Berlin, Germany (29 October 2019) – Experts called on policy-makers to put human health and wellbeing at the centre of climate action decisions at the World Health Summit, which entered its third and final day Tuesday.

“There is a need for urgent action to reduce greenhouse emissions to protect health, because we have less than 30 years of emissions left to have a reasonable chance of keeping to a 2 degrees Celsius temperature rise above pre-industrial levels,” said Professor of Environmental Change and Public Health at the London School of Hygiene and Tropical Medicine, Sir Andy Haines.

His presentation during the session, “Climate Change and Public Health: Science Guiding Policy and Practice,” covered a slew of the health impacts of climate change, including those of the wildfires, infectious diseases and increased salinity, but also of the physical and mental health toll of floods, an expected rise in pollen allergies in Europe and the productivity of crops— among others.

Tuesday, the third day of the World Health Summit, also focused on Universal Health Coverage and The Global Action Plan for Healthy Lives and Well-Being for All, which aims to better align the work of 12 global health agencies to accelerate achievement of the Sustainable Development Goals.

A helicopter prepares to drop buckets of water on a forest fire near Yosemite National Park, California USA.

Wildfires around the world cause death, illness and disruptions in people’s lives- wildfires that feed on the hotter, drier weather brought about in certain areas by climate change.

Meanwhile, in Asia, hospitals struggle to accommodate hordes of dengue patients in severe outbreaks, while parts of southern Europe are seeing domestic transmission of this deadly virus for the first time— a virus carried by Aedes mosquitoes, which thrive in changes to rainfall patterns and warmer conditions.

Then, there are the “slow burn” effects of climate change: in Bangladesh, pregnant women living on the coast were found to have unusually high incidences of pre-eclampsia, linked to drinking groundwater with unusually high levels of sodium. Salination of groundwater and soil is linked to rising sea levels, and hypertension and blood pressure are linked to sodium intake.

These are just three examples of risks posed by climate change to human health, said Haines, a drop in the growing ocean of evidence indicating that the healthcare profession has a major stake in decisions on climate change — though the links range from the obvious to the highly complex.

According to Haines, the risks to health posed by climate change include the direct effects of increased exposures to heat and extreme events (e.g., floods or droughts), the effects mediated through ecosystems (such as changes in vector-borne diseases or nutrition) and those mediated through social systems (e.g., conflict or migration).

But it was not all doom and gloom.

“Decarbonizing the world economy will bring many benefits for health, for example, by reducing air pollution,” Sir Andy said, outlining the well-established benefits of healthy, sustainable cities, increased active travel and low carbon transport, and natural green spaces and trees.

For example, he said, the health co-benefits of decarbonising the European economy by phasing out fossil fuels would prevent about 430,000 people per year from dying from air pollution-related health problems in the European Union alone.

“There is an overlap between climate change and air pollution which allows us to bring to the negotiation table the 7 million deaths caused by air pollution, bringing then a very strong argument, because the burning of fossil fuels is a cause of climate change and air pollution,” said the WHO Director of Public Health, Environmental and Social Determinants of Health, Dr Maria Neira, in an interview with Health Policy Watch.

Dr Neira, presenting yesterday on a Roadmap for Climate Action for health, reiterated the point she made at the World Air Quality Conference in London last Wednesday – that putting heath at the centre of decisions would provide the policy coherence and “perfect arguments” needed to motivate people and spur action.

“There is the health argument— this is about noncommunicable diseases and communicable diseases, this is about our brain, how it is affected, this is about gender because of all those girls collecting wood instead of going to school,” she said.

It was also a political argument, she said: “It’s a question of telling our politicians 5 years from now, they will not be able to say ‘I didn’t know’. They are going to court in some places because they are not taking action to reduce their citizens’ exposure to air pollution.”

“There is also the financial argument— the externalities of using coal and fossil fuels are paid by our hospitals and health system,” Dr Neira continued.

As for questions of feasibility of action, Dr Neira was unfazed.

“Well, mayors are doing this. Last week in London, with the Mayor of London committing to endorse WHO Air Quality guidelines along with the C40 and the commitments made at the Climate Action Summit, so it’s feasible,” she said.

She was referring to the C40 network, a group of 94 megacities which had committed to bringing their air quality to safe levels by 2030, among other things by tracking and reporting on the health impacts of their policies.

“It’s a question of putting it on the political agenda as well,” she said.

Dr Neira emphasized that the health community had credibility and needed to use the strong arguments on how climate change was affecting people’s health, as well as the health benefits obtainable from executing the national commitments in the Paris Agreement, which the WHO has previously called “potentially the strongest health agreement of this century.”

Achieving the Health-Related Sustainable Development Goals

An afternoon keynote session explored how politicians can advance health, with speakers including WHO Director-General Tedros Adhanom Ghebreyesus and Brazil’s Minister of Health Luiz Henrique Mandetta.

Dr Tedros speaking at the keynote session, “Health is a Political Choice.”

“Universal health coverage is not a choice a country makes once. It’s a choice that must be made every day, in every policy decision. Disease patterns are always changing, and so are the needs and demands of populations. There are always people at risk of being left behind,” said Dr Tedros, listing antimicrobial resistance, air pollution and climate change as new challenges for countries to confront.

He repeated the call for countries to increase spending on primary health care by 1% GDP by 2030.

Dr Tedros also emphasized the role of global collaboration, noting that, “health is one of the few areas in which international cooperation offers the opportunity for countries to work together for a common cause. Multilateral engagement is not only the smart option, it’s the only option.”

The final session focused on the Global Action Plan for Healthy Lives and Well-Being for All, which aims to better align the work of 12 global health agencies to accelerate achievement of the Sustainable Development Goals.

The plan was introduced at the World Health Summit last year and launched in September at the UN General Assembly. The discussion led by Uganda’s Minister of Health Jane Ruth Aceng, Gavi CEO Seth Berkley, Wellcome Trust Director Jeremy Farrar, and Peter Sands, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, reported on progress and plans for the future.

(left-right) Jane Ruth Aceng, Seth Berkley, Ilona Kickbusch.

