated children and adults become ill.

Benefits of wider use of available vaccines, in terms of AMR-related deaths, illness and disability avoided.

Every year, vaccines against Streptococcus pneumoniae could save 33 million antibiotic doses, if the Immunization Agenda 2030 target of 90% of the world’s children were vaccinated, as well as older adults. Vaccines for typhoid could save 45 million antibiotic doses, if their introduction was accelerated in high-burden countries.

And wider application of brand new malaria vaccines now being rolled out, could save up to 25 million antibiotic doses, which are often misused to try to treat malaria, which is caused by the Plasmodium falciparum parasite and other related strains, not a bacteria.

Tuberculosis vaccines would make a major dent in AMR deaths

Health worker visits a patient’s home in Peru to provide TB treatment. MDR-TB is a growing problem making many drugs ineffective for treatment.

TB vaccines could have the highest impact once experimental vaccines  now in clinical trials are approved and widely available, the report finds.  That’s a particular priority given the widening arc of multi-drug resistant forms of TB. Administration of 1.2-1.9 billion antibiotic doses could be averted – a significant portion of the 11.3 billion doses used annually against the diseases covered in the report. Nearly 200,000 more deaths associated with AMR could thus be averted annually.

AMR related deaths, illness and disability that could be avoided from vaccines in late-stage R&D.

Further down the line, vaccines for other deadly pathogens such as Klebsiella pneumoniae, in early stage development could save several hundred thousand more lives, once they are available.

Vaccines could significantly reduce the substantial economic costs of AMR

Globally, the hospital costs of treating resistant pathogens evaluated in the report are estimated at US$ 730 billion each year. If vaccines could be rolled out against all the evaluated pathogens, they could save a third of the hospital costs associated with AMR, the report’s authors also concluded.

“The actual cost of treating these infections is incredibly high, $730 billion every year,” Hutin said. “And what we have found that if we put together all the vaccines that we had evaluated, if we have a scenario that they could be widely used, that reaches those people who need these vaccines, that could avert up to a third of these costs, so quite a large, substantial, quite a large proportion that could contribute to reduction of AMR.”

 

Image Credits: Twitter:@WHO, UNICEF 2024 , WHO , WHO PAHO.

Heavy metals from bombs, such as those Russia is using against Ukraine, are poisoning environments in conflict zones and fueling AMR.

Conflict is a “bio-incubator” of anti-microbial resistance (AMR) yet this is not being recognised or addressed sufficiently, according to Professor Richard Sullivan.

Drug-resistant pathogens thrive in war wounds that are treated in sub-optimal conditions and in environments contaminated by heavy metals from bombs, said Sullivan, who is co-director of the Centre for Conflict and Health Research at King’s College in London.

The risk is huge with around 30% of the global population – 2.4 billion people – currently living in conflict zones, Sullivan told an event hosted by the Geneva Graduate Institute’s Global Health Centre on Wednesday.

Sullivan, who is a surgeon, said he frequently saw patients with dirty shrapnel wounds that took a long time to heal.

“Studies of surgical site infections in most conflict situations found that 70-80% are contaminated with multi-drug-resistant organisms,” he added.

Current conflict – Gaza, Sudan and Ukraine – involves “the increasing use of heavy munitions, and fighting in built-up areas”, which is causing “extraordinary toxification of the environment”, said Sullivan.

“Every single day, about 5,000 to 6000 155 millimetre shells are dropped on Ukrainian or Russian lines. These contain about 10 kilograms of RDX TNT and they contaminate the grounds with heavy metals – and that is just the shells, never mind all the propellant contamination that’s going on from the other types of weapons,” said Sullivan.

These heavy metals cause cell mutations in pathogens that help to drive AMR within the environment. 

Dr Kefas Samson from the WHO’s AMR Division said that the impact of AMR – estimated by The Lancet to have caused five million deaths in 2019 – was likely to be under-estimated because it is hard to collect data in war zones.

Meanwhile, Sullivan added that there were a “lot of implementation gaps” to prevent AMR in wars zones, including better training of health workers to “debride wounds” (remove dead and infected flesh), and provision of kits for infected wounds.

Implementing the UN Political Declaration

Despite the huge role of conflict in AMR, this is barely acknowledged in the United Nations Political Declaration on AMR adopted at the High-Level Meeting on AMR last month.

What the Declaration does do, however, is empower the Quadripartite Alliance – the Food and Agricultural Organisation (FAO), World Health Organization (WHO), World Organisation of Animal Health (WOAH) and the UN Environment Programme – to oversee the implementation of the declaration.

