The World Health Organization’s Director-General called on global and national leaders meeting at the World Economic Forum in Davos, Switzerland to increase their national healthcare spending by an average of 1% of National Gross Domestic Product (GDP).

A 1% GDP increase in spending would inject more than US $200 billion a year into community-based primary care systems, which WHO estimates will save over 60 million lives a year, as well as increasing the average global lifespan by 3.7 years by 2030, WHO Director-General Dr Tedros Adhanom Ghebreyesus said in remarks at an event hosted by the Graduate Institute in Geneva and International Geneva on Tuesday, the opening day of the four-day forum.

If the world is able to reach those health goals, low- and middle-income countries would also see an extra 2-4% in economic growth on top of the health gains.

Dr Tedros (left) with Swiss Federal Councilor of the Interior Alain Berset at WEF 2020

Focusing on such ‘best buys’ for health, Dr Tedros urged global leaders to invest in health promotion and prevention, while regulating the industries that damage human health.

“It’s not a question of whether countries can invest in health, it’s a question of whether they can afford not to,” said Dr Tedros. “Emergency preparedness, health promotion and prevention, and primary care represent some of the best value-for-money investments a country can make,” he added in a video posted on WHO’s official Twitter.

This investment is even more important in the context of aging populations, the WHO Director General also noted. “As people live longer and health care advances, countries must work to promote healthy living and “keep people out of hospitals as much as possible.”

However, most of the US $7.5 trillion dollars spent on healthcare each year is funneled into managing diseases at expensive secondary or tertiary hospital systems – after patients have already become sick. While hospital care is necessary and important, some 80% of the average person’s healthcare needs can be addressed at the primary care level.

His remarks highlighted the agency’s increased focus on health financing as key to expanding health services to more people worldwide.  This has also been a message put forward by other leading WHO officials over the past year, including Deputy Director General Zsuzsanna Jakab and Assistant Deputy Director-General Ranieri Guerra.

Speakin to economic leaders at Davos, however, Dr Tedros also underlined the comparative cost-effectiveness of health programs in terms of lives saved. “If you consider investment in health compared to investment in preventing terrorist attacks, we can’t even compare,” he said, lamenting the much larger budget often given to counter-terrorism programs.

“But if a pandemic breaks out, it will have even worse estimates than a terrorist attack – political and social.” He referred to the deadly 1918-1919 Spanish flu pandemic as an example, which infected an estimated third of the world’s population at the time and killed over 50 million people.

In terms of where countries can find resources to finance the increase in health spending, the WHO Director General pointed to increased taxation on unhealthy products such as sugary drinks and alcohol, as measures that can “add to government revenue.” Global leaders also need to rein in the trillions of dollars spent on subsidies for unhealthy industries such as fossil fuels, which not only sap government funds but harm public health through climate change and air pollution emissions.

UNAIDS took it a step further, arguing that one root cause of social and economic inequality was the lack of access to health care, while  gaps in public health financing could be met by “eliminating tax dodging” and implementing “progressive taxation” in a press release Tuesday.

“The right to health is eluding the poor, and people trying to lift themselves out of poverty are being crushed by the unacceptably high costs of health care. The richest 1% benefit from cutting-edge science while the poor struggle to get even basic health care… We’re here to tell governments to do the right thing: tax the rich and spend it on health.”

“Here in Davos there are about 100 billionaires… If they sat in one room they could solve the problem. It is a small change for them,” declared the agency’s Executive Director Winnie Byanyima, in a TV interview with Al Jazeera, Monday evening.

Mental Health – No Longer an Invisible Issue

The push for increased spending on preventative health services follows dawning recognition of the impact of non-communicable diseases – which are often chronic and crippling – on the global health agenda. Among those, WHO’s increased prioritization of mental health disorders was spotlighted in Davos during a special session with Indian actress and activist Deepika Padukone and moderated by the WHO Director-General.

“Mental illness crept up on me when I least expected it… It came with absolutely no warning signs,” said Padukone, one of the top 10 earning actresses in the world. She noted that her struggle with mental health happened during a professional and personal “high” in her life.

“It just illustrates that it can happen to anyone,” she added.

Director-General, World Health Organization (WHO), Geneva, speaking in the “An Insight, An Idea with Deepika Padukone” session at the World Economic Forum Annual Meeting 2020 in Davos-Klosters, Switzerland, January 21, 2020.

In a powerful moment, Dr Tedros then asked those in the audience who had personally experienced mental health struggles of their own, or with a family member or friend, to stand up. One by one, looking around at their colleagues, members of audience rose up until more than half of the room was standing – including not only Padukone but the WHO Director General himself.

“Nobody is immune, nobody… we all know somebody close. And that’s why nobody should be alone, because we all know someone, because we have all experienced it,” he said, breaking the silence.

Padukone, founder of the Live Love Laugh Foundation, was honoured with WEF’s 2020 Crystal Award for her work in raising awareness for mental health after coming forward with her own struggles with depression and anxiety in 2015.

“In the time that it has taken for me to accept this award, the world has lost one more person to suicide,” she said somberly in her acceptance speech. “That person was a father, a mother, a son or daughter, a brother or sister, a friend, family member or colleague.

“Every 40 seconds someone dies by suicide in the world. US $1 trillion – that is the estimated impact of depression and anxiety alone on the global economy.

“It is important to understand that depression and anxiety are like any other illness and are treatable. However, in my experience, acceptance is the first step to recovery.”

Image Credits: Twitter: @DrTedros, World Economic Forum / Boris Baldinger.

The World Health Organization will convene an Emergency Committee meeting over the new coronavirus outbreak that began in Wuhan, China, after more than 300 new cases were confirmed since 17 January, including the first cases to hit other Chinese megacities and provinces. On Tuesday, the virus crossed the Pacific, with the first case in the United States confirmed in Washington State.

The Emergency Committee will meet Wednesday, 22 January, to determine whether the outbreak constitutes a “public health emergency of international concern” (PHEIC) under the International Health Regulations, WHO’s Director General Dr Tedros Adhanom Ghebreyesus said on Monday. An official PHEIC designation would ramp up global resources for the outbreak response, including establishing an official international expert group and WHO outbreak focal points in affected countries. Short of declaring such an emergency, the Committee may also provide recommendations for managing the outbreak as new information about the mysterious disease emerges by the hour.

Along with new reports of the disease in Beijing, Shanghai, and Guangdong Province, South Korea on Monday confirmed its first imported case of the pneumonia-like virus, dubbed 2019-nCoV. Taiwan soon followed suit, with the first case confirmed in a woman traveling from Wuhan on Tuesday.

The United States Centers for Disease Control released a statement Tuesday confirming the first case of the novel virus to cross the Pacific. A patient with recent travel history to Wuhan was tested for the disease after developing symptoms after returning to the US on 15 January.

Some nine people so far have died, and the number of total cases in China has exploded from 41 confirmed cases last Friday to 473 confirmed cases, according to a report issued in the evening Beijing time on Wednesday, by the Chinese state-owned news outlet CGTN.

