In a surprise appearance before the 2019 Congress of the International Council of Nurses, WHO Director-General Dr Tedros Adhanom Ghebreyesus said that investing in a stronger nursing workforce is essential for achieving universal health coverage (UHC). He proposed that “every country bring one nurse and one midwife to the World Health Assembly next year,” as part of planned celebrations of the International Year of the Nurse and the Midwife, saying: “The world must hear their voices and their stories.”

Health workers are not a cost, they’re “an investment that pays a triple return for health, gender equality and economic growth,” Dr Tedros said, citing the 2016 United Nations High-Level Commission on Health Employment and Economic Growth.

“The world is facing a shortfall of 18 million health workers needed to achieve and sustain universal health coverage by 2030,” added the Director-General in his remarks Sunday before the Congress. Nurses and midwives make up half of this projected shortfall – a gap of 9 million professionals.

“Good move Dr Tedros. Women deliver health to 5 billion people and will deliver UHC – 70% health workers are women, majority nurses with critical role on front-lines [of] global health. Investing in female health workforce is smart move,” said Ann Keeling of Women in Global Health in a Tweet.

The WHO Director-General also noted that a first-ever WHO State of the World’s Nursing report will be published next year ahead of the WHA and during the International Year of the Nurse and Midwife, marking the 200th anniversary of the birth of Florence Nightingale, the founder of modern nursing. A State of the World’s Midwifery report will also be launched around the same time. The year will also cap off a three-year NursingNow! campaign (2018-2020), which was aimed at raising the status of nursing worldwide.

Photo: Global Fund to Fight AIDS, Tuberculosis and Malaria

The appearance by Dr Tedros at the five-day Congress in Singapore, which ended yesterday, underscores the emphasis that the World Health Organization is putting on health workers as a key component of UHC strategies.

“We simply cannot achieve universal health coverage and the health-related targets in the Sustainable Development Goals unless we empower and equip nurses and midwives, and harness their power,” said Dr Tedros in his remarks at the conference, adding that “any society with too few health workers is operating with one hand tied behind its back.”

“We can have the best medicines, the best diagnostics, the best hospitals and the best health insurance, but if we don’t have health workers delivering safe, effective, people-centred care, we don’t have a health system.”

The International Council of Nurses (ICN) is a federation of more than 130 national nurses’ associations representing the millions of nurses worldwide. The theme of its 2019 Congress (27 June – 1 July) was to explore “the many ways in which nurses work to achieve universal access to health, not only providing health care but also addressing the social determinants of health, such as education, gender equality, poverty, etc.”

ICN President Annette Kennedy said at the Congress that the WHO’s “goal of Health for All will only be achieved if there are enough properly trained nurses working at the right time and in the right place.” She added that “ICN will always strive to influence health, social, educational and economic policies to bring the best out of nurses and ensure they can provide the world with the care, treatment and comfort that only they can deliver.”

The WHO Director-General emphasised the importance of the WHO partnership with ICN, which celebrated its 120th anniversary this year, “on a range of issues, including primary health care, universal health coverage, quality of care, noncommunicable diseases, antimicrobial resistance, and more.”

Dr Tedros also referred to last week’s G20 leaders declaration, issued on 29 June at the close of the G20 meeting in Japan, which includes the commitment to “strengthen health systems, with a focus on quality, including through enhancing health workforce and human resources.”

“We must all hold the G20 leaders to the commitments they have made,” he said.

Image Credits: Global Fund to Fight AIDS, Tuberculosis and Malaria.

Sounding a note of ever-increasing urgency, United Nations Secretary General Antonio Guterres told ministers gathered at a Global Preparatory Meeting for the UN Climate Action Summit, in Abu Dhabi that “we are in a battle for our lives” with regards to climate change, which is happening at an even faster pace that what top scientists had predicted.

