Registered nurses Fatmata Bamorie Turay (left) and Elizabeth Tumoe, at the Princess Christian Maternity Hospital, in Freetown, Sierra Leone. Some ealthy countries are actively recruiting nurses from LMICs.

The International Council of Nurses (ICN) has called on the World Health Organization (WHO) to consider a “time-limited moratorium of active recruitment of nurses” from countries on the WHO Health Workforce Support and Safeguard List.

This follows a “dramatic surge” in the recruitment of nurses from low- and middle-income countries (LMICs) by wealthy countries, according to the ICN.

The Safeguard List identifies 55 countries that face the most pressing health workforce challenges related to achieving universal health coverage (UHC). Health workers shortages are one of the primary causes of countries’ inability to achieve UHC.

The ICN made this proposal in a recent report to the World Health Organization (WHO) on the implementation of the WHO Global Code of Practice on the International Recruitment of Health Personnel.

It attributed the “dramatic surge in international nurse migration and recruitment” in large part to “attempts by some high-income countries to address their vast nursing shortages by actively recruiting from LMICs and easing the entry or professional recognition of internationally educated nurses (IENs)”.

The proportion of overseas-trained nurses employed in the Organisation for Economic Co-operation and Development (OECD) – made up of 38 developed countries – jumped from 5% in 2011 to nearly 9% in 2021.

The UK, USA, Canada, Australia, Germany and certain Gulf states are driving this recruitment 

UK takes nurses from ‘red list’ countries

In the UK, for example,  over 24,000 new international nurses were registered from September 2021 to September 2022, the highest in recorded history.

Some 19% of new overseas nurses in the UK between 2021-2023 came from countries facing “severe health workforce deficits”, according to the WHO Health Workforce Support and Safeguard List.

Over six months in 2022,  over 20% of new international nurses (more than 2,200) came from just two “red list” countries: Nigeria and Ghana. 

“Although active recruitment from these countries to the National Health Service (NHS) is prohibited in the UK, nurses can be first hired by for-profit recruitment firms to work in the private sector and later apply directly to the NHS as passive recruits,” according to the ICN.

International recruiters are also directly advertising to recruit scarce health care staff from low- and lower-middle-income countries in Africa, Asia, and the Caribbean, in breach of the code. 

The US reported that over 17,000 nurses applied for visas in 2022, a 44% increase from the previous year.

“Countries that have not been traditionally active in international nurse recruitment are also showing increased demand for overseas-trained nurses, including Finland as well as Scotland, where the government announced an allocation of £4.5 million to support active international recruitment of nurses as part of the overall plan for pandemic recovery and renewal,” notes the ICN.

Low-income countries face huge nurse shortages

Tonga and Fiji reported losing 20% to 30% of their nurses, primarily to Australia and New Zealand, at the 2024 World Health Assembly (WHA).

In Fiji, 800 nurses in resigned in 2022, over a fifth of the nursing population. At present, the country has 2,003 remaining nurses and around 1,650 nursing vacancies. Many hospitals have less than 40% of their established Registered Nurse positions 

Nursing representatives from Jamaica also reported at the WHA that around 20% of the country’s nurses have applied for certificates of current professional status, indicating that they are preparing to work abroad.

Over 1,700 registered nurses in Zimbabwe resigned in 2021, and some 900 left the country in 2022, with many moving to the UK. 

The Ghana Registered Nurses and Midwives Association recently reported that around 500 nurses are leaving that country every month, particularly experienced, specialist nurses.

The Philippines has a current shortage of 190,000 healthcare workers and is expected to face a shortage of 250,000 nurses by 2030 

Nurses’ right to migrate

“The ICN recognises and supports the right of individual nurses to migrate and pursue professional achievement through career mobility and to better the circumstances in which they live and work,” according to the report.

However, it is “gravely concerned” about the “large-scale nurse migration from the world’s most vulnerable countries, in large part driven by active nurse recruitment by a small number of high-income countries, including the United Kingdom, United States, Canada, Australia, and Germany, as well as certain Gulf States”. 

It “condemns the targeted recruitment of nurses from countries or areas within countries that are experiencing a chronic shortage of nurses and/or a temporary health crisis in which nurses are needed”.

“These trends are depleting already fragile health systems, preventing LMICs from rebuilding and responding to health challenges post-pandemic, and widening the significant gap in healthcare access and quality between high-income and low-income countries. 

“This situation jeopardises the global achievement of the UN Sustainable Development Goals, including universal health coverage, by 2030.”

Mitigating migration

Some wealthier countries are increasingly their own nurse training. In the UK, for example, the NHS Long Term Workforce Plan aims to educate over 60,000 nurses in England by 2029, a 54% increase from 2022/23.

Australia is developing its National Nursing Workforce Strategy to improve sustainability and self-sufficiency, while Germany’s 2024 Nursing Studies Strengthening Act aims to attract nursing students with monthly salaries to ease the workforce shortage.

The Filipino Department of Health has recently allocated funds to provide nurses with health insurance, housing, and other benefits in an attempt to stem the tide of nurse migration.

However, several LMICs are experiencing nursing shortages and are unable to provide employment or other measures to retain their nurses due to insufficient funding and other structural factors,

In Lesotho, in southern Africa, for example, almost a third of professional nurses and midwives are unemployed because of a lack of funding.

“LMICs require support to develop and strengthen their health and care workforce and systems so that they can meet their population’s needs,” the ICN stresses.

Aside from unemployment, nurses in LMICs often face poor working conditions, low compensation and safety issues.

“We have seen increased evidence of labour unrest and/or strike action in developing and lower-income countries in the past three years, including Uganda, Ghana, Fiji, and Tonga. 

“This must be recognized as symptomatic of the underlying issues feeding nurse migration and clearly demonstrates the need for efforts to strengthen LMIC health systems rather than deplete them by draining their workforce.”

Image Credits: World Bank/Flickr.

Indian doctors on strike nationally in protest against the rape and murder of a colleague while on duty.

Indian doctors held a 24-hour national strike over the weekend to protest the rape and murder of a young female doctor in a hospital in Kolkata, demanding better protection for health workers.

Around one million health workers were estimated to have supported the strike. Some junior doctors remain on strike, saying that they will not return to work until the authorities meet their safety demands.

The bloodied body of 31-year-old Dr Moumita Debnath was found in a seminar room in RG Kar Medical College and Hospital on 9 August. 

An inquest report confirmed sexual assault, and her family wrote in a court petition that they believed she had been gang raped. She had been on duty at the time of her murder.

Following protests by junior doctors and medical residents after the discovery of Debnath’s body, the Indian Medical Association (IMA) called for a 24-hour “nationwide withdrawal of services” and the suspension of all non-essential procedures over the weekend.

“We ask for the understanding and support of the nation in this struggle for justice for its doctors and daughters,” said IMA president  RV Asokan said in a statement ahead of the strike.

In a letter to India’s Prime Minister, Narendra Modi, the IMA called for a Central Act outlawing violence and damage to property at health facilities and for the security at health facilities to be as tight as airports.

“The 36-hour duty shift that the victim was in and the lack of safe spaces to rest… warrant a thorough overhaul of the working and living conditions of the resident doctors,” added the IMA in the letter.