In the latest update of the CGTN report, authorities said that they had confirmed at least 248 new cases in Wuhan and 12 in the surrounding province of Hubei, 5 new cases in Beijing, 14 in Guangdong Province and 1 in Shanghai, Officials are monitoring suspected cases in four other provinces. Tianjin, Guangdong city, and Henan province confirmed their first cases on Tuesday. The fear is of a much larger spread of the infectious agent, as China approaches its busiest travel season of the year during the Spring Festival.

Zhong Nanshan, the Chinese expert who discovered the deadly SARS virus in 2002, told state-run CCTV network on Monday that they had found the first cases of 2019-nCoV in 14 frontline healthcare workers – one of the groups at highest risk of contracting an emerging disease – confirming the presence of human-to-human transmission.

Wuhan authorities are encouraging citizens to wear face masks to protect against potential person-to-person transmission of the new viral disease.

A national working group of experts from the Chinese National Health Commission said in an official statement released Sunday that they believe the outbreak is “controllable,” and larger epidemic is “preventable. However, the statement notes that authorities are still lacking three key pieces of information to control the outbreak; the source of the outbreak, the dynamics of how the disease spreads, and the likelihood of the virus will mutate into a more transmissible or deadlier strain.

Academics say that the sharp uptick in numbers is consistent with a new report by researchers at Imperial College London that estimates the mysterious disease has already caused symptomatic infections in over 1,700 Wuhan residents since it was first reported in the city on 31 December 2019, while even more people may be asymptomatic carriers. The study modelled likely scenarios for infection in the city of 10 million people, based on documented reports of travelers who had become infected with the virus, total volumes of daily travelers visiting or transiting Wuhan, and a presumed virus incubation period of 10 days.

Imai et al. estimate the total number of 2019-nCoV infections

Experts believe that the original source of the infection were animal hosts sold in a Wuhan live animal market, with most of the original 41 cases reported on 13 January traced back to the Huanan Wholesale Seafood Market in Wuhan, which has been closed since January 1st for health related inspections. On Friday, the World Health Organization confirmed that environmental samples from the market had tested positive for 2019-nCoV – although the exact animal host is still unknown.

However, new cases emerging now have reported having no contact with that particular market. A 35-year old Chinese woman from Wuhan was hospitalized for flu-like symptoms after thermal surveillance at Icheon airport in Seoul, South Korea detected her fever. A statement released by the South Korean Ministry of Health and Wellness said the patient has so far reported no visits to live markets nor direct contact with any known cases while in China, although authorities are continuing to investigate her case.

Similar to the South Korean case, Japan and Thailand’s cases have reported no history of traveling specifically to Huanan Wholesale Seafood Market. New patients in Beijing and Shenzhen have likewise reported no contact with the live market. Still, all patients thus far have recently traveled in Wuhan – which experts say can indicate that either the animal source of the disease is found in more than one market, or person-to-person transmission may be a larger factor than initially suspected.

Once a new virus makes the jump from an animal species to people, it can also evolve to become infectious via human transmission, carried by sneezes, coughs, or other sharing of bodily fluids. That was the case in the 2002-2003 SARS outbreak – which caused over 8,000 cases and 774 deaths. So far, the new outbreak appears to be less fatal than SARS, but authorities and academics are concerned that the virus could mutate into a more deadly strain.

As of 22 January, the new pathogen – belonging to the same family of single-strand RNA viruses as the deadly SARS and MERS (Middle East Respiratory Syndrome) viruses – has claimed the lives of nine people with pre-existing health conditions. Some 17 people remain hospitalized in “severe condition” and 3 in “critical condition” according to a statement released by Wuhan authorities on Tuesday.

This story was published 20 January 2020. It was updated 22 January 2020.

Image Credits: Flickr/Nicolò Lazzati, Imai, N et al. 2019. Estimating the potential total number of novel Coronavirus (2019-nCoV) cases in Wuhan City, China.

The failed 2019 UN Climate Conference in Madrid ended in mid-December just about when the massive wildfire destruction of Australia’s bushlands was beginning.

The wildfires that broke shortly afterward took the form of a Gaia-like revenge.  Australia, along with the United States, Japan and Brazil, had been among the countries that had blocked real progress at the UN Conference of Parties (COP25) on a more realistic system of carbon emissions accountancy – that could track and ensure real progress on emissions reductions over the critical coming decade.

And the price exacted was almost immediate –  in terms of ecosystems and wildlife damaged, and ultimately human health and well-being.

Australia’s smoke plumes seen from space, rising from forests and bushlands in the southeast.

The converging problems of global warming, environmental degradation, and public health have been well-reflected in the bushfire destruction, along with a record drought in southern Africa, floods elsewhere, and off-the charts air pollution in Delhi, India, all occuring just as 2019 ended and the new decade of 2020 began. And therefore it is not surprising that climate has been placed at the top of the 2020 agenda by groups as diverse as the World Economic Forum (WEF), as well as the World Health Organization.

The Global Risks 2020 Report, released last week, just ahead the WEF meeting that begins Tuesday in Davos (21-24 January), notes “climate response shortcomings” as well as “biodiversity loss impacts” among the top two out of five categories of risks faced by the world for 2020.  “Creaking health systems” is listed as a sixth.

WHO has also listed the climate and health crisis as among the 13 top threats to global health in the next decade. Among the other threats highlighted by the agency – as well as by a range of experts interviewed by Health Policy Watch about the globala health outlook for 2020, include:

  • Emergence of new diseases at an increasing rate and intensity – as reflected in the Wuhan pneumonia outbreak;
  • Stalled action on medicines price tranparency – watch to see if European countries take a lead this year in adopting stronger measures;
  • Failing medicines markets contributing to the rise of anti-microbial resistance (AMR) – when prices for other vital drugs, particularly antibiotics, dip too low;
  • Non-communicable Diseases (NCDs) and Universal Health Coverage – how the global “syndemic” of obesity, undernutrition and climate change creates barriers to achieving UHC.

Digital health and AI technologies – which hold much promise for improving health, but also create new ethical challenges – were among the other issues cited by experts interviewed by Health Policy Watch. Long-simmering neglected diseases, often pushed to the sidelines of health agendas was another issue noted, as the world prepares to observe on 31 January, the first-ever World NTD Day.

The global shortfall of health workers, as well as gender challenges faced by women who dominate the lowest ranks of healthcare professionals, is another issue that will be highlighted prominently this year, which WHO member states have designated as “The Year of the Nurse and Midwife.”

Climate and Health

The real-world convergence of climate and health agendas has been playing out in the Australia story, which has left some 29 people dead, uncounted numbers of people displaced, and over 1 billion animals killed – driving some species to the brink of extinction. There has been a 30% increase in asthma cases and more children presenting with respiratory infections, Sydney doctors have reported. Scientists, meanwhile, have said that the long-term human health impacts of exposures to the air pollutants “won’t be known for years.”

