Ugandan dairy farmer Tonny Kidega takes a keen interest in preventing antimicrobial resistance (AMR) in his country.

Dairy farmer Tonny Kidega is passionate about his cattle and his country’s health systems – and has been championing the importance of limiting the use of antibiotics to curb the development of drug-resistant “superbugs” and antimicrobial resistance (AMR).

Based in the Gulu district in northern Uganda, Kidega is a veterinarian and the Managing Director of the Gulu Uganda Country Dairy Limited.

He is also a firm supporter of Uganda’s new national action plan to eliminate the use of unnecessary antibiotics in livestock farming, which is the main driver of drug resistance – which could mean that common antibiotic medicines will no longer work on humans or animals.

“If I am reckless and I do not follow the procedures within my milk production value chain, and it gets antimicrobial residues, AMR will continue in the system,” said Kidega.

The Ugandan government is one of 10 countries in sub-Saharan Africa that is rolling out a national action plan to combat AMR, with support from the USAID-funded Medicines, Technologies and Pharmaceutical Services initiative   

The initiative, led by the US-based Management Sciences for Health, aims to help low-income countries to improve the prevention, detection and control of infectious agents; optimise the use of antimicrobial medicines; and generate knowledge, surveillance and  research about AMR resistance. 

“This is focused on the one health approach and under the same thematic areas of creating public awareness, training, and education; infection prevention and control; building antimicrobial stewardship as well as research and development,” says Reuben Kiggundu, who works with the Medicines, Technologies and Pharmaceutical Services (MTaPS) program. 

“If we worked in these strategic areas and with a one health approach we would to some extent control AMR.” 

Driving Change Through Education and Safe Practices

Employees at Tony Kidega’s dairy farm have been trained on safe AMR practices.

The World Health Organization (WHO) has declared AMR one of the top 10 global public health threats facing humanity. It is estimated that by 2050, AMR will kill more people globally than all NCDs combined. A 2014 review on Antimicrobial Resistance: Tackling a crisis for the health and wealth of nations estimates that by 2050, 10 million people will die every year due to AMR unless a global response to the problem is mounted.

If no action is urgently taken, the cost of treatment for infections will be more than double, hospitalised patients will spend more days in wards, food security will be threatened and there will be more deaths, warned Dr Freddy Eric Kitutu, a lecturer at the School of Health Sciences and a leader of the Sustainable Pharmaceutical Systems Unit, Makerere University. 

Importantly, the  UN Sustainable Development Goals (SDGs) on ending hunger and availability of sustainable management of water and sanitation will not be achieved by 2030, said Kitutu.

As one of Uganda’s farmers who is participating in the new project, Kidega has adopted a series of best practices on his farm to reduce reckless use of antibiotics and other anti-microbial agents in his herds – beginning with the choice of that animals he that buys to the management of the farm and decisions about how products get to markets.

“For a farmer like me it pays off, and for a consumer of my products there is consistency in what they buy which boosts consumer confidence,” said Kidega. “People buy the story behind the product. So we have to create a story behind the product to win over customers.”

At his 40-acre farm, Kidega records his livestock’s journey and only buys cattle that are the right breed with traceable disease and treatment history and movement. 

“The animal should be vaccinated, have a clear record from the diseases it was treated for and it should be the right breed,” he says. 

He stays away from foreign breeds that have not been acclimatized to the local environment and sticks mostly to crossbreeds.

“There are many farmers who fall for buying foreign breeds that cannot withstand local diseases, and then these livestock often fall sick requiring treatment using antibiotics – which promotes AMR,” said Kidega.

The animals that he buys must have a movement permit that traces the journeys they have made and their host farm has to implement biosecurity practices, including disinfecting all the people who enter it. A fence for animal confinement as well as an isolation centre where sick animals are removed from the herd and treated are also a must.

“We have been advocating for people to sanitise before entry to the farm, and now with COVID-19, it is easier to enforce,” said Kidega, who hopes that farmers will continue to enforce these practices beyond the pandemic to prevent the infections that could spread to his herds – including from workers and visitors

Uganda’s AMR Action Plan 

A 2014 review on Antimicrobial Resistance: Tackling a crisis for the health and wealth of nations estimates that by 2050, 10 million people will die every year due to AMR unless a global response to the problem is mounted.

While Uganda’s national plan is being rolled out by government authorities in the Ministry of Health and Agriculture, it also needs the support of consumers and industry.  

Kiggundu explains that the “One Health” approach is essential because drug-resistant pathogens have the potential to cross between animals and humans, as well as spreading in local environments and beyond, across international borders – which makes AMR a global health security issue.

The MTaPS program in Uganda is thus a multi-sectoral initiative: “From this platform, we go out to the agricultural sector and the human sector and respond to some of their needs that contribute to their unique needs focusing on infection prevention and control and antimicrobial stewardship,” says Kiggundu.

Data Collection and Surveillance is Key to Addressing AMR

One of the ways in which governments can help to drive the change is through providing data which is done through research and surveillance, said Kiggundu. Already, medicines therapeutic committees have been set up in hospitals to provide data and ensure the correct use of antibiotics.

The Ministry of Agriculture, supported by MTaPS, has also published the essential medicine list for treatment – which shows the medicines that should be used to treat different animals as well as standard guides for treatment, importation, and procurement. 

The guidelines on the use of antibiotics in the animal sector spells out drug use for poultry, pigs, fish, cattle, sheep and goats.

“Having such standards puts a foundation in place for surveillance, intervention and management,” says Kiggundu. “The idea is that you will improve biosafety and biosecurity on the farm, making sure you prevent infection in the first place. When you get infections, you are then able to use antibiotics appropriately.” 

But there are still challenges, especially given that most of the agricultural service delivery is in the private sector while health delivery services are mostly in the public sector.

“We have a lot of data to show that antibiotics are no longer working very well. Resistance has been reported to all known antibiotics and in Uganda and the problem is perpetuated by a lot of misuse of antibiotics and poor infection and prevention control,” said Kiggundu.

“Given, the indiscriminate use of antimicrobial agents in livestock farming in this country, AMR attributable to the practice is most likely much bigger than we can imagine,” said Jackson K Mukonzo, a lecturer at the Department of Pharmacology and Therapeutics at Makerere University.  