WHO’s Samson said that the Quadripartite’s priority is to support member states to deliver on the declaration – the most concrete aim of which is to reduce AMR deaths by 10% by 2030.

The declaration also charges the Quadripartite with setting up an independent panel to conduct research on AMR by the end of 2025, but the mechanics of this still need to be worked out with member states, said Samson.

No targets for ‘contentious issues’

Member states declined to set targets for certain “contentious issues” because they asked for evidence, added Samson – something that the independent panel needs to address.

A huge gap in the declaration is the failure of member states to commit to a target on reducing the use of antibiotics in the agricultural sector – where 80% are consumed.

“There are commitments in terms of strengthening global governance, there are commitments in terms of financing. There are commitments for health sector targets, for the animal health sector, health sector targets, and agriculture and the environment,” said Samson.

He added that, unlike geopolitical difficulties hampering other multilateral negotiations, there was “some unanimity within the international community and member states to see AMR as a real threat to global health, which requires very urgent actions”.

Ambassador Matthew Wilson from Barbados

Saudi Arabia hosts a Global High-Level Ministerial Conference on AMR on 15-16 November to discuss the implementation of the declaration, and how to raise the $100 million target to assist countries to develop plans to mitigate AMR.

However, Barbadian Ambassador Matthew Wilson described this amount as “modest”, and likely to be just enough to “catalyze the achievement of at least 60% of countries having achieved funded plans by 2030”.

Damien Somé from the Global Antibiotic Research & Development Partnership (GARDP) said that another massive challenge is the “dry pipeline” – only a handful of pharmaceutical companies are investing in finding new antibiotics.

Substantial investment was needed in R&D to find new antibiotics, added Somé.

Image Credits: UNDP.

Helen Rochford-Brennan
Helen Rochford-Brennan

Helen Rochford-Brennan, a 72-year-old Irish woman living with Alzheimer’s, was first diagnosed at 57, with a more complete diagnosis following five years later. At the time, there were no life-enhancing medications, leaving her to face the grim reality of her brain’s gradual decline, enduring what she described as “many dark days.”

“Imagine having a new medication,” Rochford-Brennan said. “My quality of life when I was diagnosed would have been improved. Right now, I have to work really hard to make my life joyful.”

Since her diagnosis, Rochford-Brennan has become a vocal advocate for early detection and access to transformative treatments for people with dementia. She told Health Policy Watch that if existing treatments aren’t approved across all OECD countries or remain available only to the wealthy, it would constitute a human rights violation.

“I need to know that everyone is going to have access,” she emphasised.

Alzheimer’s currently affects over 55 million people worldwide, costing the economy more than $1.3 trillion each year – or more than $15 trillion in a single decade. By 2050, the number of people with Alzheimer’s is expected to nearly triple.

“The world has never thought of the brain as an organ of the body that should be subject to health prevention and research,” said George Vradenburg, founding chair of Davos Alzheimer’s Collaborative (DAC). “The world needs to focus on brain health because it is so central to so much cost and suffering around the world.”

Davos Alzheimer’s Collaborative Founding Chairman George Vradenburg
Davos Alzheimer’s Collaborative Founding Chair George Vradenburg

In 2013, the G8 (now G7) pledged to stop Alzheimer’s by 2025, with a goal to make disease-modifying treatments widely accessible by then. As 2025 approaches, there has been significant progress in early detection, expanding research, and developing therapies. However, DAC stressed in a statement that more needs to be done to ensure fair access to these treatments worldwide, along with greater global investment to tackle this growing health crisis.

To advance these efforts, DAC, along with the European Brain Council, the Global CEO Initiative on Alzheimer’s Disease, the Associazione Italiana Malattia di Alzheimer, and Fondazione Prada, hosted a side event at the G7 Health Ministerial Meeting in Italy. It focused on accelerating cooperation in research, healthcare readiness, and access to innovative treatments.

During the event, organisers called on G7 leaders to address the urgent global challenge of Alzheimer’s and dementia by taking bold steps to ensure widespread and equitable access to life-extending therapies and the latest innovations.

The choice to hold the event in Italy was significant, noted Vradenburg, as Italy has the second-oldest population in the world. By 2050, more than a third of its people will be 65 or older. Currently, 44% of Italians in that age group report memory loss or other cognitive issues as major problems.