Bushfire smoke over Sydney Opera House, 29 December 2019

But immediate health impacts were visibly demonstrated to global audiences during the initial, pre-qualifying rounds of the Australia Open, where the Slovenian Dalila Jakupović collapsed on the tennis court choking for air, and other stars also cancelled matches underway. Canadian Liam Brody later tweeted that players’ blood was “boiling” over the decision to continue the games in such hazardous air quality conditions.

Ironically, just four weeks earlier, as the December COP25 climate talks wound up, it was Indians in Delhi who were gasping for breath, and Australia was among the handful of countries to thwart a critical deal on how to count countries’ carbon reductions, in order to meet the pledges of the 2030 Paris Climate Agreement.

Along with Brazil and the United States, the conservative government of Prime Minister Scott Morrison, insisted on using carryover credits from the expiring 1992 Kyoto protocol, a loophole criticized by Costa Rica, New Zealand, France as something that would thwart accurate measurement of real progress, and even described as “cheating” by former French minister Laurence Tubiana, an architect of the 2015 Paris Agreement.

The Australia narrative illustrates the Global Risks Report finding that “climate response shortcomings” are among the top five risks faced in 2020. “Weak international agreements belie rising investor and popular pressure for action, against a multitude of natural catastrophes and indicators of longer-term disruptions,” the report states. “2020 is a critical year for nations to accelerate progress towards major emissions reductions and boosting adaptation actions.”

Smoke from a wildfire near Gosford, New South Wales, Australia turns the sunset an ominous red.

Experts have described Australia’s experience as just a taste of what to expect in the world’s most fire-prone continent from a changing climate. The year 2019 was the hottest year for the country on record, with average temperatures 1.5C° higher. Rising temperatures and lower levels of winter rainfall dried out bush and forest cover, which more readily become fuel for summer fires, occurring with greater frequency in the prolonged heat and drought conditions.

In just three months, Australia’s fires are estimated to have released 350 million metric tons of carbon dioxide, said climate experts quoted by the Sydney Morning Herald, warning that a century or more will be needed to absorb the carbon dioxide released. Drifting smoke from the fires has by now lapped around the world, and turned glaciers in nearby New Zealand brown – darker glaciers accelerate ice melt, in turn threatening the long-term stability of water reserves.

It’s also a record year for drought in Southern Africa with 12 countries affected, including Zimbabwe, Angola, Eswatini, Mozambique, and South Africa. The World Food Programme estimates a record 45 million people in Southern Africa are food insecure, including 5.1 million in Zimbabwe.  That face of climate change may have had even more dire, immediate, human health consequences. But there is no Australia Open playing in Harrare.

Climate & Health Lack Synergies

Within the broader spectrum of government failure, health and climate sectors remain disconnected –  sapping efforts to face a common threat to human health and well-being.

“The climate community lacks both the political leverage, the experience and the institutional mechanisms of the health sector—this expertise is badly needed for climate negotiations, but we don’t really work together,” lamented one senior European negotiator to Health Policy Watch, during the Madrid COP25.

He contrasted the high-profile October Global Fund Replenishment event in Lyon that had raised $US 14 billion to combat just three diseases, HIV/AIDS, TB and malaria, against the Green Climate Fund Replenishment conference that took place in Paris two weeks later. The latter raised less than US$10 billion for four years – and that was far short of the $US 100 billion in near-term climate finance that developed economies had pledged to channel to developing countries at the 2015 Paris Climate Conference.

Flavia Bustreo (left) with former UN Secretary of State John Kerry at COP25

“If you look at the Global Fund Replenishment, Emmanuel Macron, Bill Gates as well as Bono were all there,” lamented the negotiator.  “But who even heard about the Green Climate Fund event? Was there a Gates or a Macron or a celebrity like Bono?  No.”

In fact, behind the rhetoric, there are few formal institutional mechanisms to bring the knowledge, capacity and power of the health sector to bear on climate negotiations or to inform effective climate policies, at either national or global levels, he remarked.

One obvious reflection of that is the fact that year after year, attendees of the COP climate meetings include virtually no health ministers – with the exception of delegations that have been sponsored by WHO from time to time, from groups such as Small Island States, are faced with the virtual disappearance of their nations as a result of climate change.

This year, while climate delegates were huddling in Madrid in December, major health conferences were also going on in Brussels and in Oman, around non-communicable diseases. Meanwhile, WHO Director General Tedros Adhanom Gheyebresus was in Geneva putting the final touches on an organizational restructuring plan. WHO’s Maria Neira, who has won acclaim as the WHO’s lead on climate, health and environment, was pulled back to Geneva by the WHO Director General before the conference ended.

“With the exception of the Gender Action Plan, agreed by the end of the meetings, discussions did not bring to agreements and ended up in a disillusioned domain of unmet expectations,” reported Flavia Bustreo, chair of governance for the Interagency Partnership for Maternal, Newborn and Child Health, one of the few health officials to attend Madrid’s COP25.

She added that: “A low number of debates concerning the link between climate change and health suggests a low prioritization of what is now one of the biggest issues in this ongoing crisis.”

Grassroots Activists Target Finance & Fossil Fuel Producers

Outside the halls of debate, however, youthful protestors have been ramping up their campaigns against governments, fossil fuel producers, as well as their industrial and financial partners. Here too, Australia’s government has been a recent target, and tennis has even played a role.

Late last year, the Australian government approved the long delayed opening of the Carmichael open pit coal mine, the world’s largest, to supply fuel to India – just weeks before the bush fire emergency. The 447 square kilometre project owned by the Indian company Adani, has been hotly criticized by Australian environmentalists as a threat to the Great Barrier Reef.

Then in January, climate activists, including Sweden’s Greta Thunberg, called on the German engineering group Siemens to withdraw from the project; Siemens is to supply rail technology to transport coal from the mine. On Monday (January 13), Siemens rebuffed those calls.

Another prominent target has been Credit Suisse. In mid-December, in fact, the bank announced that it would stop lending for new coal-fired power plants, following on its decision to halt lending for new coal mine development. But the bank remains one of the world’s largest investors in fossil fuel companies with a US $57 billion portfolio, critics say. Swiss climate activists have called upon the bank, as well as its ambassador the billionaire tennis star Roger Federer, calling on them both to step back from fossil fuels.

Swedish climate activist Greta Thunberg at the Lausanne Climate Strike, 17 January 2020

Last Friday, Thunberg joined Swiss activists at a climate protest in Lausanne, at the end of a week where protestors ramped up a @RogerWakeUpNow campaign aimed at Credit Suisse and Federer, who is also competing in the Australian Open.

That followed a landmark Swiss ruling on Monday (13 January), where young activists associated with Lausanne Action Climat  were acquitted by a local court of CHF 21,600 in fines for storming a Credit Suisse office in 2018 with tennis rackets and balls. In an unprecedented decision, the judge declared that the urgency of climate action in the public interest outweighed their violations of the law.

A day later the protestors entered the Swiss offices of UBS, another major investor in fossil fuels, and dropped bags of coal on the floor.