“As a country, we have not even been able to quantify or monitor AMR attributable to the use of antimicrobial agents in livestock even if there are scientific ways it can be done,” added Mukonzo. 

But not knowing the extent of the problem does not make it go away. Uganda is now looking at creating awareness about AMR

“AMR is a very serious problem that we do not see until it happens. We need to create awareness. My action or inaction affects everybody – it affects us collectively,” says Kitutu.

“It is everyone’s responsibility to keep these medicines as effective as possible,” said Kiggundu, who wants to create a movement in Uganda in which everyone understands that stewardship of antibiotics is everyone’s responsibility. 

Kidega said very few trained veterinarians know about AMR and this needs to change: “The people pushing for it are mostly international bodies,” he said. “I am trying to put into practice everything I know about the prevention of AMR. The advantages outweigh the effort and everyone should play a part.” 

Image Credits: Tony Kidega.

A lay counsellor on the Friendship Bench in Zimbabwe

Some community-based mental health services can outperform traditional services – and are cheaper, and often more rights-based – according to a new guidance released this week by the World Health Organization (WHO).

The guidance provides two-dozen peer-reviewed examples of outstanding community-based mental health projects – including the Friendship Bench in Zimbabwe, Atmiyata in India, and a survivors’ group in Kenya.

Using “person-centered” and “rights-based approaches” to care yielded outcomes that were far better in terms of reducing people’s dependence on psychiatric drugs and easing their full reintegration into communities, the study found. 

In addition, the trained peer- and lay-workers and day community centers are also cost-effective in comparison to expensive hospitalizations. 

Stories of Success Featured at Launch Event    

Stories from Kenya, India, the United Kingdom and elsewhere were among the case studies featured in the report – and shared in a global launch attended by over 4,000 people.  

Speakers at the event, including Dr Michelle Funk, development lead of the guidance, and WHO Assistant Director-General Dr Ren Minghui, who underlined how mental health care and service delivery demands profound change in the face of poor-quality care and human rights violations. 

“Our hope is that the WHO guidance will bring urgency to policymakers around the globe to invest in community-based mental health services and give hope to better lives for the millions of people with mental health conditions and their families worldwide,” said Minghui.  

The report provides real-world examples of good practices in mental health services in diverse contexts worldwide and describes how services need to be linked to housing, education, employment and social protection sectors.  

The report will also be used to support countries in their effort to align mental health care and service delivery with international human rights standards, such as the Convention on the Rights of Persons with Disabilities (CRPD). 

India: Volunteers Have Experience With Mental Health Problems

Dr Soumitra Pathare, Director, Centre for Mental Health Law and Policy, Indian Law Society, India

Many volunteers of the India-based Atmiyata community volunteer service were motivated to join the program as a result of their own experiences with distress, promoting and championing community inclusion. 

“People who will bring about the change are going to be people with lived experience of mental health,” said Dr Soumitra Pathare, Director of the Centre for Mental Health Law and Policy at the Indian Law Society, who works with Atmiyata.

Atmiyata identifies and supports people experiencing distress in rural communities of the Gujarat state in western India.

Volunteers raise awareness in the community about mental health issues, identify people experiencing distress and provide up to six sessions of counselling. They also refer people who may have severe mental health conditions to the public mental health service and to support people in need with access to social care benefits.

In addition, Pathare emphasized that the change in mental health service will not come from technology, but from people, making it important that these programs utilize the voice of affected communities: “We need to tap into the social capital that exists in our communities.” 

Kenya: Peer-support Restoring Power, Voice and Choice

Michael Njenga, CEO of Users and Survivors of Psychiatry, Kenya

The Users and Survivors of Psychiatry in Kenya (USP-K) promotes and advocates for the rights of persons with psychosocial disabilities through peer support groups for its members and training on self-advocacy and human rights. 

“[The value of peer-support groups] has been about restoring power, voice, and choice to persons with psychosocial disabilities,” said USP-K CEO Michael Njenga.

“Peer support is built on the premise of recovery and recovery in itself recognizes and acknowledges a person’s abilities and doesn’t focus so much on the disability,” added Charlene Sunkel, Founder and CEO of Global Mental Health Peer Network.

The group supports people to become autonomous in their decision-making and day-to-day lives by helping people think through and make decisions about their employment situation, living arrangements and health care and treatment. 

Members of USP-K have been trained on the Convention on the Rights of Persons with Disabilities and the Sustainable Development Goals, which have been the bedrock of the program, said Njenga, adding that USP-K has also been exploring alternative ways of addressing distress beyond the biomedical model. 

“This has been important in shaping the narrative towards meaningful inclusion of peer-support groups in different areas of their lives – access to government opportunities, both mainstream and disability-specific, and participation in policy and legislative reforms.” 

At the core of this, said Njenga, is the organization’s effort to support economic empowerment programs, access to social protection programs, and strengthening of support systems, which is an important aspect of living independently and being included in the community. 

“This has brought an important shift of seeing inclusion beyond the lens of mental health.” 

Zimbabwe: Problem-Solving Through Peer-Support and Community Inclusion

Zimbabwe’s Friendship Bench, derived from a Shona term which means, “bench to sit on to exchange ideas,” provides short-term problem-solving therapy for people with common mental health conditions. 

Given the scarcity of mental health services in Zimbabwe, the Friendship Bench fills an important gap and need for community mental health service provision.  

The service is delivered by lay health workers – mostly older women, who are seen as important guardians of the community and are therefore respected. 

Friendship Bench clients also can join a peer-support group, Holding Hands Together, where people can share experiences in a safe space. 

Such support groups bring people with lived experience together in a sense of solidarity, as participants support each other and create opportunities for joint problem-solving.  

Addressing Poverty, Education, Housing and Employment are Key to Mental Health 

Panelists also advocated for significant changes in the social sector, such as access to education, employment, housing, and social benefits for people with mental health conditions and psychosocial disabilities. 

“Social determinants are equally as important in mental health outcomes,” said Executive Director of Nigeria-based She Writes Woman Hauwa Ojeifo. 

Added Dr Soumitra Pathare, “Poverty and mental health go together. You cannot address mental health without addressing the issue of poverty. 

