Unitaid will expand its work in malaria to include chemoprevention for infants in the first year of life and pilot a new “agility” mechanism to support global health innovation in 2020, following approval granted by Unitaid’s Executive Board on November 20 to 21.

(left-right) ED Lelio Marmora, Board Vice-Chair Maria Luisa Escoral de Moraes, Board Chair Marisol Touraine, Deputy ED Philippe Duneton

The Board’s approval will allow Unitaid to launch a call for proposals for projects on malaria chemoprevention for infants.

“Chemoprevention is a key piece of the puzzle in the fight against malaria,” said Unitaid Executive Director Lelio Marmora in a press release.

“Adding infant malaria chemoprevention to Unitaid’s expanding malaria portfolio will not only protect millions of babies from this deadly disease but also help reignite the stalled progress in the global malaria response.” 

Infants and children are highly vulnerable to malaria because they have not yet developed protective immunity, according to Unitaid. Of the 435,000 malaria deaths in 2017, more than 60 percent occurred in children under 5.

Currently, malaria chemoprevention, or the strategy of providing medication to prevent malaria, is used by Global Fund financed programmes protect children 3 to 59 months old during the four-month rainy season in 12 countries in the Sahel, based on evidence from a Unitaid/Malaria Consortium project (ACCESS-SMC). Unitaid also invests in projects to expand and monitor malaria chemoprevention in pregnant women.

In a separate decision, the Board approved up to US$20 million in 2020 to fund a new framework to respond quickly to global health innovation, delegating the authority to enter into legal agreements under the pilot to the Executive Director. Current ED Lelio Marmora also announced to the Board that he will be stepping down by March 2020, and Deputy Executive Director Philippe Duneton has been identified as acting ED in the interim.

Image Credits: Unitaid.

A global campaign focusing on the issue of rape as a form of violence against women is being launched Monday on International Day for the Elimination of Violence against Women. The annual sixteen-day campaign, which is set to end on 10 December, Human Rights Day, will bring together activism against gender-based violence under this year’s theme “Orange the World: Generation Equality Stands against Rape.”

“We must show greater solidarity with survivors, advocates and women’s rights defenders. And we must promote women’s rights and equal opportunities,” said UN Secretary-General Antonio Guterres in a video message. “Together, we can – and must — end rape and sexual assault of all kinds.”

WHO has called violence against women a “public-health problem,” estimating that one in three women globally have experienced some form of sexual or physical violence in their lifetime. Most violence is perpetrated by intimate partners or other people the women know; almost one third of women who have been in a relationship report that they have experienced some form of physical or sexual violence, including rape, by an intimate partner in their lifetime according to the WHO.

The statistics around the prevalence of rape can be unclear, but UN Women’s Executive Director Phumzile Mlambo-Ngcuka notes in an official statement that “almost universally, most perpetrators of rape go unreported or unpunished.”

Mlambo-Ngcuka further adds that women require a great deal of “resilience to re-live the attack, a certain amount of knowledge of where to go, and a degree of confidence in the responsiveness of the services sought – if indeed there are services available to go to” in order to decide to report sexual violence. For those who do report, especially adolescent girls, less than 10% go to the police, Ngcuka says.

Health-care providers are often the first point of professional contact for a woman experiencing violence, according to the WHO. Women who are abused are more likely to seek health services even if they do not explicitly seek care for violence, making providers important first responders for survivors of sexual violence.

WHO launched global guidelines for healthcare providers to respond to sexual violence in 2013 and began working with partners to implement trainings for healthcare workers in India, Namibia, Pakistan, Uganda and Zambia. A pilot of the trainings was completed in two tertiary hospitals in the State of Maharashtra India, and a recent assessment of the impact of the trainings done by the Center for Enquiry into Health and Allied Theme (CEHAT) will be used to inform a potential national-roll out of the trainings.

See here for more information about the WHO Guidelines for Healthcare Providers and WHO and CEHAT’s work in Maharashtra.

See here for more information about the “16 Days of Activism Against Gender-based Violence.”

 

Image Credits: UNICEF/Nesbitt.

Oslo – Norway has launched a milestone “Better Health, Better Life” strategy to combat deadly non-communicable (NCDs) diseases as part of its international development assistance. This makes Norway the first to develop a strategy for combating this large and growing global health threat, which currently receives only about 1% of international health assistance.

NCDs are the cause of some 70% of deaths worldwide – and are now a major, growing cause of illness and premature death in low- and middle-income countries.

‘Worldwide, 41 million people die each year as a result of respiratory disease, cancer, cardiovascular disease, diabetes, mental disorders and other non-communicable diseases. This cannot continue,” said Norwegian Minister of International Development Dag-Inge Ulstein.

“Therefore, Norway will triple its assistance to fight NCDs, allocating over 200 million NOK to these agendas for 2020. This is just the start, we will step up the funding towards 2024,” said Ulstein.

Norwegian Minister of International Development, Dag Inge Ulstein

Speaking at a launch of the strategy in the Norwegian capital at a “Gathering for The Future of Global Health,” the minister noted the “strong upward trend” in the number of deaths from non-communicable diseases in countries at the lowest income levels.