“So far during this decade, we have seen no signs whatsoever that real climate action is coming and that has to change. To the world leaders and those in power I would like to say, that you haven’t seen anything yet, you have not seen the last of us. We can assure you that,” Thunberg told cheering crowds in Lausanne on Friday.

Such scenes may become more common throughout 2020 as youth activism, fueled by public concern over climate grows, while governments and industries try to carry on business as usual with fossil fuels.  As the next stop, Thunberg and other climate activists are heading to the WEF in Davos, to demand that financial leaders halt investments in fossil fuels.

“We don’t want these things done by 2050, 2030 or even 2021. We want this done now – as in right now,” Thunberg said in a Guardian Op-Ed published Monday (20 January) with other youth climate activists.  Since the 2015 Paris Climate Agreement, 33 leading banks have poured some $1.9 trillion into fossil fuels, the op-ed noted, and an International Monetary Fund report estimates that in 2017, the world spent $US 5.7 trillion in fossil fuel subsidies.

Although oil-producing Abu Dhabi rang in 2020 with a Futures Energy Summit devoted to clean energy, in fact investments in renewables in developing countries “plummeted” in 2018, according to a November 2019 MIT Technology Review.  Coal power production in 2018 reached an all-time high according the International Energy Agency. And across southeast Asia as well as parts of Southern Africa and the Middle East new coal power plant development continues apace, much of it driven by Chinese and Japanese investment.

Natural gas is also having a heydey. While less damaging than coal, natural gas development has often been at the expense of even cleaner solar energy sources, critics say. In the sun-drenched Mediterranean region, Turkey celebrated the New Year with the launch of a new natural gas pipeline connection to Russia; Israel launched its second major natural gas platform; and regional tensions heightened over conflicting claims between Turkey and Libya on the one hand, and Greece and Cyprus, on the other, to other potential Mediterranean gas reserves – creating new and dangerous sources of regional political tension.

Predicted future coal production capacity.

What To Watch in 2020

The 2020 Climate Conference in Glasgow on 9-19 November (COP26) will confront all of these financial and political forces head-on. This is when countries will gather to make new political commitments on emissions reductions. The European Union’s landmark agreement to reach net zero emissions by 2050, formally announced on 13 December, represented one important bright spot in the otherwise dim closing hours of the Madrid COP.  Significantly, that commitment was also accompanied by a €100 billion pledge in funding by the European Commission to help the ease the energy transition, particularly among some of the region’s most coal-dependent countries, such as Poland, as part of a European Green Deal Investment Plan that aims to attract €1 trillion in public and private finance over the next decade.

But the last hope for the global community to prevent temperatures from rising above 1.5°C still appears dim – if fossil fuel development across the rest of the world moves forward unabated, and the United States, which has announced that it will withdraw from the 2015 Paris Climate Agreement, follows through on that promise right after the US Presidential elections. Those elections are scheduled for 3 November, just days before the Glasgow COP26 commences.

Whether European leaders can and will wield sufficient muscle to convince the other big drivers of climate change to change course, including both high-income Australia, Japan and the US, as well as emerging economies led by the “BRICS” of Brazil, Russian, China and South Africa, remains an open question. Not only will COP26 be the year’s climax in climate policy-making – it could be the most decisive meeting for decades to come.

Leading up to that, observers can expect to see more youth-driven protests around Europe and elsewhere, and more civil disobedience.  It remains to be seen if this will capture the imagination of the broad public – or exacerbate social confrontations  with other interests, such as public opposition to higher fossil fuel prices. It was, after all, Emmanuel Macron’s earlier moves to raise fuel prices, which triggered the prolonged, and often violent, “Gilet Jaune” (Yellow Vest) protests seen in France over the winter of 2019, as well as civil disturbances in Africa and the Middle East on other occasions.

Also expect to see a series of protracted technical negotiations between countries over the new 2020 commitments to protect the world’s biodversity. Biodiveristy underpins what scientists call critical “ecosystem services” to health, such as food and fresh water supplies, sources of existing and future medicinal plants, as well as certain forms of natural regulation of infectious diseases.

At February meeting of the UN Convention on Biodiversity (CBD) in Kunming, China, technical experts will wrangle over proposed new targets for protecting the world’s seas, open spaces and species, hopefully paving the way for a new global agreement at the 15th CBD Conference of Parties in October. The agreement aims to halt the increasingly rapid decline and extinction of plant and animal species – after the 2010 CBD targets were largely missed.

Biodiversity loss is another topic on the Davos agenda, having been included among the top five risks in the Global Risks 2020 Report. The ways in which biodiversity loss threatens the stability of future food supplies and medicines discoveries, as well as other life support systems, are laid out in a WEF blog by a top official at Zurich Insurance Group – illustrating how an longtime scientific concern is now drawing attention from actors such as the insurance industry.

As for measuring progress on bringing health and climate agendas just a little bit closer together, watch out for where WHO’s top leadership will be in that critical week of November 9-19 – and what ministers of health, as well as rank and file doctors and nurses are saying and doing during Glasgow’s Climate Conference.

[First of two parts]  For Part II see this link

 

This story was published as part of Covering Climate Now, a global collaboration of more than 250 news outlets to strengthen coverage of the climate story, co-founded by The Nation and Columbia Journalism Review.

 

 

Originally published Friday 17 January, 2020.  Updated 20 January 2020

Image Credits: Wikimedia Commons/Rob Russell, Japan Meterological Agency/National Institute of Information & Communication Technology/Pierre Markuse, Wikimedia Commons/Nick-D, Flavia Bustreo , Twitter/@RogerWakeUp, CarbonBrief.org.

The low worldwide prices for antibiotics, combined with the need to carefully ration sale of any powerful new drugs that come to market to preserve their efficacy, continue to dampen industry investment in desperately-needed treatments for new drug-resistant superbugs, according to a sweeping new report by the AMR Industry Alliance, released today.

While civil society advocates have focused significant attention on the high prices of some new drug treatments for non-communicable diseases such as cancer, the AMR Industry Alliance Progress Report, sheds light on market forces playing out at the other end of the spectrum.

In this case, low market prices are thwarting efforts to bring promising new treatments to market, treatments needed to combat so-called “superbugs” – bacteria, viruses and parasites that are increasingly resistant to existing drug treatments.

The findings about investment trends and barriers should be a “wake-up call” for people concerned about rising antimicrobial resistance (AMR) in disease-causing pathogens, said Thomas Cueni, head of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) and Alliance Chair in a press release.

He added, “Discovering new and effective ways to leverage positive preclinical pipeline results and working together to ensure that late-stage antimicrobial drug discovery and development is better supported are vital.”

Pharmaceutical technician in sterile environment working on production of pills at pharmacy factory

The same market forces that are preventing new treatments from reaching the marketplace are also leading to increased shortages in some of the most common antibiotics, which billions around the world take for granted – although an estimated 5.7 million people die every year due to lack of access, the report states.

