Laurent Muschel, Head of Health Emergency Preparedness and Response Authority (HERA) at the European Commission hands the mpox vaccines to DRC Health Minister Samuel Roger Kamba (centre) and Africa CDC Director General Dr Jean Kaseya

Now that the first mpox vaccines have arrived in the Democratic Republic of Congo (DRC) courtesy of a European Union donation, the challenge is to ensure that they get to where they are needed most.

This includes war-torn eastern DRC, camps of displaced people in North and South Kivu, and the immediate family members of those with mpox, particularly parents and siblings of infected children – an estimated 60%-plus cases in the DRC.

The Africa Centres for Disease Control and Prevention (Africa CDC) and United Nations Children’s Fund (UNICEF) announced the arrival of 99,100 doses of Bavarian Nordic’s Jynneous (MVA-BN) vaccine on Thursday.

The DRC, the epicentre of the outbreak, declared mpox an epidemic over 18 months ago but its drug regulator only authorised the emergency use of the two mpox vaccines – Jynneous and Japan-based KM Biologics’ LC16 vaccine – in late June. 

The World Health Organization (WHO) is currently reviewing Jynneous and LC16 for emergency use listing (EUL). Had it moved to do so sooner, the DRC and other affected areas would have been able to use this to get the vaccine.

Africa CDC Director General Dr Jean Kaseya told a Friday media briefing that the drug regulators in Rwanda, Cameroon and Nigeria had now issued EULs for Jynneous, which enabled them to also receive vaccine donations.

“We are expecting the [EUL] form from Burundi very soon,” added Kaseya of the country with the second highest toll, which is also one of the poorest countries in the world with very weak infrastructure.

Jynneous is not listed for use in children. However, WHO’s Dr Ana-Maria Restrepo told a briefing on Wednesday that countries would be able to use it off-label for children.

Mpox cases continue to rise

Mpox cases continue to rise in the continent with 5,466 suspected new cases (252 confirmed) and 26 deaths in the past week, according to Kaseya.

“Displaced families living in crowded schools, churches and tents in farmers’ fields have no space to isolate when they develop symptoms of the disease,” warned the UN High Commission for Refugees(UNHCR).

“UNHCR staff have found some affected individuals trying diligently to follow preventive measures and protect their communities by sleeping outside.  A balanced diet is also important for recovery, a reality out of reach for many of the displaced who subsist on meagre food rations.”

The UNHCR also noted that, while rapid testing of suspected cases is critical, “in unstable zones of the eastern DRC, the security risks and circuitous routes necessary to get samples to a laboratory mean delays, hence test results cannot be used effectively to break transmission chains”.

One African response plan

In response to the outbreaks, Africa CDC and WHO Africa have devised a joint continental response plan to ensure a coordinated approach to the outbreaks.

According to the plan’s foreword, the COVID-19 pandemic exposed “vulnerabilities in our health systems, showed Africa’s inequity and unfair treatment in terms of access to medical countermeasures, highlighted the urgent need for enhanced preparedness, and underscored the importance of swift, coordinated action in the face of emerging health threats”.

A key lesson learnt was that public health emergencies require “solidarity, resilience, and collaboration”.

In this regard, the continent has resolved to follow a single coordination mechanism, continental response plan, budget, and monitoring and evaluation mechanism.

The plan divides African member states into four categories based on their mpox status and risk level. The highest risk is countries with sustained human-to-human transmission, followed by countries with sporadic human cases since January 2022 or endemic zoonotic reservoirs.

Countries needing enhanced readiness due to their proximity to countries with ongoing transmission are the third category, while the fourth is those who are not currently facing an outbreak or near one.

“The plan includes measures to strengthen surveillance, laboratory detection, case management, infection prevention and control, vaccination, risk communication and community engagement and research and innovation,” according to a joint media release.

Image Credits: WHO.

Prof R Subramanian, who heads the air quality sector at the Center for Study of Science, Technology and Policy, addressing the India Clean Air Summit.

Fundamental policy changes aimed at fixing India’s seemingly intractable air pollution health crisis were suggested at the India Clean Air Summit (ICAS) held in Bengaluru recently. 

Among the dozens of presentations by air quality scientists and officials, five key elements emerged for policy action that can speed up the reduction of air pollutants. These involve: adopting an airshed approach rather than the prevalent city-centric approach; changing the core focus of the National Clean Air Programme (NCAP); tackling indoor household pollution; sharply reducing combustion and black carbon emissions; and plugging data gaps with low-cost sensors and modelling. 

Hosted by the Center for Study of Science, Technology and Policy (CSTEP), the sixth meeting of what has become a staple of the global air quality ecosystem, was attended by over 300 Indian and international scientists, government officials, policymakers, health officials, political leaders and civil society. 

India’s ambient air pollution, both outdoors and indoors, has been linked to over two million premature deaths annually. This includes about 170,000 children. Pollution levels have stayed in the same ballpark for the last five years, which is more than 10 times the WHO’s guidelines (see IQAir table below); in places like Delhi it is about 20 times higher. 

Change focus from cities to airsheds

India’s main air pollution control programme, NCAP, is currently city-focused. It incentivises 131 cities to reduce pollution, and in return, these are allocated federal funds. The problem with this approach is that much of cities’ pollution comes from outside their jurisdiction, so urban local bodies (ULBs) are helpless. 

In a new study, CSTEP documented the emission inventory, or local sources of pollution, in 76 Indian cities, perhaps one of the largest such studies anywhere. 

Take, for example, Ghaziabad which borders Delhi in the east and has been identified as one of the most polluted cities in the world. The PM 2.5 pollution measures over 28,000 tonnes per year. But 95% is from the greater city area. PM 2.5 is a microscopic particulate matter pollutant which can settle deep inside the human body and is linked to multiple health disorders such as chronic lung disease, strokes, heart attacks, cancers as well as depression and hypertension. 

It is similar to Davangere, a small town in Karnataka. 

Meanwhile, for an industrial town like Kalinga Nagar in Odisha, which has large factories inside and outside city jurisdictions, the share of PM 2.5 is almost equally divided. 

The report points out that most of the cities will not be able to achieve NCAP’s target of reducing pollution by 40%. 

“Our preliminary air quality modelling results also suggest that emissions from outside the city – what we call the airshed – can also be significant contributors to urban air pollution,” said Dr R Subramanian, who heads the Air Quality Sector at CSTEP.

“We need a broader, comprehensive approach that reduces emissions from the city and the airshed at large – actions that likely require national or state-level interventions and investments in systemic change to reduce fossil fuel and biofuel use in favour of clean, renewable energy. This will move us firmly towards clean air for all – for people in cities, periurban areas, and in villages across the country.”

Ashish Tiwari, the top environment officer of Uttar Pradesh, India’s most populous state and one of the most polluted, called for NCAP to drop its city-centric approach and target airsheds. 

“We have strongly recommended that NCAP must adopt this airshed approach. And I am happy to tell you that MoEFCC (Ministry of Environment, Forests and Climate Change) has started mulling over it, and very soon, I think the airshed coordination committee of eight IGP states will see the light of day,” said Tiwari.

