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

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

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

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

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

Global Gender Gap In Physical Activity Widening

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

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

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

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

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

Countering Insufficient Activity Among Adolescents

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Image Credits: Council of Europe.

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

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

A child receives an oral polio vaccine in India.

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

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

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

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

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

Image Credits: Jean-Marc Giboux/Rotary International.

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

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

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

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

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

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

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

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

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

Image Credits: DNDi.

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

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

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

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

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

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

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

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

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

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

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

Civil Society Pushes ARIPO to Use More TRIPS Flexibilities

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

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

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

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

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

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

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

Epidemic Preparedness and Universal Health Coverage on MOU  Agenda

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

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

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

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

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

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

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

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

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

Manual pit emptying in India

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

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

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

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

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

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

Risks Faced by Sanitation Workers and Potential Solutions

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

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

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

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

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

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

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

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

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

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

Pakistan became the first country in the world to introduce the typhoid conjugate vaccine (TCV) into its routine immunization program on Friday. The government of Pakistan is launching the national vaccine with a campaign in Sindh Province, which has already been deploying the vaccine on an emergency basis since April 2019 to tackle an ongoing extensively drug-resistant (XDR) typhoid outbreak that began in November 2016.

“Children are disproportionately affected by typhoid and its associated complications, and we strongly believe that TCV would protect our children against potentially fatal disease of typhoid,” said Dr Zafar Mirza, Special Assistant to the Prime Minister on Health said in a press release issued by Gavi, The Vaccine Alliance. “Starting with Sindh Province, where the need is most urgent, the government of Pakistan has planned a phased national introduction strategy with strong, coordinated support from global and local partners.”

A child is prepared for a vaccine in Pakistan.

Pakistan’s current extensively drug resistant (XDR) outbreak of typhoid, which has infected more than 10,000 people, mostly in Sindh province, is the first-ever reported outbreak of typhoid resistant to all but one oral antibiotic for typhoid. Use of the World Health Organization-recommended TCV has helped protect some individuals against the deadly strain.

Typhoid, a serious illness caused by Salmonella Typhi, is spread through contaminated food and water and disproportionally impacts children and low-resource communities in Asia and sub-Saharan Africa. The Global Burden of Disease study estimates that, in 2017, there were nearly 11 million typhoid cases and more than 116,000 typhoid deaths worldwide.

In 2017, 63% of typhoid cases and 70% of typhoid deaths in Pakistan were among children younger than 15 years of age. TCV is the first typhoid vaccine that can be given to children as young as 6 months of age and confers longer term protection against typhoid.

With funding support from Gavi, the vaccine introduction will begin with a two-week vaccination campaign targeting 10 million children 9 months to 15 years old in urban areas of Sindh Province. It will be followed by a transition to routine immunization of 9-month-old infants in all parts of the province once the campaign ends. The vaccine will be introduced in neighboring Punjab Province and Islamabad next year and then nationally in 2021.

“Typhoid is a highly contagious disease that spreads more quickly and easily when people live in crowded neighborhoods with weak water and sanitation infrastructure. Beginning the vaccination in urban areas is critical in preventing the disease among the communities most at risk,” said Dr. Azra Fazal Pechuho, Provincial Minister of Sindh for Health, and Population Welfare. While she claims vaccination is the best protection against typhoid, the government will also be promoting water, sanitation, and hygiene solutions.

WHO issued its formal recommendation in support of typhoid conjugate vaccine introduction in March 2018 following positive results from clinical trials conducted in Bangladesh. In anticipation of the availability of typhoid conjugate vaccines, Gavi earmarked US$85 million to support eligible countries with the introduction of typhoid conjugate vaccines into their routine immunization programs.

“Before the discovery of antibiotics, typhoid would kill as many as one in five people who contracted it,” said Dr Seth Berkley, CEO of Gavi. “The rise of extreme drug resistant typhoid risks bringing us back to levels of mortality not seen since the 19th century, posing a risk to all of us.”

Liberia and Zimbabwe are also preparing to introduce the typhoid conjugate vaccine next year with Gavi support, and several other countries are considering use of the vaccine as they review data on the incidence of typhoid in their countries.

For more information see the press release.

Image Credits: CDC.

The debate around drug price transparency was a highlight of the 4th Forum on Access to Medicines in Europe, hosted by the European Public Health Alliance (EPHA) Thursday. The forum focused its discussions around cancer therapies, medicines shortages, and transparency around R&D costs.

“It is high time to challenge the status quo on medicines policy – it can no longer be dismissed as business as usual,” said Fiona Godfrey, secretary-general of the EPHA, in an opening statement at the day-long event.

The high costs of cancer treatment was singled out as a topic of particular interest, guiding discussions in the first plenary session. Speakers noted that new cancer treatments often show low evidence of substantial clinical benefit as compared to drugs already on the market, but are still priced at exorbitant prices.

