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.

Lenacapavir, packaged as Sunlenca in the US, where is sells for $42,250 for two injections.

HIV activists have hailed the announcement by Gilead on Wednesday that it has authorised six generic manufacturers to sell its breakthrough HIV treatment, lenacapavir, in 120 low- and middle-income countries. 

However, they have urged Gilead to expand the deal to include countries such as Brazil, Colombia and Mexico.

Lenacapavir is a long-acting injectable drug that has proven 100% successful in preventing HIV in women who received it twice a year, and almost 100% protective for men and gender minorities who have sex with men in clinical trials.

Results of the PURPOSE1 trial involving women were presented at the International AIDS conference in Munich in July, receiving a standing ovation.

In late September, results from the PURPOSE2 trial reported 99% success rate for the drug as pre-exposure prophylaxis (PrEP).

While lenacapavir is not yet authorised in many countries, it is licensed in the US as Sunlenca for people with drug-resistant HIV, and costs $42,250 a year for two injections.

A wide range of organisations, including UNAIDS, called on Gilead to lower costs and license generic companies to produce the injection. The company undertook to do so at a media briefing at the AIDS conference in July, 

On Wednesday, Gilead CEO Daniel O’Day announced it had signed voluntary licencing deals with the six generic companies to produce lenacapavir. Four of the companies are from India: Reddy’s Laboratories, Hetero Pharma, Emcure and Mylan (a subsidiary of Viatris). Egypt’s Eva Pharma and Pakistan’s Ferozsons Laboratories are also part of the deal.

“Given the transformative potential of lenacapavir for prevention, our focus is on making it available as quickly and broadly as possible where the need is greatest,” said O’Day.

“Gilead teams have been working with urgency to bring on high-volume generic manufacturers now, so that we can ensure a rapid transition to these voluntary licence partners after lenacapavir for PrEP is approved.”

Most of South America excluded

Activists at the International AIDS conference protesting against the high price of lenacapavir.

Public Citizen’s access to medicines director Peter Maybarduk said Gilead had “heard the call in part” from people living with HIV and allies worldwide to make lenacapavir “available for global, timely affordable supply, by licensing developing country manufacturers”.

“Its licence will help ensure access to needed treatment for many people and countries. But it leaves out others, including most of South America, where communities continue to fight against real challenges for access,” Maybarduk added.

“Gilead will continue to control who sells lenacapavir and where, through restrictive licensing terms, which will limit availability of affordable lenacapavir even where Gilead claims no patents.”

Public Citizen would have preferred Gilead to license the Medicines Patent Pool, which “would have helped Gilead reach as many people as possible through equitable access terms and brought added credibility”. 

UNAIDS applauded Gilead for licensing the generic companies – including one on the African continent – without waiting for registraion.

“Lenacapavir, which requires only two injections per year, could be game changing – if all who would benefit can access it,” noted UNAIDS.

However, it said that 41% of new HIV infections are in upper-middle income countries, so the “exclusion of many middle-income countries from the licenses is deeply worrying and undermines the potential of this scientific breakthrough”.

UNAIDS also welcomed Gilead’s statement of commitment to “non-profit pricing”, and urged the company to name a specific price.

“Respected researchers have shown it is possible to produce and sell lenacapavir for $100 per patient per year, falling to as little as $40,” it noted.

HIV advocacy organisation AVAC welcomed the speedy issuing of the licenses and the fact that the generic companies come from three different countries, but noted that “key countries with significant HIV incidence, including several of those hosting the PURPOSE 2 trials of lenacapavir” had been left out.

“This challenges the field’s ability to use this new option at the scale needed to drive down HIV incidence as quickly as possible to meet global targets,” said AVAC, noting that the price of lenacapavir is “still unknown”.

Untaid ‘prepared to invest immediately’ in generics

Meanwhile, Unitaid welcomed the announcement, adding that it is “prepared to invest immediately and collaborate to fast-track access to lenacapavir”.

Unitaid, an initiative hosted by the World Health Organization (WHO) that promotes equitable access to treatment for key global diseases, said it was ready to assist the six generic companies that have been licensed.

“This is a potentially game-changing medication that could dramatically turn the tide against HIV infections, and we must ensure, without delay, global access to lenacapavir for all those who need it,” said Dr Philippe Duneton, Unitaid’s executive director. 

Duneton urged Gilead to “expand its licensing framework to include all populations in need, clarify its plans for registration in all trial countries, and provide a clear timeline for when lenacapavir will be accessible in the countries it promises to serve”.

Brazil was one of the countries that hosted the PURPOSE trials and “cannot be excluded from licensing agreements, and registration plans,” noted Unitaid.

Unitaid, working with the Wits RHI (South Africa) and Clinton Health Access Initiative (CHAI), will soon launch an Expression of Interest for generic lenacapavir licensees to for support for “the accelerated development, regulatory filing, commercialisation, and cost-effective launch pricing for generic lenacapavir”. 

It also urged Gilead to ensure an access strategy that is “transparent, global, and equitable, prioritising those in greatest need wherever they live”. 

“There is an urgent need to understand what pricing policies would be put forward by Gilead, and whether the same populations excluded today from the possibility of acquiring lower-cost generic products in the future, will also be left with unaffordable for-profit prices.”

Story updated to include UNAIDS comment.

Image Credits: Gilead.

Thousands protest anti-LGBTQ laws in Budapest, Hungary in 2021.

UNAIDS expressed “deep concern” Wednesday over Georgia’s newly adopted anti-LGBTQ+ law, saying that it could threaten progress made over the past decade to end AIDS in the former Soviet republic of 3.7 million people at the crossroads between Europe and Asia. 

The new legislation exacerbates stigma and hinders “LGBTQ+ people’s access to essential health services” which “undermines Georgia’s efforts to end AIDS and combat other infectious diseases,” said the UN agency in a press statement. 

UNAIDS has long called out the risk such legislation poses to public health efforts to control HIV and other infectious diseases – leaving at-risk groups even more reluctant to seek out health services for fear of stigmatization and even prosecution.

The UNAIDS comments echoed a statement issued by the UN Office for the High Commissioner of Human Rights’ saying the new law will “impose discriminatory restrictions on education, public discussion, and gatherings related to sexual orientation and gender identity.”