Focus on PM 2.5

Delegates at the India Clean Air Summit

Announced in 2019, NCAP’s target is to reduce up to 40% the concentration of PM 10 by 2025-26. While PM 10 is a health risk, the finer PM 2.5 pollution can be more toxic and easily defeat the human body’s defence mechanisms. At times, the larger PM 10 can be controlled using equipment like vacuuming and mist-spraying trucks used to contain road dust. 

There’s no silver bullet to cut air pollution, but ensuring clean cooking fuel was one step backed by many scientists and officials in India and other parts of the Global South. Currently, the use of heavily polluting fuels, like wood, coal and biomass, is widely used, which emits a “cocktail” of toxic elements, as health expert Professor Kalpana Balakrishnan, a senior WHO and ICMR official, described it. 

These include PM 2.5, carbon dioxide, carbon monoxide, benzene, sulphur oxides and nitrogen oxides, among others. All this is inhaled near the polluting stove. 

Balakrishnan pointed out that different studies have put the share of household air pollution anywhere between 20 to 50%, which is a significant part of India’s ambient air pollution crisis. 

In 2016, the government launched a widely hailed programme, the Pradhan Mantri Ujjwala Yojana (PMUY), to provide free subscriptions to a gas cylinder; some refills are free but most are paid. Studies have documented a decline in PM 2.5 exposure thanks to the Ujjwala scheme. 

Several experts at ICAS called for more funding to reduce costs for the beneficiaries. Women, invariably those cooking at home, prefer using a cooking gas cylinder. But the cost of refilling – about Rs 800 or $10 per cylinder – is a challenge for most low-income beneficiaries.

However, there is a divergence between the government and health experts. In the current financial year, the government’s budget support for cooking gas subsidies has declined by 2.5%. Various studies have report

Uttar Pradesh, which has 18 million Ujjwala beneficiaries, the highest, is banking on other ‘clean’ cooking solutions such as bio-digesters and induction cooktops, Tiwari said at ICAS. He flagged the low-income status of the beneficiaries, saying, “PMUY is actually linked with the income level of the households. So that will take time. We have to think about the intermediate solutions for clean cooking. So increased bio-gas uses can actually break down PM 2.5 by 97%, black carbon by 92%, and carbon dioxide-equivalent by 70%.”

However, Balakrishnan, pointed out that there are several studies where primarily LPG (liquified petroleum gas) was used, comparing it to the use of biomass. In a “majority, or virtually all of the outcomes, the central estimate is favouring LPG. So there is very convincing evidence that the use of LPG, A, reduces exposures, B, is associated with improved health outcomes…”

Reduce combustion, track super-pollutants

Scientists like Dr Sarath Guttikunda, Founder and Director of Urban Emission, pointed out that another significant way to start reducing air pollution was to address the increasing combustion of fossil fuels. He presented data to show a rising trend in the production and consumption of coal, oil and gas. 

Monthly data shows rising production and consumption of fossil fuels. 

Monthly data shows rising production and consumption of fossil fuels.

Anumita Roychowdhury, executive director at the Centre for Science and Environment and one of the panellists at ICAS 2024, warned that some pollutants, particularly black carbon, were not being monitored enough.

“Science is telling us that there are some subsets of particulate matter such as black carbon that have much more warming potential than CO2. Moreover, when they settle on snow and glaciers, they melt and result in a water security threat. They also affect cloud formation and interfere with rainfall patterns,” she said. 

Black carbon (BC) is strongly correlated with increased blood pressure levels, a high-risk factor for cardiovascular disease and strokes. It affects pregnant women and has been linked to low birth weight. Because it has a short lifespan of about a week or two in the atmosphere and yet so many devastating effects, it is known as a super-pollutant. Common sources of BC include brick kilns, burning waste, incomplete combustion of fuels, forest fires, and burning of crop stubble. There are policies and programmes in place to reduce these, but they need to be accelerated. 

Plugging data gaps 

Finally, air quality monitoring has drastically improved with the government installing regulatory-grade monitors, from a handful a decade ago to about 550 now. But these are mainly in cities. A solution that has emerged over the last few years is low-cost sensors. At a fraction of the cost of the regulatory ones, these are reliable enough to provide actionable data. Hundreds of these are already in use nationwide as part of various programmes. 

If there has to be one backbone of the entire air quality management system, several participating scientists and officials cited the importance of modelling.

Guttikunda explains: “While monitoring data continues to be the cornerstone of regulations and management, air quality modelling needs to be the foundation of most of the discussions because this exercise provides us with information on how much, where is, when is, and what is contributing to the observed pollution levels. Going forward, in India, we need more emphasis on building this capacity.”

However, he cautions that since ambient monitoring is limited to specific locations and mostly to the cities, this data may not always reveal the full picture. “We need to keep a closer look at fossil fuel consumption trends in India, which determine the emission loads and pollution levels that we experience.”

Science vs pseudo-science

The clean air conference gave space to some frank talk about a crisis that frequently makes headlines in India. Dr Sachin Ghude, a government scientist at the Indian Institute of Tropical Meteorology, has helped to design the modelling system for Delhi based on which authorities may shut down schools and industrial units and restrict traffic among the more stringent measures to cut pollution in the short-term. 

Ghude took on the more controversial measures such as smog guns, water sprinkling, and cloud seeding often adopted or considered in Delhi and some other cities. He was clear that these are not effective in reducing pollution. Ironically, Delhi’s local state government was almost simultaneously pursuing cloud seeding.

ICAS was supported by Bloomberg Philanthropies, Open Philanthropy and Clean Air Fund, and partnered with Clean Air Monitoring and Solutions Network (CAMS-Net). 

Disclosure: Chetan was a communications consultant at ICAS.

World Meteorological Organization’s latest bulletin finds that wildfire emissions cross borders and entire continents.

Climate change, wildfires and air pollution are locked in a deadly cycle threatening human health, ecosystems and agriculture worldwide, the World Meteorological Organization (WMO) warned on Thursday.

The WMO sounded the alarm in its latest bulletin on air quality and climate, the fourth such publication this year. With a special focus on wildfires, the report analyzes global and regional concentrations of particulate matter pollution and its harmful effects on health and crops in 2023.

Ambient air pollution causes more than four million premature deaths annually in addition to high economic and environmental costs, according to World Health Organization (WHO) figures.

“Climate change and air quality cannot be treated separately. They go hand-in-hand and must be tackled together,” said WMO Deputy Secretary-General Ko Barrett. “It would be a win-win situation for the health of our planet, its people and our economies, to recognize the inter-relationship and act accordingly.”

Fine particulate matter, or PM2.5, is the major health hazard in air pollution. These microscopic particles, about 30 times smaller than human hair, can penetrate deep into the lungs and enter the bloodstream. Sources include fossil fuel combustion, wildfires, vehicles, construction sites and wind-blow desert dust.

Breathing Fire: Wildfire Smoke Linked to Sharp Rise in Dementia Risk

The WMO’s focus on wildfires aligns with emerging research highlighting the unique dangers of wildfire smoke. Recent studies suggest it may be more harmful than other forms of air pollution, potentially increasing risks of dementia, cognitive decline, cancer, heart attacks, pregnancy complications, strokes and attention deficits.