Moderator Ilona Kickbusch, chair of the Geneva Graduate Institute’s Global Health Centre, asked the panelists how the 12 agencies that are signatories to the Global Action Plan can “accelerate” their coordination in a meaningful way, noting that, “if we can work together with countries, that will be for a joint good, but if we don’t, it will be a collective failure,” she noted.

Berkeley said that Gavi had tried to create “purposeful collaboration” with fellow agencies such as the Global Fund in areas such as health system strengthening and digitalizing health records – “it makes sense to work together and that is something that Peter and I have tried to do,” he said.

As another concrete example of better collaboration, Sands noted that the Global Fund had just signed an agreement with the World Bank on a template for how the two agencies would do finance transactions, sharing reporting and audit day in a simplified way. “When you think about sustainability, challenges, being able to do those kind of blended finance transactions is very important.”

On financing, Jane Aceng said that the most important things are strengthening collaboration and transparency, noting that sometimes agencies enter countries and directly offer aid to populations without clarifying to Ministries of Health what resources are being brought into the country. “I want to have [knowledge of all financial resources] aligned into my plan, so at the end of the day… we can ask what did this money do? What has it translated into?”

Aceng said that increased transparency will help ensure accountability from both countries and external agencies, and allow all stakeholders to better allocate resources.

The World Health Summit is one of the world’s premier global health forums. This year, approximately 20 ministers from around the world, the Director-General of the WHO, top scientists, and leaders from the private sector and civil society are among the participants. For three days, over 2,500 participants from 100 countries will discuss ways to improve global health.

Other topics in the World Health Summit 2019 programme included discussion of strategies to advance Universal Health Coverage, combat the double burden of noncommunicable and neglected tropical diseases many low and middle income countries now face, improve health systems in Africa and around the world, fight against antimicrobial resistance, advance digital health, and implementing the UN’s Sustainable Development Goals.

Image Credits: U.S. Army National Guard/Master Sgt. Paul Wade, World Health Summit.

The World Health Organization has launched a plan to accelerate the use of digital technologies to meet global public health needs, following the first-ever meeting of a WHO Technical Advisory Group on digital health.

“All governments are facing increasing demands to provide health services to their citizens, and many digital technologies offer solutions to help meet these needs,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus in a press release issued on Friday at the close of the meeting.  “But countries require confidence in what works. The action plan agreed today focuses our efforts on helping the world benefit from digital health technologies and solutions while safeguarding the misuse of people’s data and protecting their health.”

Digital health experts developed an action plan to focus the new WHO Technical Advisory Group’s activities and priorities over the next two years at a two-day meeting  at WHO’s Geneva headquarters, focusing on defining WHO’s role in supporting digital transformation at the global and country level. Topics discussed included:

  • Developing a global framework for WHO to validate, implement and scale up digital health technology and solutions;
  • Recommendations for safe and ethical use of digital technologies to strengthen national health systems by improving quality and coverage of care, increasing access to health information;
  • Advice on advocacy and partnership models to accelerate use of digital health capabilities in countries to achieve better health outcomes;
  • Advice on emerging digital health technologies with global reach and impact, so no one is left behind.

WHO is particularly interested in using digital health as an “accelerator” to achieve Universal Health Coverage at the national level, said Bernardo Mariano, director of WHO’s Department of Digital Health and Innovation in a press conference. WHO is looking to achieve a “quadruple win” – for patients and providers, academia, governments, and the private sector – to “really use data to advance the achievement of Universal Health Coverage,” he said.

Steve Davis, co-chair of the new WHO Advisory Group and president/chief executive officer of Global Health at PATH, an international health technologies non-profit, added that the deployment of better data and digital health tools could particularly help in expanding primary health care coverage.

“The opportunity over the next 10 years, to be more precise about where the problems are, to get remote tools to reach new people, to empower the health workers, and to empower patients is extraordinary,” he said.

As examples, he said health systems would be strengthened by:  improving data flows; enabling health workers to be more productive by using electronic data collection systems; and getting new diagnostic and treatment tools into the hands of clinicians.

According to Mariano, the first Global Action Plan for Digital Health, covering 2020 – 2024, will be brought before WHO member states for approval at the World Health Assembly in May 2020. That will be two years after the passage of World Health Assembly Resolution (WHA/71 A71) that recognized the expanding role of role digital technologies in furthering health.

Image Credits: WHO.

A new knowledge hub Global Health Progress, highlighting over 200 collaborations between the biopharmaceutical industry involving more than 850 government, multilateral organization and civil society partners, was launched Friday by the International Federation of Pharmaceutical Manufacturers & Associations (IFPMA). The hub provides a worldwide mapping of health-related initiatives in which IFPMA members are engaged, searchable by disease area, geographic region, target population, partner type, and programme strategy.

The hub aims to showcase innovation and best practices; connects users with the various industry initiatives and their partners in low- and middle-income countries; and enhance opportunities for further collaborations, said an IFPMA press release. Health systems strengthening and “local ownership” of initiatives are overarching principles of the initiatives portrayed, IFPMA added.

Examples of the hundreds of collaborations portrayed on the hub range from the more traditional R&D partnerships in drug development; to innovative initiatives to bolster health systems and train health workers, such as an E-Diabetes partnership aimed at primary health care workers in West Africa and a safer childbirth initiative in Myanmar. The hub also collates innovative health financing initiatives, such as the Mobile Health Smiles Wallet which supports free health services to patients in Nairobi’s slums, through the mobile health payments App M-Tiba.

“If we are to overcome today’s most pressing global health challenges, we need some fresh, out-of-the-box thinking and innovative alliances….  Global Health Progress is one way in which we are helping to drive new collaborations to strengthen healthcare systems. Effective partnerships will help our innovations to grow, reaching more patients worldwide,” said IFPMA’s Director General, Thomas Cueni (see related interview on Inside View).

Click here to access IFPMA’s new knowledge hub, Global Health Progress.

Image Credits: IFPMA/Global Health Progress.