“Tobacco, air pollution, alcohol, unhealthy food, lack of physical activity…These silent killers cause 70 percent of all premature and unnecessary deaths worldwide – yet the fight against them receives only 1 percent of the international development funding that goes to health. 70 percent – One percent,” said Ulstein.

“That has to change – and that is why we are here today. In Africa, the deaths from non communicable diseases are projected to increase from around 35%  to over 50% of total deaths by 2030. We are going the wrong way.”

NCDs often develop into chronic conditions, and when they are not treated or managed early enough, the result can be catastrophically high costs for individuals as well as health systems, he observed.

“If you cannot go to work – or plow your fields – there will be one less bread-winner in the house – and one less co-fighter in our collective quest to win the 2030 race to meet the SDGs,” he said.

Norway Asks Other Donors To Step Forward on NCDS
Norwegian Minister of Health, Bent Høie. (Photo: Stine Jenssen).

In launching the strategy, Norwegian officials were clear that they hope other high income countries which provide billions of dollars in international development assistance will also step forward and follow their example.

“No country until today has presented a programme on how to use development aid as a tool … to address the NCD epidemic. This is what makes this day so special,” said Norway’s Minister of Health, Bent Høie who co-hosted the strategy launch.

Referring to Norway’s longtime record of promoting health in development aid, he said that “this strategy will take it a step further, I urge other countries to follow up and develop their own NCD strategies for development assistance.”

Historically donor aid from high income countries has been used almost exclusively on communicable diseases, he noted, referring to the billions of dollars spent every year on global health programmes to fight AIDs, TB, malaria, other neglected infectious diseases, as well as to promote immunization.

Historically those programmes “corresponded to the disease burden and the biggest challenges in global health,” he noted, but, “today, this has changed.

“The NCDs are claiming far more lives than communicable diseases with many people dying prematurely. With this change in the disease burden, we need to change our priorities accordingly.”

WHO’s Bente Mikkelsen talks about the need for collaboration between health, finance, urban development, agriculture, food and pharma sectors to reduce NCDs, at the launch of the Norway’s NCD Strategy.

While some NCD treatments can be extremely expensive, others are “relatively cheap, like getting medication to lower blood pressure. But in many low income countries, this is out of reach,” he added.

“The [Norwegian] strategy recognizes these challenges and underlines the need to provide treatment based on universal health coverage. Primary health care is the basis.”

He noted that the strategy builds upon the 16 WHO-recommended Best Buys for preventing and controlling NCDs, which include comparably simple and inexpensive measures such as reduced salt and sugar intake and increasing physical exercise. The Best Buys were agreed upon by UN Member States at last year’s Third High Level UN Meeting on NCDs.

“If these were implemented, over 8 million lives could be saved annually by 2030,” Høie said, adding that according to WHO estimates, that would also lead to a savings of $US 7 trillion in low- and middle-income countries over the next 15 years.

Three-Pronged Strategy 

The new strategy has three main points of focus: Strengthening primary health care services: Prevention of leading NCD risk factors like air pollution, tobacco and alcohol consumption and unhealthy diets; Better data management and health information systems.

Strengthening Primary Healthcare Services as part of Universal Health Coverage.

Many NCD interventions, can be delivered effectively and affordably at primary health care level, with greater benefits to patients and savings for health systems.   Examples are checks for hypertension, diabetes, prevention of cervical cancer with HPV vaccination, as well as capacity for prevention and early diagnosis and treatment of mental health disorders in primary health services.  Norway will support the strengthening health services so that primary health care services are well-equipped to support NCD prevention, early diagnosis and treatment, as well as ensuring everyone has access to health services, subsidized in part, by the public authorities.

A woman gets her blood pressure measured to test for hypertension.
Preventing and reducing risks through intersectoral action, including regulation, taxation and other measures.

Norway will help to prevent non-communicable disease through development cooperation that contributes to healthy and sustainably produced food, a healthy environment with clean air and the consumption of clean energy, opportunities for physical activity, access to high-quality education and stronger tobacco and alcohol regulations. Emphasis shall be given to social sustainability and reducing health differences from childhood to old age.

In this context, Norway will also support countries requesting assistance to improve taxation and regulation of products that are harmful to health,  through its Tax for Development Programme (Skatt for utvikling). Such measures can be used to effectively discourage consumption of health-harmful products such as tobacco, alcohol, sugary drinks, saturated and trans fats, and encourage healthier alternatives.  Similarly, pollution taxes and regulations can encourage shifts to clean energy and transport, reducing health-harmful air pollution. These are all among the key risk factors contributing to NCDs, including cancer, hypertension and heart disease as well as obesity-related disease such as diabetes.

Unhealthy, unregulated street foods are commonly sold in low- and middle- income countries.
Strengthening data management, digitalization and other health information needs.  

The strategy also calls for assisting countries in developing better health information systems, to  improve access to health data critical to facilitating early stage NCD diagnosis, treatment; supporting NCD-related health norms and standards, as well as efforts to improve access to medical equipment and medication, particularly  in areas hit by crises and conflict.

Norway’s officials say that the strategy will support the SDG 3 goals of Universal Health Coverage (SDG 3.8) and reducing premature deaths from NCDs by one-third by 2030 (SDG 3.4), as well as the commitments reached at the Third UN High Level Meeting on NCDs  in 2018 as well as the recent UN High Level Meeting on Universal Health Coverage,” Høie added.