The massive new report, which tracks successes as well as setbacks in the global fight against superbugs across the range of AMR issues, is the synthesis of a detailed survey among 65 member companies of the AMR Industry Alliance, a group of life science companies dedicated to curbing the growing threat of superbugs.

According to the report, some $US 1.6 billion was invested by the private sector in 2018 in the development of new treatments that could help combat antimicrobial resistance, along with some $US 500 million in public funds. But that probably represents a flat trend, or even a decline over private sector investments in previous years, said industry experts interviewed by Health Policy Watch.

Investors are still funding pre-clinical discoveries of potential antibiotics, as well as new generation diagnostic tests, where there is a healthy pipeline. But little money is going towards funding costlier late stage R&D, such as clinical trials, the report finds.

Smaller biotech companies are especially struggling to secure investments that “will allow them to survive,” says Greg Frank, director of Infectious Disease Policy at the Biotechnology Innovation Organization, a member of the AMR Industry Alliance told Health Policy Watch, in an interview.

He described the chill cast over the industry after the biotech firm Achaogen went bankrupt, shortly after it brought a new antibiotic to market approval. This was followed by the filing of bankruptcy by Melinta, another biotech firm with a drug candidate in late stage development.

“While Melinta continues to operate during its restructuring, this doesn’t send a good signal to the investment community. It says, ‘this is an area that you should never touch’,” said Frank.

Frank explained that once new antibiotics are approved and brought to market, they are usually regulated to only treating the most drug-resistant diseases. While that may prevent resistance to the new drug from developing as quickly, this results in only small amounts of sales. Antibiotics are also expected to be priced lower than new drugs for other diseases such as cancer, so it is difficult for smaller companies to recoup the costs of R&D and manufacturing in the first few years after new antibiotic is approved.

Thus, Frank adds, many smaller firms will bring a product to mid-development, then “shop around” and sell their product to larger firms that have the capital to take on the risk of bringing a new antimicrobial to market.

However, with the exit of several large research-based biopharmaceutical companies such as Novartis, Sanofi, and AstraZeneca from the AMR drug development space in the past two years, smaller companies are no longer able to follow this model to secure investments.

That means that highly promising early-stage discoveries may never reach patients unless investment in later and more costly sages of R&D for these products is ramped up, and new government incentives for antibiotic research are enacted.

Further Downward Trend Predicted – Unless Public Sector Rewards Increase

The industry report predicts that investment in AMR R&D may see a downwards trend in the coming years unless governments enact new incentives to pull large pharmaceutical companies back into the space. Frank says that ultimately, small companies with potential novel compounds that could “treat a public health need” must also be able to incentivize investors and make a sustainable return on investments.

One potential solution, said Frank, is the creation of new types of “market-entry rewards” by the public sector that reward a company with an approved antibiotic that meets a specific criteria with some form of cash benefits or its equivalent.

On example of such a reward would be a more flexible formula for “exclusivity vouchers,” which extend the patented life of a product by a year and have been created in some countries to reward new drug innovations. If these were made transferable, they could be used by a company to protect another, more profitable product in its portfolio or sold – providing added return on investment.

Currently, these vouchers can only be applied to the approved antibiotic, said Frank, but for a medicine that is not very profitable, this creates little incentive to advance research and production:  “I once had a company tell me, ‘it’s great that we have it; now it gives me another 5 years to solely lose money on my medicine.’”

Diagnostics – Bright Spot on AMR Investment Horizon

The threat of drug-resistant superbugs has often focused on the “arms-race” between the development of stronger disease-causing pathogens and new drugs to fight them.

Lab researcher dripping test liquid in petri dish and checking reaction.

But the AMR report also highlights one brighter spot – the increased investment in new diagnostics development, which can play a critical role in reducing drug resistance.

Expanded use of diagnostics can help make sure that the “right tools” are available for the “right patient” at the “right time,” explains Jean-Louis Tissier, vice president of public and government affairs-AMR at the in-vitro diagnostics company bioMérieux, an AMR Industry Alliance member.

For example, it can be difficult to tell if certain diseases are caused by bacteria or viruses based on symptoms alone. Acute respiratory infections, which often present with cold-like symptoms, can be caused by both bacteria or viruses. But prescribing antibiotics for viral illnesses contributes to growing drug resistance without actually treating the patient effectively.

For instance, a simple lab test for the bacterial biomarker pro-calcitonin that takes less than one hour, can tell a physician if the patient has a bacterial infection; it can also help the physician decide for how long the patient might need antibiotic treatment. This test is being widely used in some European countries, such as Germany, he said.

“Today, you see an increase in [drug resistance] because in some countries there is overuse of antibiotics… if you go to the south of Europe or the US you can see an increase in resistance in patients who are over-prescribed with antibiotics,” says Tissier.

With new diagnostic tools becoming available, the next step is to support low- and  middle-income countries to invest further in diagnostic and laboratory capabilities that can use these tools effectively, said Tissier. “Health care facilities are looking at the most efficient systems, and these countries are where we need to demonstrate the economic and medical value of diagnostics solutions. Yes, there is a cost at the laboratory level [to do a diagnostic test], but at the hospital level diagnostics are a key source of savings.”

Going a step further, newer molecular biology diagnostics for conditions such as acute respiratory infections can provide clinicians with even more accurate information about the type of pathogen involved, as well as to which drugs it may respond, leading to faster, more appropriate treatments for patients.

 Addressing Antibiotic Shortages

The same market forces that are preventing new treatments from reaching the marketplace also are also leading to supply-chain shortages for some of the most common and critical antibiotics, which billions around the world take for granted, while millions of other people still lack access, the report finds.

“Continuity of supply of antibiotics is of paramount important and there are many elements needed to ensure this is the case, including supply chains with suppliers that have robust quality and environmental health and safety systems in place,” says Steve Brooks, chair of the manufacturing working group at the AMR Industry Alliance.

“Maintaining robust systems takes management commitment and money, and it’s these costs that may not be fully valued in the current procurement practices when antibiotics are purchased by large/institutional buyers.”

Shortages also are linked to low prices, which have prompted the withdrawal of many manufacturers from antibiotic production, leading to increased concentration in supply chains that can also create bottlenecks when just one manufacturer shuts down or fails to fill an order.

Solutions can involve what some have called the “Netflix” model of longer-term contracts between health systems and drug manufacturers, said Frank. This allows drug suppliers to rationally plan production and therefore supply, without fear of the sudden loss of a customer.

Environmental Concerns, and Other Challenges

On the enviromental front, where the release of antibiotic residues from pharma production facilities can foster development of drug resistant bacteria in sewage effluent, industry members are taking additional steps to control the release of such residues into the environment, the Alliance report says. Members are two years ahead of schedule in establishing a standard framework for limiting manufacturing emissions to “no-effect” concentrations within the next seven years.

“Alliance manufacturers are committed… to auditing their sites and those of their suppliers against the Alliance Common Antibiotic Manufacturing Framework and assessing concentrations of antibiotic residue in waste streams,” explained Brooks.