Many services featured in the guidance do attempt to address the social determinants of health. For instance, KeyRing Networks in the United Kingdom provides time-limited independent but supported living arrangements for people experiencing mental health conditions. 

Housing is either rented from local authorities or housing associations or owned by members. Each network ensures that KeyRing members take control and responsibility for their lives by living in a place of their own and contributing and being connected to their local community.

Bringing Human Rights to Mental Health During the COVID-19 Pandemic 

Panelists highlighted the importance of the guidance as the COVID-19 pandemic has had a serious detrimental impact on mental health. 

“The WHO guidance comes at the right time, in a moment when we are witnessing the devastating impact of the pandemic on the mental health of our communities and in particular, populations at risk,” said Costa Rican UN Ambassador Catalina Devandas.

Gerard Quinn, the UN Special Rapporteur on the Rights of Persons with Disabilities, said:  “The question we now ask is not what limits are placed on rights and how they can be policed. The question we now ask is how we can give life to rights.” 

 

 

Administering aspirin to critically ill COVID-19 patients does not boost their odds of surviving the virus, results from a major trial studying the commonly used painkiller and blood thinner showed this week.

In the RECOVERY study, University of Oxford scientists hoped that aspirin would work because it cuts the risk of blood clots — a common and deadly complication of the virus. COVID-19 patients are at a higher risk of blood clots forming in their blood vessels, particularly in the lungs.

Joint chief investigator Martin Landray, professor of medicine and epidemiology at the Nuffield Department of Population Health at the University of Oxford, said that there has been a strong suggestion that blood clotting may be responsible for deteriorating lung function and death in patients with severe COVID-19.

“Aspirin is inexpensive and widely used in other diseases to reduce the risk of blood clots so it is disappointing that it did not have a major impact for these patients.

“This is why large randomised trials are so important – to establish which treatments work and which do not.”

The trial –  which is looking into a range of potential treatments for hospitalised COVID-19 patients –  monitored 15,000 patients infected with coronavirus across 176 hospital sites. 

‘No Evidence’ of Reduced Deaths

A total of 7,351 patients were given one 150mg aspirin tablet each day between November 2020 and March 2021. The trial also monitored a control group of 7,541 participants hospitalised with COVID-19 who were not given the drug.

The researchers found ‘no evidence’ that aspirin reduced death, as 17% of people died in both groups and there was no obvious reduction in the aspirin group.

But the study did find that the patients who were given aspirin had a slightly shorter hospital stay – eight days versus nine days – and a higher proportion were discharged from hospital alive within 28 days (75% vs 74%).

“The data show that in patients hospitalised with Covid-19, aspirin was not associated with reductions in 28-day mortality or in the risk of progressing to invasive mechanical ventilation or death,” said Peter Horby, professor of emerging infectious diseases in the Nuffield Department of Medicine, and the other joint chief investigator.

“Although aspirin was associated with a small increase in the likelihood of being discharged alive this does not seem to be sufficient to justify its widespread use for patients hospitalised with Covid-19.”

The RECOVERY trial is ongoing and continually trying new treatments for patients with coronavirus.

The results of the study will be published shortly on medRxiv and have been submitted to a leading peer-reviewed medical journal.

 

Image Credits: University Health News .

Stéphane Dujarric, Spokesperson for the Secretary-General

UNAIDS hailed a new political roadmap to end HIV/AIDS by 2030 as a “major feat”, but admitted that its implementation would remain a challenge – along with devising ways to measure how inequalities in access to prevention and treatment are reduced for people and groups most at risk.

Addressing a UN press briefing on Thursday, following a two day high-level meeting, Winnie Byanyima, Executive Director of UNAIDS, said new plan geared towards actually ending the HIV/AIDS epidemic comes after decades in which major gains have been made, but sharp inequalities in access to treatment still exist. 

“We are at a critical moment in the AIDS response. HIV has been with us for 40 years now, ravaging communities. Since the start of the epidemic, more than 77 million people have been infected with HIV, and almost 35 million people have died,”  Byanyima said.

Despite opposition from Russia, UN Member States voted this week overwhelmingly in favour of the declaration which is a roadmap for combatting the disease over the coming years. Byanyima said the targets contained in the declaration were iprepared by UNAIDS using an “inequalities” lens.

“The [targets] are progressive, and will save lives if achieved. If all countries reach their targets, new infections will be reduced by 75% by 2025, the number of people dying from AIDS-related illnesses will be reduced by about 65%,” she said.

‘Business as usual will lead to failure’

Earlier this week, Health Policy Watch reported that the government of Russia, supported by Syria, Belarus and Nicaragua, had refused to support the consensus declaration — requesting additional changes on top of some 73 amendments in the text that had already been made to accommodate Russia’s concerns.  Those last-minute changes were ultimately rejected. 

Winnie Byanyima, the Executive Director of UNAIDS

Taking a veiled swipe at Russia’s demands to further delete or water down references to “rights”; the decriminalisation of sex work; and harm reduction in the context of the battle against HIV/AIDS, Byanyima said it was not easy to gain a global agreement from all countries with such diverse laws, policies and priorities. 

“But yet, this declaration is bold and ambitious. It pushes us further and asks us to measure the gaps that exist for certain groups of people, so that we can target them and close the gaps (inequalities) that prevent them from accessing the tools of science for prevention and for treatment. The targets are ambitious,” she said.

By 2025, the roadmap also aims to end mother-to-child transmission of HIV. Another target is to end legal and social discrimination against groups like sex workers and men that have sex with men, which ultimately fuels the HIV/AIDS epidemic by depriving them of access to vital preventive tools and treatment services. 

“We’re ensuring for the first time that less than 10% of countries have restrictive laws and policies that lead to the denial or limitation of access to services, that means decriminalization of same sex relationships. We want to bring it down to just 10%,” she added.

The declaration calls for a financial investment of $US 29 billion annually by 2025. Byanyima said: “We want to peak up to $29 billion by 2025. So I would say this is a bold and ambitious declaration.”

Building Community-led Health Responses

UN Press Briefing – Winnie Byanyima, first from left

In his remarks, Stéphane Dujarric, spokesperson for the UN Secretary General said that the significant achievements in the political declaration include a commitment to end all inequalities, which he said goes further than the Sustainable Development Goals (SDGs). 