Georgia’s new law on “family values and protection of minors”  bans Pride events and public displays, as well as censoring related films and books. 

It follows moves by several other European countries – including Hungary and Poland – to curb LGBTQ+ rights. Nearly a dozen African countries have criminalized LGBTQ+ relationships, with some instituting stiff penalties, including the death penalty or life in prison. 

Georgia’s move comes after a recent study from the European Union’s Fundamental Rights Agency, which found that 14% of people who identified as a sexual minority experienced some form of violence. 

While UNAIDS and other international organizations have decried such laws, they remain popular in socially conservative countries. A 2018 poll from the Washington DC-based National Democratic Institute suggested that only 23% of Georgians believe that protecting the rights of sexual minorities is important. Similarly, a 2022 poll suggested that only 0.99% of Georgians agree that homosexuality is “justifiable” compared to 62% of Canadians and 45% of Americans. 

Anti-LGBTQ+ legislation could “undermine” fight against infectious diseases

Georgia historically has reported low rates of HIV infections, with new infections concentrated in persons who inject drugs (PWIDs) and men who have sex with men (MSM). 

Yet its Georgia country report states that the prevalence of HIV – the number of people living with the disease – remains “alarmingly stable” at 21.5% for the MSM population, suggesting that the most at-risk groups still are not being reached. Worryingly, 36% of people living with HIV were not aware of their positive HIV status. 

Furthermore, the UNAIDS country report found that over 40% of Georgians believe that HIV positive children should attend schools with HIV negative children, noting:  “Stigma kills, but solidarity saves lives. Upholding the rights of LGBTQ+ people is crucial to advancing public health, social cohesion, and equality for all.”

Image Credits: Lydia Gall/ Human Rights Watch.

WHO Director General Dr Tedros Adhanom Ghebreyesus greets Afrigen’s Prof Petro Terblanche at the mRNA facility in South Africa

The establishment of an “mRNA hub” in South Africa to build the capacity of low- and middle-income countries (LMICs) to develop vaccines during the COVID-19 pandemic was widely hailed as a solution to Africa’s lack of manufacturing ability.

But three years after its launch in June 2021, the hub faces uncertainties, risks and shortfalls –  including that it may simply become a “technological solution” that maintains the status quo rather than a genuine transfer of knowledge and capacity to LMICs, according to a recent report

Authors Professor Matthew Herder, chair in Applied Public Health at Dalhousie University in Canada and Ximena Benavides from Yale University in the US, base their observations on interviews with 35 key players and numerous documents, some of which were obtained via an access to information request to the Canadian government.

The hub is the initiative of the World Health Organization (WHO) and the Medicines Patent Pool (MPP). Spurred by the failure of high-income countries to share their COVID-19 vaccines at a time of extreme need, the WHO and MPP selected a South African consortium comprising biopharmaceutical company Afrigen Biologics, vaccine producer Biovac and the SA Medicines and Research Council, as its partner to kickstart a facility capable of developing and producing mRNA vaccines in a LMIC. 

Once this was done, they were to teach other facilities in LMICs across the world how to do the same.

The mRNA programme currently includes the South African consortium and 14 other LMIC-based partners.

The current mRNA programme partners

Championing voluntary IP transfer

But the way in which the hub is governed and operates does not sufficiently transfer power and capacity to LMICs, the authors contend.

“The architects of the programme are working within the existing system of biopharmaceutical production and, at the same time, preserving their own control over the programme’s design and preferred measures meant to remedy shortfalls in equitable access to mRNA-based interventions,” they argue.

“In particular, MPP continues to champion voluntary [intellectual property] licensing as the optimal means to improve local production capacity in LMICs even though that mechanism did not attract collaboration from more established mRNA manufacturers in the context of COVID-19 and slowed adoption of a more transformative end-to-end approach to R&D and manufacturing.”

They also argue that the “technological outcomes” of the programme are uncertain unless there is “significant reform and concerted effort to redistribute not just IP, but agency to LMIC actors”.

Without these “there is a significant risk that the programme, which is claimed by WHO and MPP as a collective effort to improve manufacturing capacity in LMICs for LMICs, will not solve the problem of equitable access to biopharmaceutical innovation”.

‘In line with status quo’

While the mRNA programme may improve the sharing of knowledge, the authors observe, it has been developed “in line with the status quo” of global biopharmaceutical production.

This includes “weak conditionalities around product affordability, participants’ freedom to contract with third parties, and acceptance of market-based competition”, they argue.

The WHO and MPP also exert “tight control over the programme” and this “evokes the dynamics that are often in play in global health, to the detriment of empowering LMIC-based manufacturers to generate mRNA products in response to local health needs”, they argue.

For example, the MPP has created its own technology transfer unit to manage technology transfer within the mRNA programme. But typically, technology is transferred from one party with direct experience in using it, to another, through sharing hands-on know-how. 

“I’ve worked for more than 30 years in the industry. You do not have a remote group that does tech transfer. If a group is going to do tech transfer, it needs to be in the facility that’s sending the technology out,” one participant told the authors.

The hub’s donors – France, the European Commission, Germany, Norway, Belgium, Canada, South Africa and the African Union – have committed $117 million to the programme (with $89 million received so far).

But some of the high-income countries (HICs) that have invested in the mRNA programme have also made demands that have shaped the programme. Canada, for example, stipulated that its funding be allocated to the hub in Cape Town and four other countries only: Senegal, Nigeria, Kenya and Bangladesh.

“According to one interview participant, while HICs are supportive of transferring technology to LMICs, they would prefer that such transfers do not extend to the more upstream inputs into mRNA vaccine production, including novel LNPs and antigens,” the authors note.

Charles Gore (MPP), Petro Terreblanche (Afrigen), WHO’s Dr Tedros Ghebreysus,South Africa’s Health Minister Dr Joe Paahla, and Anne Tvinnereim, Norwegian Minister of International Development, at the ribbon-cutting to formally open Afrigen  on 20 April, 2023.

Contradictory legal agreements – and pricing silence

The report notes that the MPP has crafted a set of legal agreements including a technology transfer template in which LMICs are granted a “non-exclusive, royalty-free, non-sublicensable, non-transferable, irrevocable, fully paid-up, royalty-free licence” to the technology.