According to the IMA, 60% of doctors and 85% of nurses in the country are female. An IMA study found that 75% of doctors have faced abuse, usually verbal, while at work, according to The Times of India.

the weekend protests took the form of marches, demonstrations and a 3km human chain of health workers in Kolkata, near the site of the attack. 

Despite its impact on patients, the action has had substantial public support. Supporters of the two biggest soccer clubs in West Bengal, the state where the attack took place, united in a march on Sunday evening to demand justice for Debnath and protection for doctors.

This Thursday, women in the state of West Bengal have called a “Reclaim the Night” march beginning at midnight, according to The Hindustan Times. The protest will coincide with the official start of India’s Independence Day.

The proliferation of untreated sewage and waste in wartime Gaza has led to the re-emergence of poliovirus.

The World Health Organization and UNICEF have appealed for ‘humanitarian pauses’ in the grinding Israel-Hamas war in the Gaza Strip in August and September to facilitate a massive polio booster campaign – as three suspected polio cases were being investigated by a Jordanian laboratory.

The appeal came as the entire region see-saws between the possibility of a regional war between Iran, the Lebanese Hizbullah and Israel, and an Israeli-Hamas ceasefire in Gaza. 

Israeli and Hamas negotiators are meeting in Doha today in a last ditch effort mediated by the United States, Egypt and Qatar, to find acceptable terms for a ceasefire that could help avert a wider war and lead to the release of some or all of the 116 Israeli hostages now held by the Islamic Hamas for over 10 months. 

But irregardless of that outcome, humanitarian pauses of at least seven days are needed to enable the mass administration of oral polio vaccine boosters to some 640,000 Gaza children, WHO and UNICEF said, in a joint statement on Friday. 

“WHO and UNICEF request all parties to the conflict to implement humanitarian pauses in the Gaza Strip for seven days to allow for two rounds of vaccination campaigns to take place. These pauses in fighting would allow children and families to safely reach health facilities and community outreach workers to get to children who cannot access health facilities for polio vaccination. Without the humanitarian pauses, the delivery of the campaign will not be possible.” 

Three children suspected of polio paralysis

Vaccine-derived poliovirus, which can spread through faeces and infect under-immunized children thus exposed, was detected in July 2024 in sewage samples in Khan Younis, in southern Gaza, as well as in Deir al-Balah, further north. More worrisome, three children presenting polio-related symptoms of suspected acute flaccid paralysis (AFP), were recently reported in the Gaza Strip, WHO revealed:

“Their stool samples have been sent for testing to the Jordan National Polio Laboratory.”

Over 1.6 million doses of the novel oral polio vaccine, nOPV2, which is used to stop vaccine derived poliovirus transmission (cVDPV2) in under-immunized populations, is due to be delivered to the Gaza Strip via Israel’s Ben Gurion Airport, WHO further revealed. 

Vaccine deliveries via Israel’s international airport

“The deliveries of the vaccines and the cold chain equipment are expected to transit through Ben Gurion Airport before arriving in the Gaza Strip by the end of August,” WHO and UNICEF stated, stressing that, “it is essential that the transport of the vaccines and cold chain is facilitated at every step of the journey to ensure their timely reception, clearance and ultimately delivery in time for the campaign.” 

“At least 95% vaccination coverage during each round of the campaign is needed to prevent the spread of polio and reduce the risk of its re-emergence, given the severely disrupted health, water and sanitation systems in the Gaza Strip,” the joint statement further said. 

“Other requirements for successful campaign delivery include sufficient cash, fuel and functional telecommunication networks to reach communities with information about the campaign,” it added. Currently, Israel and Hamas forces continue to battle across various parts of the 365 square kilometer enclave on the Mediterranean sea sandwiched between the Egyptian border and pre-1967 Israel.     

Polio is a sign of broader infectious disease crisis

The Gaza Strip has been polio-free for the last 25 years, WHO noted, with vaccine rates of 95% or more.  Israel withdrew from the enclave in 2005; two years later, Hamas seized power from the Palestinian Authority, which was violently ejected from Gaza. Israel re-occupied Gaza shortly after the Hamas invasion of Israeli communities along the enclave perimeter on the early morning of 7 October 2023, which led to the deaths of some 1200 men, women and children – as well as the capture of another 240 Israelis and foreign residents. 

Israel has been waging a bitter battle against the Islamic group ever since, cutting off access to Gaza from Egypt, but it has not succeeded in crushing the organization entirely.  Some 40,000 Gazans have since died during the fighting, while tens of thousands more people are wounded.  Amidst a sanitation catastrophe including the destruction of drinking water and waste management facilities, infectious diseases have run rampant in the enclave – exacerbated by heat, hunger and malnutrition. 

Polio’s re-emergence, “which the humanitarian community has warned about for the last ten months, represents yet another threat to the children in the Gaza Strip and neighbouring countries.  A ceasefire is the only way to ensure public health security in the Gaza Strip and the region,” said WHO and UNICEF.   

Image Credits: @WHOoPT.

mpox

The World Health Organization has declared an international public health emergency for mpox, its highest level of alarm, as the virus experiences a resurgence across Africa less than two years after ending the previous emergency.

The declaration comes as the case total in Africa this year has already surpassed the total from 2023. Over 2,500 cases and 56 deaths were reported across the African Union last week alone. Since January, 17,541 mpox cases have been reported across 13 AU states, according to the latest Africa CDC epidemic intelligence report published August 9.

“Today, the Emergency Committee met and advised me that, in its view, the situation constitutes a public health emergency of international concern,” WHO Director-General Dr Tedros Adhanom Ghebreyesus said at a briefing on Wednesday. “I have accepted that advice.” 

The Democratic Republic of Congo (DRC) is at the heart of the outbreak, accounting for more than 96% of both cases and deaths. A new variant of the virus, Clade 1b, has spread from the DRC to countries that have never reported mpox cases before, including Burundi, Kenya, Rwanda, and Uganda.

In the DRC, where mpox was first detected in 1970 and remains endemic, 60% of cases involve children under 15 years old, Africa CDC reports.

The WHO announcement follows a similar declaration by Africa CDC on Tuesday, when it declared its first-ever continental emergency of international concern since the agency’s founding in 2016.

“We declare today this public health emergency of continental security to mobilize our institutions, our collective will, and our resources to act swiftly and decisively,” said Africa CDC Director-General John Kaseya.

Both emergency declarations were based largely on evidence that the primary mode of circulation for the current mpox outbreak is person-to-person transmission, primarily through sexual networks. This differs from the historical pattern of zoonotic transmission from animals to humans.

“The potential for further spread within Africa and beyond is very worrying,” Tedros said. “It’s clear that a coordinated international response is essential to stop these outbreaks and save lives.”

Vaccines missing from outbreak frontlines

The African Union has approved $10.4 million to support Africa CDC’s crisis response efforts. The funding will target securing vaccines, improving epidemic surveillance, and assisting in overall preparedness and response efforts. The WHO has also released an additional $1.45 million from its emergency fund to support the African response.

Despite these actions, continental response systems remain underprepared and under-resourced. Africa needs an estimated 10 million vaccine doses but currently has only 200,000 available. Deployment of these vaccines has also been problematic. While the DRC received 50,000 doses donated by the United States, they have yet to be put to use. Meanwhile, doctors on the frontlines of the outbreak report that no vaccines are available at all.