As the World Health Summit opens Sunday in Berlin, one of the key themes running through the conference will be how industry, government and civil society leaders can collaborate more effectively to build strong health institutions – with a particular focus on building African capacities in a Monday keynote session. This means working across all aspects of health systems to improve health work force capacity, access to health finance and health products, and ultimately better care and treatment for patients, in line with the aims of Universal Health Coverage and the Sustainable Development Goals (SDGs). Ahead of this, I want to share with you some of the issues that will be raised in that session, highlighting why now is the time for us to come together to accelerate our actions to build strong health systems in this critical region of the world.

Over the last thirty years, strong economic growth in Africa has helped to reduce the proportion of people living in poverty from 56% in 1990 to 43% in 2012. Yet, as the continent’s population continues to expand — estimated to reach 2.5 billion people by 2050 – investments in robust health systems, to build a foundation of critical infrastructure and healthcare expertise, are key to inclusive and sustainable growth.

In 2001, all African Union countries pledged to allocate at least 15% of their annual budget to improve the health sector as part of The Abuja Declaration. Following this, many African countries have made strides in increasing domestic investments in health, however few countries have achieved this goal. In 2019, the “First Annual Africa Leadership meeting: Investing in Health” took place and reiterated that Member States must increase and reorient health spending to target diseases across the life cycle that have the greatest impact on mortality and human capital development.

These calls to action reflect the growing importance and need to involve cross-sector stakeholders to supplement and reinforce the services of the public sector in health. A report by the World Bank in 2007 found that the private sector delivered about half of Africa’s health products and services, demonstrating the important role cross-sector collaboration played a decade ago and continue to play.

The innovative biopharmaceutical industry brings valuable expertise and solutions to supporting attainment of the health-related SDGs, not only by developing lifesaving therapies but in partnering to innovate and strengthen the delivery of care. Members of IFPMA are currently engaged in 103 global health partnerships in Africa, across 47 different countries.

From these experiences, we have learned that we can achieve even more when we collaborate with diverse partners – not just with traditional development organizations but also with local governments, civil societies and other private sectors. We have had strategic collaborations with partners across Africa, including WHO AFRO and AUDA-NEPAD (New Partnership for Africa’s Development) to support the expansion of program strategies across the continent, while also collaborating with local partners to build capacity and strengthen regulatory and healthcare systems. IFPMA members recognize the value of their combined efforts when they work together and with other private sector companies and are currently collaborating together on 19 programs in Africa and 37 programs which involve other private sector organizations.

In working with other pharmaceutical companies, biotech, technology and telecom companies, logistics providers, and more, we seek to understand the expertise that each partner brings and how together we can develop holistic solutions to some of the most complex health challenges facing many African countries, including:

  • Maternal and child health: MSD for Mothers is working to improve the quality of maternal health and care services among private providers around the world, a current challenge in many African countries. The program uses research carried out in partnership with the London School of Hygiene and Tropical Medicine which highlighted a majority of women in rural areas sought care from private providers.
  • Growth of youth populations: DREAMS Innovation Challenge, in collaboration with PEPFAR, brings together thinkers from inside and outside HIV to implement solutions that address the root causes of increasing HIV risk among young girls.
  • Fighting corruption, waste and falsified medicines: We need to fight corruption, tackle waste, inefficiencies, substandard and falsified medicines across Africa. Fight the Fakes is a cross-sector campaign to tackle falsified medicine and involves a variety of stakeholders, including patients, health professionals, and public and private organizations. This complex global health challenge requires strong coordination and a comprehensive approach, including strengthening legislative frameworks, regulatory systems, and raising awareness.
  • Increasing access to care and treatment: Technology transfer programs are one way to help countries to strengthen regulatory systems, streamline supply chains, adopt more efficient procurement systems and ensure regular supplies of treatment. Gilead’s Technology Transfer program works to increase access to HIV treatment by providing generic manufacturers with licenses to produce drugs. In parallel, it is also important to build local capacity to address skills shortages and Boehringer Ingelheim’s training program works to increase healthcare workers’ technical skills while providing technology transfers.
  • Investing in the future health leaders: In collaboration with Chatham House and the Graduate Institute, IFPMA is working to support the development of the next generation of public health leaders in Africa. The fellowship aims to help participants develop the knowledge, insight and skills to become leaders in their countries. The program builds skills in leadership, policy formulation, analysis and implementation, as well as global health diplomacy.

We aspire to be a convener of other private sector expertise towards partnerships for health. As we increase our cross-sector collaboration, we are developing our understanding of the unique, innovative solutions we can develop by leveraging the strengths of specific business sectors, including:

  • Technology companies support to enhance service delivery and strengthen supply chains
    • GSK’s mVacciNation Partnership with Vodafone helps to strengthen supply chains for childhood immunization, and reached 977 children in Mozambique, Tanzania, Nigeria as of January 2019, delivering over 950,00 successful immunizations.
    • The Novartis Better Hearts, Better Cities initiative conducted a digital infrastructure assessment with Intel to understand challenges and opportunities to tackle hypertension via enhanced health literacy, prevention, screening, diagnosis, and patient management.
  • Telecom companies’ expertise to advance patient outreach, awareness and linkage to care
    • SMS for Life is a broad cross-sector partnership bringing together Novartis, Google, Safaricom, Vodafone, and Vodacom Tanzania to share health information with patients.
    • Be He@lthy, Be Mobile is a World Health Organization collaboration, including Novartis, Sanofi, GSK and Verizon, which reaches communities with targeted information to prevent non-communicable disease. Notably, the mDiabetes programme in Senegal has increased diabetes awareness, provided mTraining to healthcare workers and helped patients to manage diseases through remote consultations and support.
  • Medical devices and medical technology companies ensure patients have access to drugs, diagnostics and other infrastructure
    • Roche’s Global Access Program partners with diagnostic manufacturers as part of a holistic effort to expand access to viral load testing for HIV/AIDS.
    • Pfizer’s partnership with BD is bringing together innovative treatments and delivery systems to provide a new way of delivering contraceptive care to remote areas.