The strategy also supports other SDG 3 targets for reducing deaths and illness from hazardous chemicals and air pollution, as well as preventing and treating harmful use of alcohol.

Strategy Launched At Oslo “Gathering for Global Health” Event

Norway has become “the first in the world to launch a strategy to include non-communicable diseases in its international development policy,” said WHO’s Director General Dr Tedros Adhanom Ghebreyesus in a videotaped message broadcast at the strategy “Gathering for Global Health” launch in Oslo on Friday.

Tore Godal

“Non-communicable diseases are the leading killers of our time. As is so often the case, the world’s poorest bear the heaviest burden,” the WHO Director-General added. “The risks of dying between the ages of 30 and 70 from a heart attack, stroke, diabetes, cancer or asthma are 4 times higher in most countries of Africa than in Norway.”

“You have anchored this strategy in the political declaration on NCDs and Universal Health Coverage, which were adopted this year and last year at the UN General Assembly.”

“And you have built it on the WHO Global Action Plans on NCDs and Mental Health and the WHO Best Buys. I appreciate the central role in the strategy of primary health care, both in preventing and managing NCDs.”

“Thank you for your leadership in this important area.  WHO is delighted to accept your invitation to be a co-sponsor of this strategy. Together we can ensure more people get the health services that they need for NCDs and for all their health needs.”

The launch event included Dr Tore Godal, as a guest of honor, celebrating Godal’s lifelong service to global health on behalf of the Norwegian government and the global community.

Godal, a special advisory on global health at the Norwegian Ministry of Foreign Affairs, compared today’s NCDs challenge to the battle against tobacco, which mobilized the global health community several decades ago and is still ongoing today. Like the fight against tobacco, we need a multi-pronged strategy including legal action, awareness and taxation to achieve meaningful progress,” he said.

 

A video describing the challenge of NCDs in low income countries here:

Image Credits: Twitter: @NorwayMFA, Stine Loe Jenssen, E Fletcher/HP-Watch, Twitter: @NorwayMFA.

Lelio Marmora is stepping down as Executive Director of Unitaid in March 2020, sources told Health Policy Watch. Marmora, who has led the organization since 2014, told staff on Monday that he would be leaving to seek “new challenges.”

His departure is not likely to bring “unexpected or drastic changes” to Unitaid’s funding priorities over the next few months, Unitaid Board Member for NGOs Fifa Rahman told Health Policy Watch. The organization has already set its strategy for the next two years, and has identified an acting ED committed to the same goals.

Rahman confirmed that Philippe Duneton, current deputy executive director of Unitaid, will step in as interim Executive Director. Duneton has been with the organization since its founding in 2006, and has taken on this role at least once before.

Lelio Marmora

Still, it will be important for Unitaid to find a new ED who understands the “unique role [of the organization] in funding change in how medicines are developed and made accessible for people,” Ellen ‘t Hoen, director of Medicines Law & Policy, told Health Policy Watch.

The director of Medicine Law & Policy, which provides legal and policy analysis on issues related to access to medicines and international law, further added that Unitaid is the only funder that explicitly focuses on thorny issues such as intellectual property.

Additionally, according to observers, Marmora did exert a strong influence over the organizational culture. While Marmora doubled the staff during his tenure, sources close to the organization told HPW that there was dissatisfaction among staff about the management style, and hopes that there would be some improvements.

Rahman told Health Policy Watch that the Board will be “monitoring risks” to ensure that any organizational change moves in a “positive direction.” She further added that the Board will be making a final decision on a new ED in 6-8 months.

The announcement was first made to Unitaid’s staff on Monday, and a second announcement was made by Marmora to the Board of Unitaid at the annual Board meeting on November 20-21. The announcement comes less than a month after Unitaid’s success in helping to negotiate a new deal with rifapentine drug manufacturer Sanofi to slash prices for the essential tuberculosis drug by up to 70% in 100 low- and middle-income countries. The volume-based deal between Unitaid, the Global Fund, and Sanofi was announced at the Union World Conference for Lung Health on October 31.

UNITAID’s Role in Global Health Financing

In its 13-year history, Unitaid has emerged as a major donor of upstream health product innovation and downstream access to medicines work in the “big 3” – HIV/AIDs, tuberculosis, and malaria. Among other projects, the organization funds access to medicines work around intellectual property and pharmaceutical innovation.

Notably, Unitaid does not have a United States representative on its board, which may be why the organization can fund work on controversial issues such as intellectual property and pharmaceutical development. Experts in access to medicines work further added that unlike the other, larger “big 3”-focused organization, the Global Fund to Fight AIDS, Tuberculosis and Malaria, Unitaid is a much smaller and more nimble organization.

It has historically helped negotiate major deals to reduce antiretroviral drug prices and is currently the largest multilateral funder of tuberculosis research and development. Some of its major grantees include The South Centre, the Medicines for Malaria Venture (MMV), the Drugs for Neglected Diseases Initiative, the Stop TB Partnership, and the Foundation for Innovative Diagnostics (FIND). Unitaid also funds a significant portion of WHO’s Prequalification Programme, which provides international regulatory guidance on the safety and efficacy of new health products.