“We have to be very strategic in who we use the limited number of vaccines,” said Professor Salim Abdool Karim, head of the Africa CDC Emergency Consultative Group convened to assess the need for an emergency declaration. “Healthcare workers have been one of the groups that have to be addressed.”

Vaccine stockpiles exist in several countries outside Africa. The United States purchased 500,000 doses last year, and an undisclosed European country also made several orders. Other countries such as Japan and Canada also have stockpiles of the vaccine.

The WHO is working with international partners to coordinate what it calls “vaccine donations.” However, the willingness of countries to share their stockpiles remains unclear. The Globe and Mail reported this week that officials from Canada’s Ministry of Health said they have no plans to share their national stockpile with the frontline countries in the African outbreak.

Africa CDC said in Tuesday’s press briefing that a plan to secure the necessary doses is in place. “We have a clear plan to secure more than 10 million doses in Africa, starting with 3 million doses in 2024,” Kaseya added, without specifying the source or timeline for these vaccines.

This potential declaration comes just over a year after WHO ended the previous global health emergency for mpox in May 2023. The earlier crisis, declared in July 2022, stemmed from a worldwide outbreak mainly affecting men who have sex with men. About 90,000 cases and 140 deaths were reported across 111 countries during that emergency.

Mpox has been endemic in parts of Africa for decades, with the first human case detected in the DRC in 1970. The current outbreak underscores the ongoing challenges in controlling the virus in its endemic regions and the need for a coordinated global response to prevent its spread.

The World Health Organization has convened 10 International Health Regulations Emergency Committees to date, addressing global health concerns such as COVID-19, Ebola, H1N1, MERS-CoV, and Zika virus.

This is a developing story. 

Participants gather to share their mental health struggles and offer support at a Friendship Bench meeting in Zanzibar, part of a nonprofit initiative to improve well-being across the continent.

Africa has the highest rate of suicide in the world, and the lowest per capita spending on mental health – with critical shortages, in particular, of community health workers and facilities that could help prevent many mental health conditions from becoming even more severe. 

Two recent high-profile suicides in Tanzania have cast a stark spotlight on the nation’s growing mental health crisis, reflecting a broader struggle across the African continent.

On the evening of May 16, 2024, Archbishop Joseph Bundala of the Methodist Church in Tanzania was found dead inside his church building in Dodoma Region. Eyewitnesses reported that the respected religious leader had taken his own life by hanging, shocking the community and leaving many grappling with unanswered questions.

Just days later, on May 21, another tragedy unfolded as Rogassion Masawe, a 25-year-old Roman Catholic seminarian, was discovered hanged in his room at the seminary. Local media reports suggest that Masawe’s death may have been triggered by his failure to advance to the next stage of priestly formation, which involved taking his first religious vows.

These incidents have brought Tanzania’s mental health challenges into sharp focus. Tito Kusaga, Archbishop Bundala’s brother, expressed disbelief that overwhelming debts could have driven the bishop to such a drastic decision. The fact that Bundala did not seek help underscores a common issue faced by many struggling with emotional distress in the region.

Africa’s mental health crisis

The African continent has the highest suicide rate in the world, according to WHO.

The twin tragedies in Tanzania are not isolated incidents but part of a larger crisis gripping the African continent. Africa has the highest suicide rate in the world, according to the World Health Organization (WHO), driven predominantly by depression and anxiety. Someone dies by suicide approximately every 40 seconds, resulting in roughly 700,000 deaths per year globally.

Globally, someone dies by suicide every 40 seconds, totalling about 700,000 deaths annually. In Africa, the rate is 11 per 100,000 people, compared to the global average of nine. African men are at particular risk, with 18 suicides per 100,000 — significantly higher than the global male average of 12.2. Experts believe these statistics could well be an undercount given the lack of data.

Approximately 29 million people in Africa suffer from depression. The 2023 World Happiness Report found that 17 of the 24 least happy countries are in Africa. Yet mental health programs remain severely underfunded.

In 2020, Africa spent less than $1 per capita on mental health, while Europe spent $46.49. This stark underinvestment is directly correlated with higher suicide rates and poorer mental health outcomes across the continent.

Africa averages just one mental health worker per 100,000 people, compared to the global average of nine. The continent faces critical shortages of psychiatrists, hospital beds, and most important of all – community outpatient facilities.

Few Africans receive needed treatment as a result. The annual rate of mental health outpatient visits in Africa is 14 per 100,000 people, far below the global rate of 1,051.

Tanzania mirrors continental crisis

A stressed patient stands in deep thought in the wards of Mirembe National Mental Health Hospital. Perched on the rolling hills outside the capital, Dodoma, it is the only mental health facility in the country.

The state of Tanzania’s mental health workforce mirrors the continent’s challenges. The country has 1.31 mental health workers per 100,000 people, including 38 psychiatrists, 495 mental health nurses, 17 psychologists, and 29 social workers for its 65.5 million population.

Community-based mental health services are limited in Tanzania. Despite policies to integrate mental health into primary healthcare, resources remain scarce, especially for children and adolescents.

Neighboring Uganda faces a similar situation, with 2.57 mental health workers per 100,000 people, including just 42 psychiatrists . Kenya fares slightly better with 15.32 workers per 100,000, including 115 psychiatrists and 6,493 psychologists. However, Kenya still struggles to meet growing mental health service demands.

Chained to beds  

Perched on rolling hills on the outskirts of the country’s capital, Mirembe National Mental Health Hospital in Dodoma struggles with overcrowding and limited resources. Patients’ recovery and discharge times average six weeks, but many face relapses due to long distances, financial problems, and the side effects of antipsychotic medications.

It is Tanzania’s only mental health hospital for its population of over 65 million, offering just 600 beds in the capital and 300 more in satellite buildings.

With a lack of preventive services at community level, patients suffering from mental health issues often wind up in prison for either petty or serious crimes, where they face practices reminiscent of a bygone era. At Isanga Correctional Facility, a unit for a unit for convicted criminals with mental health issues, aggressive patients are sometimes chained to metal beds, their anguished cries echoing through urine-scented corridors, according to eyewitness accounts.

Dosanto Mlaponi, head of forensic psychiatry at Isanga, defends these measures as necessary to prevent violence. Yet the facility’s challenges extend beyond its walls.

Aziz Kessy, a 27-year-old speaking under a pseudonym, exemplifies a common post-discharge struggle. Suffering from psychosis, Kessy heard voices urging him to kill himself, prompting his father, a grape farmer, to seek professional help.

After initial treatment stabilized him, Kessy was discharged. He soon relapsed after refusing to take his prescribed medications.

“It’s very difficult to track discharged patients and ensure they stick to prescribed medications,” Mlaponi told Health Policy Watch.

Abandoned patients

Tanzania has only one mental health hospital for its population of over 65 million.

Beyond patient care, Mirembe Hospital faces another troubling issue:  some fully recovered patients remain on its grounds due to a lack of family support. Hospital guidelines require patients to be discharged into a relative’s care.

“Each patient costs between $6-8 per day,” said Dr Paul Lawala, the hospital’s director. “It’s troubling when families disappear after treatment, leaving patients in limbo.”

Extensive research maps a strong correlation between suicide and socioeconomic crises, including unemployment, failed relationships, and domestic abuse, compounding the dangers for abandoned patients.

“It’s as if some people don’t want to be associated with those who had mental health issues, even after they’ve recovered,”  Lawala explained. “We must continue to provide accommodation and food, increasing our costs and impacting our ability to care for others.”