The framework dictates that for a factory supplying one million antibiotic tablets per year, the concentration of antibiotic in the collected waste water must be less than 1 microgram per litre. Effectively this would mean that residue concentrations released annually into wastewater effluent would not contain enough active ingredient for even one antibiotic tablet, he said.

So far, the findings show that 82% of participating companies’ antibiotics manufacturing facilities meet or partially meet the framework requirements. Those suppliers that don’t meet the standard are required to take action to reduce their antibiotic emissions, or potentially face losing their contracts.

“In the event changes are not not being made in a timely manner, members may look at alternate supply arrangements,” said Brooks.

Industry members have also made efforts to combat falsified and substandard antimicrobials; develop strategies to improve access to medicines in low-income countries; and formalize standards for appropriate use of antibiotics.

Together, the AMR Industry Alliance group of some 91 biotech, diagnostics, generic medicines, and research-based biopharma companies account for approximately one-third of the global antibiotic supply, and nearly half of the antibiotics in pre-clinical development, and half of the diagnostics sector producing AMR-related products.

Additional information about the report can be found at the AMR Industry Alliance.

Image Credits: AMR Industry Alliance.

The mysterious new pneumonia coronavirus that has emerged in Wuhan, China may also be transmitted between people, health experts in China and Geneva now suspect. Officials are concerned that the outbreak may also spread globally as a new exported cases of the novel virus were confirmed in Thailand on Friday and Japan on Thursday, and local sources reported a second death due to the virus in China.

The outbreak has claimed its second victim, a 69-year old man named ‘Mr. Xiong’ who was reportedly hospitalized on 31 December 2019. The Wuhan Municipal Health Commission said in an official statement that the man’s condition deteriorated on 4 January and died on 15 January at Wuhan JinYinTan Hospital shortly after midnight (translated from Chinese).

The second Thailand case was also in a Chinese national who was found to have fever on arrival at Suvarnabhumi airport on 13th January. Initially hospitalized for mild pneumonia, Thai and WHO officials have since confirmed the man to be positive for the new viral disease.

Earlier in the week, reports surfaced that the coronavirus, dubbed 2019-nCOV, has been confirmed in family clusters, including at least one family member who had not visited the Wuhan seafood and live animal market that is suspected of being the source of the new infectious agent.

On Thursday Japan’s Health Ministry also reported its first case of the virus in a man who fell ill during a visit to Wuhan earlier in the month, although he had not visited the market, said NHK World News. The man was hospitalized upon his return to Japan on 6 January, and was discharged on Wednesday. Later Thursday, WHO confirmed the report of the Japanese case.

Seafood and fresh food market in Wuhan, Hubei, China. Most confirmed cases of 2019-nCoV were traced back to Huanan Wholesale Seafood Market, although at least two confirmed cases have reported never visiting the market. Authorities are concerned that this could mean the source of infection is present in other markets, or the disease could spread directly from person to person.

Chinese authorities and researchers are now struggling to pinpoint the original infection reservoir among the live animal species sold in the market; routes of transmission; and confirm definitively if the disease can be spread by person-to-person contact – possibly in a weakened form.

A commission of technical experts from Hong Kong, Macao, and Taiwan visited Wuhan on 13 – 14 January and found two family clusters of confirmed cases – three male family members living together and a husband-wife duo.

The three men were all believed to have contracted the disease from working at the seafood market, Dr Chuang Shuk-kwan, a commission expert from Hong Kong, was quoted saying at a press conference Wednesday morning in the South China Morning Post. However, the wife with a confirmed case of the 2019-nCoV infection had not recently visited the market where her husband worked as a trader, according to a statement by Wuhan authorities (translated from the Chinese). Chuang Shuk-kwan said this could suggest “limited” human-to-human transmission of the virus is occurring.

In Geneva, a WHO official expressed similar concerns: “From the information that we have, it is possible that there is limited human-to-human transmission, especially among families who have close contact with one another,” Maria Van Kerkhove, acting head of WHO’s Emerging Diseases Unit, told journalists at a briefing.

The possibility that the virus is being transmitted between humans – but resulting in asymptomatic or mild cases that remain undetected by the health system – is an important concern for Chinese authorities as hundreds of thousands of people prepare to travel around the country during the Lunar New Year, the annual holiday that begins January 25.

The number of confirmed cases has risen by 44, and caused two deaths. Three cases have now been reported outside of China, in Thailand as well as Japan. Officials are investigating whether the latest Thai case has had contact with the local seafood market where most cases have been traced. The Japanese case, announced publicly Thursday, was a man who fell ill on 3 January and had been in close contact with some of the Wuhan residents who became infected, although he did not visit the suspect live market. He was hospitalized after returning home to Japan and has since recovered. In Thailand, a case was reported on 8 January in a 61- year old Chinese tourist from Wuhan who became sick while traveling to Bangkok for a vacation; she was immediately hospitalized and is also now recovering, according to WHO.

While that patient reported visiting a local fresh market in Wuhan on a regular basis, she had not visited the Huanan Seafood Wholesale Market, where most of the other cases have been traced. Experts say that this means that the source of the infection could be a live animal commonly sold at other markets as well.

Number of New Ebola Cases Stabilizes

Infectious disease outbreaks, epidemics, as well as increasing drug-resistance among certain viruses and bacteria, are among a list of urgent global health challenges for the next decade, WHO said this week.

And along with the emerging coronavirus in China, the new year of 2020 also opened with the world still battling a stubborn, 1.5 year-long Ebola outbreak in the Democratic Republic of the Congo.

The last embers of the Ebola outbreak in the Democratic Republic of the Congo are still smoldering as the response effort moves into the new decade. The deadly virus resurged in December, after a month of civil unrest and armed attacks on health workers in eastern DRC – the epicenter of the outbreak. Although there were signs that numbers may be stabilizing in the new year. Some 14 new cases were confirmed between 8-14 January, compared to 12 new cases the previous week. Case numbers are down again after a small resurgence of 27 cases in the first week of December 2019.

A Red Cross team demonstrates a safe and dignified burial.

Insecurity and community mistrust have plagued the response, with the International Federation of the Red Cross confirming Wednesday that yet another attack on Ebola responders had occurred at a safe burial conducted in Mambasa. Two Red Cross volunteers were injured.

“Despite an overall improvement in the community’s acceptance, this attack shows that community engagement is crucial to building trust and ending the Ebola outbreak,” IFRC Africa tweeted on Wednesday. On Thursday, WHO reported that several health areas continue to be difficult to reach due to insecurity, including Mandima Health Zone, where there are rumors of several community deaths in Lwemba Health Area.

In 2019, WHO recorded 978 attacks on health care workers and outbreak responders, resulting in 193 deaths. As of 14 January, 3406 Ebola cases have been reported, of which 2236 cases have died.

Story updated 17 January 2020

Image Credits: Arend Kuester/Flickr, IFRC.