George Vradenburg, founding chairman of Davos Alzheimer's Collaborative, speaks at an event in Italy on October 8, 2024.
George Vradenburg, founding chair of Davos Alzheimer’s Collaborative, speaks at an event in Italy on 8 October, 2024.

The event brought together global health ministers, leaders in public health, and experts in dementia and Alzheimer’s. Key participants included OECD Deputy Secretary-General for Health Yoshiki Takeuchi, Charlotte Refsum from the Tony Blair Institute (TBI), UK Dementia Task Force Co-Chair Hilary Evans, US White House Global Health Security Coordinator Stephanie Psaki, and Japan’s Counsellor for Dementia Policy Planning, Yoshimasa Tosaka.

“OECD countries must lead by example by placing dementia higher in the policy agenda,” Takeuchi emphasised. “We must work together to address diagnosis challenges, improve quality of care and support efforts in monitoring outcomes for people with dementia, while continuing to promote research and development for innovative treatments which make a difference in the lives of people with dementia.”

At the event’s conclusion, the partners issued five specific calls to action for G7 governments:

  • Expand global and cross-sector collaboration: Strengthen partnerships between governments, private sectors, scientific communities, philanthropic organisations, and others to foster innovation in dementia research.
  • Invest in healthcare system preparedness: Equip healthcare systems with the resources and capabilities needed to use the latest tools, from cognitive screening and early detection to accurate diagnosis and effective treatment and care.
  • Improve early detection and diagnosis: Build the capacity to detect cognitive impairment early and provide accurate diagnoses, utilising blood-based biomarkers and other technologies starting at the primary care level.
  • Accelerate Alzheimer’s treatment development and delivery: Speed up the creation and distribution of therapies, including new disease-modifying drugs and immunotherapies.
  • Promote global research, access, and equity: Conduct research across diverse populations and develop strategies that work for countries at all resource levels.

A growing global challenge

Alzheimer’s is a neurodegenerative disease that worsens over time, starting with physical changes in the brain, such as the build-up of toxic amyloid plaques, which can occur up to 20 years before symptoms become apparent. Currently, it can take up to two years for a person to receive a diagnosis, and many countries still lack access to the latest diagnostic tools for detecting cognitive impairment.

New treatments are emerging. FDA-approved drugs like Leqembi, for mild dementia, and Kisunla, for early-stage Alzheimer’s, are now available in countries such as the US, UK, Japan, Hong Kong, the UAE, China, and Israel. However, European regulators have rejected both drugs, leaving most European citizens without access.

“Science and industry are starting to deliver groundbreaking, disease-modifying therapies, and more are on the way,” said Vradenburg. “Now we need to ensure these innovations reach the families who need them.”

He urged G7 nations to lead the way by boosting Alzheimer’s research funding and developing healthcare models that ensure early detection, diagnosis, and treatment are universally and equitably available to all, regardless of income.

Vradenburg also criticised the European Medicines Agency for rejecting the drugs, pointing out that, according to the European Commission, over 20% of the EU’s 448.8 million people are 65 or older.

“Decisions about these medications should be made between patients and their doctors, not by bureaucrats in Brussels,” he said, referencing concerns over potential side effects. “Patients should be informed of the risks and benefits and decide for themselves—not the government.”

Push for preventative healthcare

At the event, TBI’s Charlotte Refsum advocated for greater investment in preventative healthcare. She told Health Policy Watch that while people in developed countries are living longer, they aren’t necessarily living in good health. This leads to a growing financial strain on healthcare systems, with increasing costs and a shrinking tax base as more sick people leave the workforce.

“We all know prevention is a good idea, but we are trying to convince governments of its economic necessity,” Refsum said.

She explained that many governments see healthcare spending as a “black hole.” However, TBI’s stance is that not all health spending is equal, and investing in prevention can yield significant returns compared to funding more hospitals or treatments.

Refsum also highlighted the importance of delivering preventative care through innovative, non-traditional means. Instead of relying solely on general practitioners or family doctors, she suggested providing support where people already are—online, at home, or in their communities.

“We have to think about different models of care that make better use of pharmacies, gyms, workplaces, and other local resources,” she said.

The Lancet Commission on Dementia estimates that addressing risk factors like smoking, high blood pressure, high cholesterol, obesity, and inactivity can reduce dementia risk by up to 45%.

Refsum pointed to New Zealand’s CBAX tool, a spreadsheet model with a database that helps agencies monetise impacts and conduct cost-benefit analyses. In the health sector, this tool is being used to assess people’s risk factors for certain life events, justifying investment in areas like children’s and young people’s health.