Experts emphasize the dire need for innovative solutions. Over 70% of Tanzania’s population resides in rural areas with limited access to health services. Primary health facilities are ill-equipped to handle psychological problems, as many staff lack diagnostic expertise and medication is scarce.

Dr Praxeda Swai, a senior psychiatrist at Muhimbili National Hospital, agrees. She told Health Policy Watch that the country  is facing “a serious mental health crisis that requires a [more] holistic approach to address it.”

Desperate need for solutions at primary healthcare level

The need for innovative solutions is particularly dire at the primary healthcare level. The Health Ministry is investigating options and seeking funding for a feasibility study on using mobile phones to connect patients with health workers, potentially enhancing communication and reducing relapses.

One approach under consideration is harnessing mobile technology for mental health counseling.

A recent study, “Using Mobile Phones in Improving Mental Health Services Delivery in Tanzania: A Feasibility Study,” explores how technology can bridge the gap between mental health patients and health workers.

“An ICT/mobile phone-driven platform can significantly reduce the need for patients to physically visit hospitals, saving time and money,” says lead researcher Perpetua Mwambingu of the University of Dodoma.

Patients could receive medical advice, information on medication side effects, and reminders for appointments and medication refills via their phones. Health workers could monitor symptoms and provide therapeutic interventions remotely.

This continuous communication could also lead to earlier diagnosis and treatment, potentially reducing hospital stays.

Causes and solutions

Dr Michelle Chapa, the founder and CEO of a Dar es Salaam-based  Foundation that innovative mental health programs, attributes the rise in suicides to clinical depression, exacerbated by poverty, unemployment, and cultural stigma.

“Poverty and unemployment are major contributors to the mental health crisis in Tanzania,” she told Health Policy Watch. “Unemployment can lead to a loss of identity, purpose, and self-worth, which are significant contributors to depression and anxiety or poor mental health.”

Chapa explained that constant financial instability, lack of access to basic needs, and uncertainty about the future trigger chronic stress, often manifesting as anxiety and depression.

“Poverty can lead to unemployment, which results in food insecurity and increases the likelihood of substance abuse,” she noted. “Inadequate nutrition directly impacts brain function and development, increasing vulnerability to mental health disorders.”

Traditional beliefs may hinder individuals from seeking professional help, Chapa added. Men, for instance, are expected to be stoic and self-reliant, and are thus less likely to seek help for mental health issues, perceived as weak or unmanly.

“Exposure to violence also can lead to long-term psychological trauma, including PTSD, depression, and anxiety,” Chapa said. “Violence disrupts community cohesion and family structures, leading to social isolation and a lack of support systems, which are crucial for mental well-being.”

Mental health services are not well-integrated

Chapa described Tanzania’s mental health services as “often not well integrated with general healthcare, resulting in fragmented care and missed opportunities for early intervention.”

“This issue is particularly pronounced in rural and remote areas, where access to mental health services is more limited,” she added.

Chapa emphasized the need for increased funding to build and renovate mental health facilities, integration of mental health services into primary healthcare, and robust training programs for mental health professionals.

She also called for public awareness campaigns to reduce stigma and encourage individuals to seek help. Chapa stressed that suicide should be decriminalized.

New directions and long-term strategies 

Experts told Health Policy Watch that long-term strategies to build a robust mental health support system in Tanzania are multifaceted. These include policy reform to prioritize mental health, workforce development to increase the number of mental health professionals, and infrastructure expansion to improve facilities and services.

Community-based care initiatives and education campaigns are also crucial, the experts noted. They emphasized the need for increased research and innovation, as well as stronger collaborations and partnerships across sectors.

To guide these efforts effectively, improved data collection and policy advocacy are necessary. These strategies aim to address the diverse mental health needs of Tanzania’s population and improve overall mental health outcomes.

‘Grandmothers’ as mental health workers 

The Friendship Bench (FB) project, an innovative mental health initiative founded in neighbouring Zimbabwe, bridges the treatment gap with a unique approach. Developed over two decades, the FB uses problem-solving therapy delivered by trained lay health workers, focusing on individuals suffering from anxiety and depression.

The project employs ‘grandmothers’ as community volunteers, who counsel patients through six structured 45-minute sessions on wooden benches within clinic grounds.

“Since 2006, we have trained over 600 grandmothers who have provided free therapy to more than 30,000 people in over 70 communities,” said Dr Dixon Chibanda, who leads the project.

The FB model has expanded beyond Zimbabwe to Malawi, Zanzibar, and even New York City, demonstrating how mental health interventions from low-income countries can be adapted globally. Several ongoing studies, including the Youth Friendship Bench and FB Plus, continue to expand the project’s impact.

In Africa, the initiatives are supported by private philanthropies and donors. Government officials express interest in mainstreaming these approaches but cite financial constraints as a persistent challenge.

A series of local initiatives are pushing to make a difference in the mental health of people in Zanzibar. Zanzibar Mental Health Shamba (ZAMHS), established in 2014 by UK mental health nurses, has been pivotal in enhancing services on the island. ZAMHS has provided consistent support for mental health care in Zanzibar’s rural areas, including medication delivery.

“Here in Zanzibar, the need for mental health interventions is pressing, especially for our young people who are grappling with drug abuse and mental distress,” said Amina Hassan, a coordinator at the Friendship Bench of Zanzibar. “The Ministry of Health has been incredibly supportive of our initiative, recognizing the importance of addressing these issues head-on.”

Hassan explained that the mental health policy and legislation introduced in 1999 have led to significant enhancements in mental health activities over the past decade. “Despite our extremely low resources, we’ve seen progress, but it’s a constant struggle,” she added.

A child splashes water during a heatwave in Sudan
A girl cools off in the Bieh camp for internally displaced people in South Sudan. The region has seen an increasing number of extreme heat days.

One in five children now live in parts of the world that are experiencing double the number of extremely heat days per year, as compared to six decades ago, according to a new analysis by the United Nations Children’s Fund (UNICEF). 

The analysis comparing average temperatures during the 1960s to the period 2020-2024, highlights a dramatic increase in the frequency of extreme heat days, where temperatures exceeded 35° Celsius (95° Fahrenheit), as well as in the frequency of heat waves. UNICEF defines a heatwave as a period of three days or more of above-average heat.

Heatwave duration, severity, and frequency all intensified since 1960, with more than half of the world’s children 18 and under now experiencing twice as many heatwaves as 60 years ago. 

In the worst affected regions, two-thirds of children in West and Central Africa and 28% of children in the Middle East and North Africa now experience three times as many heatwaves, in comparison to children growing up in the 1960s. In Latin America and the Caribbean, nearly 57 million children – 60% – are now exposed to twice the number of heatwaves. And in the United States, 36 million children – more than half of that population – are exposed to double the number of heatwaves in comparison to their counterparts in the 1960s. 

Frequency of heatwave events by region in the 1960s, when most of the world was seeing 0-3 (beige) or 3-6 (very light brown)events a year.
Frequency of heatwave events in the 2020s, where most of the world is seeing 6-9 events (medium brown), or 9-15 or more events (darker brown) a year.

Hottest summer days now seem normal

“The hottest summer days now seem normal,” remarked UNICEF Executive Director Catherine Russell in a press statement. “Extreme heat is on the rise, disrupting children’s health, well-being, and daily routines.”