Initially formed by France, Brazil, Chile, the UK, and Norway at the height of the global HIV/AIDs crisis in 2006, Unitaid uses so-called “innovative financing” mechanisms to raise money for the “big three” – HIV/AIDs, tuberculosis, and malaria. As of 2019, the organization reports it has received some US$3 billion from donors, with 70% of its funding coming directly from a “solidarity levy” on airline tickets – a funding mechanism first piloted by France and since adopted by nine additional countries. Other member states earmark a portion of specific tax revenues for the organization, such as Norway, which contributes part of its carbon emissions tax revenue to Unitaid.

This article has been amended on November 23 to update Ellen ‘t Hoen’s name and title.

Image Credits: UN Photo/Rick Bajornas.

Over 80% of school-going adolescents worldwide get less than one hour of physical activity per day – leaving children at risk of poorer cardiorespiratory and muscular fitness, bone and metabolic health, and slower cognitive development than their more active peers. The new study published Friday in the Lancet Child & Adolescent Health journal also found that girls are more likely to be insufficiently active than boys, and the gender gap is only widening in most countries.

“Urgent policy action to increase physical activity is needed now, particularly to promote and retain girls’ participation in physical activity,” says study author Dr Regina Guthold of the WHO in a press release.

The first-ever such study to analyze global trends for adolescent physical activity, Global trends in insufficient physical activity among adolescents: a pooled analysis of 298 population-based surveys with 1·6 million participants, was a massive undertaking funded by the World Health Organization and conducted by researchers from WHO, Imperial College London, and the University of Western Australia. The extensive study evaluated data collected annually between 2001 to 2016 on some 1.6 million 11 to 17-year-old students across 146 countries.

In 2016, Bangladesh had the lowest levels of insufficient activity in both boys and girls at 63% and 69% respectively, which the authors attribute to a strong focus on national sports like cricket, or societal factors like traditional gender roles. In contrast, the Philippines had the highest level of insufficient activity in boys at 93%, and South Korea had the highest levels of insufficient activity in girls at 97%.

In a third of the countries surveyed, the fraction of girls meeting the one-hour guideline for daily physical activity was more than ten percentage points lower than the percentage of boys meeting the recommendations, with the United States and Ireland seeing the biggest gaps. Between 2001 – 2016, the gender gap widened in almost three-quarters of the countries surveyed.

Global Gender Gap In Physical Activity Widening

The study found some 15% of girls and 22% of boys maintain the minimum WHO-recommended level of daily activity, and in all but four countries, girls were less active in boys.

And the gap is widening. Globally, the proportion of boys being sufficiently active actually slightly increased from 20% to 22% between 2001 and 2016, but there was no global change in the proportion of girls getting the minimum amount of daily physical activity. The global trend is largely reflected at the country level as well, with some countries experiencing a huge increase in the proportion of boys getting enough physical activity, but little change in the proportion of girls getting enough daily exercise. Interestingly, the study found that the gender gap is growing more in high-income countries.

“The trend of girls being less active than boys is concerning,” said study co-author Leanne Riley, WHO. “More opportunities to meet the needs and interests of girls are needed to attract and sustain their participation in physical activity through adolescence and into adulthood.”

As a case study, the country with the starkest gender difference in physical activity levels is the United States, where approximately 36% of all boys but less than 20% of girls were sufficiently active in 2016. The authors posit that good physical education in schools, pervasive media coverage of sports and availability of sports clubs may have contributed to the increase in the proportion of boys exercising, but girls were not getting the same benefits.

To increase physical activity for young people, governments need to identify and address the many causes and inequities – social, economic, cultural, technological, and environmental – that can perpetuate the differences between boys and girls, the authors said.

Countering Insufficient Activity Among Adolescents

WHO recommends that adolescents do moderate or vigorous physical activity for at least an hour every day. However, the sobering results from the study show that few adolescents actually meet the daily minimum for all types of physical activity – including time spent in active play, recreation and sports, active domestic chores, walking and cycling, or other types of active transportation, physical education or planned exercise.

At current rates of change, the global target of a 15% relative reduction in insufficient physical activity by 2030 – a  goal set by all Member States at the 71st World Health Assembly – will not be achieved.

To improve levels of physical activity among adolescents, the study recommends that:

  • Known effective policies and programmes to increase physical activity in adolescents be scaled up, rather than scaled back.
  • Multisectoral action to create new opportunities for young people to be active, involving education, urban planning, road safety and others.

“Countries must develop or update their policies and allocate the necessary resources to increase physical activity,” said Dr Bull. She added that policy-makers should aim to increase all forms of physical activity through “physical education that develops physical literacy, more sports, active play and recreation opportunities,” as well as invest in providing “safe environments so young people can walk and cycle independently.”

But ultimately, she noted, comprehensive action requires engagement with multiple sectors and stakeholders, including schools, families, sport and recreation providers, urban planners, and city and community leaders.

Image Credits: WHO, Global trends in insufficient physical activity among adolescents: a pooled analysis of 298 population-based surveys with 1·6 million participants.

Incarcerated people suffer from poorer health outcomes and limited access to health care, which can impact them and their communities even after release. However, prisoners’ health is not being monitored well, and there is a lack of evidence to inform policy making to improve the health of prison populations.