“Cancer drugs should be the cheapest. I don’t understand how we pay so much when we don’t know what we are buying. We need a dialogue to find a better balance between commercial and non-commercial research,” said Denis Lacombe, director-general of the European Organisation for Research and Treatment of Cancer.

The session also shed light on the inequity in cancer treatment between Eastern and Western Europe, challenges in scaling up innovative products, and the opacity around cancer R&D, observers noted.

Bjørn-Inge Larsen speaking at the 4th EPHA Forum on Access to Medicines in Europe.

Along with other figures that have been driving the transparency agenda in global health policy-making, Bjørn-Inge Larsen, secretary-general of Norway’s Ministry of Health and Care Services, challenged policy-makers to tackle the transparency issue and growing concerns about rising drug prices.

“We need to find balance between new technology and costs…It’s good that so many new medicines are available, but we need to make sure patients can benefit from them” said Bjørn-Inge Larsen in a keynote speech.

Inge Larsen highlighted the importance of drug price transparency and the challenges associated, noting that “we need to show how we are spending [taxpayers’] money, and currently politicians cannot explain prices and availability to patients.” He added that Norway was in discussions with Denmark and Iceland to jointly negotiate access to innovative, but expensive new therapies.

Image Credits: Twitter: @EPHA_EU.

WHO’s agenda for the next Executive Board (EB) meeting, scheduled for 3-8 February 2020, will see discussions grouped for the first time ever around the three key pillars of the WHO Global Plan of Work for 2019-2023, including expanding health and wellbeing, protection from health emergencies, and universal health coverage to one billion more people.

This is an innovation in the way governing board sessions are organized – but may also help to bring greater focus to debate, organized around key themes.

The 144th Meeting of the EB

Proposed EB discussions on access to gene and cell therapies for cancer and medicines for rare diseases, requested by South Africa and Peru respectively, will be merged and postponed until 2021, according to the list of topics to be tackled at the next EB session included in a note on the EB agenda released Thursday.

The decision received a mixed response from access groups wishing to keep these two issues alive following last year’s approval of the milestone WHA Resolution on transparency in medicines markets.

“The challenges of providing equal access to the new technologies are significant, and the WHO needs to engage now. That said, the deferral to the 2021 Executive Board [meeting] gives everyone more time to prepare and reflect on the measures needed to address the shocking inequalities of access,” said James Love, director of Knowledge Ecology International.

KEI also welcomed the fact that there will be a discussion of public health, innovation and intellectual property issues as proposed by Brazil in the February 2020 meeting.

It is likely that the tight schedule for this year’s governing body meetings also has created pressure to keep the agendas more limited, observers noted.

Exceptionally, the next meeting of the Executive Board, which includes some 34 country representatives elected by the World Health Assembly for 3-year terms, has been scheduled for February. Usually meetings are in the first month of the year but the schedule has been shifted due to the Lunar New Year on January 25.

Next year’s WHA meeting in May 2020 will also take place over only 4 ½ days due to the concurrence of the Muslim festival of Eid al-Fitr, making the scheduling for that meeting particularly tight.

One change welcomed by civil society has been the publication of more detailed notes under Director-General Dr Tedros Adhanom Ghebreyesus’s tenure, such as this one, which give an indication of upcoming priorities and discussion items in the WHO governing boards.

Other key items on the EB agenda will include a discussion of the WHO’s NCD Action Plan, including an item on the elimination of cervical cancer as a public health problem, the Roadmap on Neglected Tropical Diseases (NTDs), healthy ageing, nutrition, WHO’s work in health emergencies, and a global digital health strategy.

For more details see the Preliminary Draft Agenda of the 146th EB Meeting and the Note for the Record on the October 5 EB Meeting.

 

Image Credits: WHO.

The world is experiencing a record-breaking surge in wildfires, downward trends in crop production, unprecedented heat waves, and a rise in infectious diseases as a result of the unabated pace of climate change – affecting the health and safety of hundreds of millions of people worldwide. However, dramatic action now could still keep the global average temperature rise to below 2 degrees Celsius if bold new, approaches are taken.

These are among the main findings of the annual Lancet Countdown on Health and Climate Change, one of the most comprehensive scientific reviews of the ongoing effects on health of climate change. The report collates data on some 41 key climate and health indicators culled from studies by 35 academic and research institutions and 120 experts worldwide, to lay out the lifelong health consequences of rising temperatures should the world follow a “business-as-usual” pattern.

A woman shows how her maize ears have dried in her drought-stricken garden. Due to lack of rain exacerbated by climate change, people living in the Mauritanian Sahel were at risk of food insecurity in 2012.