As we work towards our aspiration of ‘health for all’ across the globe and in Africa, we recognize collaboration is a foundational building block and benefits patients. By growing our partnerships, we are learning about effective program strategies that go beyond traditional corporate social responsibility and philanthropy approaches and are using these insights to strengthen and develop initiatives that change the way we are working across Africa.

I look forward to hearing panelists’ perspectives at the World Health Summit tomorrow on cross-sector collaborations and hope our discussions will start to ignite new partnerships, ultimately serving as a catalyst to bring together more collaborations over the next 10 years to support of the SDGs.

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Thomas B. Cueni is an economist, journalist and former Swiss diplomat, and today is director-general of the IFPMA, representing the innovative pharma industry and accredited organization in official relations with the United Nations.

 

 

Image Credits: IFPMA.

Wild polio virus type 3 (WPV3) has been eradicated worldwide, the World Health Organization declared Thursday following a review of the global data by an independent commission of experts. The announcement about WPV3, coinciding with World Polio Day, comes after wild polio virus type 2 (WPV2) was declared eradicated in 2015.  Although one other wild virus strain, as well as vaccine derived infections, still persist, the announcement brings polio one important step closer to eradication. That would make polio the second human disease to disappear from the planet, following smallpox, which was eradicated in 1980.

Oral polio vaccine is administered to a one-day old child in Ethiopia.

The last case of WPV3 was detected in Yobe, northern Nigeria in 2012. Seven years later, after no new cases of WPV3 were detected by the Global Polio Eradication Iniative’s (GPEI) global surveillance system, an official certificate of global WPV3 eradication was presented to the World Health Organization by the Global Commission for the Certification of Poliomyelitis Eradication, the independent body of experts responsible for certifying polio eradication.

“Today we’re celebrating another milestone on the road to a post-polio world – the eradication of wild polio virus type 3…But this is only a milestone – we have not reached our destination. The last mile, as we all know, is the hardest mile [to reach] and we must continue with greater dedication until polio is finally eradicated,” said Dr Tedros Adhanom Ghebreyesus, director-general of the WHO and chair of GPEI’s Polio Oversight Board, at Thursday’s event announcing the global eradication of WPV3.

In addition, no cases of wild polio virus type 1 (WPV1), the only wild-type strain still circulating, have been detected in Africa since 2016, also setting the WHO African Region on track to be certified for eradication of all wild types of polio virus in 2020. The WHO European region, the Americas and Southeast Asia eradicated all three strains of wild polio virus some years ago.

Still, WPV1 circulation in Pakistan and Afghanistan, and new cases of vaccine-derived polio virus remain barriers to global eradication. Despite differences at the genetic level, all the different strains of polio can cause paralysis or death – making the eradication of these last two types crucial to completely erasing the threat of polio.

WHO hopes that the announcement of the eradication of WPV3 will spur a renewed commitment to the global polio eradication campaign, led by the public-private partnership GPEI, which consists of WHO, Rotary International, the US Centers for Disease Control and Prevention (CDC), the United Nations Children’s Fund (UNICEF) and the Bill & Melinda Gates Foundation. Donors and leaders in global health will announce new commitments to the GPEI’s Endgame Strategy 2021-2023 at the Reaching the Last Mile Forum on November 19th in Abu Dhabi, United Arab Emirates, which will convene under the theme “Accelerating the Pace.”

The Last Threats: Wild Polio Virus Type I (WPV1) and Vaccine-Derived Polio Virus (VDPV)

Now, there is only one strain of wild polio virus (type 1) circulating in pockets of Afghanistan and Pakistan – where insecurity and community mistrust hinder the eradication campaign. Pakistan in particular has seen an upsurge in cases with over 70 reported so far this year.

In addition, cases of vaccine-derived polio virus (VDPV), reported mainly in Africa, remain a threat to the eradication campaign. VDPV is caused by a mutated strain of the weakened virus found in the oral polio vaccine – when a population is underimmunized against wild polio virus, VDPV can circulate in the community until it mutates to regain the ability to attack the nervous system. Therefore, achieving high consistent vaccination coverage is still the best way to prevent VDPV outbreaks, according to GPEI. Still, most VDPVs appear to be less transmissible than strains of wild polio virus, and outbreaks can cease on their own or with additional immunization activities.

To tackle VDPV, a group of immunization experts at WHO announced two weeks ago that they are conducting clinical trials on a new oral polio vaccine formulation (nOPV2) that could offer the same level of protection against polio while reducing the risk of VDPV. They are working with an Indonesian manufacturer to produce a batch of over 100 million doses of the new formulation, which could be rolled out as early as June of next year.

“We remain fully committed to ensuring that all necessary resources are made available to eradicate all polio virus strains. We urge all our other stakeholders and partners to also stay the course until final success is achieved,” said Dr Tedros in a press release.

Image Credits: UNICEF Ethiopia/Mulugeta Ayene 2018.

Although it was governments that made the big commitments to tackle climate change in the 2015 Paris Agreement, mayors are leading the charge in reducing air pollution on the ground.

At a first-ever World Air Quality Conference, hosted by the City of London, mayors and city leaders from around the world convened Wednesday, to confer with each other and with experts from the World Health Organization and civil society about how to ramp up action on air pollution and climate change.

“When people ask me, ‘Why is WHO so engaged in this?’ I say, ‘I don’t just have one reason, I have 7 million good reasons,” said Maria Neira, director of WHO’s Department of Public Health, Environmental, and Social Determinants of Health, referring to the 7 million premature deaths attributable to air pollution every year.

That number has not so far triggered the kind of urgent action from governments that WHO would have hoped to see, Neira said, “But there is hope. We see opportunities like this one where many people – policymakers, people with responsibility at the city level – they are called to this field and saying, ‘this is a public health emergency.’”

Panel session on “The Global Threat of Air Pollution and the Climate Emergency” at the World Air Quality Conference.

As just one example of global action, mayors of the C40 network – a group of 94 megacities around the world representing over 700 million people and a quarter of the global economy – signed the “Clean Air Cities Declaration” just last month at the C40 Mayors Summit in Copenhagen.

The Declaration committed the 35 founding cities of the network to take “bold action to reduce pollution by 2025, and work towards meeting the WHO’s Air Quality Guidelines,” said Los Angeles Mayor Eric Garcetti, Summit chairman.