These are the main findings of a new study, “Status report on prison health in the WHO European Region,” released Thursday by the World Health Organization European Regional Office. The study collated data from the 53 countries of the WHO European Region collected between 2016-2017 that was reported in WHO’s Health in Prisons European Database (HIPED), launched in January 2018. It notes that a variety of the 90 health indicators in HIPED, such as infectious disease prevalence in prisons, were underreported, and little or no data on the prison population was available for about a fourth of the countries in the Region.

“We only have data from 39 countries, but the data that we have indicate an enormous difference in the general health of people in prison compared to those in the outside world,” said Dr Carina Ferreira-Borges, programme manager for Alcohol and Illicit Drugs at WHO EURO, in a press release.

In the countries that did report, the study found that the overall mortality rate in prisons is 45 per 10,000 individuals, substantially higher than the general mortality rate in the population of 27 per 10,000 individuals, although the reasons for the contrast are unclear.

The report notes that over 1.5 million people are incarcerated in the region each year, and rates of recidivism can be high, causing individuals to shuttle back and forth between disjointed community and prison health systems. Additionally, for those who suffer from addiction or mental health disorders, the risk of suicide, self-harm and drug overdose is high in the early days of a person’s release.

“A prison sentence takes away a person’s liberty; it should not also take away their health and their right to health,” said Dr Bente Mikkelsen, director of the Division of Noncommunicable Diseases and Promoting Health through the Life-course at WHO EURO.

Outside of individual considerations, poor health access in prisons can impact the wider community once an incarcerated person is released; some prisons experience overcrowding, and infectious diseases can spread quickly in such settings, the report notes. The report found that resources for the prevention of infectious diseases are “not universally available” across European prison health systems, with some countries reporting such resources are entirely unavailable. A full vaccination course for hepatitis B is available in only 31% of the Member States in the study.

“A large proportion of people in prison return to the community every year, so viewing prison as a setting for public health opens an opportunity for public health actions and for improving health literacy to support and protect vulnerable populations,” said Mikkelsen.

According to the report, prisons can be seen as settings in which health interventions can address existing health conditions and contribute to positive lifestyles and behaviour changes. Time in prison can also be used to improve people’s skills to help them find a job after release and reintegrate into society.

“The prison population, with its disproportionate disease burden, is one that cannot be forgotten in WHO’s pursuit of the United Nations Sustainable Development Goals. To achieve universal health coverage and better health and well-being for all, as in WHO’s vision, it is vital that prisons are seen as a window of opportunity to change lifestyles and ensure that no one is left behind,” said Mikkelsen.

Limited Availability of Health Care, Health Promotion, and Health Data

The report notes that access to key health care or health-promoting services can be limited in prison settings:

  • Of the 37 countries with national data available, 97% reported that meal production of meals in prisons occurs in centralized kitchens, and 38% reported self-cook kitchens are available. Some 50% of countries reported fresh food is available in prison.
  • Of the member states reporting, 14% do not screen for severe mental health disorders on or close to reception, and 41% do not screen for harmful use of alcohol on reception.
  • Of the 36 countries that provided data on treatment for mental health and substance use disorders, 97% reported specialist mental health support is available. In 35 countries that reported on these indicators, opioid substitute therapy is available in 81% of 35 countries, and only 51% have guidelines on preventing post-release drug-related deaths.

However, the authors note that the limited availability of data makes it difficult to draw more specific conclusions about the health of prison populations. The report found that monitoring and surveillance systems for health in prisons are generally poor, and this affects the development of evidence-based policies that effectively target the needs of the prison population.

“Collecting this data is essential to enable the integration of prison health policies into the broader public health agenda benefiting the entire society,” said Ferreira-Borges.

Image Credits: Council of Europe.

Global leaders pledged US$2.6 billion to the global fight to eradicate polio at the Reaching the Last Mile (RLM) forum in Abu Dhabi on Tuesday, just one day ahead of World Children’s Day. The commitment fulfills part of the first phase of funding requested by the Global Polio Eradication Initiative to finance their 2019 – 2023 Polio Endgame Strategy – leaving a gap of some US$670 million.

The pledging event comes on the heels of a major announcement last month that the world has eradicated two of the three wild poliovirus strains, leaving only wild poliovirus type 1 (WPV1) still in circulation. Additionally, Nigeria – the last country in Africa to have cases of wild polio – has not seen wild polio since 2016 and the entire WHO African region could be certified wild polio-free in 2020, leaving Pakistan and Afghanistan as the last two countries where wild polio still circulates.

A child receives an oral polio vaccine in India.

“From supporting one of the world’s largest health workforces, to reaching every last child with vaccines, the Global Polio Eradication Initiative is not only moving us closer to a polio-free world, it’s also building essential health infrastructure to address a range of other health needs,” said World Health Organization Director-General and Chair of the Polio Oversight Board Dr Tedros Adhanom Ghebreyesus in a press release.

The commitments are critical to continue the momentum of the decades-long polio eradication effort. Barriers to reaching every child – including inconsistent campaign quality, insecurity, conflict, massive mobile populations, and, in some instances, parental refusal to the vaccine – have led to ongoing transmission of the last wild poliovirus strain in Pakistan and Afghanistan. Furthermore, gaps in vaccination coverage in parts of Africa and Asia have resulted in unimmunized children have sparked outbreaks of a rare, vaccine-derived form of the virus.