In 2023, Canadian wildfires burned a record area, seven times more than the 1990-2013 average. Smoke from these fires spread across the United States and reached Europe, while Algerian wildfire smoke crossed the Atlantic to Latin America, underscoring the international scope of the threat.

With climate change intensifying fire seasons globally, health risks from wildfire smoke are escalating worldwide, the WMO reported.

“Smoke from wildfires contains a noxious mix of chemicals that affects not only air quality and health, but also damages plants, ecosystems and crops – and leads to more carbon emissions and so more greenhouse gases in the atmosphere,” said Dr Lorenzo Labrador, a scientific officer in WMO’s Global Atmosphere Watch network.

While the bulletin focuses on 2023 data, Barrett noted that the trends have continued into the current year.

“The first eight months of 2024 have seen a continuation of those trends, with intense heat and persistent droughts fuelling the risk of wildfires and air pollution,” he said. “Climate change means that we face this scenario with increasing frequency.”

Record wildfires suffocate ecosystems, agriculture

Air pollution’s dangers extend far beyond human health. Pollutants such as nitrogen and sulphur that settle on Earth’s surface threaten ecosystems and agriculture. These contaminants reduce vital ecosystem services, including clean water, biodiversity and carbon storage

The threat to agriculture is also significant. High concentrations of particulate matter can block sunlight and hinder plants’ carbon dioxide absorption. In heavily polluted areas of India and China, experimental evidence shows particulate matter deposition reduced crop yields by up to 15%, according to the WMO bulletin.

Farming practices in Central Africa, China, India, Pakistan and Southeast Asia — regions most affected by pollution’s impact on agriculture — contribute significantly to particulate matter pollution. These practices include stubble burning, fertilizer and pesticide use, soil tilling, harvesting, and manure management.

Emissions rise in North America, India but fall in Europe, China

The WMO bulletin used two different products to estimate global particulate matter concentrations: the Copernicus Atmospheric Monitoring Service and NASA’s Global Modeling and Assimilation Office.

Both Copernicus and NASA found that North American wildfires caused exceptionally high PM2.5 emissions compared to the 2003-2023 reference period.

Large, persistent fires burned from early May in western Canada until late September 2023, the bulletin said. This worsened air quality in eastern Canada and the northeastern U.S., particularly New York City. Smoke travelled across the North Atlantic to southern Greenland and Western Europe.

Above-average PM2.5 levels were also measured over India, due to increased pollution from human and industrial activities.

China and Europe measured below-average levels, thanks to decreased human-source emissions. This trend has been observed since the first WMO Bulletin in 2021.

In recent years, China, once heavily reliant on coal, has become a world leader in renewable energy, resulting in reduced emissions.

Monthly mean anomaly in total aerosol optical depth at 550 nm for June 2023 relative to June 2003–2022.

Wildfires spike ozone levels

Wildfires have also spiked ozone levels in several regions.

Devastating wildfires struck central and southern Chile in January and February 2023, killing at least 23 people. More than 400 fires, many intentional, burned vast plantations and woods. High temperatures and winds fuelled the fires in an area affected by a decade-long drought.

Daily short-term ozone exposure increased drastically at several monitoring stations across the country as a result. Chilean authorities declared an environmental emergency in various central Chile regions.

“Concurrent observations of ozone, carbon monoxide, nitrogen oxides and PM2.5 in central Chile show the extreme detriment to air quality caused by intense, persistent wildfire events made more common in a warming climate,” the WMO bulletin reported.

The WMO released the bulletin ahead of Clean Air for Blue Skies Day on Sept. 7 – a U.N.-designated day to highlight air quality and improve cooperation.

This year’s theme: “Invest in Clean Air Now.”

Image Credits: WMO, WMO.

Dr Ana-Maria Restrepo

UN agencies have vaccinated more than 187,000 children against polio in central Gaza over the past three days, which was more than expected, The World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus told a media briefing on Wednesday.

The vaccination drive, aimed at children up to 10 years of age, continues in southern Gaza on Thursday.

“Together, we are helping to prevent the spread of polio in Gaza, but other health needs remain immense,” said Tedros.

“We acknowledge that the humanitarian pause has been respected to allow the vaccination campaign to be conducted safely and successfully. We ask not only for that to remain the case, but also for a ceasefire,” added Tedros.

However, the WHO’s Dr Rik Peeperkorn


Dr Rik Peeperkorn, joining the briefing from the WHO’s office in Gaza, said that UN agencies still needed a further three days at least to complete the polio vaccination campaign in southern Gaza before heading to the north of the territory.

“I’m deeply concerned about the overall health situation,” added Peeperkorn, explaining that only 16 out of 36 hospitals were partially operational, while less than a third of  the 152 primary health care centres were partially functional.

“We’ve seen an enormous spread in infectious diseases – more than 600,000 cases of diarrhoea, more than 510,000 cases of hepatitis, a huge number of acute respiratory infection; dismal, horrible water and sanitary conditions etcetera.”

Dr Rik Peeperkorn

DRC to start weekend mpox vaccinations

Mpox vaccines donated by the European Commission’s Health Emergency Preparedness and Response Authority (Hera) will arrive in the Democratic Republic of Congo (DRC) on Thursday and the country’s health ministry plans to start vaccinations over the week, said Tedros.

“WHO is working with our partners to coordinate vaccine demand, share information on doses available and ensure those doses are directed to areas where they can contribute to controlling the outbreak,” he added.

While up to 60% of the DRC’s mpox cases are children, the donated vaccine – Bavarian Nordic’s Jynneos (also called MVA-BN) is not yet registered for use in children.

However, the WHO’s head of R&D, Dr Ana-Maria Restrepo, said that the DRC could use the vaccine off label for children, and that there were a number of studies – including clinical studies – that had established its effectiveness in children.
“Vaccines alone will not stop these outbreaks,” Tedros stressed. “We’re also working to strengthen surveillance, risk communication, community engagement, clinical and home care and coordination between partners at every level.”

The WHO’s Dr Maria van Kerkhove added that the WHO was “deeply concerned” about the spread of mpox Clade 1b in Burundi, the site of the second largest outbreak after the DRC.

“What’s concerning about Burundi is that the cases are dispersed through the country, so we aren’t seeing these small pockets of outbreaks. This indicates that there’s more transmission, there’s more circulation that’s happening,” said Van Kerkhove.

Surge in cholera deaths

The WHO also published global cholera statistics for 2023 on Wednesday, showing a 71% increase deaths and a 13% increase in cases in 2023 in comparison to 2022.

“Over 4000 people died last year from a disease that is preventable and easily treatable,” said Tedros.

“Conflict, climate change, unsafe water and sanitation, poverty and displacement all contributed to the rise in cholera outbreaks last year,” he added, flagging that the geographical distribution of the disease had changed significantly, with cases from the Middle East and Asia declining by a third while cases in Africa more than doubled. 

Cholera is an acute intestinal infection spread through contaminated food and water. Communities with limited access to sanitation are most affected.

“Afghanistan, the DRC, Malawi and Somalia continue to report large outbreaks of over 10,000 suspected or confirmed cases, with Ethiopia, Haiti, Mozambique and Zimbabwe adding to the tally in 2023,” according to the WHO report.