The WHO Guideline level for concentrations of PM2.5 – fine particles considered to be among the most health harmful due to their ability to penetrate the lungs and circulate in the bloodstream – is 10 micrograms/cubic meter of air.  However, outside of North America, many or most large cities worldwide exceed those levels. And the problems are particularly acute in emerging economies and developing regions where emissions of diesel and other fuels are higher in particulate content.

Along with high-level policy commitments, cities have begun to implement climate actions on the ground. London was the first megacity to sign onto the WHO/UN Environment/World Bank Breathe Life Campaign, committing to reach WHO’s Air Quality Guideline levels. The campaign now includes 70 cities, regions, and countries. The city has successfully implemented an “ultra-low” emissions zone in central London, historically the most polluted part of the city, which has contributed to slashing emissions in that area by over 1/3rd in under two years.

“I’m proud of what we’ve accomplished… but we’re not resting on our laurels. We still need to do much more. Many parts of London are still plagued by dangerously polluted air, as are parts of many other global cities. We know we can’t solve the problem alone,” said Shirley Rodrigues, deputy mayor of Environment and Energy for the City of London.

Although cities can take the leadership in such strategies, in other areas they are limited in their regulatory powers, and thus more action from national governments is still required to mitigate all the health effects of air pollution.

Christiana Figueres, former executive-secretary of the UN Framework Convention on Climate Change (UNFCCC), reminded the conference of the global commitments made by country governments in the 2015 Paris Agreement.

“Your choices will either put us on track for a more polluted future, or a future where we scrub it out of our lives for good,” said Figueres, currently Vice-Chair of the Global Covenant of Mayors for Climate and Energy.

Transportation Sector Emissions Targeted

WHO estimates that road transport is responsible for up to 30% of particulate emissions (PM) in European cities, and up to 50% of PM emissions in all OECD countries.  This is partly due to the high proportion of diesel passenger vehicles that circulate in developed economies outside of North America – where strict clean air legislation and other historical factors limited diesel vehicle use.

In response, more and more cities in Europe and elsewhere have now created low- or ultra-low emissions vehicle zones to keep older diesel vehicles out of the center city. Other tactics include the creation of pedestrian zones, as well as higher parking prices or commuter tolls on vehicles coming into the downtown area.

“Cities have enormous power in how they control transport and other activities,” said Andrea Fernandez, director of Governance and Global Partnerships, C40 Cities.

Along with London’s new “ultra-low” emissions zone, the city is shifting its public transport fleet to zero-emissions taxis and buses.

Thanks to these policies, average air pollution concentrations in the area have declined by 29%, while emissions in the “ultra-low” emissions zone have been reduced even more, according to a new report by the Mayor’s office.

London, along with the rest of the leading C40 cities that signed the Clean Air Cities Declaration, has pledged to only procure zero-emissions buses from 2025 and take other measures to ensure “major areas” of each city are zero-emissions by 2030.

City-to-city collaborations have also spurred some healthy competition, Neira observed. She noted that London, Santiago, and even Moscow seemed to be “competing” informally to see which city can roll out the most electric buses, outside of China.

Speaking directly to the mayors in the room, Neira said, “You are a kind of health minister. Most of the decisions you can take relating to sustainable transport will have a positive or negative impact on people’s health.”

Power of Cities is Still Limited

Still, most cities lack the regulatory power to control pollution emissions from many sources, including power plants and industries, which are generally governed by national regulations. Similarly, standards for fuel quality and tailpipe emission limits are usually fixed on a national scale, and those determine overall levels of vehicle efficiencies as well as the amount of polluting sulfur in diesel fuel.

National energy and air pollution standards also affect emissions from the use and burning of fuels such as wood, kerosene and coal in residential and commercial buildings, which can be highly polluting as compared to natural gas, LPG, solar or wind, which have few or no particulate emissions.

“London can reach the WHO air quality goals by 2030, but we can’t reach them without the power of the [national] government…it’s important we get the power to bear down on the other issues. We need government to devolve the powers down to the implementation level,” said Rodrigues.

Earlier this month, London’s Mayor Sadiq Khan was among the C40 Mayors to endorse a “a Global Green New Deal” targeting “transportation, buildings, industry, and waste” to keep global temperature rise below 1.5 degrees Celsius. The message was issued by city leaders attending the C40 World Mayors Summit in Copenhagen on 10 October.

In supporting the Global Green New Deal, the mayors of Paris, Copenhagen, Rio de Janeiro, Sydney, London and Tokyo, among others, challenged national leaders, CEO’s and investors to match the level of ambition detailed in the Global Green New Deal.

“World leaders met in New York just last month and once again failed to agree anything close to the level of action necessary to stop the climate crisis. Their ineptitude directly threatens all people around the globe as time keeps running against us,” a press release quoted C40 Chair and Mayor of Paris, Anne Hidalgo, as saying, referring to the UN Climate Summit on 23 September.

But health can be used to accelerate climate action. “Climate can feel a long way away, whereas public health is really immediate,” noted Polly Billington, director of UK100, a network of local government leaders across the United Kingdom dedicated to climate action.

(left-right) Polly Billington, Shirley Rodrigues, Andrea Fernandez, Maria Neira.

The WHO Director of the Department of Public Health, Environmental and Social Determinants of Health agreed, saying “If you put health up front, you will have the perfect argument to motivate people, you will have the coherence that is needed on the policies, you will have a perfect way to incorporate the economic arguments for climate action, for example, for reducing coal subsidies.”

Still, the link between climate and health is just beginning to be recognized on the global policy level, said Neira, noting that a report on air pollution and health was presented for the first time only last year at the COP24 conference, the major gathering of UN member states on climate action.

That is precisely why next year’s COP26 Conference should be themed around “health,” said Neira.

“We need to incorporate the health angle because that will prove that any investment needed to take climate action, the [positive] trade-off is already there.”

 

 

This article appears as part of the Health Policy Watch partnership with Covering Climate Now, a global collaboration of more than 300 news outlets to strengthen coverage of the climate story.  