Pledges came from a variety of donors, such as the host of the pledging moment, His Highness Sheikh Mohamed bin Zayed Al Nahyan, Crown Prince of Abu Dhabi, who pledged US$160 million. Commitments also came from classic bilateral donors and the last key countries of the polio campaign, including US $215.92 million from the United States, US$160 million from the Islamic Republic of Pakistan, US$105.05 million from Germany, US$84.17 million from the Federal Government of Nigeria, and US$10.83 million from Norway.

Other pledges came from philanthropic organizations and the private sector, such as a $US 1.08 billion commitment from the Bill and Melinda Gates Foundation, US$150 million from Rotary International, and US$50 million from Bloomberg Philanthropies.

The pledges will not just go towards fighting polio, they will also help fund resources and infrastructure built by the GPEI that can support other health needs. In addition to delivering polio vaccines, polio workers deliver Vitamin A supplements, provide other vaccines like those for measles and yellow fever, counsel new mothers on breastfeeding, and help strengthen disease surveillance systems to anticipate and respond to outbreaks.

Image Credits: Jean-Marc Giboux/Rotary International.

Efforts to eliminate river blindness, a debilitating parasitic disease that causes vision loss in 1.15 million people, may be threatened by another infection known as African eye worm, according to a modelling study published in Clinical Infectious Diseases. While the World Health Organization has set a target to eliminate river blindness in most African countries in the next five years, the study predicts that 4 million people living in areas with African eye worm will still be at risk of the blinding disease in 2025, threatening almost four decades of elimination efforts.

The study, co-authored by researchers from Erasmus MC, University Medical Center Rotterdam in the Netherlands, and the Drugs for Neglected Diseases Initiative, also predicts that 90% of these people will live in areas currently not covered by treatment programmes for river blindness.

A villager’s eyes are being examined for African eye worm by Dr Philippe Urwotho, a medical doctor and Provincial Coordinator of the DRC’s Neglected Tropical Disease National Programme.

Elimination of river blindness, also known as onchocerciasis, is mainly reliant on a strategy of “mass drug administration,” whereby entire communities living in endemic areas are given a safe and effective drug called ivermectin regularly in order to prevent the parasitic disease from progressing or spreading. Ivermectin only targets the juvenile worms that can cause blindness or severe chronic skin itching, so mass drug administration needs to be repeated for the full life span of the adult parasite – 10 to 12 years – to fully eliminate the parasite from a community.

The problem arises when communities live in areas with both the river blindness parasite and the African eye worm, or Loa loa – people who have a high number of Loa loa larvae in their blood are at risk of life-threatening complications if they receive ivermectin. As a result, ivermectin cannot be safely used in mass drug administration campaigns in areas co-endemic for both diseases, and river blindness treatment programmes in these areas have not started.

“The current approach to preventing river blindness based on mass drug administration of ivermectin has been extraordinarily successful,’ says Sabine Specht, Head of Filarial Clinical Programme at DNDi, in a press release. “But alternative treatment strategies will be needed if we want to eliminate the disease, including the development of entirely new tools that offer a rapid and safe cure for river blindness.”

The authors predict that in 2025, there will still be at least 31,000 individuals infected with onchocerciasis and unable to use ivermectin, due to the high load of  Loa loa worms in their bloodstream – as the current treatment regimens for co-infected people are not well adapted for use in the field. According to the study, there are also currently no safe medications that can be used to kill adult forms of the worms that cause river blindness. The authors highlight that the lack of existing field-friendly treatments and diagnostics for both diseases merit further R&D for both diseases.

River blindness is transmitted by the bite of infected blackflies, which live near fast-moving rivers. The disease can progress to severe itching, skin lesions, and eventual blindness. Before large-scale control campaigns began in the mid-1970s, whole villages would eventually go blind from the disease. In 2017, it was estimated that 14.6 million people infected with onchocerciasis had severe chronic itching and skin disease, and 1.15 million had vision loss.

African eye worm, or Loa loa, gets its name from its most infamous tell-tale sign: the visible passing of the Loa loa worm through the eye. While previously thought to be rather mild, recent studies show that Loa loa infection can cause severe illness such as cardiac fibrosis, encephalopathy, and neurological or psychiatric disorders.

Image Credits: DNDi.

The World Health Organization and African Union have signed a sweeping Memorandum of Understanding to collaborate on improving access to medicines, strengthening epidemic preparedness, and expanding universal health coverage across the African continent.

These are the three main pillars of the MOU signed Monday by the WHO Director-General Dr Tedros Adhanom Ghebreyesus and African Union Chair Moussa Faki Mahamat at a two AU meeting in Geneva.

Moussa Faki Mahamat (left) and Dr Tedros Adhanom Ghebreyesus (right) hold the signed MOU

The MOU commits WHO to providing technical expertise to the newfound African Medicines Agency (AMA), in order to support regulatory approvals and local production of essential medicines, hopefully increasing access to quality-assured drugs. The African Union voted just last year to endorse a treaty to establish the AMA, and officially adopted the treaty in February 2019.