The report’s findings are particularly alarming for children in 16 countries, which now see over a month more of  extremely hot days compared to the 1960s. Among those are children in war-stricken Sudan.

“[The analysis] has a real relevance to Sudan, where 80% of children now face double the number of heat waves that their grandparents did,” said UNICEF spokesperson James Elder at a Tuesday press conference at the UN in Geneva.

Most of the 16 flagged countries are in Africa: Senegal, Burkina Faso, Mali, and Senegal all struggle with rising levels of heat, while Tunisia and Paraguay also made the list. For example, children in South Sudan face an average of 165 extremely hot days annually this decade, up from 110 days in the 1960s. In Paraguay, the number of such days has doubled from 36 to 71.

Extreme heat in Cambodia
A typical summer day in rural Cambodia, where temperatures reach as high as high as 40 degree Celsius.

Health effects of  extreme heat on children

With climate change upending global temperature norms, the burden of extreme heat on children, as well as pregnant women, can often be as severe as the impacts on other adults. That’s despite the fact that adults often get most of the attention insofar as they suffer from more chronic respiratory and cardiovascular diseases, which are exacerbated by heat. 

“Children are not little adults. Their bodies are far more vulnerable to extreme heat. Young bodies heat up faster, and cool down more slowly. Extreme heat is especially risky for babies due to their faster heart rate, so rising temperatures are even more alarming for children,” Russell said.

The analysis links heat exposure to a range of adverse health outcomes, including pregnancy complications, low birth weight, preterm birth, child malnutrition, heat-related illnesses, and increased vulnerability to infectious diseases such as malaria and dengue. Additionally, extreme heat has been shown to negatively impact neurodevelopment, mental health, and overall well-being.

Compounded by other climate related hazards

The impact of extreme heat on child health is compounded by the broader effects of climate-related hazards on food and water security, infrastructure, education, and displacement. These challenges are further exacerbated by existing vulnerabilities such as socioeconomic status, gender, location, and underlying health conditions. 

Heat interventions are often out of reach financially – heat relief like air conditioning is costly. Many experts point to urban planning and building design to alleviate extreme heat. Narrow streets, green rooftops, and cul-de-sacs are all design techniques aimed at keeping buildings cool.

With the upcoming submission of new Nationally Defined Contributions (NDC 3.0) under the Paris Agreement, UNICEF is urging governments and the private sector to take bold climate action.

West and Central Africa heats up

Heatwave in Chad
Children gathering water in Moussoro, in the East of Chad. Chad is one of 16 countries that has seen more than 30 days of extreme heat per year compared to 1960.

Most notably, children in West Africa and Central Africa are facing the highest exposure to extremely hot days and the most significant increases in the past 60 years, warned UNICEF in a statement. 123 million children—39% of the region’s youth—experience extreme heat for at least a third of the year, equating to 95 days or more. In countries like Mali, Niger, Senegal, and Sudan, children are living through 195 to 212 days of extreme heat annually.

“Almost 40 per cent of children in the region live through extreme heat for more than one third of the year, the equivalent of at least four months in temperatures above 35 degrees [Celsius]. In many countries where infrastructure often isn’t available to manage this level of heat, there is a huge impact on children especially at school. The heat means many children in schools with overcrowded classrooms and inadequate ventilation or other means to manage extreme heat, get sick, are unable to study, play, or thrive,” says UNICEF Regional Climate Specialist in West and Central Africa David Knaute. 

“Just earlier this year the region suffered an extended heatwave, affecting several countries in the Sahel, where we saw the risks posed to vulnerable populations, especially children. Young people in Casamance, Senegal, told me how they had suffered or witnessed dehydration, dizziness, and exhaustion as a result of the extreme heat.”

 

Image Credits: © UNICEF/UN0836989/Naftalin, UNICEF, © UNICEF Cambodia/2019/Fani Llaurado, © UNICEF/UN0794414/Dejongh.

Sharing experiences across continents: A group of community health workers in a remote Guyana community describe their training to a visiting HeDPAC delegation.

The recent CARICOM summit of Caribbean leaders has endorsed a new Afro-Caribbean Health and Development  (HeDPAC) initiative aimed at stimulating South-South collaboration on resilient health systems, health worker capacity building, and local medicines and vaccines manufacture. 

The formal CARICOM Communiqué at the close of the Summit in Grenada invited its 15 member states and five associated states to join the voluntary partnership: 

“The HeDPAC initiative has three main priorities: to mitigate the difficulties faced by the health workforce of the Africa and Caribbean regions, including education, employment, deployment, retention, and performance; to build resilient health systems capable of withstanding emerging threats; and to promote the local manufacturing of medical products, including vaccines,” stated the Communiqué, noting that the overarching aim is “to manage the gaps identified during the COVID-19 pandemic. 

CARICOM leaders at the close of the recent summit, which endorsed a new initiative on Afro-Caribbean health and development cooperation.

“The Partnership could also be leveraged to improve knowledge exchanges between Africa and the Caribbean, to enhance regulatory capacity for medicines, medical supplies and equipment, and to facilitate the free movement of CARICOM nationals within the Community through advancing the digitalization of health information systems,” the Communiqué added. 

“All Member States are invited to partner with HeDPAC to leverage sustainable health development and capacity building through political, technical, and scientific collaboration between the Regions.” 

The communiqué was issued in early August, shortly after the conclusion of the summit in Grenada, which was postponed to the end July, due to Hurricane Beryl.   

It also referred to “health-related issues of the climate crisis” as another potential area of collaboration – in the wake of the devastating effects of Hurricane Beryl on the region’s small island states.  

Next stop, Africa

Following the CARICOM summit, HeDPAC’s advocates are now making a swing through Africa to build support among member states on the continent for stepped-up collaboration.  

In Addis Ababa last week, the African Union’s Technical Committee on Health, Nutrition, Population, and Drug Control (STC-HNPDC-5) heard a presentation on the initiative. 

Member States were invited to engage, beginning with stepped up participation in cross-regional events such as the upcoming Africa CARICOM day, observed on 7 September.

The initiative also may be a topic of discussion on the sidelines of the upcoming WHO African Committee meeting in Brazzaville, set for 26-30 August, sources say.

The media highlight of the AFRO Committee meeting is sure to be the election of a new Regional Director to replace the outgoing Matshidiso Moeti, the AFRO region’s first female RD, elected in 2015. [In this round, all four candidates are men].  

But some two-dozen WHO-led global and regional action plans are also on the agenda, covering critical topics ranging from local manufacturing to vector borne and infectious diseases, as well as health emergencies. 

A declaration Tuesday by Africa CDC of a continental health emergency on a new, and rapidly-expanding strain of mpox, first identified in DR Congo, along with a possible WHO declaration of a global mpox health emergency, will undoubtedly be another focus for discussions. 

Promoting salaried and certified community health workers

A community health worker who has graduated from her training describes her role in managing vaccine cold storage at a Guyana health facility in Lethem, a primarily indigenous community on the border with Brazil.

Most experts agree that a cross cutting requirement to address all of these challenges involves more robust primary health care systems, built around more and better trained health workers.

And one of the first concrete aims of the HeDPAC initiative is precisely that, says Dr Haileysus Getahun, CEO. It aims to harness lessons learned in the Caribbean to foster stronger cadres of African community health workers (CHW), serving on PHC frontlines.   