More public disclosure and information-sharing about drug prices and their R&D costs, is key to determining a fair price for essential medicines, concludes a series of five articles on fair pricing published Monday in the BMJ. The series, supported in part by the World Health Organization, highlights the increased priority drug price transparency is receiving on WHO’s agenda.

The five articles discuss the barriers to information-sharing between private and public sectors about R&D costs, as well as between health systems in different countries, which typically keep data on real drug purchase prices confidential, which have become a central theme on the transparency agenda over the past year.

But the series also explores some new, win-win approaches to pricing that could help make higher-price medicines more affordable while maintaining incentives for the private sector to invest in R&D and manufacturing, according to the study authors.

“Transparency is a key element to determine what is fair, but there is an absence of reliable data on development costs,” Alison Colbert, technical officer in the Essential Medicines and Health Products Department at WHO wrote in an introductory editorial published in the BMJ for the series. The editorial was co-authored by top WHO officials, including the director and assistant-director of the Essential Medicines and Health Products Department at WHO, Suzanne Hill and Mariângela Simão, along with Soumya Swaminathan, chief scientist at the WHO.

The WHO officials add that “ultimately, there is no simple algorithm that will calculate a fair price for each medicine,” but that transparency and collaboration will ensure that the “right data” are available to the “right stakeholders” to help ensure affordable access to essential medicines.

However, before “fair” prices can be set, the global health community must first agree about what a “fair” price means.

“”For too long, governments and other purchasers of medicines have not had clear frameworks for how to assess the fairness of medicines prices, especially when considering pricing within a global market. We know medicines prices have been climbing year after year, but how can we assess when a high price is too high?” asked Suerie Moon, co-director of the Global Health Centre at the Graduate Institute.

Suerie Moon et al. propose hypothetical price ceilings (ie, the maximum that is affordable to the buyer) and fair prices for countries with different affordability thresholds. Prices below the red line indicate hypothetically “fair” prices.

In the first article in the series, Moon and her colleagues from WHO highlight the differences between what matters to sellers’ and buyers’ in defining a “fair price.” The authors note that both groups have a very different set of parameters.  Buyers may consider a drugs overall value to individuals and health systems;  affordability and financial hardship risks; and supply security. Pharmaceutical companies, on the other hand, are concerned with prices that cover the costs of R&D, regulation, manufacturing, and distribution while generating a profit.

Moon and her colleagues propose a framework that combines both buyers’ and sellers’ concerns in defining a range of fair prices for medications, proposing that price ceilings for medicines could be set by consideration of consumers’ concerns while price floors could be set by manufacturers’ priorities. Public intervention should occur in cases where prices fall outside of this range.

“A key concept here is that companies can earn a fair profit, but the profit should not be excessive and should not come at the cost of affordability to patients,” Moon clarified.

Altogether, the series includes five papers that address issues around medicines prices that could be described as “fair” while still incentivizing the pharma industry to invest, entitled as follows:

While generally, high prices are associated with patented medicines, the second and third papers also explore lesser-publicized issues of high pricing for biosimilars, generic medications, as well as the prices of  off-patent drugs which may have too few manufacturers. The fourth paper argues for a radical shift towards alternate business models that reward the pharma industry for innovation, but not through the vehicle of prices, to spur more development in areas of unmet health need.

Finally, the last paper presents how the WHO’s Market Information for Access to Vaccines database has allowed middle-income countries to share market data and negotiate more equitable prices, highlighting an example of a transparency initiative that has helped increase access to essential vaccines.

The series’ authors include researchers from WHO, the Organization for Economic Co-operation and Development (OECD), the Graduate Institute in Geneva, University of KwaZulu-Natal, and Harvard University, among others.

Image Credits: BMJ, Suerie et al. Defining the concept of fair pricing for medicines.

[UN News] Kenya, Mozambique and Niger curbed different outbreaks of vaccine-derived poliovirus over the past 24 months which affected 14 children, said a senior WHO official on Monday.

Although wild poliovirus virus has not been detected in Africa since 2016, roughly 12 countries are currently facing outbreaks of vaccine-derived poliovirus.

© UNICEF/Claudio Fauvrelle
Mothers take their babies to receive vaccinations at a mobile unit in Molumbo district, Mozambique.

“Ending outbreaks in the three countries is proof that response activities along with high quality immunization campaigns and vigilant disease surveillance can stop the remaining outbreaks in the region”, said Dr. Modjirom Ndoutabe, coordinator of WHO-led polio outbreaks Rapid Response Team for the African Region.

“We are strongly encouraged by this achievement and determined in our efforts to see all types of polio eradicated from the continent. It is a demonstration of the commitment by governments, WHO and our partners to ensure that future generations live free of this debilitating virus”.

Polio is a highly infectious viral disease that can lead to paralysis.  It mainly affects children under five.

While there is no cure, the disease can be prevented through a simple vaccine.

Polio is transmitted from person-to-person and is spread through contact with infected faeces or, less frequently, through contaminated water or food.  The virus enters the body via the mouth and multiplies through the intestines.

“When children are immunized with the oral polio vaccine, the attenuated vaccine virus replicates in their intestines for a short time to build up the needed immunity and is then excreted in faeces into the environment where it can mutate”, Ndoutabe explained.

Vaccine-derived polioviruses are rare, according to WHO. They only emerge in areas where overall immunization rates are low and sanitation is inadequate, leading to transmission of the mutated polio virus via sources such as contaminated sewage.

Another 12 African countries continue to experience vaccine-derived polio outbreaks, including: Angola, Benin, Cameroon, Central African Republic, Chad, Côte d’Ivoire, Democratic Republic of the Congo, Ethiopia, Ghana, Nigeria, Togo and Zambia.

Weak routine vaccination coverage, vaccine refusal and difficulty in accessing some locations, are some of the risk factors behind these outbreaks, according to WHO.

 

Image Credits: © UNICEF/Claudio Fauvrelle.

The number of cholera cases decreased by 60% in 2018 compared to 2017. Cholera-endemic countries such as Haiti, Somalia, and the Democratic Republic of the Congo saw some of the highest reductions.

Cholera vaccination in Nigeria

“The decrease we are seeing in several major cholera-endemic countries demonstrates the increased engagement of countries in global efforts to slow and prevent cholera outbreaks and shows the vital role of mass cholera vaccination campaigns,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus in a press release. “The long-term solution for ending cholera lies in increasing access to clean drinking water and providing adequate sanitation and hygiene.”

There were 499,447 reported cases and 2990 deaths in 2018, significantly lower than the 1.2 million cases and 5654 deaths reported in 2017. The country most affected by the ongoing cholera pandemic continues to be Yemen, which reported 128,121 cases and 2485 deaths in 2018, according to data collected by WHO.

However, several cholera-endemic countries saw dramatic decreases in the number of cases – including Haiti, Somalia, DRC, Zambia, South Sudan, United Republic of Tanzania, Somalia, Bangladesh, and Nigeria – thanks to the implementation of new national action plans for cholera control.