“This is a good example of using data to target prevention more effectively,” Refsum said.

Helen Rochford-Brennan (far right) participates in the "Advancing Global Collaboration for Dementia and Healthy Aging" event on October 8, 2024.
Helen Rochford-Brennan (far right) participates in the “Advancing Global Collaboration for Dementia and Healthy Aging” event on October 8, 2024. Other members of the panel include from left: Drew Holzapfel of the Davos Alzheimer’s Collaborative; Yoshimasa Tosaka of the Ministry of Health, Labour and Welfare of Japan; Hilary Evans-Newton of Alzheimer’s Research UK; and Howard Bergman of McGill University.

Rochford-Brennan also expressed hope that the conference would inspire G7 countries to listen to the needs of dementia patients and invest not only in treatments but also in the infrastructure surrounding detection, care, and ongoing support.

“The cost would be so much less if newly diagnosed people could stay at work, continue their lives, and have another 20 years of productive living,” Rochford-Brennan said. “There are so few countries in Europe with a dementia plan. We need to ensure healthcare systems provide early diagnosis and long-term, individualised support.”

Image Credits: Courtesy of Helen Rochford-Brennan, Courtesy of the Davos Alzheimer’s Collaborative, Courtesy of the Davos Alzheimer's Collaborative.

Palestinian children being getting the oral polio vaccine during the first phase of vaccinations in northern Gaza in September.

The second round of polio vaccinations for Gaza’s children are due to begin on Monday – but the World Health Organization’s (WHO) Eastern Mediterranean Region (EMRO) is assessing whether it may be affected by Israel’s renewed military activity in northern Gaza, including evacuation orders for three hospitals over the past 48 hours.

WHO EMRO officials appealed to Israel for a “humanitarian pause” to enable it to complete its polio vaccination campaign at a media briefing on Tuesday.

The first polio case in Gaza in 25 years was identified in a 10-month-old baby in August and the virus has also been detected in wastewater samples. In response, the WHO launched a mass vaccination campaign last month, which reached some 540,000 children under the age of 10 – 90% of all kids in this age group.

However, these children need a second polio vaccine within four weeks.

Dr Rick Brennan, EMRO’s regional emergency director, said that the WHO was still trying to determine how Israel’s new evacuation orders, for both the hospitals and various parts of the territory, would affect the polio vaccination campaign.

“Of course, what we need to successfully conduct the campaign is a pause in military operations. We were able to get that temporary pause for the previous round and we need that again,” said Brennan.

He added that it was “absolutely vital” to both complete the second round of vaccinations and get the cooperation of the relevant authorities to do so.

Dr Rick Brennan, WHO EMRO’s regional emergency director

“We’re working on it very hard right now,” he added.

The WHO has planned its vaccination campaign in three phases – in southern, central and northern Gaza. Brennan estimates each phase will take three days, with an extra day or two to find children who have missed out.

“We’re using a broad combination of measures: vaccinating kids in health facilities, sending teams out to communities, and working with community members to ensure that children are brought to sites where vaccinations are going on.”

Unlike the first vaccinations, children will also get vitamin A. 

“Vitamin A is very important for the immune system, particularly with the high level levels of food insecurity, with 96% of the population in Gaza at crisis levels of food insecurity,” said Brennan, describing “significantly increased rates of acute malnutrition in kids under the age of five”.

Extensive damage to population and health facilities

WHO EMRO regional director Dr Hanan Balkhy

Less than half of Gaza’s hospitals are functioning due to “damaged infrastructure, lack of fuel, supplies and human resources, and ongoing attacks”, EMRO regional director Dr Hanan Balkhy told the briefing.

Of the 15,600 requests for medical evacuations, only 5,130 have been approved, “leaving thousands of Gazans stranded without essential care”, she added.

“Twelve months of conflict in Gaza has resulted in 6% of the entire population killed or injured. Many of the injured are women and children who now face lifelong disabilities,” Balkhy said.

“Ninety percent of Gaza’s population is displaced and living in overcrowded shelters with limited access to food, water, or health care. And they are repeatedly on the move, with further evacuation orders issued over the past few days,” she added.

Describing health service delivery under such circumstances as “daunting”, Balkhy paid tribute to the health workers of Gaza “who continue to work heroically under unimaginable conditions”.