Caribbean countries can offer some African countries examples of a way forward, in terms of the standardized training of community health workers and their integration into the health workforce as certified and salaried civil servants, he points out. 

In contrast, many African CHW’s may serve primarily as volunteers, or for small stipends.

“We want to promote certified and salaried health workers to be part of the system in Africa. Not only that, but with career development schemes,” Getahun said in an interview with Health Policy Watch.

Conversely, some African countries, like Rwanda, have useful experiences to share with Caribbean partners related to strengthening regulatory and clinical trial capacity, Getahun noted.   

Building a community health care workforce 

A pharmacist assistant in Lethem, who first began her career as a community health worker, takes HeDPAC CEO Haileysus Getahun on a tour of products available in the clinic pharmacy.

On a recent visit to Guyana, Getahun said he had the opportunity to observe the country’s community health workers in action, in both remote indigenous communities such as Lethem, which sits aside the border with Brazil, as well as busy urban settings near the capital of Georgetown. 

“I found Guyana and the region very much developed and mature in terms of its  primary health care systems – and particularly community health care integration into primary health care.” 

 Community health worker (CHW) training is carried out in a hybrid mix of online-and in-person sessions – with a national curriculum and accreditation system ensuring a standard level of competencies.  

“In addition to being trained and salaried, Guyanan CHWs are offered paths for career advancement;  nursing assistant and pharmaceutical training courses keep them motivated and retained,” Getahun noted.   

A Guyana Online Academy of Learning (GOAL), offers a portal for virtual training in healthcare provisions – supported by a government scholarship programme for those that apply and qualify. There is also a programme for high school students to test out various work options in the health care sector. 

As a next step in building the partnership, HeDPAC is working with African and Caribbean  health leaders to organize experience-sharing visits. 

‘Health leaders in both regions are eager to learn from each other, and we are organizing those platforms to do so starting from field and exchange visits,” he said.

Finance remains a challenge

Barbados Prime Minister Mia Mottley laying out her Bridgetown agenda at the UN Climate Conference in Sharm el-Sheikh (COP 27) in 2022.

Along with awareness and political will, a key challenge for many African states remains finance for new community healthworker and primary health care initiatives. 

Much of Guyana’s innovation in the health sector has been financed by government budgets flush with funds from newfound oil and gas reserves. Surging revenues from oil and gas helped catapult the tiny nation from the status of a middle income country to an upper income one in World Bank classifications last year.  

But some other Caribbean countries, as well as many more of their African counterparts, remain hobbled with debt, which impedes their ability to develop their health systems – an issue Barbados Prime Minister Mia Mottley has called out repeatedly, as part of her “Bridgetown” Initiative calling for creative forms of debt relief that would also free up funds for development in health and climate projects in low- and middle-income nations.    

Along with Guyana, Mottley has also been one of the leading champions of the HeDPAC initiative in the CARICOM community. 

Regulatory standardization 

International political leaders at the launch of BioNTech’s new facility in Kigali in 2023.

Incubated by WHO, HeDPAC  was launched as an independent non-profit in December 2023. It aims to leverage lessons learned from the COVID-19 pandemic to promote health development across the Global South, beginning with more African-Caribbean collaboration. It works directly with government leaders and heads of state – minimizing the bureaucracy that intergovernmental organizations often involve. 

And while Africa may have a lot to learn from the Caribbean, Getahun argues that the collaboration is not a one way street. 

In Africa, Rwanda has been a leading African country championing the cross-continental partnership – and it also has lessons to share across the ocean. Rwanda recently became the host to the COVID pharma giant BioNTech’s first modular mRNA manufacturing facility, thanks partly to its conducive regulatory environment.   

“On the regulatory side, Guyana is just now establishing their own food and drug administration, whereas Rwanda has almost reached a WHO Maturity Level 3 in terms of its regulatory system and standards,” he remarked.

“So Guyana may be able to take some of the regulatory experiences from Rwanda,” he observed. 

  • Linda Straker in Grenada also contributed to reporting on this story.

_______________________________________________

Note: HeDPAC is also supporting expanded Health Policy Watch reporting on the healthcare workforce, resilient health systems and local manufacturing in Africa as well as the Caribbean.  

Image Credits: Sophie Mautle/HeDPAC , CARICOM/X, Sophie Mautle/HeDPAC, @DPA.

In Sudan, one of the most neglected humanitarian crises globally could mean tens of thousands avoidable deaths, James Elder, UNICEF Spokesperson said during a press briefing Tuesday

Without urgent humanitarian assistance, tens of thousands of people in Sudan may die of famine in coming weeks, UN officials warned during a Geneva press briefing Tuesday. 

Their calls for a ceasefire to enable humanitarian assistance to flow more freely came on the eve of peace talks scheduled to take place in Geneva with the Rapid Support Forces (RSF) that  mounted a 15 month insurgency against the Sudanese government – leading to the world’s largest humanitarian crisis. 

At the beginning of August, a UN Committee declared that at least 100,00 households in Sudan’s  Zamzam refugee camp near the town of Al Fasher, in the Darfur region west of Khartoum, were facing famine conditions (Integrated Food Security Phase Classification (IPC) – an extreme and rare claim, Health Policy Watch reported.

Map of Sudan food insecurity
IPC mapping of levels of food insecurity concentrated in the western portion of the country.

But that could be only the beginning, warned UNICEF Spokesperson, James Elder, in the briefing.

If nothing changes, “tens of thousands of Sudanese children may die over the coming months and that is by no means a worst-case scenario,” Elder said. “Any disease outbreak and we will see mortality skyrocket.”

”Beyond Zamzam, there are another 13 areas in Sudan that are on the brink of famine, and they are home to the staggering 143,000 children already suffering the most lethal type of malnutrition,” stressed Elder.

“Famine in Zamzam camp is the first determination of famine by the Famine Review Committee in more than seven years, and it’s only the third famine determination since that monitoring system was created 20 years ago,” he added, underling the gravity of the situation. 

Despite its large scope, the crisis in Sudan has received surprisingly little international attention. 

It’s “a crisis of neglect,” Elder said, noting the lukewarm international response. As of mid-year, UNICEF had recruited only 21% of the estimated $317 million budgeted for humanitarian aid in Sudan and neighbouring countries where displaced Sudanese have fled.

Mohammed Refaat, Chief of Mission for Sudan at the International Organization for Migration (IOM) during a press briefing Tuesday

“We must confront painful truths. The international community is not doing enough. The crisis in Sudan demands more than our sympathy, and it demands our action,” said Mohammed Refaat, Chief of Mission for Sudan at the International Organization for Migration (IOM). “We must go beyond words and pledges,” he stressed.

Famine conditions

Famine is the most severe phase of the IPC. Dubbed IPC Stage 5, it means at least one in five households faces extreme deprivation of food. To declare an area to be in a famine, the IPC committee also has to confirm that over 30% of the children there are acutely malnourished and that in a population of 10,000, more than two people die every day.

As access and data collection for humanitarian organizations in Sudan is limited, the easier-quantifiable assessment for the Zamzam camp, home of over 500,000 internationally displaced persons, is considered a bellwether for many other areas in North Darfur, a vast region of Sudan stretching along its western border.