The WHO’s Dr Philippe Barbosa said some technical surveillance issues that influenced the increase in mortality, many people died before they had reached health facilities.

“The very large cholera outbreaks are deadlier,” said Barbosa. “But treatment is simple and cheap. It is immoral that people do not have access to treatment, safe water and hygiene.”

Understanding pathogen origin

On Wednesday, the WHO also published a global framework to help member states to investigate the origins of new and re-emerging pathogens, with the guidance of its Scientific Advisory Group for the Origins of Novel Pathogens (SAGO).

“We still don’t know how the COVID-19 pandemic began, and unfortunately, the work to understand its origins remains unfinished,” said Tedros.

“As I have said many times, including to senior Chinese leaders, China’s cooperation is absolutely critical to that process. That includes sharing information on the Huanan Seafood Market, the earliest known and suspected cases of COVID-19, and the work done at laboratories in Wuhan, China.

“Without this information, none of us are able to rule any hypothesis out. Until or unless China shares this data, the origins of COVID-19 will largely remain unknown.”

The WHO framework outlines six areas in which scientific investigations are needed to identify the origins of outbreaks: early investigations; human studies; animal-human interface studies; environmental and ecological studies; genomic and phylogenetic studies; and laboratory biosafety and biosecurity assessments.

Patients undergoing chemotherapy for cancer.

How many children worldwide have been orphaned by the death of their father due to cancer?

This is one of the pressing questions researchers will aim to answer and that is a topic amongst the abstracts at this month’s World Cancer Congress. The study, conducted by the France-based International Agency for Research on Cancer (IARC), builds on a previous 2022 report revealing that one million children lose their mother to cancer each year. According to the research team, these children often feel trapped in a “vicious cycle of disadvantage.”

The World Cancer Congress will occur from September 17-19 in Geneva. Some 2,000 people from around 100 countries are expected to take part. Attendees will hear from Malaysian Health Minister HE Datuk Seri Dr Dzulkefly bin Ahmad; Olivier Michielin, chairperson of the Department of Oncology, Geneva University Hospitals; Pierre Maudet, Geneva State Counsellor in charge of Health; and many more related leaders. The event is a project of the Union for International Cancer Control (UICC), the largest and oldest – founded in 1933 – international cancer organisation. Today, UICC has over 1,100 member organisations in 170 countries and territories.

The event will focus on six themes: Prevention, screening and early detection; cancer research and progress; healthcare systems and policies; cancer treatment and palliative care; tobacco control; and people living with cancer

“I think the highlights of any congress are the plenaries because that’s when everyone attending the congress gathers in the same room to discuss and listen to a subject matter that is critically important to the community,” Cary Adams, CEO of UICC, told Health Policy Watch. “This year’s plenaries cover global advocacy, which will lead to the high-level meeting on non-communicable diseases next year; the challenges of women and cancer, and the differences between cancer affecting women and men, and what can be done to ensure that gender differences are appreciated country by country; and the third plenary on the real-world applications of new technologies like AI, which are important to the global cancer community. I always look forward to the plenaries because I know the subject matters are pertinent and relevant to all.”

In Dwazark Community, Freetown, Sierra Leone, students at St. Augustine School are receiving the HPV vaccine to protect against cervical cancer.

HOW CANCER DEATHS COULD BE AVOIDED

Equity in cancer care will play a big role in this year’s event, said Eric Grant, communications and media manager for UICC. He told Health Policy Watch that participants will look at ways to ensure that there is access to care regardless of gender or geography, amongst other factors.

A related, first-of-its-kind study will debut at the congress that quantifies the socioeconomic burden of ovarian cancer across 11 countries and highlights the significant disparities between countries and income groups.

Relatedly, there will be a session on cancer care during humanitarian crises, drawing on experiences from Sudan, Gaza, and Haiti.

UN Headquarters in Geneva: Participant in 43rd Session of the UN Human Rights Council dons mask to protect herself from COVID-19. All parallel sessions and side events have been cancelled.

WHY GENEVA?

According to CEO Adams, the World Cancer Congress is being held in Geneva for the second time since 2022, a decision originally influenced by the COVID-19 pandemic.

“We normally take the congress around the world, but given the pandemic, we felt it was inappropriate to go to a location where it was unclear what the COVID situation would be,” Adams explained. “We spoke to the Geneva Government and various organisations that support international events here and received a very positive response. So, in 2022, we decided to hold the Congress in Geneva.

“The board then decided, as a result of how successful that meeting was and given the ongoing challenges of the pandemic, that although tradition says that we take the congress around the world, there would be real value and benefits in running it a second time in Geneva,” he continued. “I must say that given that the first congress in 2022 ran so well and everyone enjoyed being in the hub of global Health, meeting organisations like the World Health Organisation, the Medicines Patent Pool, FIND, and individuals from other UN agencies in Geneva, it was an experience that could be repeated and would be appreciated just as much the second time around. So that’s why we’re in Geneva for a second year.”

This year’s congress will once again have a focus on COVID-19, including the release of an IARC assessment on the pandemic’s impact on cancer diagnosis and stage distribution based on data from population-based cancer registries in seven countries.

Ad for tobacco

TOBACCO ADVERTISING REMAINS ‘SIGNIFICANT’ OBSTACLE

When it comes to the causes of cancer, multiple sessions will deal with the impact of commercial determinants on Health, such as the influence of tobacco and alcohol on cancer.

Grant highlighted that tobacco advertising remains a significant obstacle to reducing tobacco use. One session will equip attendees with skills to monitor, document, and expose the tactics used by the tobacco industry.

A new study on tobacco advertising on social media in Germany will be presented. Another study will examine how the “no safe level” message regarding alcohol consumption relates to cancer risk.

The use of artificial intelligence and other new technologies in healthcare to transform patient care and enhance diagnostics and treatments will also be explored—both from the standpoint of the advancements they can provide and challenges like data privacy.

PATIENTS WILL BE PRESENT

Grant told Health Policy Watch that about 40% of UICC’s members are members of patient groups, meaning they had cancer themselves. They will have a strong presence at the congress. Mobilising their voices can help encourage policymakers to move legislation forward to support cancer diagnosis, treatments and patients, Grant said.

“We’re fortunate at the World Cancer Congress in that we appeal to not just oncologists, added Adams. “There is a tendency for people to think that a cancer congress will be attended only by oncologists, but this is not true for the World Cancer Congress. We have organisations attending, such as patient groups, cancer societies, cancer leagues, research institutes, and cancer hospitals. They come from a range of disciplines—from tobacco control specialists to palliative care specialists, advocates, and fundraisers—and we get a wide variety of ages and a really diverse population of people, but with a common ambition to improve cancer control in their country, whether that’s improving prevention, early detection, treatment, care, or supportive care.

“That is a unique aspect of this congress.”

This article is part of a Health Policy Watch-UICC media partnership, with no financial compensation involved.

To register for the congress, visit https://www.worldcancercongress.org.

Image Credits: National Cancer Institute, Roche, Gavi, UN Photo / Jean Marc Ferré, Standford School of Medicine .