He called on governments worldwide to stop subsidising fossil fuels and building coal power plants; put a tax on carbon emissions; and shift to a green economy powered by renewable energy, in order to cut greenhouse emissions 45 percent by 2030 and achieve carbon neutrality by 2050. Scientists estimate such drastic cuts are needed to keep global warning to 1.5°C, and avert “a catastrophe for life as we know it’, said Guterres.

The two-day conference (30 June-1 July) included a first-ever global gathering of health and environment ministers to talk about the health threats from air pollution and climate-induced disasters. That meeting signaled growing political recognition of the intimate links between climate change and health, including deaths and injuries from extreme weather as well as a global toll of 7 million air pollution-related deaths annually.

Climate threats strike at no less than the fundamentals of life itself, said Guterres in his remarks at Sunday’s opening session.

“Climate disruption is happening now and it is happening to all of us,” said Guterres in his opening address Sunday before the meeting of ministers of climate, environment, health and energy from around the world. “Every week brings new climate-related devastation. Floods, drought, heatwaves, wildfires, superstorms.”

“It is progressing even faster than the world’s top scientists have predicted, and it is outpacing our efforts to address it. Climate change is running faster than what we are,” he said, calling for a “rapid and deep change in how we do business, generate power, build cities and feed the world.”

Guterres said solutions should include major global shifts in how energy systems are financed and taxed. “First, let’s shift taxes from salaries to carbon,” he said. “We should tax pollution, not people. Second, stop subsidizing fossil fuels. Taxpayers’ money should not be used to boost hurricanes, spread drought and heat waves, and melt glaciers. Third, stop building new coal plants by 2020. We need a green economy, not a grey economy. New infrastructure must be climate-smart and climate-friendly. And we must provide sustainable, clean and affordable energy for the more than 800 million people who still live without access to power.”

The two-day Climate Action meeting in Abu Dhabi aims to build political will for slashing emissions ahead of the 23 September UN Climate Summit in New York City, which will bring together heads of state to make firm commitments on climate change.

Statements by United Arab Emirates (UAE) officials and other organisers described the ministerial meeting as an important political platform to raise the visibility of issues ahead of the Summit.

Health and Environment Ministers Meet in Abu Dhabi

Along with meetings on energy, infrastructure and finance, the “health-climate nexus” was another featured element of the Abu Dhabi event as health and environment ministers sat down together today for the first time ever.

Rodolfo Lacy, OECD Director of Environment was quoted saying that it was a “historic moment”.

The meeting was organised in collaboration with the World Health Organization and the UAE’s Ministry of Health and Prevention as well as the Ministry of Climate Change and Environment.

Organisers said that the meeting aimed to (a) strengthen and endorse health-centered climate mitigation and adaptation initiatives and (b) demonstrate political commitment to dual strategies for climate and health issues.

Themes addressed included: air pollution and health risks; reducing morbidity and mortality from climate-induced disasters and extreme weather events; and financing for creative solutions that simultaneously address climate threats and benefit health, for instance by cleaning up air pollution, water contamination, and improving waste management.

The ministers also discussed how such solutions could be integrated in government policies and programs, including Nationally Determined Contributions (NDCs) which are a voluntary mechanism by which countries commit to climate mitigation actions under the 2015 Paris Agreement, as well as, National Adaptation Plans.

“Fighting climate change is the best investment ever; we can save 7 million lives a year,” Thani Al Zeyoudi, UAE Minister of Climate Change and Environment, was quoted on Twitter as saying, referring to the WHO estimate for lives lost from outdoor and household air pollution every year.

Image Credits: Rodolfo Lacy/OECD.

Heads of state from the world’s largest economies concluded this year’s G20 Summit in Japan with a general declaration committing to advance global health priorities – but the statement still left much to be desired in terms of concrete goals and targets.

In the G20 Osaka Leaders’ Declaration, issued on Saturday at the close of the two-day meeting (28-29 June), heads of state committed to: move towards universal health coverage (UHC) through bolstering primary health care and access to medicines; promote healthy and active aging through the prevention of noncommunicable diseases; improve emergency preparedness & response;  provide support for African countries affected by the Ebola outbreak; and address antimicrobial resistance by identifying better models for antimicrobial drug research and development.