Almost 1000 health workers have been killed in the year-long conflict, according to the Gaza Health Ministry, while 289 United Nations staff  have also lost their lives in “one of the most dangerous places in which the UN and partners operate”, said Balkhy.

“For the past 12 months, WHO and its partners have repeatedly called for an end to the conflict in Gaza. However, the situation continues to escalate in the occupied Palestinian territory and across the region,” she added.

She also expressed “extreme concern” about the escalation of violence in Lebanon, with “almost 12,000 people killed or injured, and more than 540,000 people internally displaced”.

The WHO EMRO, one of the most conflict-ridden regions of the world where an estimated one in six people need humanitarian assistance, holds its annual regional committee meeting next week.

Image Credits: WHO.

A WHO official providing nutrition support to internally displaced children in Gedaref state, Sudan.

Over half of Sudan’s citizens face acute hunger and three-quarters of a million are in danger of starving to death – the official definition of famine – yet international assistance has been slow and inadequate.

Conflict has killed approximately 30,000 people and forced over a fifth of the population of 50 million to leave their homes, most in the past 15 months since fighting began between the Sudanese Armed Forces (SAF) and the paramilitary Rapid Support Forces (RSF).

The warring factions, previously allies in a successful coup in 2021, have used heavy artillery on each other, destroying  infrastructure, including health facilities and homes.

The RSF, which evolved from the Arab Janjaweed militia, has also been accused of “ethnic cleansing” of non-Arab groups, particularly the Massalit in West Darfur.

“Targeting the Massalit people and other non-Arab communities by committing serious violations against them with the apparent objective of at least having them permanently leave the region constitutes ethnic cleansing,” Human Rights Watch noted back in May, reporting widespread killing and raping of civilians.

Others including the United Nations Special Adviser on the Prevention of Genocide, Alice Wairimu Nderitu, have warned that RSF may be involved in genocide.

“The global inaction in the face of atrocities of this magnitude is inexcusable,” said HRW executive director Tirana Hassan.

Famine in Darfur 

A malnourished child in one of the few remaining functional health facilities in Sudan.

The UN Office for the Coordination of Humanitarian Affairs (OCHA) reported last week that nutrition surveys carried out in all 18 states indicate “an alarming deterioration of the nutrition situation”.

The surveys recorded global acute malnutrition (GAM) of 30% and over – the famine threshold – in Al Lait, At Tawisha and Um Kadadah in North Darfur.

Over 80% of the surveys recorded a GAM prevalence of 15% and above, which is higher than the World Health Organization (WHO) emergency threshold. 

However, Sudanese military leaders have denied that there is a famine, which could trigger a UN Security Council resolution empowering agencies to deliver relief across borders, according to the BBC.

Meanwhile, Medecins sans Frontieres (MSF) warned that thousands of children could die of malnutrition in ZamZam camp for displaced people in North Darfur last month, and the independent Famine Review Committee confirmed that famine was “plausible” in the camp back in July.

Most supply roads to the camp are controlled by the RSF who have made it “all but impossible to bring therapeutic food, medicines, and essential supplies” into the El Fasher area since May, according to MSF.

“The malnutrition rates found during the screening are massive and likely some of the worst in the world currently,” says MSF’s Claudine Mayer. “It’s even more terrifying as we know from experience the results are often underestimated in the area when we use only the mid-upper arm circumference criteria, like we did here, instead of combining it with measuring [children’s] weight and height.”

Residents of the camp, which shelters about 500,000 people, held a protest on 30 September demanding that the RSF allow aid to reach the camp, reporting dire shortages of food, water and medicine, according to the Sudan Tribune.

OCHA warned that the nutrition situation is “expected to deteriorate further in 2025 due to ongoing conflict, food insecurity, compromised health, water, sanitation and hygiene (WASH) services, displacement, access constraints and disease outbreaks”.

Floods, cholera and malaria

In September, calamitous floods damaged more infrastructure and homes, exacerbating cholera, malaria and dengue fever and displacing even more people.

“Since the current [cholera] outbreak began in July 2024, over 18,000 cases of cholera and approximately 550 deaths have been reported in 10 states across the country,” according to UNICEF, which delivered 1.4 million doses of oral cholera vaccines to Sudan last week.

Vaccinations will be offered to people living in the hardest-hit states of Gedaref, Kassala and River Nile.

A UN humanitarian relief worker walks through the remains of a house destroyed by recent floods.

Save the Children’s interim country director, Mohamed Abdiladif, said that most of the child cholera deaths “are from other complications due to weakened immune systems due to malnutrition”.