It is hoped that the AMA’s creation will foster more uniform drug rules and regulations across the continent, also fostering faster approval for new medications and cheaper prices. Up until now, most African countries wait until a new drug is approved by a developed country regulatory authority, such as the US Food and Drug Administration or the European Medicines Agency, and then a number of regional African entities, or each country individually, considers if to approve the drug for use.

“The three pillars of our new MOU pose three challenges that we must address together if we are to realize our shared vision for a healthier, safer, fairer Africa,” said Dr Tedros in a statement to the AU Commission Chair and AU ambassadors on Sunday.

“First, we must invest in access to medical products that are high-quality, safe and effective. Second, we must invest in preparedness, not panic. And third, we must invest in primary health care.”

Once it is up and running, the AMA will be responsible for assessing the safety and efficacy of new health products proposed for use in Africa, issuing guidance to African Union countries regarding regulatory approval and use. It will be modeled after the European Medicines Agency, which provides regulatory guidance for new health products introduced on the European continent.

The next steps are to define more precisely the scope of activities for the new regulatory body. In particular, Tedros says, the AMA should also focus on “creating an enabling environment to foster local production,” noting that “too many of our brothers and sisters don’t have access to the medicines they need, or use medicines that are substandard or falsified.”

About 1 in 10 medical products in low- and middle-income countries is either manufactured or packaged in substandard ways or falsified, according to a 2017 WHO report. The WHO African Region contributed 42% of the substandard or falsified product reports to this analysis.

The AMA will also provide a continental approach towards harmonizing existing regional initiatives to regulate new health products,  including those by the Economic Community of West African States (ECOWAS), the South African Development Community (SADC), and the East African Community Medicines Regulatory Harmonisation (EAC MHR).

Civil Society Pushes ARIPO to Use More TRIPS Flexibilities

The MOU announcement between WHO and the AU coincided with an open letter published by over 90 civil society organizations demanding reform of the African Regional Intellectual Property Organization (ARIPO), which handles patent applications for pharmaceutical products for 18 countries contracted to the Harare Protocol.

The civil society organizations signed an open letter to Ministers of ARIPO asking them to take bolder actions in leveraging TRIPS flexibilities to promote access to generic medicines at the ARIPO Ministerial Meeting from November 18 – 20 in Liberia.

ARIPO’s patent practices are largely dictated by the Harare Protocol, and the patents issued apply to the ARIPO region, which includes countries such as Kenya and Zimbabwe. The letter urges Ministers to update the Harare protocol to incorporate more TRIPS flexibilities at the regional level to allow generic versions of new drugs to enter the market earlier.

TRIPS flexibilities, which allow countries to remedy anti-competitive practices in situations of public health need, are currently not being implemented in the ARIPO patent process, the letter says. Specifically, key TRIPS flexibilities such as the Least Developed Country (LDC) patent exemption, which gives the LDCs maximum flexibility in patenting pharmaceutical products until 2033, have not been implemented through the Harare Protocol. Some 13 of the 18 ARIPO member states are classified as LDCs according to UN.

Experts say that establishing the AMA and reforming ARIPO patent practices together could improve access to cheaper, quality assured generic medications.

“IP reform has to go hand in hand with regulatory reform and coordination to remove two of the main barriers to robust generic competition in quality assured medicines,” says Brook K. Baker, professor at Northeastern University School of Law and senior policy advisor at Health GAP (Global Access Project), an HIV advocacy organization that works in several ARIPO countries.

Setting high standards for issuing patents could allow generics to be produced for more medicines, and having the regulatory mechanisms that can assess the safety and efficacy of these products will provide the regulatory approval needed to to speed their entry to market, he says.

Epidemic Preparedness and Universal Health Coverage on MOU  Agenda

The other two pillars of the WHO-AU MOU also focus on building capacity in the African continent, to respond more strongly to epidemic threats and to expand primary health care.

Tedros called the ongoing Ebola outbreak in the DRC as “a stark reminder than many AU countries are vulnerable to the impact of epidemics.”

Dr Tedros delivering a statement at the Sunday meeting with the AUC Chair and AU ambassadors

For too long, he said, the world has “invested in panic, rather than in epidemic preparedness,” noting that the global health community has largely responded to outbreaks reactively, instead of preemptively investing in health systems to prevent epidemics.

Working with the African Center for Disease Control, the WHO will support efforts to strengthen the health workforce in AU countries and establish a Volunteer Health Corps for Africa, and support the development of national action plans for emergency preparedness.

Lastly, the MOU commits the WHO to support the implementation of the Addis Ababa Call to Action on universal health coverage, endorsed by the African Union Summit in February. The WHO will help facilitate dialogue between Health and Finance Ministers to help countries increase domestic financing for primary health care by at least 1% GDP.

Image Credits: Twitter: @WHO, Twitter: @DrTedros.

Millions of sanitation workers in the developing world are forced to work in toxic conditions, coming into direct contact with human waste and toxic chemicals, with little to no pay or legal protections. Sanitation workers provide essential public services, yet are often the most marginalized, poor, and discriminated against members of society.