They also get access to any rights held by Afrigen and Biovac “to make, or have made, use, offer for sale, sell, have sold, export or import” products in their respective territories and other LMICs.

In exchange, LMICs must grant MPP a worldwide, non-exclusive, royalty-free licence to data and the inventions to “facilitate the development and equitable access of health technologies”.

Brazil’s Bio-Manguinhos has baulked at the idea that technology it has developed with  funding from the Brazilian government “would flow to manufacturers from participating LMICs, which in some cases, are for-profit commercial entities, without anything in return”, with official Patricia Neves describing this as an “injustice”.

South Africa also contested the absence of royalties, and its agreement with MPP states that any licence may include a “royalty sacrifice”.

Meanwhile, Indonesia’s BioFarma negotiated the right to sell products to HIC. 

“MPP also stopped short of requiring that resulting mRNA products be priced affordably for populations in need outside of a Public Health Emergency of International Concern (PHEIC),” the authors note.

If an mRNA product developed by an LMIC partners targets a PHEIC, they cannot charge more than the cost of production plus a 20% mark-up.

“Traditionally, MPP has not interfered in pricing. Our model is based on competition, and clearly we are potentially giving this to 15 companies around the world,” MPP executive director Charles Gore told the authors.

In response, the authors remark that the MPP “appears to be comfortable relying on free-market competition among LMIC-based manufacturers instead of imposing affordability clauses when it comes to products generated by virtue of participating in the mRNA programme”.

Moving beyond COVID

A researcher in the WHO mRNA hub at Afrigen in South Africa.

It took Prof Petro Terblanche’s Afrigen only two months to develop an mRNA vaccine for COVID-19 based largely on a Moderna “recipe” published online. It has since transferred this knowledge to facilities in countries including Bangladesh, Serbia and Brazil.

But the urgency related to COVID-19 has passed. Expanding the programme’s focus upstream is now seen as crucial to its overall sustainability given that demand for COVID-19 vaccines is limited. 

At a meeting in Bangkok in late 2023, WHO and MPP officials outlined “potential sub-consortia – engaging partners both inside and outside of the programme – focused on R&D around pathogens of shared, regional interest,” according to the authors.

Afrigen is increasingly focusing on the development of second-generation technologies important in mRNA production, such as novel lipid nanoparticles (LNPs), and new disease targets like TB, malaria and HIV.

“The critical question is whether the funding that has been secured for the programme and supporting the development of these second-generation mRNA technologies has been leveraged into a shared set of commitments geared towards improving equitable access,” the authors note.

While Afrigen targeted 11 potential diseases for mRNA product development, its proposals focusing on Lassa fever, RSV, and other disease targets have been turned down by a variety of funders.

Terblanche has conceded that her “hand will now be forced to prioritise” in favour of market rewards – particularly as the MPP expects the programme to be “self-sustaining” by 2026.

But an increasing number of “use patents” that claim IP on the use of mRNA technology are being filed in South Africa and other LMICs, and these threaten to block Afrigen and partners’ R&D plans.

Recalling that some of the companies that took part in the the influenza vaccine hub later shut down production, WHO’s Martin Friede estimates that if a handful of LMIC manufacturers manage to make mRNA vaccines, the programme will be an overall success.

Meanwhile, MPP’s Gore noted that “we are funding [Afrigen] to develop and then shift [the technology] out,” but “they don’t [yet] have a business model.”

MPP’s Marie-Paule Kieny speculates that Afrigen will, in the end, probably yield to market forces: “The hub is really there to establish a first platform and improvement, and to help with an early pipeline. After that we are fully aware that Afrigen is a private company, at one point they will try to find somebody to buy them out and to get the benefit,” she told the authors.

‘Failure of imagination’

But the authors describe the “near inevitability of Afrigen’s exit in the eyes of those who designed the programme” as an indication of the “underlying failure of imagination concerning how the mRNA programme is governed”. 

A more “inclusive and decentralised” governance structures could “shield initiatives such as the mRNA programme from the risks and constraints posed by dominant market actors”. 

This decentralized structure could involve “representatives from participating LMICs capable of steering the programme’s R&D towards local population” in the overall governance and day-to-day decision-making., they argue.

“Second, multiple actors would need to serve as regional mRNA hubs – as originally planned – in order to mitigate the risk that one organization’s failure (or acquisition by an outside actor) might compromise the programme as a whole,” they argue.

“Instead, WHO and MPP internalised programme decision-making within two hand-picked committees [the “Scientific and Technical Review Committee and the mRNA Scientific Advisory Committee], leaned on private actors like Afrigen to play crucial roles, preserved their discretion about what projects and partnerships to pursue, and limited input from LMIC governments and civil society during the programme’s first two-plus years of operation,” they note.

“It remains to be seen whether MPP, which has ascended in the sphere of global health during the pandemic as a result of its role as the central power broker for the entire mRNA programme, will over time cede some of its control and take the steps necessary to truly empower LMIC manufacturers,” they observe.

Health Policy Watch will publish an interview with the Medicines Patent Pool responding to these findings shortly.

Image Credits: WHO, WHO, Kerry Cullinan.

WHO Director-General Dr Tedros Adhanom Ghebreyesus, (left) and Dr Vanessa Kerry, CEO of the health non-profit Seed Global Health (middle) in conversation with Ravi Agrawal, editor-in-chief of Foreign Policy (right).

Specific health actions need to be included in countries’ climate targets – officially called the Nationally Determined Contributions (NDCs) – according to several health advocates speaking at the UN Climate Week in New York City over the past week.

“Our agenda should be health-centric,” said Dr Tedros Adhanom Ghebreyesus, Director General of the World Health Organization (WHO), speaking on the sidelines of the annual UN General Assembly.

“We need to use the resources wisely, meaning targeting those populations, affected populations and then from there of course you can move to the rest because resources are limited,” Tedros said.

The demand for a holistic view in framing NDCs to ensure a “healthy and stable future” in was also reiterated in a signed letter by 20 leading civil society organizations and sent to officials at the UN Framework Convention on Climate Change (UNFCC), the entity supporting global response to climate change.

The rise in extreme weather events, such as heatwaves and floods, are directly impacting health and healthcare facilities. 

Dr Vanessa Kerry, CEO of the health non-profit Seed Global Health, called for health to be “embedded in the NDCs”. 