“The 95-95-95 targets by 2025 for testing treatment and viral suppression, and a third significant achievement is that it is empowering communities in building community-led health responses,” Dujarric said.

He described this as “very profound and very significant” as it ensured human rights are woven through the declaration and said Russia and co’s failed attempt to remove some of the Human Rights references in the declaration was “resoundingly defeated”. 

“So, what we had with 165 member states voting for the final declaration was a very strong endorsement of a broad range of countries who were prepared to commit to a bold political declaration, which is a significant advance on the political declaration of 2016,” Dujarric said.

Image Credits: UN, WebTV UN.

Matshidiso Moeti, Regional Director of the WHO Regional Office for Africa

US President Joe Biden’s announcement today of some 500 million Pfizer doses to the African Union and 92 low- and middle-income countries elsewhere in the world could help begin to “turn the tide’’ on the continent’s pandemic battle, said WHO African Regional Director, Matshidiso Moeti. 

“The tide is starting to turn. We are now seeing wealthy nations beginning to turn promises into action,” Moeti said, speaking at a WHO press briefing on Thursday. “This comes as we see other countries such as France also making tangible deliveries via COVAX, Moeti said, adding,

“Vaccines have been proven to prevent cases and deaths, so countries that can, must urgently share COVID-19 vaccines. It’s do or die on dose sharing for Africa.” 

The White House announcement coincided with Biden’s arrival in the United Kingdom to attend this weekend’s G7 Summit. “This is the largest-ever purchase and donation of vaccines by a single country and a commitment by the American people to help protect people around the world from COVID-19,” said the White House statement. 

The help could come in the nick of time, as African health officials warned that countries are running out of vaccine doses to combat the COVID-19 pandemic – and the number of new COVID-19 cases remains on the rise for the third week running. 

Without more help soon, “nearly 90% of African countries are set to miss new global targets of vaccinating 10% of people against COVID19 by September, Moeti warned.

 

Less than 1% of Africans Vaccinated So Far 

Less than 1% of Africans have yet been vaccinated, and four countries are yet to commence vaccination at all, said John Nkengasong, Africa’s Center for Disease Control director, in a separate press briefing. 

So far, “35.9 million COVID-19 vaccine doses have been administered, which corresponds to 65% of the total supply available in Africa. Only 0.6% of the population has been fully vaccinated on the continent.” 

John Nkengasong, Director of the Africa CDC

Against that landscape, Biden’s announcement was being welcomed by global health leaders as a potential game changer that could also prod other high-income countries to make more generous vaccine donations. 

“Excellent news,” tweeted José Manuel Barroso, chairman of the board of Gavi, The Vaccine Alliance, which is the key co-sponsor with WHO and UNICEF of COVAX, the global vaccine facility, which has been the main clearinghouse for vaccines donated or sold at cost for use in low and middle income countries. 

The deal will see deliveries of the new US donations begin in August, with 200 million doses to be shipped in 2021, and a further 300 million doses by June 2022, said Gavi in a separate statement. 

According to the plan, the vaccine doses will be made available through the COVAX facility to member states of the African Union, as well as a few dozen other countries around the world that are eligible for donor-funded vaccines through Gavi’s procurement mechanisms. 

The 500 million dose donation is in addition to the plan to share 80 million doses of existing vaccines in US stocks, as part of a broader global vaccine sharing strategy detailed just last week by the Biden Administration.    

Missing COVID Vaccination Goals – Third Virus Wave Looms 

vaccine
COVID-19 Vaccination in Africa

Moeti, WHO African Regional Director noted that the delay in vaccine supply to Africa has led to nine out ten countries on the continent to miss their COVID-19 vaccination goal for September.

As of now, 47 out of Africa’s 54 countries will miss the September target of vaccinating 10% of their population, Moeti revealed. The goal could still be met, however, if the continent rapidly receives 225 million more doses, she added. 

According to WHO’s tally, Africa accounts for under 1% of the over 2.1 billion doses administered globally.  Only about 2% of the continent’s nearly 1.3 billion people have received one dose and only 9.4 million Africans are fully vaccinated.

 

That, as the continent faces a third wave of COVID-19 cases, with new case numbers rising for the third week running. 

While Africa’s cumulative case count hasn’t been lower than almost any other continent, officials there are nervously eyeing events in India, followed by Latin America, which have seen massive  new COVID waves recently. In India, those occurred in cities and regions that historically had not suffered from very high case rates – while in Latin America, they are recurring in countries already battered by previous waves of the virus. .   

“As we close in on 5 million cases and a third wave in Africa looms, many of our most vulnerable people remain dangerously exposed to COVID-19,” Moeti said.

Big Vaccine Inequalities within Africa Too  

Even within Africa, there is inequality in access, a brief assessment by Health Policy Watch Reveals.  A closer look at doses administered so far shows just five countries accounting for about 64% of all doses administered on the continent.

Those include Morocco, having administered 15.8 million doses, followed by Egypt (3.1 million), Nigeria (2.1 million),  Ethiopia (1.9 million), and South Africa, (1.4 million doses out of 2.4 million that it has available).  

On the other hand, Tanzania, the Saharawi Republic, Eritrea, and Burundi are yet to receive or administer any COVID-19 vaccines.

Along with the new US vaccine offers, some other fresh donations are finally beginning to trickle into some African countries, Nkkengasong said. 

“On 1 June 2021, Togo received 100,620 doses of the PfizerBioNTech vaccine from the COVAX facility making it the third country to receive such from the initiative. On 4 June 2021, Chad started vaccinating health personnel and the elderly with 400,000 doses of Sinopharm received on 3 June 2021,” he noted. 

Tackling Vaccine Wastage

Along with the plea for more donations, the health officials also acknowledged that African countries need to take more assertive action to avoid vaccine wastage and spoilage – challenges that will become even more significant as temperature sensitive Pfizer vaccines begin to be distributed. 

In April 2021, Health Policy Watch reported on the concerns that many African countries were inadequately prepared to quickly administer the doses before their expiry. 