These are the main findings of a new report, Health, Safety, and Dignity of Sanitation Workers, released Thursday by the World Health Organization, International Labour Organisation, WaterAid, and the World Bank. The report examines case studies of sanitation workers’ conditions in nine countries – Bangladesh, Bolivia, Bukina Faso, Haiti, India, Kenya, Senegal, South Africa, and Uganda – and is the most extensive study of sanitation workers’ occupational conditions and livelihoods to date.

Manual pit emptying in India

“A fundamental principle of health is “first do no harm.” Sanitation workers make a key contribution to public health around the world – but in so doing, put their own health at risk. This is unacceptable,” said Dr Maria Neira, director of WHO’s Department of Public Health and Environment in a press release. “We must improve working conditions for these people and strengthen the sanitation workforce, so we can meet global water and sanitation targets.”

Meanwhile, a report published by OECD on the same day found that antibiotics and other pharmaceutical residues are being discharged into freshwater systems through untreated household wastewater and runoff from municipal wastewater treatment plants – throwing ecosystems out of balance and potentially exacerbating the problem of growing drug resistance in deadly bacterial, fungal, and viral diseases.

Sanitation workers provide key public health services such as cleaning public toilets, emptying pits and septic tanks, cleaning sewers and manholes, and transporting fecal sludge. Workers are often exposed to a number of hazardous chemicals or diseases such as cholera in untreated waste or water, the WHO report finds.

Many sanitation workers work informally for little pay, and have few legal or social protections. The work is often stigmatized and done at night with little lighting or protective equipment, increasing the occupational risks to the job. While there are few statistics on how many sanitation workers there are around the world, the report estimates that one sanitation worker dies every five days in the sewers of India.

Still, report ends on a positive note, highlighting examples of countries such as South Africa where sanitation work is more formalized and protected under national labor standards and explaining next steps that can be taken to improve the health, dignity, and autonomy of sanitation workers.

Despite the horrid working conditions, sanitation work is an essential public health service, and the workers themselves know it. The report quotes workers like Senzi Dumakude, a sewage blockage crew member in South Africa, who says, “I enjoy serving the community, making sure that our city is clean… We are making sure it is safe.”

Risks Faced by Sanitation Workers and Potential Solutions

While some sanitation workers are public or private employees that have benefits and clear legal protections, a number of people work informally, for little to no pay in ghastly conditions exposing workers to a number of health hazards. The WHO report found four key challenges and risks to sanitation workers:

  • Sanitation workers are exposed to multiple occupational and environmental hazards.
  • Sanitation workers have weak legal protection resulting from working informally, a lack of occupational and health standards, and weak agency to demand their rights.
  • Financial insecurity is a great concern because typically, informal and temporary sanitation workers are poorly paid, and income can be unpredictable. Some sanitation workers report being only paid in food.
  • Social stigma and discrimination exist, and in some cases, are experienced as total and intergenerational exclusion.

The report highlights so-called “manual emptiers” as a particularly vulnerable class of workers. These laborers are responsible for emptying pits, cleaning toilets or sewers with little to no protective clothing, and often use buckets, ropes, and shovels for their work. Some workers can only use their hands and feet. Efforts to ban manual emptying have driven the practice underground, where workers have even fewer protections in the informal sector.

Sanitation workers who are not protected by adequate health and safety measures are at high risk of health problems. Dizziness, fever, cholera, hepatitis, and polio, along with physical trauma such as puncture wounds and cuts, back pain, and death by asphyxiation from noxious gases have all been directly associated with unprotected sanitation work, the report notes.

Countries such as Bangladesh and South Africa have formalized the sanitation sector, which represents a huge step in protection sanitation workers. To protect the health and safety of sanitation workers, the report recommends five good practices:

  • Providing acknowledgment and formalization to sanitation workforce (including legal protections)
  • Mitigating occupational health risks for sanitation workers, such as protective clothing or mechanical equipment for sanitation work.
  • Delivering health services to sanitation workers
  • Establishing standard operating procedures and guidelines
  • Promoting workers’ empowerment through unions and associations
Antibiotic Residues In The Environment Could Contribute To AMR
Credit: aus der Beek T. et al., 2016

Antibiotics and other pharmaceutical residues are being found in water systems around the world, with untreated wastewater as a primary source of these runoffs. An OECD report, Pharmaceutical Residues in Freshwater: Hazards and Policy Responses, released Thursday pointed to a growing prevalence of pharmaceutical residues in the environment, citing studies that show residues from up to 200 different compounds have been found in parts of the world. The report cited a forthcoming study that found antibiotics in 65% of 711 river sites in 72 countries.

In 111 of the sites, the concentrations of antibiotics exceeded safe levels, with the worst cases more than 300 times over the safe limit set by the AMR Industry Alliance. The over-use and mis-use of antibiotics is greatly associated with growing antimicrobial resistance, as continued exposure to antibiotics may enable bacteria to evolve new genes resistant to the drugs.

Drug-resistant infections are currently estimated to cause 700,000 deaths annually, and an AMR review commissioned by the UK Prime Minister estimates that AMR-related deaths could increase to 10 million per year by 2050.

Image Credits: CS Sharada Prasad/Water AId/Safai Karmachari Kavalu Samiti, Health, Safety, and Dignity of Sanitation Workers: An Initial Assessment.