“For children, the collapsing healthcare system is not only depriving them of emergency medical care, but also disrupting their access to essential routine services, including lifesaving vaccinations for children under five and maternity care for pregnant mothers. Cases of cholera, measles and dengue fever have risen exponentially in recent months, and now hundreds of people are losing their lives to entirely preventable causes,” he added.

Earlier in the week, UNICEF also delivered some 190,000 doses of malaria vaccines to help protect children from malaria.

“Ongoing disease outbreaks are pushing Sudan’s already fragile healthcare system to a breaking point and exacerbating weaknesses in the sanitation and hygiene infrastructure,” according to UNICEF.

“Limited access to safe water and adequate sanitation, especially in overcrowded displacement sites and camps increases the risk of transmission. Children who have never been vaccinated and those suffering from malnutrition are particularly at risk.”

WHO estimates that 70-80% of health facilities are either closed or barely operational in areas worst affected by conflict, such as Al Jazirah, Kordofan, Darfur and Khartoum, while about 45% of health facilities in other parts of the country are similarly affected.

Muted international support

US-backed peace talks held in Geneva in August were boycotted by SAF leader Abdel Fattah al-Burhan.

However, a group of mediators calling itself the “Aligned for Advancing Lifesaving and Peace in Sudan (ALPS) Group”, representing Saudi Arabia, Egypt and the United Arab Emirates (UAE), is negotiating for humanitarian aid.

But a Ministerial meeting convened by Germany, France and the US last month on the sidelines of the United Nations General Assembly in New York, failed to come up with any tangible aid plan for Sudan. 

“Participants expressed deep concern about the catastrophic and still rapidly deteriorating situation in Sudan,” according to a joint statement of participants issued after the meeting 

The meeting was attended by representatives of the UN, Germany, France, US, EU, African Union, the Intergovernmental Authority on Development (IGAD) in Eastern Africa, the League of Arab States, UK, Ethiopia, Uganda, Egypt, Saudi Arabia, UAE, Norway, Switzerland and Türkiye. 

Participants called on the warring parties to “immediately re-engage in negotiations, cease hostilities and finally end the war”. 

They also called on them to commit, as a first step, to “localised humanitarian pauses and ensure immediate humanitarian access to El Fasher, Sennar and Khartoum so that civilians are protected and humanitarian operations can reach those in most dire need of lifesaving assistance”.

They also appealed to “all foreign actors” to refrain from “providing military support to the warring parties and to focus their efforts towards building the conditions for a negotiated resolution of the conflict”. SAF has accused the UAE of arming the RSF (denied by UAE), while it may be getting arms from Iran.

While the statement also noted that the international community “should be prepared to explore options to support the implementation and durability of any future local or nationwide cessation of hostilities”, it did not propose any concrete actions.

Meanwhile, UN agencies report being woefully under-resourced to support the Sudanese people. Humanitarian organisations have requested $2.7 billion in aid, yet received less than half this, according to WHO Director General Dr Tedros Adhanom Ghebreyesus.

Tedros visited Sudan in mid-September ande descried seeing children “wasted to skin and bone” while their mothers pleaded for food.

Image Credits: @UNHCR, WHO, BBC, UN Office for the Coordination of Humanitarian Affairs (OCHA).

From left: Corine Karema and Francine Ntoumi
From left: Corine Karema and Francine Ntoumi

Three African countries—Algeria, Cabo Verde, and Mauritius—have successfully eliminated malaria, but dozens more still face this deadly disease. Globally, only 44 countries have eradicated malaria.

The question of whether the rest of Africa catch up was explored in the latest Global Health Matters podcast, hosted by Dr. Garry Aslanyan.

To delve into this issue, Aslanyan spoke with two pioneers in the field: Francine Ntoumi, founder and executive director of the Congolese Foundation for Medical Research in the Republic of the Congo, and Corine Karema, director of Malaria, NTDs, and Global Health at Quality and Equity Health Care in Rwanda.

“I believe that with the few African countries that have eliminated malaria and the tools we currently have, it is possible for Africa to eliminate malaria,” said Karema. “But we need to be serious. We need to boost and accelerate our efforts in malaria elimination.”

So, what’s preventing its eradication? The experts identified four key challenges:

  • Research
  • Community engagement
  • Finances
  • Biological challenges, like drug resistance

“The major gap, we say, is the financial gap,” said Ntoumi. “To have our government putting more funds in for fighting malaria.”