“We need to have health metrics, and we need to stop thinking about it as a sunk cost, but rather as an investment,” Kerry said. 

Centering health at COP

This decade, health has already gone from being a side note at the annual UN Climate Conference of Parties (COP) to having a day dedicated to the subject at the last COP in Dubai, United Arab Emirates (UAE). 

Both the Baku (Azerbaijan) COP presidency, which will  host this year and the Belém (Brazil) COP presidency, which will host next year, said that they aim to integrate health into climate conversations further.  

“Brazil was hit this year with the biggest dengue epidemic for ever, and this was the very consequence of the climate change and the high temperature that we are facing in Brazil and in all of the world,” said Ethel Maciel, Brazil’s Secretary of Health Surveillance and Environment.

She added that health equity will be a major focus and that Brazil has appointed a specific coordinator to work on the link between climate change and health equity.

The speed and extent of action though rely also on resources. For instance, the UAE recognized that having the resources and universal health coverage helps as they have the building blocks for what you need to be healthy. 

“We would say, for the nationally determined contributions, please embed [and] institutionalize targets for health in there, be they things like the impact of air pollution on health, be they heat stroke, be they mental health issues, number of events prevented. Whatever they are, please institutionalize certain metrics of health inside your nationally determined contributions,” urged Prof Maha Taysir Barakat, Assistant Minister for Health and Life Sciences in the UAE Ministry of Foreign Affairs. 

Prof Maha Taysir Barakat, Assistant Minister for Health and Life Sciences in the UAE Ministry of Foreign Affairs

Dr Maria Neira, WHO’s director of Environment, Climate Change and Health, drew attention to the fact that access to renewable energy will improve health by reducing air pollution.  

“So now we need to use health as a motivation. The health argument that we are taking to the COPs has to be extremely strong, and we are the ones that needs to engage,” she said, referring to the health sector.  

Working with cities for impact

It has become clear over the years that national governments are slow to move on climate targets. In addition, when it comes to the climate and health link, a range of stakeholders are needed for effective response. 

The Baku COP Presidency has an initiative on climate resilient cities of which health will be a big part. 

Patty O’Hayer, global head of corporate affairs at Reckitt, said that city mayors need to be supported to bring out change as they have a unique perspective and don’t work in silos. 

“Cities give you that kind of umbrella way that you can look at all of those aspects and make sure that you’re spending your time, your effort, your energy around the social determinants of health, decarbonizing the health care systems and thinking about public health in a much more holistic way,” she said. 

 

 

UN High Level Meeting, presided over by heads of FAO and UNEP (far left), and WHO WOAH (right), approves new declaration to fight AMR.

A UN High Level Meeting on Antimicrobial Resistance (AMR) pledged to reduce by 10% deaths from drug resistant bacteria over the next six years in a new declaration on the “silent, slow-motion pandemic” that could kill some 39 million more people by 2050.

Thursday’s milestone statement, the first on the topic since 2016, also pledges to raise $100 million to fund the updating of countries’ AMR action plans and their implementation. 

It also formalizes the standing of the Quadripartite secretariat made up of the World Health Organization (WHO), UN Environment (UNEP), the Food and Agriculture Organization (FAO), and the World Organization of Animal Health (WOAH), as the body coordinating global AMR response across the human, animal and environmental sectors.  

 Step forward despite no target for reducing animal antibiotic use

Mia Mottley, Prime Minister Barbados, at press briefing on on AMR threat before the HLM session.

The final draft of the declaration failed to include an earlier target to reduce the animal use of antibiotics by 30% by 2030, due to pressure from meat-producing nations and the farm industry. 

This, critics say, remains a serious shortcoming in the final draft as livestock use comprises as much as 73% of global sales of a range of antimicrobial agents (including antibiotics, antivirals and antiparasitics). 

Even so, the initiative was hailed as a major step forward in spurring more action on trends that few governments have fully recognized until very recently. 

“This declaration.. is an impressive blueprint for action,” declared Barbados Prime Minister Mia Mottley, who has become a global leader and advocate on AMR. 

“But the truth is the hard work starts tomorrow,” she said. “We’ve set a very, very modest target of $100 million [for national plans of action] and I hope that we can reach out to the leaders within the private sector, the pharmaceutical industries, the meat industries, all of the various players. 

“Because, as I’ve said very often with climate, unless they have a plan to live on a different planet, then we have to define the win-win solution for us all.”

No country is immune

WHO Director General Dr Tedros Adhanom Ghebreyesus at the UN High Level Meeting on AMR.

 “No country is immune to this threat, but low and middle income countries bear the greatest burden,” WHO Director General Dr Tedros Adhanom Ghebreyesus warned in his remarks.

“The threat of AMR cuts across the health of humans, animals, agriculture and our environment, and so must its solutions,” Tedros added.  “That’s why WHO, FAO and UNEP are working together closely with the World Organization for Animal Health (WOAH) in a One Health approach.” 

While 90% of countries have developed AMR action plans, only 11% of countries have allocated budgets to implement those plans, he said. 

As next steps, Tedros said that WHO and other members of the Quadrapartite would set up an independent science panel to produce a major report synthesizing evidence for more action on AMR by 2025.  WHO would also update its decade old global strategy on AMR by 2026. 

Deaths from superbugs 

New drug resistant bacterial strains are emerging more and more rapidly after the introduction of new antibiotics: WHO

Drug resistant bacteria are estimated to have killed an estimated 1.14 million people in 2021, and were somehow associated with the deaths of 4.71 million people, according to estimates published in The Lancet in mid-September. 

In the declaration, countries committed to reducing annual AMR deaths by 10% using a 2019 baseline level of mortality. In that year, 1.27 million deaths were attributed to drug resistant bacteria while 4.95 million deaths were somehow associated with drug resistant infections.  

Should global efforts to curb AMR fail, drug resistant pathogens could become the number one cause of death by 2050, warned Mottley at a press briefing just ahead of the High Level Meeting.

That would mean just going to the dentist, or getting cut doing garden work could lead to life threatening infections for some people “purely because of the ineffectiveness of the antibiotics,” Mottley warned.