Following that, Malawi’s incineration of nearly 20,000 expired doses called even more attention to the issue – even as WHO and African CDC officials said that the vaccines could still have been used beyond their expiration date. Other countries, such as the Democratic Republic of Congo, have pre-emptively returned unused doses to the African CDC, saying they could not use them in time. 

At today’s briefing, Moeti revealed that 14 African countries have used nearly all (80 — 100%) of the doses they received in the spring through the COVAX Facility, primarily temperature resilient AstraZeneca vaccines supplied by the Serum Institute of India. 

On the down side, however, 20 countries have used less than 50% of the doses received, while 12 countries have more than 10% of their AstraZeneca doses at risk of expiration by the end of August.

“We need to ensure that the vaccines that we have are not wasted because every dose is precious,” said Dr Moeti. “Countries that are lagging behind in their rollout need to step up vaccination efforts.”

She noted that countries like Côte d’Ivoire and Niger are seeing more success by adjusting their vaccine rollout strategies. 

“Where possible, WHO recommends spreading vaccinations beyond large cities into rural areas, prioritizing vaccines that are close to expiring, tackling logistical and financial hurdles and working to boost public demand for vaccines,” Moeti suggested.

Image Credits: Paul Adepoju.

mental health
Dr Michelle Funk of the Department of Mental Health and Substance Use, who led the development of the WHO guidance

Providing community-based mental health care that is respectful of human rights and recovery-focused has proven successful and cost-effective, according to a new report released by the World Health Organization. 

WHO’s new “Guidance on community mental health service: promoting person-centered and rights-based approaches”, released today, includes examples from countries including Brazil, India, Kenya, Myanmar, New Zealand, Norway, and the United Kingdom of community-based mental health services that have demonstrated good practices that are non-coercive, incorporate the community, and respect people’s legal capacity, or their right to make decisions about their treatment and life. 

“[These services] look more holistically at supporting people in their overall lives. [There are also] services that don’t tell people what to do but work in partnership with people, to find the best way forward for that person in their life,” Dr. Michelle Funk of the Department of Mental Health and Substance Use, who led the development of the guidance, told Health Policy Watch.  

The report reviews what is required in areas that include mental health law, policy and strategy, service delivery, financing, workforce development, and civil society in compliance with the Convention on the Rights of Persons (CRPD), adopted as the international human rights standards in 2006. 

Few Countries Meet CRPD Requirements; Majority of Mental Health Budget Towards Psychiatric Hospitals

Though an increasing number of countries have sought to reform their laws, policies, and services to mental health care, few countries have established the frameworks necessary to meet the requirements of the CRPD. 

“We see many of the services that are being provided are not helping people in the way that they want to be helped,” said Funk. 

Reports from around the world highlight severe human rights abuses and coercive practices that are still far too common for countries of all income levels. These include forced admission and forced treatment; manual, physical, and chemical restraint; unsanitary living conditions; physical and verbal abuse. 

The lack of compliance with the CRDP is “very challenging for many countries,” she added, attributing this to several reasons. 

There is still a stigma associated with mental health that leads people with psychosocial disabilities and mental health conditions to be perceived as incapable of making decisions for themselves. There is also the lack of overall investment in mental health services, with a focus instead towards institutionalization and specialized care. 

“Countries continue to invest in what they’ve been investing in.” 

According to WHO’s latest estimates, governments spend less than 2% of their budgets on mental health, with the majority of reported expenditure on mental health allocated to psychiatric hospitals. 

Good Mental Health Services Already Exist, Should Be Scaled-Up

Users and Survivors of Psychiatry in Kenya (USP-Kenya) – promotes and advocates for the rights of persons with psychosocial disabilities through peer support

Shifting the whole paradigm to community-based mental health service that respects human rights may be difficult, but there have been successful services that remain on the periphery and can demonstrate to policymakers and service providers that it is possible to achieve.

These services include crisis support, mental health services provided within general hospitals, outreach services, supported living approaches, and support provided by peer groups. 

“The services are available and functioning well in low-, middle-, and high-income countries are producing really good results. And they’re doing it at either a comparable cost or even less than the traditional mainstream services,” said Funk. 

While it is important to focus on services provided in a low-income context, she added, middle-income and high-income countries also have services that can be adapted and scaled-up by low- and middle-income countries. 

Funk emphasized the importance of learning from the principles of these services to create country-specific mental health services, whether it is a low-, middle-, or high-income country.  

Larger Investment in Mental Health Needed

During the COVID-19 pandemic there has been increased recognition of the importance of mental health

In addition to adapting and scaling up existing person-centered mental health services, there also must be a larger investment in mental health. 

Over the course of the COVID-19 pandemic, there has been increased recognition of the importance of mental health and how it is closely linked to what is happening around us and the psychosocial determinants of health.

Concluded Funk: “We cannot afford to just perpetuate the services we have already. If we’re going to have increased investment, we must change the way we invest that money in mental health – towards community mental services that respect and promote human rights.” 

Image Credits: USPKenya/Twitter, AMSA/Flickr.

Reeta Roy, President and CEO of the Mastercard Foundation

The Mastercard Foundation will spend US$ 1.3 billion over the next three years to help vaccinate 50 million Africans against COVID-19 and accelerate the continent’s economic recovery from the pandemic, one of the world’s biggest foundations has announced.

Tuesday’s announcement by the Foundation and the Africa Centres for Disease Control and Prevention(Africa CDC) comes less than a week after the World Health Organization’s Africa region called for an increase in vaccine dose sharing as it witnessed a resurgence of COVID-19 cases in southern and eastern African countries – some of which are also entering the chilly winter season now. 

It also comes amid growing global concerns over Covid-19 vaccine inequality – with WHO’s African Regional Office announcing on 3 June that only 0.54% of Africa’s 1.2 billion people have been fully vaccinated. The African Development Bank has warned that the COVID-19 pandemic could drive 39 million people into extreme poverty in 2021, and said that widespread vaccination is critical to the economic recovery of African countries.

Reeta Roy, President and CEO of the MasterCard Foundation said the Foundation’s new Saving Lives and Livelihoods initiative will also lay the groundwork for establishing more vaccine manufacturing capacity in Africa by focusing on human capacity development, and strengthening the Africa CDC.

Roy told journalists during a media briefing that the aim of the initiative is to ensure that “all lives are valued and Africa’s economic recovery is accelerated”. “Ensuring equitable access and delivery of vaccines across Africa is urgent,” she said.