Other health-related topics addressed in the declaration included: climate change; transitioning towards clean energy; and sustainability of the world’s oceans, particularly the need to take action to address plastic litter and micro-plastics that are overwhelming aquatic life, with potential far-reaching impacts on important food sources.

Notably, in the declaration’s section on climate change, the United States reiterated “its decision to withdraw from the Paris Agreement because it disadvantages American workers and taxpayers,” but affirmed its commitment “to the development and deployment of advanced technologies to continue to reduce emissions and provide for a cleaner environment.”

The countries that remain signatories to the Paris Agreement, on the other hand, reaffirmed their “commitment to its full implementation, reflecting common but differentiated responsibilities and respective capabilities, in the light of different national circumstances.”

Participants in the G20 Summit, described as the “premier forum for international economic cooperation”, include leaders from 19 countries and the European Union, as well as invited guest countries and international organisations.

“Building on work done by previous presidencies,” the declaration states that G20 leaders “will strive to create a virtuous cycle of growth by addressing inequalities and realize a society where all individuals can make use of their full potential,” and to “further lead efforts to foster development and address other global challenges to pave the way toward an inclusive and sustainable world, as envisioned in the 2030 Agenda for Sustainable Development.”

Just ahead of the meeting, WHO Director-General Dr Tedros Adhanom Ghebreyesus told G20 leaders in a Tweet: “Our message is simple: health is a political choice. We call on G20 countries to invest in health, a driver of jobs & growth, and in preparing for and preventing emergencies, rather than just responding to them.”

In another Tweet, he posed three “asks” to G20 leaders:

  • Support the fight against Ebola in DRC [Democratic Republic of the Congo];
  • Invest in global health preparedness now, before the next pandemic ravages the global economy;
  • Commit to Health For All [through] UHC

Under the banner of the G20 Summit’s focus on financial markets and the world economy, the role of digital technologies was also a key theme throughout the summit and declaration, particularly its dual role of driving economic growth while offering cost-effective solutions to address global challenges.

Image Credits: G20.

An ambitious Global Action Plan to accelerate progress on some 50 health-related targets of the 2030 Sustainable Development Goals through better alignment of work in a dozen different UN and international agencies is open for public comments until Tuesday, 2 July.

Drafts of the Global Action Plan for Healthy Lives and Well-being for All (GAP) published so far reflect the heavy lifting that the agencies have yet to do in order to complete the plan as well as to etch out a clear strategy for implementation, both supporters and critics of the process told Health Policy Watch.

The plan is due to be launched at September’s meeting of the United Nations General Assembly. But key to its success is what happens after that – and particularly how it will work at the country level, those interviewed stressed.

“There are still more questions than answers on how this will work,” said one observer close to the process. “We know that the system is not efficient as it is now. You give money to two different organisations to do the same thing, [and] the countries have to respond to two agencies instead of one.”

And while improving coordination and efficiencies between agencies on the ground is a key goal – the plans’ backers and co-sponsors are also searching for creating ways to do that, without creating still more bureaucracy at the country level, which could make things worse, rather than better.

Some say that the name of the plan can also be misleading as it is not meant to be a global roadmap, as such, for achieving the SDGs, but rather a plan for how global health agencies can better work together to help countries advance their own health priorities across the 17 Sustainable Development Goals. Those include not only SDG 3 – Good Health and Well-Being – but also goals for No Poverty & Zero Hunger (SDGs 1 & 2), Gender Equality (SDG 5), Clean Water and Sanitation (SDG 6), Affordable and Clean Energy (SDG 7), Decent Work (SDG 8), Industry & Innovation (SDG 9), Sustainable Cities (SDG 11), and Climate Action (SDG 13) – all of which are intertwined somehow with health.

WHO, which is coordinating the overall GAP process, is hopeful that the public comments phase now underway will help address some of these thorny challenges as well as getting broader buy-in from countries, civil society and other actors.