“This, therefore, is a press conference not for us with grey hairs, so much, but for the young people in the world because they are the ones who will have to face the possible threat of a reversal of a century of medical progress in what we dub the ‘silent, slow motion pandemic,'” Mottley said.

Even so, AMR has already hit millions of families in the world, including her own, with tragic results, she added: “When I started this journey, I didn’t know it would become personal for me and my family, and I pray that no family has to experience what we did with respect to the loss of someone purely because of the ineffectiveness of antibiotics to be able to deal with infection.”

Four pronged assault – priorities for health and environmental sector 

The declaration outlines a four-part strategy to combat AMR. It calls for more careful use of antimicrobial agents in healthcare, farming, and animal sectors, alongside improved management of untreated sewage and hospital emissions. These emissions create environments where microbes from urine and feces can mutate and develop resistance to antibiotics, which are also released by hospitals and communities.

There is an urgent need for new antibiotics in many classes – and too few products in R&D.

Tedros, Mottley and others also called out the alarming dearth of new antimicrobials in the product pipeline. 

The number of pharma firms working on new antibiotics has declined substantially since 2000 due to the perception that there is little profitability in producing new products that can’t be used in large volumes, precisely because that may foster a spiral of new resistance risks.  

Mottley said that antibiotics should be recognized as a “global public good” with “dedicated financing”’ that goes beyond commercial investments.  

“I hope, therefore, that the World Bank in the general discussion as to its own reform and its movement towards the finance of global public goods and the guardian of global public commons, will be able to see appreciable progress in its reform efforts, so that this can be one of the early beneficiaries…  because…, this is as much an existential crisis.” 

Tackling fake medicines, sewage discharge and hospital emissions

Inger Andersen, United Nations Environment Programme at the UN High Level Meeting.

Tackling fake and substandard medicines, which can also lead to emergent resistance, is another huge priority cited in the declaration. And along with reducing overuse of antibiotics at risk of becoming impotent, as per WHO’s AWaRe classifications, there is a need to improve access to the right antibiotic formulations in low- and middle-income countries, where many more people still die from lack of any access whatsoever, Tedros emphasized. 

Moreover, some 56% of sewage effluent discharged is untreated, leaving cesspools of pathogens to breed and develop in lakes, rivers and aquifers of developing countries, in particular, pointed out Inger Andersen, Executive Director of the UN Environment Programme. 

Prevention is key to stop antimicrobials from leaking into our environment from municipal wastewater, from municipal waste, as well as wastewater from pharmaceutical production, hospitals, and farms that over use and intensify crop production sprayed with antimicrobials, Andersen added.  

“The pharmaceutical sector can strengthen inspection systems, change incentives and importantly, we can change subsidies and ensure adequate waste and waste management containment,” Andersen said. 

“The food and agriculture sector can take preventive action to limit the use of antimicrobials and to reduce the discharge from crops and terrestrial and aquatic, marine and animal and fish production facilities and the healthcare sector can improve access to high quality, hospital-specific wastewater treatment systems.

“This will take political determination, she stressed. “This will take leadership. These actions and more must be backed at the highest level, with policies, with laws and with regulations to reduce effluent releases.”

Animal use remains ‘elephant’ in AMR arena

Most of the world’s antibiotics sold are consumed by livestock not people – where they are often use as growth promoters or to prevent, rather than treat, infections.

But in terms of sheer volumes of use, antimicrobial use in the livestock sector remains one of the biggest threats to curbing AMR trends. It is estimated that some 73% of antimicrobials sold globally are used in livestock production, including continued use of antibiotics as growth agents in many nations.

Dropping the 30% target for their reduction significantly weakens the armory of the new declaration, observers said. 

“The AMR political declaration heralds a major shift in the global health response for AMR notably with the inclusion of commitment for targets and accountability including the recognition of the Quadripartite Joint Secretariat as the central coordinating mechanism as well as the call to establish an Independent Panel” said Dr Haileyesus Getahun, CEO of the South-South HeDPAC partnership. He led the foundation of the Quadripartite Secretariat, and served as its first director, in a previous role at WHO. 

“But it is very disappointing to see that the Muscat Manifesto targets on the 30% reduction of antimicrobial use in animals is not included, despite endorsement by 47 countries, ” he added, referring to a November 2022 declaration issued at the end of a High-Level Ministerial Conference on AMR hosted by the Sultanate of Oman in Muscat as part of the lead-up to the 2024 UN High Level Meeting. 

“Commitment for the targets would have galvanised county-level action not only to strengthen the animal health system but also the research and development for alternatives to antimicrobials,” Getahun said.

“It is unfortunate that there was a major push back by the animal food industry who were able to influence some member states and even divide the Quadripartite organizations on this very topic.”

WOAH cites its plans for action in animal sector

Emmanuelle Soubeyran, WOAH Director General, speaking at the UN HLM.

There is, however, increasing recognition that overuse of antibiotics and other antimicrobials also represents an economic threat to the meat and dairy industry as the drugs will also become less effective in animal populations, asserted new WOAH Director General, Emmanuelle Soubeyran, at the HLM meeting.

“Drug resistant pathogens could jeopardize food security for over two billion people globally, more specifically on livestock, if no action is taken,” she said. 

“The impacts of AMR on livestock could reduce global GDP by $40 billion per year,” she said.  “But achieving a global 30% reduction in animal antimicrobial use within five years can raise [global] GDP in 2050 by €14 billion. 

“Thus, the World Organization for Animal Health welcomes the political declaration in alliance with our four priorities.”

Improving access to animal vaccination as an alternative to antimicrobials

Soubeyran said that improving access to animal vaccinations for vaccine-preventable diseases can reduce unnecessary use of antimicrobials. 

“We welcome your commitment to define animal vaccination strategies with clear implementation plans… and we’ll update the priority list of diseases of which vaccines could reduce antimicrobial use.”

At the same time, she admitted that the animal sector needs to do more to reduce its use of drugs deemed by the WHO to be “highest priority” for use in human health – and not animals. 

“The use in animals of highest priority antimicrobials to human health has been globally reduced to 16%,” she said.  “Regulation, awareness campaign, trainings, and public private partnerships have allowed such developments. 

“But we strongly encourage all of you, all of our members, to accelerate along this line. So, the important gaps still observed in the compliance with our international standards are closed.”