Explained Karema: “With the anti-malarial drugs we are currently using, we’re already seeing partial resistance in four countries—Rwanda, Uganda, Tanzania, and Ethiopia—to the only effective treatments we have.”

Another significant challenge is climate change, as environmental factors will affect the mosquito, the vector of malaria, and subsequently impact both humans and animals.

Both experts advocated for a One Health approach to eradicating malaria, which involves bringing together experts from various disciplines.

“The environmental component has not been fully considered in our investigations,” said Ntoumi. “So, that is an opportunity to do better.”

The discussion also addressed the malaria vaccine, which has made headlines in public health circles for its potential to save lives, particularly children’s lives. However, the results so far have been limited, returning to one of the core challenges: research.

“We hear many promises to reduce the malaria burden, but so far, the results with these two vaccines—R21 and RTS, which are pre-qualified by the WHO and recommended for use in seasonal and high-transmission areas—are still limited,” Ntoumi explained. “The data is promising, but there’s more to be done. Additionally, the limited availability of vaccine doses remains a problem. Perhaps this will change, but cost is also a concern. We need financial support to gather local data to improve vaccine implementation. If we don’t have enough doses, who gets them? We need more research to guide our advice to stakeholders.”

Karema emphasised that it took over 50 years to develop the vaccine and 20 years to create anti-malaria combination therapies. She added, “Just imagine if research prioritised malaria.”

For now, she concluded, there is no “silver bullet” except for “data, data, data” to guide policies and interventions toward eradication.

Listen to the Global Health Matters podcast on Health Policy Watch.

Visit the podcast website.

Image Credits: Screenshot.

Abbott’s Alinity m MPXV assay

The first mpox test that enables health facilities to test people and get results onsite has been given Emergency Use List (EUL) approval by the World Health Organization (WHO).

Abbott’s Alinity m MPXV assay is a polymerase chain reaction (PCR) test that can give an mpox diagnosis within around two hours from a swab of a patient’s lesion.

Until now, African countries affected by mpox have had to send samples away to laboratories, often waiting days for the results.

Although a suspected 34,297 mpox cases have been identified in 16 African countries since the beginning of the year, a mere 6,806 have been confirmed by a laboratory test.

In addition, the positivity rate of tests has been under 50% (47% average) – particularly in the Democratic Republic of Congo (DRC) where the majority of cases have been identified. Only 37% of suspected cases in the DRC have been tested this year.

Dr Jean Kaseya, Director-General of the Africa Centres for Disease Control and Prevention, has pointed to numerous problems with testing including that specimens have not been collected properly, been compromised during transportation or have been processed by people without the necessary experience.

The WHO described its EUL as “pivotal in expanding diagnostic capacity in countries facing mpox outbreaks, where the need for quick and accurate testing has risen sharply”. 

“Early diagnosis of mpox enables timely treatment and care, and control of the virus,” it stressed.

Dr Yukiko Nakatani, WHO Assistant Director-General for Access to Medicines and Health Products, described the listing of the first mpox diagnostic test as a “significant milestone in expanding testing availability in affected countries”.

“Increasing access to quality-assured medical products is central to our efforts in assisting countries to contain the spread of the virus and protect their people, especially in underserved regions.”

The WHO is considering the EUL of three other mpox tests from Cepheid, Roche and CerTest Biotec after calling on mpox IVDs manufacturers to submit an expression of interest for EUL on 28 August.

The Alinity test can detect both clade I and clade II of the mpox virus. However, it needs to be administered by “trained clinical laboratory personnel who are proficient in PCR techniques and IVD procedures”, according to WHO.

The EUL process accelerates the availability of life-saving medical products in a Public Health Emergency of International Concern (PHEIC). 

“The EUL for Alinity m MPXV assay, allowing for its use, will remain valid as long as the PHEIC, justifying the emergency use of mpox in vitro diagnostics, is in effect,” said the WHO.

Rwandan Health Minister Dr Sabin Nsanzimana

The first two people with Marburg also had malaria, which slowed down their diagnosis, Rwandan Health Minister Dr Sabin Nsanzimana told a media briefing on Thursday hosted by the Africa Centres for Disease Control and Prevention (Africa CDC).

This follows the revelation that the suspected index case died on 8 September, according to Dr Brian Chirombo, the World Health Organization’s (WHO) Rwanda representative, speaking at a global WHO briefing held at the same time. 