“The signatory agencies are committed to ensuring an inclusive process in developing the Global Action Plan,” said Peter Singer, who is overseeing the process as Special Adviser to WHO Director-General, Dr Tedros Adhanom Ghebreysus. “In order to raise awareness about the online consultation process, WHO and the other agencies have shared the announcement via social media (website, twitter, newsletters, etc) and partner networks.” He added that the invitation to contribute had also been shared widely with civil society, drawing from a pool of some 250 NGOs in 70 countries. All of the inputs received will be considered in the development of the final Global Action Plan, to be launched at the UN General Assembly in September.  September’s UNGA will also host a High Level Meeting on Universal Health Coverage, 23 September.

Three-Pronged Strategy; Accelerated Action in Seven Areas

The draft Global Action Plan, also known as the GAP, is anchored in a three-pronged strategy including:

  • Stronger alignment between the 12 agencies that each operate large bureaucracies with their own goals, priorities and budgets;
  • Common milestones on progress for some 50 health-related SDG targets and indicators covering both infectious and noncommunicable diseases, as well as health risks related to poor nutrition and polluting energy sources in workplaces and in cities, such as air pollution;
  • Accelerated action in 7 thematic areas that offer special opportunities for rapid change, including: primary health care; sustainable finance; R&D and innovation; civil society engagement; action on environmental risks and commercial drivers of ill health (e.g. tobacco, alcohol & sugar); data and digital health; and innovative programmes for fragile states.

Originally initiated by the governments of Ghana, Germany and Norway, some 12 global health agencies signed a commitment in October 2018 to work together on the plan – a precedent in its own right. Those agencies included, Gavi, the Vaccine Alliance, the Global Financing Facility (GFF), the Global Fund to Fight AIDS, TB and Malaria, UNAIDS, UNDP, UNFPA, UNICEF, Unitaid, UN Women, World Bank Group, World Food Programme and WHO.

Donor countries reasoned that a better division of labour between this broad panoply of actors would presumably lead to greater efficiencies on the ground. That, in turn, would generate savings so that funds can accomplish more. It would also accelerate action in areas where progress is seriously lagging on ambitious SDG targets for dramatically reducing mortality from leading infectious and non-communicable diseases, as well as from health risks such as poor nutrition, unhealthy workplaces, unsafe drinking water, climate change, unsustainable urban growth and air pollution.

Some Elements of the Plan May Be More Advanced Than Others

UN insiders say that different agencies have approached the so-called GAP planning process with varying levels of knowledge, enthusiasm, and zeal. The results are apparent in the initial discussion drafts online now for public comment.

Some of those papers describe a detailed consultation process; metrics on the status quo; practical action points for moving ahead; and case studies of good practice. Others lack detail on the consultative process as well as a clear outline of the biggest risks and action points. For instance, a paper on “determinants of health,” led by UNDP and UN Women, passes over the health burden caused by urban environmental health risks such as air pollution, physical inactivity, and traffic injury, which health sector actors including WHO have said are central to confronting the non-communicable disease epidemic faced by an urbanising world.

Queried about this, UNDP, one of the leaders of the draft, was frank in acknowledging that the papers remain works-in-progress, where public comments may also help fill existing gaps and holes.

“UNDP fully agrees that unsustainable urbanization poses significant challenges to health and well-being,” said a UNDP spokesperson in response to a query. “This draft plan identifies environmental determinants as one of three priority areas needing more attention because of the increased understanding of threats such as air pollution on non-communicable diseases, and the pressing priority to focus on clean energy for health. In fact, UNDP and WHO recently launched an initiative to bring the health and energy sectors closer together to advance health.

“This plan is currently in draft form and open for public comments and we very much welcome feedback,” the UNDP spokesperson added. “We can aim to be more explicit in our reference to the potential for urban solutions, including for example through improvements in public transportation, to have multiple co-benefits for health – to reduce traffic injuries and be a positive contribution to climate action.”