“The global decrease in case numbers we are observing appears to be linked to large-scale vaccination campaigns and countries beginning to adopt the Global Roadmap to 2030 strategy in their national cholera action plans,” said Dr Dominique Legros, head of WHO’s cholera programme in Geneva.

“We must continue to strengthen our efforts to engage all cholera-endemic countries in this global strategy to eliminate cholera.”

Nearly 18 million doses of Oral Cholera Vaccine (OCV) were shipped to 11 countries in 2018, financed in part by Gavi, the Vaccine Alliance. However, experts at WHO say that vaccination must be supplemented with efforts to improve access to clean water and sanitation. Vibro cholerae, the bacterium that causes the acute diarrhoeal infection, breeds in contaminated food and water.

Mass vaccination and water and sanitation interventions are recommended as part of the Global Roadmap strategy, which provides a three-pillar framework for national action plans focusing on:

  • Early detection and rapid response to contain outbreaks
  • A multisectoral approach integrating strengthened surveillance, vaccination, community mobilization, and water, sanitation and hygiene to prevent cholera in hotspots in endemic countries
  • An effective mechanism of coordination for technical support, resource mobilization and partnership at the local and global levels.

Image Credits: WHO.

For the first time in two decades, tobacco use is projected to decline among men in 2020, according to a new World Health Organization report on trends in global tobacco use. However, the new report does not consider trends in e-cigarette use, where use may in fact be increasing.

“For many years now we had witnessed a steady rise in the number of males using deadly tobacco products. But now, for the first time, we are seeing a decline in male use, driven by governments being tougher on the tobacco industry,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus in a press release about the new report.

Based on data collected from 149 countries, global tobacco use has been steadily declining for the past 18 years, from 1.397 billion people in 2000 to 1.337 billion in 2018. But that downward trend had been primarily driven by declining use in women.  About 100 million fewer women used tobacco in 2018 as compared to 2000, and women’s use of tobacco is projected to decline further over the coming five years.

However, over the same 2000-2018 period, the number of men using tobacco actually increased by 40 million people, and males currently represent some 82% of tobacco users.

Yet over just the past year, prevalence of tobacco use in males has plateaued, and it is now projected to begin declining in 2020, the latest data shows. WHO estimates that there will be 2 million fewer male users in 2020 as compared to 2018, and 5 million fewer by 2025.

“Showing that tobacco use can be reversed gives the public health community confidence we can get back on track and meet the global targets of a 30% reduction [in smoking rates] by 2025 as compared to 2010,” Ruediger Krech, director of WHO’s Department of Health Promotion said at a press briefing.

Projections of a decline in male tobacco use for 2020 are not the same across all regions either, the WHO officials cautioned. While fewer men are expected to be seen smoking in the Americas, Europe, and Western Pacific regions, WHO’s South-East Asian region, which currently has the highest proportion of male smokers at 62.5%, is projected to see a slight increase in absolute numbers over the next five years. Numbers of male smokers are also predicted to increase in the WHO Eastern Mediterranean and African regions.

And around the world, 43.8 million children between 13-15 used tobacco in 2018. That number excludes the use of e-cigarettes and other such nicotine delivery devices, which some country specific surveys have found is on the rise in youth in countries such as the United States.

Krech credited the inroads made against tobacco use over the past two decades to increasingly strong policy measures such as: banning smoking in public places, tobacco taxation, and marketing restrictions like plain packaging of tobacco products, as well as bans on marketing aimed at teens and children.  But he said that such measures must be amplified in order to reach the global targets.

“The downwards trend in tobacco use offers a challenge to governments. We cannot be satisfied with a slow decline when over 1 billion people are still using tobacco,” said Krech. “We must dramatically accelerate tobacco control measures to protect current and future generations from tobacco.”

The Unknown Contribution of E-Cigarette Use

Another unknown involves the use of smokeless tobacco devices. Use of e-cigarettes, as welll as other electronic nicotine delivery and heated tobacco devices were all excluded from the analysis, raising questions about whether potential smokers might also be shifting away from traditional tobacco products over to such methods.

Originally marketed as smoking cessation devices, electronic nicotine delivery systems (ENDS) have gained increasing notoriety for allegedly hooking young people onto nicotine at earlier ages. According to the US National Youth Tobacco survey, one of the most comprehensive national surveys that collects data on nicotine consumption annually, the proportion of high-school students who have used an ENDS device at least once shot up to 27.5% in 2019, as compared to only 12% in 2017. Manufacturers have been accused of targeting their marketing directly towards young people, particularly by producing the nicotine liquid pods in a variety of flavors popular among teenagers.

“If there are flavors like chewing gum or strawberry, who is the target audience? Me or my grandchildren,” Krech remarked.

As for whether an increase in e-cigarette use has perhaps led to a decrease in use of other tobacco products, Krech said that WHO could not at this time “say whether that has an impact or not.”  However, he acknowledged that many tobacco smokers are so-called “dual-users” – using both combustible cigarettes and e-cigarettes.

Krech added that WHO is currently collecting data on e-cigarette use and tobacco vaping, and is planning to release a more comprehensive report on the subject in February 2020. Countries have only begun collecting nationally representative data on the use of ENDS in 2013, and currently data from 42 countries is available, with more reports coming in every day.

“There is no “safety” associated with e-cigarettes,” said Krech. “There are a lot of risks associated with e-cigarettes, and we’re going to be a bit more concrete about those risks [in the February report].”

Accelerate Actions to Decrease Tobacco Use

In terms of policy measures, the report finds a clear trend towards more stringent government policies and regulations aimed at reducing tobacco use and second-hand smoke exposures. As of 2018, 137 countries have put into place at least one of the six methods recommended by the WHO in line with guidelines of the Framework Convention on Tobacco Control (FCTC).

Some 116 of these 137 countries have seen their tobacco use rates decline since implementing the measures, which include stronger measures for monitoring tobacco use; protection against second-hand smoke exposures; quit smoking programmes; awareness raising about tobacco’s dangers; restrictions and bans on tobacco advertising, promotion, and sponsorship of activities; and increased taxes on tobacco products.

The report found that strong declines in average tobacco use prevalence were mostly seen in regions that implemented the policies. This was true for the WHO South-East Asia region, which saw reductions in tobacco use – mostly in smokeless tobacco – after all 11 countries of the region had implemented at least one policy.

“Continuing to reduce tobacco use will help save lives, nurture families, and strengthen communities,” said Krech. “We must dramatically accelerate tobacco control measures to protect current and future generations from tobacco.”

Civil society organizations agreed. Gan Quan, director of Tobacco Control at the International Union Against Tuberculosis and Lung Disease and a partner in tobacco industry watchdog STOP (Stopping Tobacco Organizations and Products), said in a statement, “The problem is that the tobacco industry continues to undermine such measures all over the world and to market their products aggressively.”

Quan added, “The data is clear: tobacco use falls when governments implement policies that are proven to encourage quitting and deter youth from starting to use tobacco.”

Image Credits: WHO, WHO global report on trends in the prevalence of tobacco use, MomentiMedia/Flickr.