However, Nsanzimana stressed that Marburg was only confirmed on 26 September.

“The hospital that was attending to the first suspected cases raised the alarm, saying we’re seeing patients, two cases, that are not responding to usual [malaria] treatment. The symptoms for Marburg are very similar to those of  malaria,” said Nsanzimana.

“Its high fever, a severe headache, muscle pain and joint pain and fatigue, and later on, gastrointestinal [pain], nausea, vomiting.  For malaria-endemic countries, these are well known symptoms for malaria.”

As the first case was becoming very sick, Rwanda’s Biomedical Centre, the National Public Health Institute and National Reference Laboratory were called in to investigate and take samples. After running a multitude of tests, they eventually diagnosed Marburg last Thursday.

The outbreak, now comprising 36 confirmed cases, stems from a single cluster in Kigali. This is centred on the two hospitals that treated the earliest suspected cases – the University Teaching Hospital of Kigali (known as CHUK) and the King Faisal Hospital. 

All cases reported in other districts first had contact either with the index case or the health workers who treated him in the capital city before travelling elsewhere. However, the minister added that an Africa CDC map (below) of affected districts was slightly misleading as included districts with case contacts as well as cases.

Marburg outbreak, mapping both cases and location of contacts.

Nsanzimana confirmed that one case has been confirmed in the district alongside the Democratic Republic of Congo (DRC), but as the incubation period for Marburg is up to 21 days, more cases could emerge in the coming days.

Some 80% of Marburg cases are health workers, while new cases steam from their “very close contacts”, said Nsanzimana. Eleven people have died so far.

‘No travel ban’

Meanwhile, in the absence of a Marburg diagnosis, widow of the earliest known case travelled to Belgium. However, she did not have symptoms, had since tested negative and completed 21 days’ quarantine under the guidance of Belgian authorities.

A young German medical student who had been an intern in own of the hospitals had also returned to Germany, but had also tested negative for the virus.

However, the health minister said said his country would be tightening controls at airports. None of the contacts of cases would be allowed to leave the country until they had completed the 21-day quarantine. Thermal cameras were already in use at the siport to screen for people with high temperatures.

Earlier, the Rwandan government suspended visits to hospital patients and boarding school students.

However, Africa CDC Director General Dr Jean Kaseya was emphatic that “there is no travel ban policy”. He reported being inundated by people asking whether they should continue to travel to Rwanda.

“We are flying to Rwanda. I will be in Rwanda, attending meetings. It’s an outbreak that is managed and, as we have outbreaks in all other countries, there is no travel ban. And I repeat it: travellers should not cancel their trips to Rwanda,” said Kaseya.

Pipeline for Marburg vaccines and therapeutics

Dr Ana Maria Restrepo, WHO Co-Lead of R&D Blueprint for epidemics, said that while there were candidate vaccines and therapeutics for Marburg, “they don’t yet have the clinical efficacy data that will allow our colleagues in the regulatory team to proceed with emergency use listing”.

“WHO has been working with a consortium of over 180 researchers and developers from all around the world, and we hope that we all continue to work collectively and together to support the government Rwanda, to seek the opportunity to evaluate these candidates and therapeutics using a state of the art randomized trials,” Restrepo told the WHO press briefing.

In the absence of any approved treatment, Gilead has donated around 5000 doses of its anti-viral medication, remdesivir, which is being given to patients, said Kaseya.

Mpox continues to surge

Mpox cases, 2 October 2024

While mpox has been upstaged by the more deadly Marburg, there continues to be a steady uptick in cases – around 2,500 every week – said Kaseya.

Currently, there are 34,297 suspected cases but the confirmed cases remain a very low due 6,806 due to a myriad of logistical problems. Ghana this week became the 16th African country to confirm an mpox case.

Kaseya also reported that cases in DRC capital of Kinshasa had surged in late September, coinciding with the reopening of schools. Some 46% of all mpox cases are in children.

Trials would soon begin to test the efficacy of a new therapeutic drug, Brincidofovir, while another trial testing the efficacy of “fractional doses” of the current Bavarian Nordic MVA-BN vaccine is also imminent. If successful, this could massively reduce the need for vaccines, which are in short supply.

Meanwhile, the WHO’s director of regulation and pre-qualification, Dr Rogerio Gaspar, reported that the global body was on the brink of authorising Bavarian Nordic’s MVA-BN vaccine for children aged 12 to 17, and was still engaged with the Japanese producer of the vaccine LC16, which has emergency use listing.