At the other end of the scale, other “accelerator” themes have been approached with a sense of extreme urgency – as per a recent Wellcome Trust op-ed on the theme of Research & Development, Innovation and Access entitled “We’ve only got ten years left and no, I’m not talking about climate change.”

Wellcome Trust, together with WHO, led the work on this 10 page brief that aims to explore how R&D for critically needed diagnostics and medicines can be advanced more rapidly and also available more equitably in countries. The paper describes a process of country-based workshops and case studies to build a profile of existing gaps and needs, and concludes with an outline of 5 strategic goals, supported by key proposed actions, with ideas including: a global standard of “good access practices” for how public and private R&D investments will be designed to ensure availability, affordability and access; shifting public-sector co-funding for innovation to more countries and regions; creating a WHO clearinghouse of innovations ready to be scaled-up; and promoting country-led forums on R&D as well as an annual global forum to review, update and advance health products in the pipeline.

Asked by Health Policy Watch why such actions would make a difference, Alex Harris, Head of Global Policy at Wellcome said:

“During our 6-month consultation, a diverse group of consultees agreed that the most pressing issue we face is a lack of coordination and alignment. These five actions will ensure better alignment of global research and innovation for health systems with national research and health priorities. It sounds simple, but if we can implement these actions, then I believe our limited resources can be more efficiently and effectively directed to have the greatest impact on health over the next 10 years.”

Harris added that a number of the proposed actions are also “specifically designed to place country policy-makers’ and patients’ needs at the heart of research and innovation decision-making. They will alter the dynamic between global and local actors and contribute towards a positive shift in the centre of gravity for R&D and innovation.”

Harris, one of the champions of the GAP, agrees however that the process will only have an impact if it goes beyond the September launch of the fully-developed plan.

“We will have to work hard to ensure that the GAP continues to focus minds,” he said. “The danger is that following the launch we revert to business as usual. If we are to accelerate progress towards 2030, then we should be making tough decisions about how we will work differently and more effectively with one another to have greater impact. I’m looking forward to the launch at UNGA and working on making the GAP actions a reality.”

Image Credits: WHO.

Gavi, the Vaccine Alliance, just finalised its new strategic plan for 2021-2025, which aims to reach communities missed by previous immunisation efforts, including those most marginalised by poverty, geography and conflict. It also prioritises sustainability of vaccine programmes through co-financing arrangements with countries to build domestic investment in health and reduce reliance on Gavi funding.

“For the next five-year period equity will be the Alliance’s key guiding principle,” said Dr Ngozi Okonjo-Iweala, Chair of the Gavi Board, quoted in a Gavi press release. “This will mean focusing on those left behind, whether they be girls and women, refugees or remote communities, to ensure nobody goes without lifesaving vaccines.”

“With this new strategy we will make the millions of children around the world who are missing out on vaccines our absolute priority. By bringing immunisation to these missed communities the Alliance will also be extending primary health care systems, building a foundation for Universal Health Coverage,” said Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance.

“[T]he 2021-25 period will mean new vaccines, new technologies and new approaches to help build healthier, wealthier communities across the developing world,” Berkley said, adding that this will bring “all the economic benefits that come with a healthier population.”

The Gavi Board yesterday approved the new strategy at the close of its latest meeting, which took place in Geneva from 26-27 June, according to the release.

The new strategy, “anchored in the Sustainable Development Goals” and “echoing its driving mission to leave no one behind,” is the culmination of 18 months of consultations with stakeholders. It will target four goals to increase the equitable and sustainable use of vaccines:

  1. To introduce and scale-up vaccines
  2. Strengthen health systems to increase equity in immunization
  3. Improve sustainability of immunisation programmes
  4. Ensure healthy markets for vaccines and related products

Since 2000, Gavi has greatly expanded the scope of its work, supporting countries to introduce more than 400 new and under-used vaccines. Gavi initially supported vaccines protecting against six infectious diseases, but by 2025, this number is expected to increase to at least 18. Over the next 5 year period, Gavi will also support vaccines to tackle outbreaks of infectious diseases such as Ebola, cholera and typhoid, and will increase its role in fighting antimicrobial resistance, the release said.