Describing the new partnership as a “bold step towards establishing a New Public Health Order for Africa”, Africa CDC Director John Nkengasong said: “Ensuring inclusivity in vaccine access, and building Africa’s capacity to manufacture its own vaccines, is not just good for the continent, it’s the only sustainable path out of the pandemic and into a health-secure future.”

Africa’s Race To Economic Recovery and Vaccination Agenda

A $1.3-billion donation from the Mastercard Foundation will help vaccinate 50 million Africans over the next three years.

With billions of doses of COVID-19 vaccines administered globally, the reopening of several economies now hinge on expanded vaccine coverage to begin the journey towards economic recovery.

This is also expected to happen in Africa which however has been plagued by the dual impacts of vaccine inequality and vaccine hesitancy that could further prevent the continent from regaining the economic losses attributable to COVID-19.

For the first time in 25 years, Africa, in 2020, faced an economic recession and the African Development Bank warned that COVID-19 could reverse hard-won gains in poverty reduction over the past two decades and drive 39 million people into extreme poverty in 2021. It described widespread vaccination as critical to the economic recovery of African countries.

The Mastercard Foundation said the initiative was aligned with the African Union’s vaccination goal. While less than 2% of Africans have received at least one dose of the COVID vaccine, the AU aims to vaccinate 6 out of 10 Africans by 2022, this means reaching about 750 million Africans — roughly the continent’s entire adult population.

Strengthening Africa’s Public Health Institutions

In remarks at the launch, Paul Kagame, President of Rwanda, said the initiative will strengthen the continent’s public health institutions and help save lives.

“It is practical and immediate. Lives are going to be saved through the vaccines  that will be purchased. There is also a commitment to work directly with our public health institutions and make them strong, creative parallel systems have not been effective,” Kagame said.

The partnership, said Kagame, also puts Africa’s long-term vision to produce medicines and vaccines on the continent into consideration. “But we have to do our part with a sense of urgency and excellence,”  said Kagame, urging key players in Africa to do things differently and not “a business-as-usual” mindset.

Nkengasong said the new initiative will work in synergy with others to advance and expand vaccine access in Africa –  including the WHO co-sponsored COVAX vaccine facility and the African Union’s own COVID-19 African Vaccine Acquisition Task Team (AVATT), which has offered a continent-wide procurement and financial mechanisms for African countries purchasing their own vaccines. However, many countries have been reluctant to borrow funds to buy needed vaccine doses. 

Kagame again called on the global community to expand access to vaccines across Africa, noting that doses of vaccines available to Africa are only a small portion of the global supply. Nkengasong said the continent still needs to meet the financial costs to purchase, deliver, and administer vaccines remain significant. 

But he was confident in the continent’s ability to meet the vaccine goal which he said will be achieved with active involvement of governments, global funders, the private sector, and other key players including citizens’ acceptance of the vaccines when they become available. 

The move received wide applause from other leading African health influencers with former Liberian President Ellen Johnson Sirleaf calling it a ‘game changer’.

 

Voting on the UN High-Level Declaration on AIDS

Russia stunned the United Nations High Level Meeting on AIDS on Tuesday when it proposed a series of last-minute oral amendments to the meeting’s final political declaration – removing references to “rights”; the decriminalisation of sex work; and harm reduction in the context of the battle against HIV/AIDS.

The text of the final declaration had been negotiated over the past two months under the leadership of Australia’s Mich Fifield and Namibia’s Neville Gertze, and Gertze told the meeting that 73 changes had already been made to accommodate Russia’s concerns.

The declaration text was finally adopted, not by consensus but by a vote, after the vast majority of delegates rejected further last-minute amendments proposed by Russia at the meeting. The declaration was approved by 162 countries voting in favour and four against, with Belarus, Nicaragua and Syria siding with Russia.

However, after the vote, a number of countries that supported the declaration also made it clear that their support was qualified.  Countries including Bahrain, Egypt and Libya disassociated themselves in particular from references to “key populations” – those groups considered particularly vulnerable to HIV, including sex workers, men who have sex with men and injecting drug users.

They described such groups as being against their culture, while Russia described them as an affront to “family values”.

Meanwhile, a number of African countries including South Africa, Rwanda and Cameroon expressed disappointment that the declaration, which is meant to guide the next stages of the global campaign against HIV, had not been adopted by consensus at the High Level meeting.

Declaration ‘Does Not Measure Up’

However, the US was the most direct in its condemnation of Russia’s “new and hostile amendments” – as well as the compromises that had been made to get to the current declaration.

“The political declaration before us, put simply, does not measure up,” said the US delegate.

What started as a “strong, ambitious declaration” that was evidence- and science-based, has become a text that “lacks the ambition needed to meet the stated goals of this High-Level Meeting: ending inequalities and ending AIDS”, she said.

The main issue the US had with the declaration was how “national sovereignty” had been given prominence, enabling countries an escape from implementing various clauses because of “national context”.

“Comprehensive sexuality education, and the recognition of sexual orientation and gender identity are central to an effective HIV/ AIDS response,” stressed the US delegate.

“HIV prevention and treatment programmes that do not recognise the diversity of populations and their unique needs will not successfully stop HIV infection or ensure that all persons living with HIV AIDS have access to treatment.”

Delegates from the US, Canada and Portugal (on behalf of the European Union) also condemned Russia’s approach which scuppered weeks of sensitive negotiations.

Research findings, such as a study published just this week also underline the importance of sensitivity to sexual orientation and gender identity in the battle against HIV/AIDS. The study, led by Matthew Kavanagh, of the Global Health Policy and Politics Initiative at Georgetown University, found that countries that criminalise same-sex relationships, illicit drug use, and sex work have worse outcomes against HIV.

Kavanagh’s research found that “in countries with criminalised legal environments, a smaller portion of people living with HIV knew their HIV status and had suppressed virus compared to countries with less criminalising laws”.

Russia Opposed to Harm Reduction, ‘Key Populations’ and ‘Rights’

Russia opposed a number of clauses including harm reduction measures.

The clauses that particularly offended Russia included those related to “key populations”, harm reduction; and reference to a “rights-based” approach in combatting HIV/AIDS.