 

 

Image Credits: London Mayor's Press Office, Mayor of London Environment Team, Mayor of London Environment Team.

The World Health Organization and UN Environment kicked off a week-long campaign asking countries to take more assertive action to ban lead paint, coinciding with International Lead Poisoning Prevention Week.

The Global Alliance to Ban Lead Paint,  a WHO-UN Environment Partnership involving countries and civil society, has set a goal to ban lead paint in all countries by 2020. To date, only 73 of the 194 WHO member states have legally binding control measures on lead paint.

“Of course this is an achievement, but we need more – much more. In fact, we need to triple our efforts,” said Dr. Maria Neira, director of WHO’s Department of Public Health, Social and Environmental Determinants of Health at WHO, in a video message. “Lead paint [poisoning] is preventable, and that’s why we need to attack the source of exposure to lead. Paints can be made without toxic lead – safe paints exist. That’s why it’s time to ban lead paint.“

According to WHO, there is no minimum “safe” level of exposure to lead, which is particularly toxic to children, and can reduce their IQ along with increasing the risk of developmental and behavioral problems. Lead paint is a leading source of domestic lead exposure in children.

The week-long campaign has three objectives:

  • Raise awareness about the health effects of lead poisoning;
  • Highlight countries’ and partners’ efforts to prevent childhood lead poisoning;
  • Urge further action to eliminate lead paint through regulatory action at country level.

Achieving these objectives falls under the broader Sustainable Development Goals agenda that aims to improve the management of “chemicals and all wastes throughout their life cycle” in an “environmentally sound” way and “significantly reduce their release to air, water and soil in order to minimize their adverse impacts on human health and the environment” by 2020.  This, WHO says, would “substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water, and soil pollution and contamination” by 2030.

Exposure to lead can also impact the reproductive system, kidneys, and cardiovascular system, along with impairing immune function. In 2017 alone, lead poisoning accounted for 1.06 million deaths, according to the Institute for Health Metrics and Evaluation (IHME). The IHME also estimates that in 2016, lead exposures accounted for 63.2% of the global burden of certain types of developmental intellectual disabilities, 10.3% of the global burden of high-blood pressure associated heart disease, 5.6% of the global burden of coronary heart disease and 6.2% of the global burden of stroke.

Lead poisoning results in a staggering global economic cost of $977 billion annually – with China and India bearing the brunt of the loss at $227 billion and $236 billion lost annually.

“We would like to call on governments, academia, industry civil society, on everyone… to raise awareness and address the devastating effects of lead exposure, especially for children,” said Neira, urging all stakeholders to hold events on the dangers of lead poisoning this week.  The campaign includes a series of posters, videos and social media materials in six languages that can be freely downloaded by individuals and groups that want to share the campaign messages.

Image Credits: UN Environment/ Global Alliance to Ban Lead Paint, WHO.

In August, the Democratic Republic of the Congo (DRC) passed a milestone—surpassing 3,000 cases of Ebola since the outbreak began over a year ago. While the number of new infections has since slowed, there continue to be cases in hard to reach areas, posing challenges to response teams. The outbreak response has been complex, with security concerns hampering proven interventions.

Even with the availability of a vaccine and new treatments, the complicated political and social dynamics have hindered efforts. It’s a sobering reminder that the development of robust systems to prevent, detect, and respond to health threats is critical to saving lives.

Dr. Tedros Adhanom Ghebreyesus, the Director General of the World Health Organization (WHO), has stressed throughout the DRC Ebola crises of the need to build stronger health systems that can prevent epidemics before they occur. And specifically, support dedicated epidemic preparedness efforts.

A global strategy, executed locally, to improve preparedness

A critical tool to gauge a country’s preparedness ahead of a crisis is the Joint External Evaluation (JEE), a tool developed by WHO to assess how ready countries are to find, stop, and prevent epidemics. The recent completion of the 100th JEE is evidence that the tool has received widespread uptake since it was launched in Tanzania in 2016 – although many gaps identified in the JEE have yet to be addressed.

The JEE is a transparent, external assessment of health emergency preparedness designed to identify how ready a country is to prevent, detect, and respond to public health threats such as Ebola, yellow fever, and pandemic influenza. A peer-to-peer measurement, it acts as a kind of report card, where countries first evaluate themselves and are then joined by an external group of international experts. The evaluation covers 19 specific preparedness areas ranging from real-time surveillance to risk communications and national legislation, policy, and financing.

Each of the 19 areas is comprised of a series of indicators which are assigned scores during the peer-to-peer evaluation. Collectively, the information gathered through the JEE, including average national scores, provides important insight into the overall strength of a country’s system to deal with disease threats and other health emergencies. Countries lead the process with operational and technical support from WHO and other partners.

In the DRC, this has translated into a series of practical and critical initiatives to build stronger risk communication and community engagement teams; spread messages about the importance of seeking Ebola care early at health facilities; facilitate activities around vaccination, infection prevention and control; and ensure safe and dignified burials. Uganda and Rwanda have both stepped up their preparedness to prevent spread in their countries by operating vaccine drives, conducting border screenings for people with possible Ebola symptoms, improving cross-border collaboration and communication to reduce fear and keep borders open, and establishing isolation units and Ebola treatment centers.

Africa leads the world in evaluating preparedness – but many gaps identified

Nearly half of all countries with completed JEEs are in the WHO African Region, with 91 percent of African countries having completed an assessment. However, African countries have the lowest average JEE score (41 on a scale of 100) – the DRC scored only 35% in its recent assessment.

Of the nine countries sharing a border with DRC, none of the WHO priority 1 countries have achieved an average JEE score above 60% (Uganda, Rwanda, South Sudan, and Burundi). And of the WHO priority 2 countries, none have scored above 50% (Zambia, Tanzania, Central African Republic and Republic of Congo; Angola has not yet carried out a JEE). These scores indicate that these countries are underprepared and remain vulnerable to real risks that are playing out within the region.

The WHO Eastern Mediterranean and South-East Asia Regions also have high JEE completion rates (86% and 73% respectively), with marginally higher average scores (59% and 52% respectively). Countries in other WHO regions have also undergone the JEE assessment process, although their average scores are generally higher.