While “Gavi-supported countries reached a record 64 million children with a full course of basic vaccines in 2017, up from 41 million in 2000,” there are “still as many as one in ten children in Gavi-supported countries [that] receive no routine vaccines,” it said. To address this, Gavi is focusing its new strategy on closing this gap, including through innovative service delivery, strengthening primary care, and addressing gender-related barriers.

Co-Financing for Sustainability

In the new plan, Gavi will continue its co-financing arrangements with countries. These arrangements maximise the reach of Gavi funding while supporting countries to build domestic investment in health, particularly towards strengthening primary care systems, which are essential for effective vaccine programmes. As low-income countries become wealthier, they are expected to increase their proportion of financing, and to ultimately transition away from Gavi funding to self-finance their vaccine programmes.

“From 2011 to 2018, countries have increased the amount they themselves spend on Gavi-supported vaccines from US$ 36 million to US$ 475 million, and 19 countries are expected to have transitioned out of Gavi support completely by 2020,” according to the release.

At their meeting earlier this week, the Gavi Board requested that Gavi also “explore approaches to engaging with self-financing lower middle-income countries in recognition of major challenges in those countries.”

To further global efforts towards eradicating polio, the Board agreed to a new cost-sharing approach for inactivated polio vaccine (IPV). “Gavi will fully-finance the vaccine for the very poorest countries, however other countries which receive Gavi support for IPV will need to use the amount they currently spend on bivalent oral polio vaccine (bOPV) – roughly US$ 0.60 per child – for IPV once bOPV is withdrawn after eradication is certified.”

In an exception to their co-financing rule, the Gavi Board also approved an extension of Papua New Guinea’s transition from Gavi funding, extending it from 2020 until the end 2025, in light of particular challenges the country is facing with recent outbreaks of polio and measles, despite its considerable economic growth. “The Board therefore agreed that this exceptional situation warranted an extension to the country’s transition, subject to the government setting out and committing to reforms to the health sector,” the release said.

All of these plans set out in the strategy depend on Gavi’s successful replenishment for the 2021-2025 period, beginning with a high-level event hosted by the Japanese government in August 2019 at which Gavi will launch its call for investment, and culminating at a pledging event in London in summer 2020. Successful replenishment will enable Gavi to provide predictable financing for both vaccine manufacturers and implementing countries throughout the five year period.

Image Credits: Gavi, the Vaccine Alliance.

[WHO News Release]

Maputo/Geneva – The number of people at risk of trachoma – the world’s leading infectious cause of blindness – has fallen from 1.5 billion in 2002 to just over 142 million in 2019, a reduction of 91%, WHO has reported.

New data presented today at the 22nd meeting of the WHO Alliance for the Global Elimination of Trachoma by 2020 (GET2020) also show that the number of people requiring surgery for trachomatous trichiasis – the late, blinding stage of trachoma – has dropped from 7.6 million in 2002 to 2.5 million in 2019, a reduction of 68%.

Photo: RTI International/Nabin Baral/WHO

“Eliminating trachoma contributes to the ocular health and quality of life of the poorest,  most disadvantaged people worldwide and thereby moves us a step closer to achieving universal health coverage,” said Dr Mwelecele Ntuli Malecela, Director, WHO Department of Control of Neglected Tropical Diseases. “Ridding the world of this painful, debilitating disease is being made possible through generous donations of the antibiotic azithromycin, sustained contributions from a network of dedicated funding agencies and partners, and the efforts of hundreds of thousands of front-line workers who work tirelessly to engage communities and deliver interventions.”

Trachoma remains endemic in 44 countries and has blinded or visually impaired around 1.9 million people worldwide. Mapping of trachoma has been completed to identify its distribution and target control measures through the SAFE strategy, namely: surgery for trichiasis, antibiotics to clear infection, and facial cleanliness and environmental improvement to reduce transmission. The disease is caused by infection with a bacterium.