In particular, Russia had wanted to drop a clause that committed the global community to “urgent and transformative action to end the social, economic, racial and gender inequalities, restrictive and discriminatory laws, policies and practices, stigma and multiple and intersecting forms of discrimination, including based on HIV status, and human rights violations that perpetuate the global AIDS epidemic”.

In addition, Clause 28, was also viewed as unacceptable by Moscow. This expresses “deep concern about stigma, discrimination, violence, and restrictive and discriminatory laws and practices that target people living with, at risk of and affected by HIV”.

Clause 37 on countries’ lack of progress on “expanding harm reduction programmes” was also earmarked for deletion. 

Overall, Russia accused UNAIDS of abandoning it’s science-based approach in favour of a “rights-based approach” and asked that all such references to “rights-based” be removed. 

In addition, Russia sought to delete language committing countries to “eliminating HIV-related stigma and discrimination, and to respecting, protecting and fulfilling the human rights of people living with, at risk of and affected by HIV” and “reviewing and reforming restrictive legal and policy framework” that create barriers or reinforce stigma and discrimination was also unacceptable (Clause 65 A and B).

These clauses are in line with the Joint UN Programme on AIDS (UNAIDS) 2025 “10-10-10 targets”: Less than 10% of countries with punitive legal and policy environments; less than 10% of people living with HIV and key populations experiencing stigma and discrimination, and less than 10% of women, girls, people living with HIV and key populations experience gender inequality and violence.

AIDS is Not Over, Says UNAIDS Head

UNAIDS Executive Director Winnie Byanyima

UNAIDS Executive Director Winnie Byanyima, told the opening plenary: “AIDS is not over. It is one of the deadliest pandemics of modern times. Since the start of the pandemic, 77 and a half million people have been infected with HIV globally and we have lost nearly 35 million people to AIDS. An AIDS death every minute is an emergency.”

A number of countries have made good progress to eliminate new cases by 2030 – a goal set at the last UN High Level Meeting in 2016 – but the COVID-19 pandemic had undermined progress, she added.

“The evidence shows that when laws are strengthened to support gender equality, the rights of key populations and confront stigmatisation, countries have made greater progress in treatment and prevention programmes benefiting everyone,” added Byanyima. “We need to keep moving forward in our common journey away from harmful punitive, outdated, often colonial laws and from all forms of discrimination.”

Yana Panfilova, a 23-year-old woman who was born with HIV and is a member of GNP+ Global Network of People Living with HIV, also addressed the plenary.

“The AIDS response is still leaving millions behind: LGBTQ people, sex workers, people who use drugs, migrants and prisoners, teenagers, young people, women and children who also deserve an ordinary life with the same rights and dignity enjoyed the most people in this room,” said Panfilova.

“If we’re going to make a real change, these four things must become a reality. First one, comprehensive sexuality education in all schools in all countries. Second, psychological support, and peer support for every adolescent living with HIV and young key populations.

Third, the community needs HIV services to become the reality, not the exception. And the last one, finally, get an HIV vaccine.”

President of Uganda Yoweri Museveni addressing the nation

Uganda has imposed more stringent measures to control COVID-19 transmission after it recorded over 1000 new cases per day on 2 June – its highest tally ever, mostly among people aged between 20 and 39 years.

On Sunday, President Yoweri Museveni instituted a 42-day lockdown during which time all schools and institutions of higher learning will be closed. Teachers will also have to be fully vaccinated before they are accepted back to the classrooms.

Since March, Uganda’s education institutions have been a major source of COVID-19 infections with a total of 948 reported cases in 43 schools from 22 districts. 

Over 60% of cases have come from Kampala, Gulu, Masaka and Oyam districts. 

“We believe this number is much higher, only that most schools are not reporting. They are hiding because they don’t want to be closed and most of them want to get money,” said Museveni. 

The increased COVID-19 infections in schools has been attributed to poor compliance with behavioural guidelines such as mask-wearing, inadequate sanitation facilities and overcrowding.

Communal gatherings of over 20 people, including at places of worship, conferences and cultural gatherings, have also been suspended for the next 42 days.

However, the Cabinet, legislature, and the judiciary are allowed, as are small gatherings under 20 people and agriculture activities, factories, construction, shopping malls, food markets and supermarkets. But all have to close by 7pm.

Test Positivity Reaches 18%

Last Friday, the Ministry of Health’s testing results indicated 1,259 new cases out of 7,289 samples tested and nine deaths. 

Uganda’s cumulative confirmed cases are 52,935 and deaths are up to 383. Active cases on admission at health facilities are 634 and the test positivity rate has increased to 18.1%.  

“A test positivity above 10% is a cause for concern especially in a country where testing is reasonably being done,” said the World Health Organisation regional director for Africa, Dr Matshidiso Moeti. 

Museveni said this situation is beginning to stress the health facilities, with pressure of available  beds and oxygen in hospitals.

“The intensity of the illness and severity among the COVID-19 patients is higher than what we experienced in the previous phase,” said Museveni about the second wave. He encouraged people to work from home with only 30% of the staff who work in offices allowed with physical presence.  

Inter-district movement has also been suspended except for tourist vehicles and cargo trucks that have to carry only two people.

Museveni said all travelers have to undergo mandatory COVID-19 testing because some who would come into the country with purported negative PCR test results were tested positive.

To date, Uganda has confirmed a total of 126 cases from travelers coming in through Entebbe International airport out of 4,327 travelers entering the country since the pandemic started. 

 

Health Director General Henry Mwebesa

Meanwhile, the country has used 748,676 AstraZeneca vaccines out of 964,000 available, with 712,681 people having their first dose and 35,995 people having received both doses.

The country received 864,000 doses from COVAX in March and 100,000 as a donation from the Indian government.

Museveni said the government is committed to vaccinating all the 21.9 million eligible Ugandans, starting with the priority groups of 4.8 million people. 

The country is also trying to avoid wastage of COVID-19 vaccines by reassigning vaccines from low to high absorption areas. Malawi destroyed vaccines last week due to expiration.

Districts that have a below 50 percent uptake of COVID-19 vaccines in Uganda will have them withdrawn and redeployed elsewhere unless they act immediately, the Ministry of health has announced. The vaccines are due to expire by 10 July.