Emergency preparedness is directly related to the quality of the health systems in a country, and the amount of resources used to strengthen it. However, as shown by the uptake of JEEs in regions like Africa, low and lower-income countries have taken greater initiative to assess gaps as the first step to improving their preparedness.

Since 2016 the JEE has identified more than 7,000 action items that must be addressed, giving us a playbook to make the world safer from epidemics. Although some countries are reasonably well prepared, many lack basic systems to find, stop, and prevent infectious disease threats. Many are developing national action plans but have yet to implement them. The gaps in preparedness, if not urgently addressed, make it not a question of if, but when the next devastating epidemic will strike.

Empowering progress

The results of these assessments show many countries have strong immunization programs, disease surveillance, and laboratory networks. This likely reflects the financial resources provided by global donors and the technical assistance devoted to these areas. In contrast, critical areas such as legal frameworks, financing, disease-specific assessment and planning, and emergency response operations are among the weakest. This includes laws that set a legal precedent for disease control and preparedness, as well as activation and mandate of Emergency Operations Centers. Without these critical pieces, countries remain unprepared and unable to adequately protect their people, neighboring countries, and the world.

But progress is happening. Countries are starting to take action to fill their preparedness gaps. Nigeria developed a National Action Plan for Health Security and obtained funding from the World Bank and others to close gaps and improve preparedness. Uganda and many other countries are also using the JEE results to allow donors and partners to know which areas need the most support.

The second round of JEEs, to begin soon, will show us how these countries have progressed in just a few short years. Stepping up preparedness is difficult and will require sustained commitment from countries and from the global community. We must continue to conduct rigorous assessments while increasing support for countries.

And this support must include financing – from within and outside each country – as well as technical support. The World Bank estimates that annual global funding for effective preparedness is currently about $4.5 billion short. This may sound like a lot, but it’s less than a dollar per person per year, and far less than the cost of responding to disease outbreaks after they occur.

Recent studies show that every $1 spent on preparedness is worth more than $2 in the event of a public health emergency. In the absence of preparedness, costs will be high. SARS cost between $30-50 billion worldwide, and the 2014-2016 Ebola outbreak cost $53 billion in the three affected West African countries. A severe global pandemic could cost trillions, up to 5 percent of global GDP.

Completing over 100 JEEs illustrates the commitment of the global community to assess gaps in our ability to fight health threats. Now we must work with countries to translate JEE recommendations into urgent action that will close the gaps and prevent, detect, and respond to threats to public health.

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Amanda McClelland is Senior Vice President, Prevent Epidemics of Resolve to Save Lives, an initiative of Vital Strategies. Dr. Stella Chungong is Chief Country Capacity Assessment, Monitoring and Evaluation, WHO.

Image Credits: Resolve to Save Lives/Vital Strategies.

The world is not on track to reach the 2020 targets of the End TB Strategy, according to the World Health Organization’s latest Global Tuberculosis Report, published on Thursday.

On a more positive note, 2018 saw a reduction in the number of TB deaths with some 1.5 million deaths from TB, down from 1.6 million in 2017, according to a WHO press release. The number of new cases of TB also has been declining steadily in recent years. However, the burden remains high among low-income and marginalized populations: around 10 million people developed TB in 2018, WHO officials said in a press conference.

In Southeast Asia, a patient with multi-drug resistant TB receives his daily treatment.

While most high-burden countries are not on track to reach 2020 goals for ending TB as an “epidemic”, the report found that there are a handful of high TB burden countries in Africa and Asia that are on track to meet 2020 targets to reduce TB morbidity and mortality, as well as countries in WHO’s European Region.

Kenya, Lesotho, Myanmar, the Russian Federation, South Africa, the United Republic of Tanzania, and Zimbabwe were highlighted as high-burden countries on track for ending TB as an epidemic. Progress in TB control was credited to improved access to treatment, driven by technical advances in diagnostics and high-level political commitment to reducing the TB burden.

However, the total reduction in TB incidence between 2015 and 2018 was only 6.3%, falling considerably short of the End TB Strategy milestone of a 20% reduction between 2015 and 2020.

Globally, the number of TB deaths fell by 11%  between 2015 and 2018 was 11%, also less than one third of the way towards the End TB goal of a 35% reduction in TB deaths by 2020.

“WHO stands behind every country and person who decides that TB is not in their future,” Tereza Kaseva, director of WHO’s Global TB Programme, WHO, said in a press conference. “TB remains the world’s leading infectious killer,” she noted, calling for “urgent acceleration across all sectors” to reach the 3 million people that “missed out from receiving lifesaving TB treatment in 2018.”

“TB is a preventable, treatable, and curable disease. It is possible to accelerate our progress and reach our targets – it works when we have high level political commitments and those commitments are translated into actions.”

 

Image Credits: USAID Asia.

A request by South Africa to the World Trade Organization (WTO) TRIPS Council to “address the transparency of R&D costs and pricing of medicines and health technologies” is expected to be reviewed Friday, 18 October 2019 as the TRIPS Council meets this week for its third session this year.

The TRIPS Council, the administrative body for the 1995 TRIPS Agreement, will thus become the third international  body to take up the issue of drug pricing, following a landmark resolution by the World Health Assembly (WHA) in May urging countries to adopt transparency policies, followed by a Human Rights Council Resolution in July.

While the discussion at the third annual meeting (17-18 October) is unlikely to have immediate policy impacts, it will highlight the political barriers that countries face in using TRIPS flexibilities, which can involve threats of political repercussions far from the pharma arena.

The request by South Africa is also the latest in a series of moves by individual countries, as well as civil society, to move the transparency agenda further forward following the adoption of a landmark WHA resolution.

The United Kingdom’s Labour Party leader, Jeremy Corbyn, highlighted the high price of Orkambi, a life-saving cystic fibrosis drug, in a speech at his party conference in September, saying that the Labour Party, if elected, would override patent protections for excessively-priced medicines. Civil society watchdog, Observatoire Transparence Médicaments, appeared in front of the French Parliament to discuss a “transparency checklist” – a document that proposes establishing a public database of R&D and drug pricing data from different countries.