While more countries are concerned about antimicrobial resistance (AMR) than a decade ago, many are reluctant to commit to a specific target to reduce the overuse of animal antibiotics as they negotiate a political declaration ahead of the United Nations high-level meeting on AMR.

The zero draft of the declaration issued on 20 May proposed a target of “at least 30%” reduction in “the quantity of antimicrobials used in the agri-food system globally” by 2030.

But “a lot of countries still seem keen to water down very concrete commitments on things like reducing animal use of antibiotics”, Jeremy Knox, head of infectious disease policy at Wellcome Trust, told a media briefing on Monday.

However, Knox said he was “cautiously optimistic” about the outcomes of the UN high-level meeting set for 26 September – eight years after the only other HLM on the issue in 2016.

Wellcome has proposed three key strategies to address AMR  – a political “rallying cry” (such as the climate sector’s target of no more than a 2ºC temperature increase), a global scientific evidence panel on AMR, and sustained political follow-up, said Knox.

“I don’t think we’ll end up with the kind of very clear and ambitious rallying cry that we might have hoped for, but I do think we will see some commitments which are steps in the right direction,” said Knox.

“We will most likely have something like an ambition for a 10% reduction in mortality [on the 2019 baseline figure of 1.27 million annual deaths] but that’s narrower and less ambitious than some of us might have hoped for.”

Wellcome head of infectious disease policy Jeremy Knox

Investors call for action

The Investor Action on AMR (IAAMR) initiative, supported by 80 investors who represent $13 trillion in assets, issued a call on Tuesday for global policymakers to take “critical action against the escalating AMR crisis”.

AMR claimed 1.27 million lives in 2019, surpassing deaths from HIV and malaria, with this figure set to rise to 10 million annually by 2050.

“With the global economic costs associated with AMR likely to reach $100 trillion and lead to a 3.8% decrease in global GDP by 2050, the investor community is increasingly concerned with the negative impact AMR will have on global financial markets, economic stability and long-term value generation,” said IAAMR in a statement. 

IAAMR was founded by the Access to Medicine Foundation, the $75 trillion FAIRR investor network and the UK Department of Health and Social Care,

“Companies – from pharma to pork producers – take advantage of lax regulations allowing the routine use of antibiotics in animals enabling them to cut corners in animal welfare, while diminishing antibiotic effectiveness in humans,” said Jeremy Coller, Founder and Chair, of FAIRR, which works on building a more sustainable and equitable food system.

“An estimated 80% of antibiotics are administered to livestock rather than people in the United States alone. Investors recognise that AMR is not only a threat to the health of our people and planet, but to the financial well-being of those who rely on investment returns to fund their retirements.” 

IAAMR has seven proposals, three of which dovetail with Wellcome’s three strategies. Like Wellcome, they want a “rallying” aim, political will and an independent global scientific panel on AMR along the lines of the Intergovernmental Panel on Climate Change (IPCC).

This proposal has the support of the governments of the UK and Saudi Arabia, according to IAAMR.

‘Crisis of innovation, talent and market’

There is a “crisis of innovation” in the development of new antibiotics, says Damiano de Felice, chief of external affairs at CARB-X, a public-private partnership that supports the development of new antibiotics.

Even the AMR Action Fund, which was given $1 billion from big pharmaceutical companies, the European Investment Bank and Wellcome, “struggled to find investment opportunities in clinical development exactly because the pipeline is insufficient”, he added.

In the early stages of development, there is a lot of innovation – but most of the product developers are vulnerable because they “tend to be very small”, often coming from academia.

“The few companies that have been scientifically successful in bringing a new product to the market, have done very poorly financially,” he told the Wellcome media briefing.

“At least seven of the small biotech companies that brought a new antibiotic on the market in the past five to 10 years all had significant financial problems, and most of them actually went bankrupt.”

De Felice describes the market conditions for new antibiotics as “broken”. Large pharma companies are not that interested in antibiotics as they are short courses, face competition from generics – and clinicians tend not to prescribe them “to prevent the development of resistance”.

This lack of investment and interest also means that researchers don’t stay in antibiotic R&D – resulting in a “crisis of talent”.

But, says de Felice, there are “push” and “pull” incentives to address these problems. Push incentives provide financial, technical and business support to developers for R&D. Meanwhile, 

A pull incentive meanwhile rewards a new antibiotic which has already been brought to the market, and at least $300 million a year for 10 years should be available for this, he estimates.

‘Best time for bugs’

Anand Anandjumar, co-founder and CEO of Bugworks

Anand Anandjumar, co-founder and CEO of Bugworks, a small biotech company based in Bangalore, wants the UN political declaration on AMR to include a commitment to support innovation.

“We are looking at a long, dark, dangerous battle, so at least setting some very basic goals like five new antimicrobials by 2030 – that gives us about six years to work with – would be good,” said Anandjumar, whose company gets support from CARB-X.

“The bugs that we are seeing today, which are resistant to most antibiotics, are not going to wait for humanity to figure out solutions in our own timelines,” Anandjumar told the Wellcome briefing.

“If you’re a bacteria, there’s no better time than today,” he added. “You have heavy abuse of antibiotics on the one side. Therefore the bacteria are becoming much smarter and are developing mutations and other skills to avoid it. 

“On the other side, you have no R& D because the big pharmaceutical companies don’t find this exciting.”

India has one of the “toughest problems with AMR because of the easy availability of antibiotics and population density, he added,

“It’s a great honour to work on creating a new class of antibiotics from India, because the worst bugs are here.”

He added that AMR was being exacerbated by climate change and war: “Rising temperatures are making bugs much more pathogenic and virulent”, while the wars in Ukraine and Gaza are creating conditions for “superbugs”.

A health facility in DRC’s Maniema receives donated health supplies to address an mpox outbreak in June 2022, but the country has yet to get a single mpox vaccine.

While the Democratic Republic of the Congo (DRC), the epicentre of mpox, has yet to get a single vaccine dose despite battling large outbreaks since 2022, a flurry of activity last week aims to finally change this.

Last Friday, UNICEF announced it had issued an emergency tender for the procurement of mpox vaccines.

Usually, the World Health Organization (WHO) has to issue an emergency use listing (EUL) or full approval before UNICEF or the vaccine alliance, Gavi, can procure vaccines.

But WHO Director-General Dr Tedros Adhanom Ghebreyesus clarified at a media briefing last Friday that the global body has given UNICEF and Gavi authorisation to waive the usual procedure to speed up the procurement of the vaccines.

The emergency tender allows UNICEF to set up conditional supply agreements with vaccine manufacturers that will enable it “to purchase and ship vaccines without delay once countries and partners have secured financing, confirmed demand and readiness, and the regulatory requirements for accepting the vaccines are in place”, said UNICEF.  

UNICEF is also coordinating vaccine donations with the vaccine platform, Gavi, the Africa Centre for Disease Control and Prevention (Africa CDC), WHO and Pan American Health Organization (PAHO).

Derrick Sim, Gavi’s interim chief vaccine programmes officer, said that the tender enables “UNICEF to purchase and deliver vaccines after Gavi and other partners make funding available and sign purchase or donation agreements with manufacturers for the most immediate dose needs”.