This year, the accelerating impacts of climate change have become clearer than ever”, said Professor Hugh Montgomery, co-chair of The Lancet Countdown and director of the Institute for Human Health and Performance at University College London in a press release. “The highest recorded temperatures in Western Europe and wildfires in Siberia, Queensland, and California triggered asthma, respiratory infections and heat stroke.”

But while the world is already seeing the very immediate health impacts from climate change in terms of greater exposures to heatwaves, wildfires, and extreme weather, as well as greater food insecurity, the lion’s share of the health burden will fall on the younger and future generations, the report warns. Children born today could be threatened by even more widespread food insecurity, even greater increased risks of infectious diseases, and lasting health effects from environmental pollution related to climate change.

“Children are particularly vulnerable to the health risks of a changing climate. Their bodies and immune systems are still developing, leaving them more susceptible to disease and environmental pollutants,” says Dr Nick Watts, executive director of The Countdown.

If global action against climate change isn’t accelerated, average global temperatures could rise between 4-7 degrees Celsius by the end of the century, according to the report. However, a 7.4% year-on-year reduction in fossil fuel-related CO2 emissions starting between 2019 to 2050 could still limit global warming to under 1.5 degrees Celsius by 2050, the report concludes. Limiting global warming to 1.5 Celsius is one of the goals outlined in the 2015 Paris Agreement.

Sobering Trends and a Glimmer of Hope

Among the most sobering trends, the Countdown notes the following:

  • Globally, 77% of countries experienced an increase in daily population exposure to wildfires from 2001–2004 to 2015–18. India and China sustained the largest increases, with an increase of over 21 million exposures in India and 17 million exposures in China over this time period.
  • In 2018, vulnerable populations experienced 220 million additional heatwave exposures globally, breaking the previous record of 209 million set in 2015. Already faced with the challenge of an ageing population, Japan had 32 million heatwave exposures affecting people aged 65 years and older in 2018, the equivalent of almost every person in this age group experiencing a heatwave.
  • In 2018, 45 billion potential work hours were lost globally; southern areas of the USA lost 15–20% of potential daylight work hours during the hottest month of 2018.
  • In low-income countries, almost all economic losses from extreme weather events are uninsured, placing a particularly high burden on individuals and households.
  • Downward trends in global yield potential for all major crops tracked since 1960 threaten global food production and food security. Crop growth season duration has been reduced by 2.9% for maize, 3.8% for winter wheat and 3.1% for soybean crops from 1988 to 2017. Air pollution as well as more extreme heat, rainfall and drought can reduce crop productivity.

Despite this gloomy outlook, the Countdown report finds positive trends as well, which could be the basis for slowing warming, if these picked up momentum.

For instance, despite a small increase in total coal use in 2018, in key countries such as China coal’s share in electricity generation has declined.

Renewables accounted for 45% of global growth in power generation capacity in 2016, and low-carbon electricity reached a high of 32% of global electricity in 2016.

Global per capita use of electric vehicles increased by 20.6% between 2015 and 2016, and now represents 1.8% of China’s total transportation fuel use.

Improvements in air pollution seen in Europe from 2015 to 2016 could lead to significant reductions in air pollution-related illness and disability if trends are maintained over the course of the average lifetime, potentially saving economies up to €5.2 billion annually.

And cities and health systems are becoming more resilient to the effects of climate change; about 50% of countries and 69% of cities surveyed reported efforts to conduct national health adaptation plans or climate change risk assessments.

Authors Urge For Action For Future Generations

However the positive trends are nowhere strong enough at present to blunt the continued increase in climate emissions. Bold new actions are required to keep global warming below 2 degrees Celsius, the report says. The health impacts of climate change can be mitigated by four key actions:

  • Delivering rapid, urgent, and complete phase-out of coal-fired power worldwide.
  • Ensuring high-income countries meet international climate finance commitments of US$100 billion a year by 2020 to help low-income countries shift to low-carbon technologies and adapt to climate change.
  • Increasing accessible, affordable, efficient public and active transport systems, particularly walking and cycling, such as the creation of cycle lanes and cycle hire or purchase schemes.
  • Making major investments in health system adaptation to ensure that the health impacts from climate change don’t overwhelm the capacity of emergency and health services.

Authors of the report point to the upcoming COP25 Climate Change Conference in Madrid (2-13 December) and a growing global movement against climate change, led by young people as catalysts for more assertive action.

Co-Author Dr. Stella Hartinger was quoted in The Countdown’s press release saying, “We must listen to the millions of young people who have led the wave of school strikes for urgent action. It will take the work of the 7.5 billion people currently alive to ensure that the health of a child born today isn’t defined by a changing climate.”

For more information about the 2019 Report, its findings and policy implications, see the Lancet Countdown’s Resources Page.

Image Credits: Pablo Tosco/Oxfam, The Lancet Countdown on Health and Climate Change, The Lancet Countdown.