And earlier this month, Malta’s deputy prime minister and one of the leaders of the “Valletta Group,” composed of Italy, Malta, and eight other European states. described a new initiative by the group to share drug pricing data in an effort to improve their collective bargaining power to negotiate down prices with pharmaceutical companies.

High-level regional officials have also brought the issue to their forums, with the outgoing European Union Health Commissioner, Vykenis Andriukaitus calling transparency “a priority of the Commission.”

“We need transparency on public investment in R&D and pricing to ensure supply of affordable meds… Public funding should be reflected in the price and be given back in case of launch of successful products,” Andriukaitus said at the European Health Forum (Gastein).

High drug prices have been a major barrier to accessing treatment for many patients in countries of all income levels.

Defendants of the high costs of new medications say that the prices are justified in light of the risks and costs associated with R&D. Yet research and development information, including information about the associated costs, is highly protected, so that the true cost of R&D for many or most drugs remains largely unknown.

The issue is particularly thorny in the debate about drugs where the initial research was carried out in public institutions or subsidized by public grants.

The TRIPS Agreement, a two-decades old global trade agreement, created important categories of exemptions for governments, whereby they could bypass certain patent protections in cases where patents have impeded access to new products, including new essential medicines.

So called “TRIPS flexibilities” allow those governments to issue “compulsory licenses” for local production of patented drugs under certain conditions, parallel importation of patented drugs from generic producers, or other curbs on patent rights, so as to bring down prices. But implementation of these flexibilities has seen mixed results.

Transparency as a Facilitator of TRIPS Implementation

Historically, low- and middle- income countries that have trouble affording costly new medicines for complex chronic conditions or rare diseases such as cancer and cystic fibrosis have pushed forward the transparency agenda. But drug prices have skyrocketed to a point where even high-income countries are now looking for ways to bring down prices.

A researcher tests the efficacy of a generic drug in the United States.

In an Op-Ed published in the Financial Times on 17 October, Suerie Moon, co-director of the Geneva Graduate Institute’s Global Health Centre, pointed to the recent proposals floated in the United Kingdom, the EU and by players on both sides of the US political spectrum as evidence that drug pricing and transparency have become key issues in broader political campaigns.  Her op-ed entitled “There are solutions to the global drug price problem” looks at next steps that countries could take in the wake of the WHA price transparency resolution.

“Italy blazed a trail at the World Health Organization in shaping the passage of the historic transparency resolution (WHA72.8)…At the World Trade Organization, South Africa has crossed the Rubicon in bringing the transparency debate into the halls of the TRIPS Council,” said the Geneva Representative of Knowledge Ecology International (KEI), Thiru Balasubramaniam.

The WTO TRIPS Council is expected to accept South Africa’s request, which “will challenge trade negotiators to provide state practice on measures to enhance the transparency of R&D costs including “information on grants, tax credits or any other public sector subsidies and incentives,” said Balasubramaniam.

In its submission to the TRIPS Council, South Africa said, “The current model of medical innovation [based on patent protections] is ill-equipped to respond to the increasing emergence of infectious diseases, the unprecedented explosion of NCDs and neglected tropical diseases.”

South Africa argues that “abuse of IP rights” is difficult to monitor when there is no “reliable, transparent, and sufficiently detailed data on the costs of R&D inputs (including information on the role of public funding and subsidies), the medical benefits and added therapeutic value of products.”

Quoting the UN Secretary General’s High-level Panel on Access to Medicines, South Africa pointed to the panel’s observation of “transparency as a component of good governance, especially where civil society and patient groups rely on transparency of information. Transparency, as further stated, can also ensure fairness during negotiations that take place between biomedical companies and procurement organizations.”

In recent years, the WTO TRIPS Council, the governing body for the TRIPS Agreement, has focused its attention on aspects of intellectual property and innovation including innovation incubators, sports, and university technology partnership. According to Knowledge Ecology International, an intellectual property watchdog, the past few years have seen developing countries such as South Africa, India and Brazil pushing for agenda items to be more related to issues of “public interest.”

Mixed Success In Implementation of TRIPS Flexibilities

WTO’s Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), which entered into force in 1995 attempted to strike a balance between the long term social objective of providing incentives for future inventions, and the short term objective of allowing people to use existing inventions and creations.

But in the case of public health, the adoption of the TRIPS minimum standards resulted into a significant loss of policy flexibilities by developing countries in regulating the granting and use of pharmaceutical patents and controlling the cost of medicines, notes a South Centre assessment.

The Agreement, however, did provide for so called “TRIPS flexibilities” allowing governments to take certain measures to remedy anti-competitive practices and in situations of clear public health needs. These included issuing producers “compulsory licensing” to produce generic versions of patented products or engaging in the “parallel importation” of products when the appropriate patented product was either unavailable or too expensive.

In 2001, the rights of countries to make use of TRIPS flexibilities for public health were reaffirmed under the Doha Declaration on the TRIPS Agreement and Public Health. More recently, a WTO protocol amending the TRIPS Agreement to permit the granting of special compulsory licenses for the export of medicines entered into force on 23 January 2017.

A variety of ARV drugs used to treat HIV infection.

Over the past 15 years, TRIPS flexibilities were a major tool used in health milestones such as the decisions by South Africa, Brazil, and other low- and lower middle income countries to produce and use generic anti-retroviral (ARV) drugs for treatment of HIV/AIDS.

But in lesser profile cases, countries have been less successful in wielding the tools – or reluctant to use them at all because of the inherent political pressures. For instance, countries such as Colombia have been discouraged by the US and Switzerland from issuing a compulsory license for imatinib, an expensive cancer drug for which Novartis, a Swiss company, holds many national patents.

And over two decades on – no authoritative international body has done a truly comprehensive and systematic mapping and assessment of experience with TRIPS – another reason why the South African question to WTO is relevant.

Elaine Ruth Fletcher contributed reporting to this story.

Image Credits: NIAID, WTO, FDA/Michael Ermarth.