“Eliminating trachoma has immediate benefit in preserving vision for people at risk. But work against trachoma has required the creation of innovative partnerships, which will help ensure that the most remote and marginalized people are not left behind as more comprehensive health services are strengthened,” said Mr Scott McPherson, Chair, International Coalition for Trachoma Control.

In 2018 alone, 146112 cases of trichiasis were managed and almost 90 million people were treated with antibiotics for trachoma in 782 districts worldwide.

Since 2011, eight countries have been validated by WHO as having eliminated trachoma as a public health problem 1. At least one country in every trachoma-endemic WHO Region has now achieved this milestone, demonstrating the effectiveness of the SAFE strategy in different settings.

“This is great progress, but we cannot afford to become complacent,” said Dr Anthony Solomon, Medical Officer in charge of WHO’s global trachoma elimination programme. “We should be able to relegate trachoma to the history books in the next few years, but we will only do so by redoubling our efforts now. The last few countries are likely to be the hardest.”

The significant reduction in the global prevalence of trachoma has resulted from increased political will in endemic countries, expansion of control measures and generation of high-quality data. The global programme has been supported by the world’s largest infectious disease mapping effort – the Global Trachoma Mapping Project (2012–2016) – and, since 2016, by Tropical Data, which has assisted health ministries to complete more than 1500 internationally-standardized, quality-assured and quality-controlled prevalence surveys.

GET2020

In 1996, WHO launched GET2020, and with other partners in the Alliance, supports country implementation of the SAFE strategy and strengthening of national capacity for epidemiological assessment, monitoring, surveillance, project evaluation and resource mobilization.

Elimination of trachoma is inexpensive, simple and highly cost–effective, yielding a high rate of net economic return.

Information on trachoma

Trachoma is a disease of the eye caused by infection with the bacterium Chlamydia trachomatis. Transmission occurs through contact with infective discharges from the eyes and nose, particularly in young children who harbour the main reservoir of infection. It is also spread by flies which have been in contact with the eyes and noses of infected people.

The immune system can clear a single episode of infection, but in endemic communities the organism is frequently reacquired. After years of repeated infection, the inside of the eyelid can become so severely scarred (trachomatous conjunctival scarring) that it turns inwards and causes the eyelashes to rub against the eyeball (trachomatous trichiasis), resulting in constant pain and light intolerance. This and other alterations of the eye can lead to scarring of the cornea. Left untreated, this condition leads to the formation of irreversible opacities, with resulting visual impairment or blindness.

1. Cambodia, Ghana, Islamic Republic of Iran, Lao People’s Democratic Republic, Mexico, Morocco, Nepal and Oman.

Image Credits: RTI International/Nabin Baral/WHO.

By Laura Klivans, KQED

San Francisco’s Board of Supervisors is slated to vote Tuesday to ban the sale and distribution of e-cigarettes in the city. The city is the corporate home of Juul Labs, the biggest producer of e-cigarettes in the country.

The ordinances would make the sale of e-cigarettes illegal in brick-and-mortar stores and online when shipping to San Francisco addresses.

San Francisco Mayor London Breed has 10 days to sign the legislation, which she has said she will do. The law will be enforced seven months from that date, in early 2020.

San Francisco Supervisor Shamann Walton, who co-authored the legislation, sees it as part of a long-term battle against the effects of smoking.

“We spent a few decades fighting big tobacco in the form of cigarettes,” Walton said. “Now we have to do it again in the form of e-cigarettes.”

Photo: Mike Mozart

Under federal law, the minimum age to buy tobacco products is 18. California and 15 other states, however, have raised that age to 21 or passed measures that will set it to 21 by 2021. Despite this, use of e-cigarettes, or vaping, has skyrocketed among teenagers nationally.