“Securing access to supply and financing, delivering doses, and in parallel ensuring countries are ready to administer them, are all vital actions that need to be conducted rapidly but thoroughly, and in a coordinated manner. We welcome this tender as another positive step our alliance and Africa CDC are taking in this response,” added Sims.

Meanwhile, Africa CDC Director General Dr Jean Kaseya said he expects the DRC to start receiving donated vaccines from the US and EU this week.

No approval for mpox vaccines

The WHO decision on EULs for the two vaccines – Bavarian Nordic’s Jynneous (also called MVA-BN) and the Japanese company KM Biologics’ LC16 – is expected in mid-September. As they are already authorised in the European Union and USA, this is expected to be straight forward. 

The DRC issued emergency use approval for the vaccines in late June, but some other African countries with mpox outbreaks – including Burundi, Rwanda, Uganda and Kenya –  have yet to do so.

This will make their access more difficult and once again underscores how useful and important the African Medicines Agency (AMA), currently in the process of being set up, will be in health emergencies. 

Over 18,000 suspected mpox cases, including 629 deaths, have been reported in the DRC so far this year. Four out of five deaths have been in children.

A health worker examines skin lesions that are characteristic of mpox on a child at an mpox treatment
centre near Goma in DRC, on 14 August 2024.

‘Scramble for funds’

The WHO estimates that $135 million is needed to address mpox. Currently, each mpox vaccine costs $100.

Helen Clark, former co-chair of the Independent Panel for Pandemic Preparedness and Response, called on Gavi and other donors to see whether they can use some $1.8 billion left in the COVID-19 vaccine platform, COVAX, for vaccine access for the mpox response. 

“This current scramble for funds is a major reason why The Independent Panel recommended the establishment of an emergency surge finance mechanism – a recommendation which is highly relevant right now,” said Clark in a statement issued on behalf of all active members of the Independent Panel.

“The most urgent focus and investment on the ground must be on rolling out and intensifying basic public health measures,” added Clark.

Focus on public health measures

“It is clear that existing diagnostics cannot be immediately scaled, the vaccines available are insufficient in number and will take time to deploy, and there currently is no proven treatment. 

The spread and harm of mpox can and must be reduced by public health measures that are tailored to the affected communities and to the transmission patterns of the local outbreak. This includes support to health facilities and health workers, and investment in community risk communication and engagement to ensure people understand the risks of both zoonotic infection and human-to-human transmission.”

Over the weekend, over 75 organisations under the Pandemic Action Network sent a letter to the G20 Health Working Group meeting currently underway, urging them to prioritise “the immediate need for resources, including vaccines, to address the mpox outbreak”. 

“The G20 must honour its commitment to prioritising prevention, preparedness, and response to pandemics, including boosting local and regional production of medicines, vaccines, and strategic health supplies,” the letter added.

Image Credits: Eugene Kabambi/ WHO, Guerchom Ndebo/ WHO.

A woman addicted to opium hides her face at a treatment centre in Mazar-i-Sharif.

KABUL, Afghanistan — On Kabul’s eastern outskirts, far from the bustling city centre, lies what locals call “the camp of addicts.” The Avicenna Drug Treatment Center, a massive compound enclosed by towering concrete walls, looms over the Afghan capital.

Within its gates, Afghans face forced rehabilitation in the Taliban’s escalating war on drug addiction, a nationwide crackdown that has intensified since the Islamist militant group reclaimed power in 2021. Nearly 10% of Afghanistan’s population — an estimated four million people — struggle with addiction.

“I was addicted to heroin for 10 years,” said Ehsanullah, a pale man in his late 40s, his voice quivering. “Two months ago, they brought me here to quit drugs. They beat me and warned me not to relapse.”

The Taliban’s methods are often violent. Drug users are forcibly detained using whips and guns, then held for at least 45 days. Their heads are shaved, and they are given inmates’ uniforms.

Overcrowding has forced many drug users into the same prisons that once held Taliban fighters under the previous government’s rule.

Modern drug treatments are virtually non-existent. Medicines like methadone, crucial for managing opioid withdrawal symptoms, are scarce.  International aid, which once supported this treatment, has evaporated since the Taliban’s return to power three years ago.

Ehsanullah’s younger brother, who has witnessed his sibling’s ongoing battle with opioid addiction, said the Taliban’s brutal methods are not working.

“Whenever he gets a chance to escape and return to addiction, he does, because he feels alienated, insecure and stressed in normal settings in society,” he said, adding that the Taliban’s methods are not backed by medical evidence.

Health experts agree. Maiwand Hoshmand, a psychologist at Kabul’s Avicenna Hospital, emphasized the complex nature of addiction, noting that family problems and mental disorders play a major role in Afghanistan’s addiction crisis.

“Forty-five days is considered a standard period for quitting addiction, but for patients who have mental problems, the process of leaving them continues for 90 days,” Hoshmand said.

Many people addicted to drugs spend much longer in recovery facilities and prisons than the 45 days prescribed by Taliban authorities. Radio Azadi, Radio Free Europe’s Afghan arm, reported prison stays of up to six months.

Those who are admitted must sign a pledge to stay off drugs and complete an assessment before their release. If they fail multiple assessments, their time in prison or the recovery facilities can be extended indefinitely.

The United Nations reported that the conditions at Avicenna Hospital – considered the ‘gold standard’ of drug treatment centers in Afghanistan – are “heartbreaking.” International funding has dried up, leaving underpaid, poorly trained staff to deal with patients. Food is scarce, and pharmacy cabinets are practically empty, forcing patients into shock detoxification.

“My children have no one to feed them,” one detainee, held for six months in a Taliban-run rehabilitation program, told the UN.

Afghanistan’s forgotten women addicts

Thousands of women in Kabul with drug addictions face a uniquely harrowing struggle. The women’s drug treatment facility, separated from the men’s and hidden from public view, can house only 150 addicts for 45-day stints.

Overcrowding means that hundreds of women sleep in hallways with barely enough food to survive. Survivors recount prison-like conditions.

Many share similar stories: they became addicted to drugs due to the influence of men or situations where men were the cause.

Mah Gul (a pseudonym), sits upright in her bed, her pale face and frightened eyes telling a story shared by women across Afghanistan.

“I had no idea he was addicted before we got married,” she said, recounting how her husband, unable to afford treatment for her chronic illness, introduced her to opioids to ease her pain. “He gave me poppy, and my pain eased. Whenever I got sick, I used more and more.”

Halima, a 27-year-old mother separated from her husband and children, says she was forced to resort to drugs to endure the separation.

“My husband was addicted and took my children away from me. He went to Iran, leaving me alone with no one,” Halima said. “I became addicted due to the pain of the loss of my children. I searched a lot to find them, but could not.”

The women’s struggles extend beyond addiction, revealing a complex web of substance abuse, domestic violence and societal pressures amid eroding rights under Taliban rule.

“They can’t keep me here for long once my 45 days are completed,” Halima added, her eyes darting nervously. “I am afraid of my husband. I have no place; I don’t have a job. I can’t go from here. What will happen if I stay on the street? I have no home or shelter.”