Economic carrot and stick

Since 2015, WOAH has seen the number of countries reporting quantitative data on antimicrobial use in animals increase three-fold, with 130 member states [of 183] now reporting, she added at a press briefing just before the HLM.

At the same time, the Paris-based WOAH, unlike FAO, WHO and UNEP, is not a UN-affiliated agency. Member states’ reports of their antimicrobial use are voluntary and not made public, leaving researchers to cull regional and country data from surveillance data on international drug sales in the animal health market. 

For instance, a  2019 WOAH report on trends in use of antibiotics as growth promoters, showed a decline in the practice. But not all 183 member states report data, and WOAH does not name the 45 countries that did report but continue antibiotic use for growth promotion.  

Among countries that continue to use antibiotics as growth promoters, the overall use of antibiotics is much higher overall, without much regard for risks, Soubeyran acknowledged. 

“Some 76% of WOAH members still using antimicrobials as growth promoters have not carried out a risk assessment … and countries using antimicrobials for growth promotion in livestock have an estimated average of 45% higher antimicrobial use than countries that do not use growth promoters.” 

Despite the resistance to change, emerging new economic data showing how antimicrobial abuse in livestock could lead to big economic losses over time, while judicious use will yield economic benefits, could begin to make a difference to the industry and policy makers. 

 “It is something very important to say to the sector,” she said. 

Image Credits: Yvan Hutin/WHO, IFPMA, Flickr: Paul van de Velde.

Nearly 4.1 billion people, roughly half the planet’s population, experienced unusually hot temperatures between June and August, in what was Earth’s hottest season on record.

Climate change made these high temperatures three times more likely, according to the latest report by Climate Central, a US-based non-profit of scientists and science communicators that conducts research on climate change.  

The average person experienced 17 extra days of risky heat because of climate change during this period. Risky heat days are when temperatures are hotter than 90% of the temperatures recorded in a local area from 1991-2020. Heat-related health risks rise when temperatures climb above this local threshold.

The report looked at 22 regions across 218 countries and territories using the Climate Shift Index (CSI), a metric developed by Climate Central and launched in 2022, that quantifies the influence of climate change on daily temperatures.
The report is among the growing pieces of evidence on the deadly impact of heat. In July this year UN Secretary-General António Guterres called on countries to act on heat by protecting vulnerable populations and by investing in early warning systems. 

The health impacts of climate change have also been discussed at the ongoing climate week in New York as well as the United Nations General Assembly.

Hottest season on record

The effects of human-induced climate change, mainly from burning fossil fuels, were evident in all regions of the world in the form of extreme heat, climate scientists found.  

The heat was so bad that one in four people on the planet had no break from climate change-driven heat. On every day in June, July, and August, they experienced unusually warm temperatures made at least three times more likely by climate change. 

Global exposure peaked on 13 August, by which time 4.1 billion people or roughly half (50%) of all people worldwide experienced unusual heat at CSI level 3 or higher.

Over two billion people or 25% of the global population experienced 30 or more days of risky heat that were made at least three times more likely by climate change. 

This heat can worsen underlying illnesses including cardiovascular disease, diabetes, mental health, asthma, and can increase the risk of accidents and transmission of some infectious diseases, according to the World Health Organization (WHO).  
Heavy rainfall, deadly floods and storms, and raging wildfires were also exacerbated during this period. 

Global phenomenon

The areas affected by deadly heat were spread around the world. This included nearly the entire population of the Caribbean and at least three in every four people in Western Asia, Micronesia, Northern Africa, and Southern Europe. 

As many as 72 countries, home to more than 2.3 billion people, experienced their hottest June–August period since at 1970. The average person in these countries experienced a very strong influence of climate change on 34 of the 92 total days from June-August.

Around 180 cities in the Northern Hemisphere where June to August were the summer months had at least one dangerous extreme heatwave. Heatwaves were calculated as a place having at least five consecutive days with temperatures hotter than 99% of temperatures recorded in that city from 1991-2020.

Across these 180 cities, extreme heat waves of this intensity and duration are, on average, 21 times more likely today because of human-caused climate change, the report found. 

Influence of climate change 

The report did not just look at the heat extremes but also the influence of climate change.

Of the 22 regions analyzed, the highest regional average temperature anomalies were in Eastern Europe. The region experienced temperatures 1.9°C above normal, and 14 days with temperatures very strongly influenced by climate change.

Western Asia, Southern Europe, Northern Africa and Eastern Asia were other regions that saw temperatures significantly above normal for several days.

WHO and the World Meteorological Organization (WMO) are already working together to draw attention and respond to the health impacts of heat on human health. 

Guterres has reiterated the call for limiting temperature rise to 1.5°C by phasing out fossil fuels and scaling up investment in renewable energy to prevent further heat escalation. 

Image Credits: Dikaseva/ Unsplash.

European Health Forum underway in Bad Hofgastein, Austria.

BAD HOFGASTEIN, Austria — Declining health is driving more citizens to support far-right, populist parties and reducing overall participation in the democratic process, according to a new review of studies from a World Health Organization-backed (WHO) think tank.

The report, released Wednesday by the European Observatory on Health Systems and Policies, analyzed 97 studies at the intersection of health, democracy and populism. 

“There are two findings. One of them is that ill health reduces political participation. The other, possibly more shocking, is that ill health leads to a substantially larger likelihood that you’re going to vote for whatever your local populist radical right party is,” said Scott Greer, lead author of the report and professor of Global Health Management and Policy at the University of Michigan.

Europeans who report worse health have much lower trust in political actors and lower satisfaction with democratic and health institutions

Europe faces a perfect storm of health challenges that could shake its political foundations, the study warns. An ageing population, rising chronic illness rates, and COVID-19’s after-effects combine with looming threats from climate change, conflict-driven migration, and widening income gaps. 

These pressures have exposed weaknesses in health systems and put health at the center of the European political battleground for the foreseeable future, with over half of Europeans saying health is their top political priority, according to Comission data.

“The stakes if you’re an elected politician are really high,” Greer said. 

The report found that people in poor health are significantly less likely to vote, often by margins of 10 to 20 percentage points compared to healthier individuals. This trend has been documented across Europe, the United States, and Canada.

When those in poor health do vote, they are primarily supporting far-right populist parties. Greer pointed to the 2016 Brexit referendum as an example of how health issues can influence major political outcomes. 