The area where the camp is located has been besieged for months by the Rapid Support Forces (RSF), a paramilitary group that broke away from the Sudanese Armed Forces which enjoys backing from Russia’s Wagner Group, has been fighting government forces since April 2023.

One in five Sudanese have been displaced since the crisis began. And one-half of Sudanese, some 26.6 million people, are food insecure, World Food Programme (WFP) data shows. Fighting between the RSF and the Sudanese armed forces is at the root of the food crisis.

Rampant sexual violence

People denied access to humanitarian areas due to fighting, travel or logistic restrictions in Sudan in June

Rampant sexual violence is also an issue, Elder noted. 

“Yesterday in Khartoum, I spoke to a senior medical worker who…has had direct contact with hundreds of women and girls, some as young as eight years old, who have been raped,” Elder said. Sexual violence is increasing, he stated, especially in places where UNICEF and other organisations are denied a humanitarian presence.

Due to travel and logistic constraints as well as in conflict zones, about 1.78 million people were denied crucial humanitarian assistance in June, according to the UN’s Office for the Coordination of Humanitarian Assistance (OCHA).

An “immediate ceasefire” and unimpeded and safe humanitarian access is needed to ensure aid can reach those who need it, Elder highlighted at the press briefing.

On Wednesday, ceasefire talks in Geneva, initiated a month ago by the United States, are set to convene with only the RSF representatives, despite the absence of the Sudanese Army.

The US has decided to go ahead with the talks as planned despite that – and the failure of previous attempts at negotiations. The first round, planned as a separate engagement of each party with the US envoy, is expected to last up to ten days – even though only the RSF is currently present.

“We will move forward with our international partners to reach […] a concrete action plan about how we can advance to a cessation of violence and have full humanitarian access, and a monitoring enforcement mechanism. These are long past due,” Tom Perriello, the US special envoy for Sudan told Voice of America.

Image Credits: UNICEF/UNI530171/Mohamdeen, IPC , UNOCHA.

Bottom: Africa CDC Director Jean Kaseya; Above Margaret Edwin and Prof. Salim Abdool Karim, at the press briefing announcing the continental health emergency.

“Words must now be matched with deeds,” Africa CDC Director General Jean Kaseya said after the official declaration.

The Africa Centers for Disease Control and Prevention (Africa CDC) has officially declared the surging mpox outbreak a “public health emergency of continental security” – the first time it has made such a declaration on its own.

Jean Kaseya, Africa CDC’s Director-General said the centre’s historic move represents a pivotal moment in Africa’s fight against the long-simmering and now rapidly spreading disease.

“Today, Tuesday, 13 August 2024, I declare with a heavy heart, but with an unwavering commitment to our people, to our African citizens, we declare mpox as a public health emergency of continental security in Africa,” Kaseya stated at a Tuesday afternoon press briefing.

In just the past week,  more than 2500 new mpox cases and 56 deaths were reported in some five African Union member states, Africa CDC officials noted at the briefing.  Those included Burundi, the Central African Republic, Congo, the Democratic Republic of Congo (DRC), and South Africa.  Since the beginning of the year, 17,541 mpox cases have been reported across 13 AU states, according to the latest Africa CDC epidemic intelligence report, published 9 August.

In the days leading up to the declaration, Health Policy Watch reported that a new variant of the mpox virus, known as Clade 1b, is fueling an outbreak in eastern Democratic Republic of Congo (DRC) that has now spread to neighboring countries. 

In other areas of DRC, Clade 1a of mpox is also spreading, according to WHO reports. Historically Clade 1a variants of mpox have seen high mortality rates of up to 10%. A mix of Clade I and II cases also continue to be reported in multiple other countries of West, Central and East Africa, affecting children and adults and spread through multiple modes of transmission. 

The case fatality rate (CFR) from this mix of mpox clades and variants is a startling high 2.95%, according to Africa CDC.

In Africa and throughout the world, the milder Clade IIa variant, spread mainly through men having sex with men, also continues to spread.  

Since the beginning of the year, a total of 17,541 mpox cases have been reported, including 2,822 laboratory confirmed, with 517 deaths – Africa CDC.

A consultation process involving more than 600 people

Describing the journey to the declaration, Kaseya said it was not made lightly. He noted it was the culmination of an extensive consultative process involving a diverse array of stakeholders at various levels, as mandated by the Africa CDC statutes. 

“Africa CDC didn’t sit in its office and make a decision. No, it was a constructive, consultative process led at various levels by capable people…at least 600 people were reached in various capacities to discuss data and evidence and to provide a way to move forward for this outbreak,” the DG said at the press briefing.

The Emergency Consultative Group (ECG), comprising African and international experts, reviewed epidemiological data and unanimously recommended declaring a public health emergency. 

“We resolved to make a recommendation to the Director-General of the Africa CDC to declare mpox a public health emergency of continental security,” Professor Salim Abdool Karim, the ECG chair, said at the briefing.

Karim expressed concerns, in particular, that the virus variants are now spreading almost entirely between humans – well beyond traditional animal reservoirs. 

“The evidence we have does not seem to be that it’s zoonotic transmission, in other words, from an animal reservoir. It seems to be almost all, mostly from human to human transmission,” he said. 

“We are seeing new cases in countries that didn’t have cases before,” Karim added, saying  saying the declaration should help “ensure that the disconnected attempts that are being made are brought together in a large plan with some coordination to improve the efficacy of our intervention measures.”

Africa CDC aims to leverage the emergency announcement to coordinate a stronger international response, mobilise resources, enhance surveillance, accelerate research and development, and foster global solidarity, Kaseya said. 

All of those have been sorely lacking in previous months. 

“Words must now be matched with deeds, and today, I commit to you that Africa CDC will lead this fight with every resource at our disposal, together with our partners,” Kaseya added.

Africa’s growing mpox disease burden – 60% children

Mpox research as part of a Nigerian -UK collaboration. Much more is neeeded.

According to the DG, the decision to declare a public health emergency was driven by the new modes of transmission, including sexual transmission; a growing proportion of cases involving children; late detection of cases; and limited access to countermeasures like vaccines and diagnostics. “This is one of the aspects that is alarming us…you will see it’s mostly driven by cross-border transmission linked also to sexual transmission,” Kaseya added.

A staggering 60% of cases in the DRC involve children under 15 years old, according to Africa CDC. Kaseya said this alarming statistic underscores the urgency of the situation and the need for swift action to protect the most vulnerable populations.

Furthermore, the outbreak has spread to non-endemic countries, such as Burundi, Kenya, Rwanda, and Uganda, which have reported their first-ever cases of mpox this year. This unprecedented spread, Kaseya noted, has necessitated a coordinated, continental approach to curbing the disease’s transmission.

Addressing the challenges posed by the outbreak, Kaseya acknowledged the complexity of the situation, citing insecurity in certain regions, limited understanding of the epidemiological and transmission dynamics, inadequate global attention, and the unavailability of countermeasures as significant hurdles. 

Support at the highest levels 

However, Kaseya expressed optimism in light of the fact that the decision to declare the public health emergency had garnered political support at the highest levels in Africa, especially the leadership of the African Union. 

This he said is important to ensure engagement now in a more coordinated, multi-sectoral response.

Already, the African Union has approved the emergency release of $10.4 million to support the continental response to the outbreak, he said. He announced that the funding will aid in securing necessary vaccines, strengthening surveillance systems, and bolstering overall preparedness and response efforts.