Vaccines to be Redeployed

Health Director General Henry Mwebesa says the withdrawn vaccines will be redeployed to the  Kampala Metropolitan Area where the infection rate and uptake are high.

“Take note that there will be penalties for those that waste vaccines or allow vaccines in their possession to expire yet these are very expensive life saving vaccines,” warned Mwebasa.

When the vaccines were delivered, the districts were given three months to vaccinate vulnerable groups including health workers, teachers, security personnel and anyone between 18 and 50 years with comorbidities.

According to some district leaders, some places have been unable to roll out vaccinations properly as they are under-staffed or newly created with inefficient management systems.

“Most of these districts have valid reasons for the low absorption. Ultimately, they have no capacity to translate policy into action,” said Alfred Driwale, the manager of the Uganda National Expanded Programme on Immunization (UNEPI) at the Ministry of Health.

Meanwhile, Museveni warned the public to either comply or face a total lockdown and fines: “Failure to observe the stated directives within a week, I will direct a total lockdown. Those who do not care for the health of Ugandans will pay financially.”

 

 

A smoke-free poster at a bus stop in Yunnan

Eight campaigns and initiatives aimed at encouraging people to quit smoking were launched this week by Vital Strategies and partners to mark World No Tobacco Day on 31 May 2021. 

Tobacco use is the single greatest source of preventable death and disease worldwide – responsible for eight million deaths each year and the theme of this year’s World No Tobacco Day was “commit to quit.” 

José Luis Castro, President and CEO of Vital Strategies

“Now is the time for bold, comprehensive action on tobacco. COVID-19’s tragic toll has fuelled vulnerabilities from decades of under-investment and inattention to prevention and preparedness, including more than a billion people more susceptible to illness because of current tobacco use,” said Jose Luis Castro, President and CEO of Vital Strategies, in a statement. 

Vital Strategies’ World No Tobacco Day campaigns support policies to discourage and reduce smoking, and to keep the industry out of tobacco control legislation, reaching millions around the world. 

India – “When You Quit” Campaign

Vital Strategies and WHO India launched the campaign, “When You Quit” on national radio stations and on digital television platforms, and disseminated a communications toolkit with social media resources to communicate the harms of tobacco use. 

Indonesia – New Smoke-Free Laws 

In Bandung, Indonesia, Mayor H Oded Muhammad Danial unveiled a new smoke-free law that prohibits smoking in seven types of public spaces. Bandung, with its smoke-free law, was part of the many cities that participated in the Partnership for Healthy Cities global network supported by Bloomberg Philanthropies in partnership with WHO and Vital Strategies.   

Philippines – Running to Quit

The Philippines Department of Health and Vital launched a virtual ‘Smoke-Free Challenge’, where participants competed in virtual distance-based activities, such as running, walking, and swimming, promoting health activities. 

China – Promotion of Smoke-Free Policies 

Vital Strategies promoted smoke-free policies in China with two public service announcements, “Cigarettes are Eating Your Baby Alive” and “Smoke-Free Family”, reaching more than one million people through an online event organized with the National Health Commission. 

Vital also worked with the Yunnan Health Education Center and Health Education Association to provide posters on the importance of smoke-free policies for 200,000 posters bulletin boards across the province. Other cities in China also launched social and mass-media campaigns. 

Ukraine – Tobacco Use and Risks From COVID-19

“A Doctor’s Warning” is a new media campaign on tobacco use and COVID-19 launched in Ukraine, in partnership with the Public Health Center of the Ministry of Health and the NGO Life Advocacy Center. The campaign featured a testimonial from a prominent doctor on how smoking increases the risk of COVID-19. 

Vietnam and Bangladesh – Protecting Loved Ones From Secondhand Smoke

In Vietnam, “Quit Smoking to Protect Your Loved Ones,” recounts the story of Le Thi Tinh, who developed lung cancer after regular exposure to secondhand smoke in her home. The campaign is run on national television channels and on the Smoke-Free Vietnam Facebook page through June.  

In Bangladesh, the government aired the public service announcement, “Smoke-Free” homes for six weeks on the state-owned television channel, Bangladesh Television. The messaging focused on the importance of quitting smoking to protect loved ones from secondhand smoke, and was supplemented by posts to the Facebook page, Stop Tobacco Bangladesh. 

Brazil – Ending Electronic Nicotine Delivery Systems 

The Brazilian Medical Association and Cancer Foundation launched a social media campaign focused on the importance of banning ENDS in Brazil and pushing back against industry efforts to overturn it. 

The Facebook live launch event of “Quit Smoking to Protect Your Loved Ones” in Vietnam

Stopping Tobacco Industry Interference in National Policy

Castro urged governments to enact policies that support healthier choices for all, especially through the use of effective tobacco control laws, such as the WHO’s Framework Convention on Tobacco Control (FCTC). 

“For our healthiest future, we must act to shape our society and our environment to support health,” he said, adding that this includes contending with persuasive marketing from the tobacco industry and the influence of the industry on government policies. 

The Global Tobacco Industry Interference Index 2020, released by STOP (Stopping Tobacco Organizations and Products), also showed that the tobacco industry has been using the pandemic to promote itself through donations of necessary goods, in order to gain a foothold in tobacco policies of national governments.  

Pakistan health authorities continue in their struggle to implement the FCTC, though the treaty was signed in 2004. In addition, tobacco control activists fear that the government has given in to industry pressure to close down its only government body addressing tobacco consumption, the Tobacco Control Cell (TCC). 

Meanwhile, the Kenyan government, earlier this year, had issued a directive requiring the tobacco industry to register all nicotine products as tobacco products. 

The Kenya Tobacco Control Alliance (KETCA) had also called on the government to act fast, as tobacco use is a bigger epidemic than COVID-19, and requested the Ministry of Health to tighten tobacco control regulations. 

“Tobacco use continues to kill at least 9,000 Kenyans every year. This is three times the total number of Kenyans killed by Covid-19 in the last one year. By Sunday, May 30, 2021, Covid-19 had killed 3,157 Kenyans,” said Joel Gitali, chairman of the KETCA.

 

 

Image Credits: Vital Strategies, Vital Strategies.