Women are feeling increasingly isolated under the Taliban with no rights to study or work. Recent edicts ban women’s voices from being heard singing or reading aloud in public, with the regime declaring a woman’s voice “intimate” and forbidden outside the home.

“Women with addiction should not be judged because they are dealing with an illness, with a disorder, that they cannot cure themselves,” said Haibatullah Ebrahimkhil, a psychologist in Kabul. “We should educate them about addiction.”

On Thursday, the Taliban’s Minister of Education extended the ban on women’s education – the only such ban in the world – even further: to speaking about it.

“Just as education for girls is banned,” he said, “questioning it is also banned.”

Taliban celebrates ‘success’ 

Before the Taliban takeover, around 100 drug treatment centres operated across Afghanistan. Today, only 61 remain, according to Taliban government figures. The withdrawal of international aid has left even surviving centres struggling to keep their doors open.

“Public healthcare facilities, especially tertiary hospitals … are struggling to cover essential running costs like staff salaries, medicines and medical supplies, fuel, and oxygen supply,” Médecins Sans Frontières, one of the last international organizations still working in Afghanistan, said in June, noting “the lack of long-term structural support for the health sector in Afghanistan.”

This has not stopped the Taliban regime from celebrating the perceived success of their strict counter-narcotics policies. The regime frequently conducts highly visible — and often violent — raids on addicts’ encampments, presenting these actions as evidence of their commitment to eradicating drug abuse.

In June, the Taliban held an opulent ceremony to mark the ‘Day Against Drug Abuse and Illicit Trafficking’ at Kabul’s Intercontinental Hotel, perched high above the city’s poorest areas where many addicts live.

The Intercontinental, which opened its doors in 1969 as Afghanistan’s first luxury hotel, has been a silent witness to the country’s turbulent history. It has seen seven different governments come and go and has stood through nearly half a century of continuous conflict since 1978.

Once a symbol of Afghanistan’s aspirations for modernity and progress, the hotel is now under Taliban management.

The Intercontinental, Kabul’s largest hotel is perched on the mountains surrounding the city. It has been a symbol of power in Afghanistan’s capital since it opened in 1969.

“Since the establishment of the Islamic Emirate, 54,374 drug addicts have been treated,” Abdul Wali Haqqani, the Taliban’s Deputy Minister of Public Health, declared from the Intercontinental ballroom.

Shams Al-Rahman Minhaj, representing the Ministry of Interior’s Anti-Narcotics Directorate, offered even higher figures: “Since the Islamic Emirate took power, 114,340 drug addicts have been collected and sent to addiction treatment centres. In 2023, 33,226 individuals were collected.”

Talib officials were joined by Jamshid Tanwali, a representative of the World Health Organization (WHO), who spoke on the concerning increase in addiction worldwide.

“In 2011, there were 240 million drug addicts globally; this number rose to 296 million in 2021,” Tanwali said. “Given the global increase, drug use in Afghanistan might also have risen.”

As addiction rates climb, Afghanistan’s opium production has plummeted under Taliban rule. UN figures show poppy cultivation in Afghanistan fell by 95% in 2023. Opium production dropped from 6,200 tons to 333 tons.

Myanmar has overtaken Afghanistan as the world’s largest opium producer, ending Afghanistan’s two-decade dominance of the illicit global market. At its peak in 2007, Afghanistan supplied 93% of the world’s illicit opiates.

Habibullah Aqli, a sociologist, argues that the current approach is insufficient. “There are three basic solutions,” he says, “identifying the main sponsors and drug growers, defining a legal mechanism for drugs and sellers, and developing a policy to address mental aspects of the addicts.”

The decline in opium production comes as the Taliban crackdown on a trade they long profited from. For two decades, the Taliban financed their insurgency through the opium trade, weaving a complex tapestry of economic dependency and addiction throughout Afghan society.

Now in power, the Taliban face the daunting task of dismantling a national crisis they helped create.

Stefan Anderson contributed reporting for this story. 

Image Credits: Jacksoncam, Olaf Kellerhoff.

US officials hand over the mpox vaccines to Nigerian health officials

Nigeria, accounting for just 1% of Africa’s confirmed mpox cases, has become the first African country to receive a vaccine shipment outside a clinical trial. 

This week, Nigeria received 10,000 doses of Jynneos, a vaccine manufactured by Bavarian Nordic and donated by the United States government.

“We are pleased to receive this modest initial donation of the mpox vaccine which is safe and efficacious,” Nigeria’s Minister of Health, Muhammad Ali Pate said. “We will continue to strengthen surveillance and be vigilant to prevent and control mpox.”

Leading up to the vaccine delivery, Dr Jean Kaseya, Director-General of the Africa CDC, confirmed that Nigeria was one of the two African countries to have issued regulatory approval for the vaccine’s introduction. 

Nigeria’s preparedness, marked by a robust vaccination plan, ensured its place at the forefront of receiving these doses.

According to Africa CDC’s latest epidemic intelligence report, nearly 21,000 suspected and fewer than 3,400 confirmed mpox cases have been reported across Africa this year. 

While the Democratic Republic of Congo (DRC) accounts for 95% of suspected and 90% of confirmed cases, Nigeria has only confirmed 40 cases and no deaths — a mere 1% of the continent’s total confirmed cases. 

Despite this relatively low number, Nigerian public health officials have raised the alert level and strengthened outbreak preparedness.

‘Very, very busy’

Dr Jide Idris, head of Nigeria’s frontline agency for disease prevention and control, the Nigeria Centre for Disease Control (NCDC), has had action-packed days since mpox was declared a public health emergency of international concern (PHEIC) – for the second time in two years.

The day after the announcement, Idris was too busy for interviews, his schedule crowded with preparations and briefings. 

The atmosphere at the NCDC’s head office was intense, mirroring the urgency felt across the country as teams worked tirelessly to monitor and coordinate response to multiple outbreaks. 

Meanwhile, requests for guidance on Nigeria’s mpox preparedness poured in. Between briefings for the health minister, press briefings and meetings with health commissioners from Nigeria’s 36 states, he found a few moments to speak to Health Policy Watch.

“It is very busy, very busy,” he said. “We do not have Clade 1b in Nigeria. All cases are Clade 2,” Idris said. 

Clade 1b is the new strain that is spreading fast in the DRC and neighbouring countries.

Idris outlined Nigeria’s three-pronged mpox response strategy: enhancing surveillance at ports of entry, boosting laboratory capacity for testing and genomic surveillance, and providing medical countermeasures (MCM) commodities.

Although mpox is currently classified as a PHEIC, the NCDC’s latest situation report for Nigeria shows a stable outlook: no surprises in case counts, no fatalities, and a consistent pattern in states reporting cases. 

There has been no change in cases since 18 August 18, when the cumulative case count for 2024 stood at 40 across 19 states. Only five states reported more than two confirmed cases: Bayelsa (5), Akwa Ibom, Enugu, and Cross River (4 each), and Benue (3).

Bayelsa, which reported the third highest number of confirmed cases (45) during the 2022 outbreak and ranked second the previous year, has consistently been among the top three states for mpox cases in Nigeria over the past eight years, except in 2020.

So far in 2024, children under the age of 10 years account for 35% of confirmed cases, followed by adults aged 31 to 40 years, who make up 20%.