“Moving from self-reported fair to poor health makes you about 16-20% more likely to vote for the populist radical right,” Greer explained. “It is mathematically possible that the number of people in the United Kingdom whose health state deteriorated as a fairly clear consequence of the Cameron government’s austerity budgets and who therefore voted for Brexit is larger than the Brexit victory margin.” 

Scott Greer, lead author of the report and professor of Global Health Management and Policy at the University of Michigan

Protecting health, rebuilding trust in democracy

“Policies that protect health and ability are not only essential to preserving the economic and social well-being of Europe – but they may also be essential to rebuilding trust in democracy and democratic institutions,” the authors state.

While the study focuses on how health influences political behaviour, experts caution that the relationship between health and politics is complex and potentially bidirectional. For instance, research has shown that political affiliations can influence health behaviors, from Trump supporters frequently rejecting COVID-19 precautions in the United States to Labour supporters in the United Kingdom more likely to smoke. 

Untangling the causal relationships between health, socioeconomic factors, and political preferences presents significant challenges. However, the authors argue that the mounting evidence is compelling enough to warrant serious attention from policymakers.

“To be clear, population health is unlikely to be the primary driver of the rise in anti-democratic politics,” the authors explain. “Even so, the connection between the two highlights an important shortcoming in the performance of democratic institutions: people in poor health have systematically low trust in their health systems and governments.” 

Mistrust in political actors and dissatisfaction with democratic and health institutions are widespread throughout Europe

The shift towards populism marks a dramatic change from historical patterns. Until recently, people in poorer health typically favored left-leaning parties that supported greater health and social protections. However, the rise of right-wing populist movements has provided a new outlet for voters frustrated with existing institutions.

“Why does becoming seriously sick seem to lead to this change in political behaviour? The answer is trust,” Greer said. “People whose health status gets worse tend to lose trust in the healthcare system, the political system, the elements of society at large, and they tend to lose a sense of agency.”

This loss of trust appears to be driving support for parties that promise to reshape what they describe as a “failing” political establishment, even when these parties often oppose public health measures.

The study cites examples such as the National Rally in France, the Alternative for Germany (AfD), and Vox in Spain as typical European populist parties that have attracted support from voters in poor health.

Historical data identified in the report suggests this is not a unique phenomenon. German communities with worsening mortality in the 1930s became more supportive of the Nazi Party, while Italian cities hit harder by the 1918 influenza pandemic showed greater support for the Fascist Party in the 1924 election.

“Governments are moving through uncharted waters, facing new crises that threaten both health and the long-standing political order,” the report states. “A better understanding of the interplay between these forces and their impact on political thought and action can help policy-makers protect not only the health of populations but also democratic institutions.” 

If we aren’t fixing health – why expect votes? 

Clemens Martin Auer, President of European Health Forum Gastein

Minutes before the new data was presented, Clemens Martin Auer, President of the European Health Forum Gastein, challenged the health policy experts in attendance: Does anyone believe our system is properly addressing the impending crises of health workforce shortages? 

No hands were raised. 

“The healthcare sector has to be clear that it contributes to populism,” Martin Auer said. “Stop just talking about problems without operationally solving them… … just wait until they throw our incompetence to solve health problems to delegitimise democratic legitimacy.” 

Martin Auer didn’t mince words at a closed-door presser earlier Wednesday either. Populism, in his view, isn’t just about finger-pointing. EU citizens keep flagging health as their top concern and demanding reform in the sector. And when they don’t see the changes they’re after? Well, their ballots are doing the talking.

“We have to act, we have to make people not vote for populists, and we have to act in these areas where people are affected by health policy measures,” Martin Auer said. “Every single person is affected by the healthcare sector. 

“If we don’t do anything, that is why people support populists.”

EU Health Commissioner controversy

Ursula von der Leyen outraged European health advocates and MEPs with her selection of Olivér Várhelyi to be the bloc’s next health commissioner. 

Meanwhile, Austrian Health Minister Johannes Rauch joined the chorus of European officials alarmed at the appointment of a far-right, EU-skeptic, Viktor Orban loyalist with no health experience to lead the bloc’s health policy for the next five years. 

“This is a very important department,” Rauch said on Wednesday, speaking at a closed-door press briefing at Gastein. “I am worried that if a representative of an EU-hostile government is appointed, this will lead to problems.” 

Olivér Várhelyi, Hungary’s nominee for EU commissioner, has faced fierce backlash from Brussels insiders since Commission Chief Ursula von der Leyen announced last week he would head Health and Animal Welfare in her next commission.

European Parliament members have ample reasons to oppose Várhelyi’s appointment as health commissioner – chief among these an incident last year when he was heard on a hot microphone calling MEPs “idiots.”

MEPs also remain furious at his unilateral declaration last year that the EU would cut off all aid to Palestinians, which he had no authority to do and was quickly overruled by Von der Leyen. His close ties to Israeli officials, including meeting with Prime Minister Benjamin Netanyahu and Defense Minister Noav Gallant after the International Criminal Court issued arrest warrants for their arrests for war crimes, have left MEPs worried he could impact EU assistance to Gazans. 

Former staff and Hungarian officials are also not fans of Várhelyi, variously describing him to Politico as “incredibly rude,” having an “appetite to humiliate,” and running his office in an environment of “emotional terror.” 

Várhelyi’s loyalty to Orban has also raised fears that, should he be appointed, no action at the EU level on abortion protections or reproductive rights will be possible during his mandate – a goal many states had hoped to advance. 

The complex European health portfolio handed to Várhelyi is set to include major files such as a complete revamp of EU pharmaceutical regulations, the European data space, and building a European Health Union, continuing efforts to combat cancer, and promoting preventive health,” von der Leyen said.

Várhelyi is also viewed in some MEP circles as being friendly to pharmaceutical interests given his three years as the leader of the EU’s intellectual property rights division from 2008 to 2011 – a potential conflict of interest given that, as Commissioner, he would oversee the reworking of pharmaceutical regulations. 

His appointed has to be agreed to by the European Parliament’s environment and health committee, and there is widespread expectation that he is unlikely to get past the MEPs represented there. 

But if he does, some solace can be found in that he is not the only Commissioner with power to influence health given the EU’s labyrinthine structure.