Last year, 1 in 5 high school seniors reported vaping in the past month. That’s almost double the number from the year before. Even eighth graders are vaping in record numbers.

These increases come after years of declines in teenagers smoking traditional cigarettes.

Public health officials are concerned about the rising number of teenagers using e-cigarettes, as nicotine can harm a young person’s developing brain. The Centers for Disease Control and Prevention warns that young people who vape may be more likely to start smoking traditional cigarettes.

Walton said he’s disgusted with the actions of Juul and similar companies, who he said are “putting profits before the health of young people, and people in general.”

Despite the tobacco age limit, Walton noted that vaping devices are commonly confiscated from students in the city’s middle and high schools.

The ordinance is accompanied by another that prevents the manufacture, distribution and sale of e-cigarettes on San Francisco property. The ordinance takes direct aim at Juul Labs, which leases space from the city on San Francisco’s Pier 70. The ordinance is not retroactive, so it would not remove Juul from the company’s current space, but it would prevent other e-cigarette makers from renting city property in the future. In a statement, Juul spokesman Ted Kwong wrote that, regardless, the company does not “manufacture, distribute or sell our product from this space.”

Juul’s vaping device was introduced in 2015. It’s small, sleek and discreet, looking similar to a flash drive. The company now controls 70% of the vaping market.

In a statement, Juul Labs said it shares the city’s goal of keeping e-cigarettes away from young people. The company said it has made it harder for underage buyers to purchase Juul off its website and has shut down Juul accounts on Facebook and Instagram.

But, the company argues that “the prohibition of vapor products for all adults in San Francisco will not effectively address underage use and will leave cigarettes on shelves as the only choice for adult smokers, even though they kill 40,000 Californians every year.”

Walton doesn’t buy that argument, however. He said that’s simply “trading one nicotine addiction for another.” What’s more, he’s concerned that for every adult that might benefit, dozens of young people could become addicted.

San Francisco resident Jay Friedman said the complete e-cigarette ban goes too far. The software engineer smoked a pack of cigarettes a day for 20 years, and smoking e-cigarettes has reduced his regular cigarette habit to two to three a day. He said he feels better physically.

Friedman supported a ban on flavored tobacco that city voters passed last year. “I feel like it was good to get rid of the fruit flavors for kids,” he said, “but this feels like maybe a step too far.”

If e-cigarettes are banned, he said, he would try to quit nicotine altogether. But, “there would be a point in a moment of weakness where I’d just end up buying a pack of smokes again and then it’s just a slippery slope from there.”

Small businesses in San Francisco are concerned the ban will hurt their bottom line.

Miriam Zouzounis and her family own Ted’s Market, a convenience store near downtown San Francisco. She said e-cigarettes are an “anchor” product: They draw people into the store.

“When people come and want to purchase something at the store and we don’t have that exact item that they want, they’re not going to buy the rest of the items that they might on that trip: a drink or a sandwich,” Zouzounis said.

She said sales from e-cigarettes account for at least $200 to $300 a day in sales. As a board member of the Arab American Grocers Association, she said she believes laws like this mostly affect businesses owned by immigrants.

Abbey Chaitin is a 15-year-old lifelong San Francisco resident. She isn’t drawn to using e-cigarettes, she said, because she has seen peers become addicted to them.

“I’ll see them in class fidgeting,” Chaitin said. “They need it to focus, to function.”

And Chaitin predicted that, regardless of a ban, young people will still get their hands on e-cigarettes: “People my age can find a way around that if they really need to,” she said.

Meanwhile, Juul is collecting signatures for a November ballot initiative to override the ban.

This story is part of a partnership that includes KQED, NPR and Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

A sensitive, closed-door selection of the new Executive Director for UNAIDS has kicked up a noisy social media debate among a number of leading global health figures, who questioned whether a separate bureaucracy for one disease, founded at the height of the AIDS epidemic, remains justified today – when bigger global health threats now loom.Continue reading ->

Image Credits: Wikimedia Foundation, John Zarocostas, UNAIDS.