“Before 2024, most of the confirmed cases were in young adults aged 10-40 years, with males being predominantly affected. In 2024, however, over 33% of confirmed cases are in children aged 0-10 years,” Idris told Health Policy Watch.

Beyond Nigeria and beyond vaccines

According to the official announcement, the 10,000 vaccine doses will be administered in a two-dose schedule to 5,000 individuals most at risk of mpox, including close contacts of confirmed cases and frontline healthcare workers. 

The vaccination exercise will primarily target the five states with recorded cases, with provisions for reactive vaccination in other states as needed.

With DRC not getting the first mpox shipment despite its central status in the outbreak, attention is on the global health players’ ability to let priority guide allocation and delivery of doses. 

Gavi CEO Sania Nishtar revealed that, aside from donations from the US government and the vaccine manufacturer, DRC can also access 65,000 doses of mpox vaccine from Gavi immediately after it makes a request to Gavi. 

However, Nishtar noted that the current supply of mpox vaccines will not be enough to reach everyone in Nigeria, the DRC or elsewhere that needs the shots hence the need to also bring attention to other areas, especially in the short term.

“The first response should be to boost areas such as surveillance, data collection, case management and community engagement: these important foundations are critical for helping us to understand and ultimately contain the outbreak,” Nishtar told Health Policy Watch.

Idris agrees. When asked what he thinks has uniquely positioned Nigeria to fully contain the spread of mpox without having to consider travel restrictions, he did not mention vaccine donations or any medical countermeasures. 

Instead, he acknowledged Nigeria’s vast experience in responding to multiple outbreaks including more fatal ones, and the “surge capacity” it has acquired already – capacity for coordinated response mechanisms, genomic sequencing and molecular diagnosis.

This is why Nigeria is one of the very few African countries reporting cases that do not have a wide gap between suspected and confirmed cases.

Image Credits: WHO.

A UNICEF staff member checks a polio vaccination shipment for Gaza’s vaccine campaign. The proliferation of untreated sewage and waste in wartime Gaza has led to the re-emergence of poliovirus.

BREAKING:  A massive polio vaccine campaign targeting some 640,000 Gaza children is now set to begin on Sunday, 1 September, with agreement by Israel for a three-day humanitarian pause in fighting, a senior WHO official said on Thursday. A second round of the campaign for the two dose vaccine is planned three weeks later. 

“We have had discussions with Israeli authorities and we have agreed to humanitarian pauses…for three days,” said WHO’s Dr. Rik Peeperkorn, speaking to reporters at a briefing at UN Headquarters in New York City.  “I am not going to say this is the ideal way forward. But this is a workable way forward…we have to stop [polio] transmission in Gaza and outside Gaza.”

“Of course, all parties will have stick to this. We have to make sure that everyday we can do this campaign in this humanitarian pause…it is an ambitious target of 90%, but the teams here are ready for it, we are ready to go,” said Peeperkorn.
He was referring to the nearly 11-months of Israeli-Hamas fighting that began 7 October with a bloody Hamas incursion into two dozen Israeli communities near the Gaza enclave in which 1200 people, mostly civilians, were killed and 240 people taken hostage. Following that, Israel launched a devastating invasion of Gaza in which some 40,000 Palestinians have died.
Against the backdrop of continued fighting, some 1.2 million polio vaccine doses reached the Gaza Strip on Sunday via Israel’s Kerem Shalom crossing, after arriving at Tel Aviv’s Ben Gurion airport the week before.
Inside Gaza, some 2,700 medical staff have been trained and poised for deployment at 400 vaccination points to ensure doses can be delivered to all eligible recipients in two stages, Palestinian health officials said.
Trucks carrying special refrigeration equipment for vaccine storage and transportation were also brought into the Gaza Strip by the United Nations Children’s Fund (UNICEF) last Friday. 

Distribution complicated by evacuation orders

UN agencies have pressed ahead with a planned polio vaccination campaign against the background of a rash of new Israeli military evacuation orders imposed on displaced Palestinians sheltering in designated “safe zones”.

Tens of thousands of Palestinians have been ordered move once again from parts of the central Gaza city of Deir al Balah as well as sections of Khan Younis in the south. The areas were among those previously designated by the Israeli army as humanitarian zones for the more than 1.2 million Gazans who have been internally displaced during the grinding war between Israel and the Palestinian Hamas.

“Mass evacuation orders are the latest in a long list of unbearable threats to UN and humanitarian personnel,” Under-Secretary-General Gilles Michaud said in a statement on Tuesday. 

“The timing could hardly be worse,” he added, referring to the polio vaccination programme that was about to start. 

Poliovirus was first detected in Gaza in late June by the Global Polio Laboratory Network. The virus was confirmed in six sewage samples from Khan Younis and Deir al Balah, cities in the south and centre of the 365 square kilometer Gaza Strip. 

In mid-August, three suspected polio cases in children were identified, Health Policy Watch reported, followed by the confirmation of one case in a 10-month old infant last week. As nine out of 10 polio cases are generally asymptomatic, the spread of the virus is likely far wider than reported cases. 

In response, WHO, UNICEF and UN Relief and Works Agency for Palestine Refugees (UNRWA) organised a vaccination campaign targeting over 640,000 children.  

Delaying the vaccinations would have serious consequences, Dr Hamid Jafari, the director of the WHO’s polio eradication programme in the Eastern Mediterranean warned on 23 August.

“The risk of this virus spreading into Israel, into the West Bank and into surrounding countries like Lebanon, Syria, Egypt and Jordan is high. So we need to act fast.”

Humanitarian pauses

To reach the intended vaccination target and gain better population immunity, WHO and other UN agencies had appealed for at least two humanitarian pauses of seven days to deliver the vaccine doses.

The pause in the grinding 11 month Israel-Hamas war is necessary to ensure a cold chain of the vaccines, as well as to guarantee the safety of patients reaching healthcare points and the right timing of the second dose, officials have stressed.

The operation in a conflict zone will be complex, and its outcomes will depend on the conditions on the ground, Sam Rose, Senior Deputy Field Director for UNRWA in Gaza stressed in a statement Monday. 

UN agencies and partners “stand ready to vaccinate children, but need a humanitarian pause. We and the rest of the system involved will do our absolute utmost to deliver the campaign,” Rose said, “because without it, the conditions will be much worse sadly.”

Overcrowding

Polio is a highly infectious viral disease largely affecting children younger than five years of age. It spreads between humans by a fecal-oral route or, in the minority of cases, through contaminated water or food.

One in 200 infections causes permanent paralysis and, in 2-10% of the paralysed, death. While there is no known cure for polio, the disease was mostly eradicated in the World Health Assembly-initiated Global Polio Eradication Initiative starting 1988. 

In some cases, the weakened virus present in the oral polio vaccine (OPV) can mutate and spread in communities not fully vaccinated against polio, especially in poor hygienic conditions or in overcrowded areas. The longer it is allowed to circulate, the higher the chance for further mutations, creating concerns about a large-scale outbreak.

Updated 29 August, 2024.  Elaine Ruth Fletcher contributed to reporting on this story. 

Image Credits: UNICEF.