Health-related responsibilities will be spread across several portfolios. Commissioners from Spain and Romania will share oversight of certain health tasks, while a Belgian representative will focus on emergency preparedness and medical supplies. Meanwhile, France’s nominee to the Industrial Strategy role is set to spearhead efforts in biotechnology and pharmaceutical policy development.

Image Credits: European Commission.

Geneva Graduate Institute panellists David Evans, Erika Placella, Nathan Sussman (chair) and Alegnta Gebreyesus.

Financing for public health is dwindling in many countries, sapped by COVID-related economic difficulties, debt repayment and “poly crises” such as climate and conflict. 

“In the current economic conditions, the only way [some countries can spend more on health] when their overall government spending is going down, is to give more priority to health in government budgets,” said David Evans, visiting professor in interdisciplinary programmes at the Geneva Graduate Institute (GGI) told a recent event on health financing organised by the institute.

But, Evans warned: “Historically, when your government expenditure is falling, giving more priority to health is often very politically difficult. It doesn’t happen very often.”

“Some of you are involved in the push to have more money for pandemic preparedness and response. It’s very worthy, but if the budget is going down, where is that money going to come from?” asked Evans, who described competition between different urgent needs as a “zero-sum game”.

Development assistance for health in 2021

However, he said there was much diversity within low-income countries and middle-income countries, with some facing economic contraction or stagnation while others were progressing.

“It might be time to think about changing the criteria under which countries get development assistance.”

Evans also identified some opportunities including debt restructuring, special drawing rights at the International Monetary Fund (IMF) and the reform of international financial institutions to direct more money to countries most affected by economic crisis.

Development Assistance for Health: challenges and opportunities.

Seeking complementarity

Erika Placella, head of health at the Swiss Agency for Development and Cooperation (SDC), agreed that the “competition for replenishment” with a “proliferation of funds and the fragmentation of initiatives” was “a zero-sum game”.

“In this zero-sum game, there is a race to find the smallest comparative advantage and the sexiest narrative,” said Placella.

Every international negotiation forum and resolution calls for a dedicated fund and new global health instruments are also being introduced, she added.

“So it is a very fragmented landscape, [and] it’s very difficult to navigate it.”

SDC was pushing for “complementarity” at a global level, said Placella.

“I’m going to take off with the pandemic preparedness and response from the Swiss government. First of all, instead of supporting new ventures and new narratives and new funds, we tried to adapt the mandate of existing organizations to the current context and needs and to promote complementarity. 

“A lot of our partners already had pandemic prevention, preparedness and response (PPR) functions, but in our narrative, it was not understood as such,” she said.

Organisations such as UNAIDS, the Global Fund and FIND include PPR, she noted.

“So we are trying to leverage and to build on what partners were already contributing to in the PPR space, instead of further fragmenting the financing landscape.”

The Swiss government’s health funding uses “many instruments to support health”, including global and thematic work supported through large health organisations including the World Health Organization (WHO) as well as bilateral cooperation.

These different avenues are important to address bottlenecks, she added.

“We also take a systematic approach to avoid further fragmentation. For example with mpox, we are supporting strengthening the primary health care services to include sexual reproductive health services.”

Ethiopia’s dependence

Ethiopian health diplomat Alegnta Gebreyesus said that almost half of her country’s health expenditure depends on overseas development assistance (ODA) so the funding crunch could impact on all aspects of health.

To mitigate this, Ethiopia is discussing setting up a health fund – “a sort of basket fund” which will cover a range of key health issues, with government matching donor investment in some of these.

The fund “would cater for resilience, health system strengthening, equity and, of course, preparedness for pandemics,” she added.

But high prices for medicines, vaccines and other medical commodities can only be addressed by building “a conducive environment for sustainable local manufacturing” at country and regional level – covering research and development, supply chain and logistics, the regulatory system, technology transfer and know-how.

Joyce Ng’ang’a, senior policy advisor at WACI Health.

Kenyan Joyce Ng’ang’a, senior policy advisor at WACI Health, a Nairobi-based health advocacy organisation, said the current global health landscape is already in a poly crisis involving pandemics (COVD-19 and now mpox), food shortages and climate change. 

“We need to make health a priority. We need to make health a political agenda. I believe that there is enough money in the world to fund health and to replenish the global health institutions,” said Ng’ang’a.

“As civil societies and communities, we refuse to accept that there’s not enough money to fund systemic issues for health,” she said, calling for a health approach that started by tackling the social determinants of health.

“By the time cases are coming to the health facility or hospital, the community health system has failed because there should have been preventive and promotive care at community level.

“Most LMICs now have a deliberate strategy on community health and how health is structured, and at the basic unit is the primary level, which is a prevention and health promotion.”

The ECDC chief said the move is part of a broader strategy to increase global public health cooperation before the next pandemic.

The European Centre for Disease Prevention and Control (ECDC) will sign an official memorandum of understanding with its Japanese counterpart next month, the director of Europe’s largest public health agency announced Wednesday.

“Next month I will sign a cooperation agreement with the Japanese Center for Disease Control,” said Pamela Rendi-Wagner, who took over the agency in June.

Her remarks came at a closed-door press briefing on pandemic preparedness at the European Health Forum in Gastein, Austria. She said the deal was part of a wider European effort to expand global cooperation within and outside the EU to better prepare for future pandemics.

“Scientists [globally] need to understand each other before the crisis, not during the crisis,” Rendi-Wagner said. “We learned our lessons from the pandemic.”

The ECDC chief added that the agency has deepened its ties with many other centres for disease control globally since the COVID-19 pandemic, including a four-year partnership with Africa CDC signed in 2021 with financial support from the European Commission.

The memorandum of understanding with Japan will add the country to a list of CDCs that have signed such agreements with the European agency, including those in the United States, China, Mexico, the United Kingdom and South Korea.

ECDC collaborators without official agreements include regional CDCs in Africa, the Caribbean and Gulf states, as well as Israel, Singapore, Thailand and Australia.

In her closing remarks, the ECDC chief warned global public health authorities that the window to prepare for the next pandemic “will close” and urged immediate action.

“Only joint and cooperative preparedness will allow us to cope with pandemics in the future,” Rendi-Wagner said.

Image Credits: ECDC.