“We are advocating strongly and we are going to be creating subcommittees on surveillance and diagnostics, on communication, on vaccines and therapeutics to ensure that we have a holistic view on the way we address this issue,” he added.

Africa needs 10 million vaccine doses – only 200,000 available

One of the critical challenges facing the response efforts is the limited availability of mpox vaccines, as well as multiple hurdles to their rollout. Existing vaccines have been produced by only two manufacturers, Bavarian Nordic, whose production has been constrained, and the Japanese LC16 KMB, produced by KM Biologics. The latter has the advantage of being just one, rather than two jabs, but it requires intradermal administration – a procedure requiring training for the health workers unfamiliar with the technique.  

Currently, Africa requires at least 10 million doses of mpox vaccines. But only 200,000 doses are right now available, said Kaseya.  He said that underlines the urgency of more local vacccine manufacturing. “Local manufacturing of vaccines [and] medicines is the second independence of Africa,” he said.

In a bid to address the vaccine shortage, Africa CDC said it is actively engaging with various partners, including the Oslo-based Coalition for Epidemic Preparedness Innovations (CEPI) and the German-based BioNTech which partnered with Pfizer to produce the mRNA COVID vaccine, as well as others to finalise contracts and scale up production for millions of doses in 2025. 

In light of the current shortages, however, Karim emphasised the importance of strategic vaccine distribution. 

“We have to be very strategic in who we use the limited number of vaccines on…for example, healthcare workers have been one of the groups that have to be addressed,” he said.

All eyes on WHO

Mpox is an orthopoxvirus, a disease in the same family as smallpox., which was eradicated in 1980. Previously called monkeypox, it was renamed by WHO  in 2022, due to the racist stigma associated with the historic name. In July 2022, WHO declared a public health emergency over the first worldwide outbreak of mpox, involving a milder Clade II variant spreading internationally, parimarily between men who have sex with men; it was declared to be over in 2023. 

In the wake of the Africa CDC announcement regarding this latest outbreak, all eyes are on now WHO – where an emergency expert committee is holding further consultations on Wednesday over the possible declaration of a global mpox public health emergency as well. 

That meeting is convening in Geneva under the auspices of the circa 2005 WHO International Health Regulations (2005) – the framework under which global health emergencies, known as Public Health Emergencies of International Concern (PHEIC), are declared.  

There has been simmering criticism, however, that WHO criteria for issuing global health emergency declarations are always not fit for purpose in the case of many of the outbreaks that Africa has faced first on the continent, alone.  In the wake of the worldwide COVID pandemic, the World Health Assembly in May finally approved amendments to the IHR that now allow  for the declaration of a pandemic emergency. However, in the two years of negotiations leading up to the revisions, member states ultimately rejected proposals to revise the  “binary” system of emergency declarations to a tiered system dubbed a “traffic light”, allowing for a WHO declaration of regional emergencies, or emergencies with global potential. 

In the case of the current outbreak, those long-simmering issues all contributed to the decision of Africa CDC to act on its own first, on Tuesday. 

Image Credits: US Centres for Disease Control , Paul Adepoju, Africa CDC, CDC.

Anna Maria Żukowska, a PM from the New Left, displays a t-shirt with the symbol of the Women’s Strike, just after the Parliament decides to postpone a vote on liberalising Poland’s restrictive abortion laws.

Nearly a year after new Polish Prime Minister Donald Tusk promised a fresh start for abortion rights, following his election victory in October 2023, reform efforts have stalled as campaign promises collide with the realities of coalition politics in a divided Poland. 

Poland is amongst only four countries worldwide to have restricted abortion rights in the past three decades, joining El Salvador, Nicaragua, and the United States. In 2020, Poland’s Constitutional Tribunal, stacked with judges appointed by the right-wing Law and Justice (PiS) party, further tightened the country’s already strict 1993 abortion law.

The Tribunal has even banned abortions due to fetal defects, which had accounted for about 90% of legal terminations. Current law permits abortions only in cases of rape, incest, or when the pregnancy endangers the mother’s life or health. At least six women have died after being denied abortions since the 2020 ruling.

The ruling sparked nationwide protests, mobilising millions of women across the country. Then, in the 2023 election that brought Tusk to power, 74% of eligible women voted, up from 61.5% in 2019. Exit polls indicated abortion policy as a key motivator. 

Tusk, capitalizing on the women’s rights movement, made the promise to liberalize abortion laws central to his campaign, which led to his centrist Civic Platform party taking power in a coalition with the New Left and centrist Third Way party – the latter a coalition of Poland 2050 and the rural-based Polish People’s Party (PSL). Even so, since his victory, hopes that the reform promises would be realized have turned to anger and frustration. 

First major legislative test fails

In its first major legislative test, the government coalition faced defeat on July 12 when a bill to decriminalize assistance for women seeking abortions was narrowly rejected by the Parliament’s lower chamber (Sejm), including by members of Tusk’s own Civic Platform, who abstained, as well as the Third Way and most notably the PSL, who voted outright against the reform.

Votes on the draft law decriminalising abortion help in the Polish Sejm (Parliament)

“Among us activists, we’re furious,” said Agata Adamczuk of the feminist NGO Dziewuchy Dziewuchom, or Gals Help Gals. “Decriminalising help in getting an abortion directly affects activists because criminalisation has immediate consequences for us.”

The defeated bill would have removed potential three-year prison sentences for those helping women obtain abortions by providing tools, such as abortion pills, or persuading them to terminate a pregnancy. While assisting in abortions is criminalised, ending one’s own pregnancy remains legal in Poland, regardless of circumstances.

Estimates suggest 80,000 to 93,000 abortions occur annually in Poland, with only a few hundred performed legally. Most women rely on NGOs for information about accessing abortion pills online or through procedures abroad.

“Punishing abortion help is absurd and inhumane,” Adamczuk told Health Policy Watch. “People are sentenced for helping their loved ones.”

Coalition joins opposition

The bill’s defeat has exposed deep fissures within Tusk’s coalition and ignited public outrage. Tusk swiftly disciplined his own party members who were absent during the vote, suspending their party membership and stripping them of government and party functions.

“I feel very bad that I haven’t found arguments that would convince all those who voted differently than I did,” Tusk said following the vote. “I have a clear conscience because I’m doing everything so that this women’s hell will disappear.”

Even more notably, the Polish People’s Party’s (PSL) added its 24 votes to those of opposition forces: 175 from the right-wing Law and Justice party, 17 from the far-right Confederates, and two other right wing parliamentarians associated with a party known as Kukiz’15 (Law and Justice aligned). This coalition of 218 lawmakers narrowly blocked the legislation.

Advocating for a national referendum

Instead of a parliamentary vote on a new law, the PSL has advocated for a national referendum. This proposal is opposed by coalition allies and women’s rights organisations, who fear it could be weaponised by right-wing forces against women’s interests.

“PSL is a separate party, we have our own policy,” said Władysław Kosiniak-Kamysz, the PSL leader. “In matters of personal belief, members always vote individually.”

The bill’s defeat was met with thunderous applause from its far-right opponents. Lawmaker Bartłomiej Wróblewski hailed the outcome as a triumph for “life and the constitution.”

“The Sejm has rejected the most blatant attempt to violate the Constitution since 1989 and strip unborn children of legal protection,” Wróblewski said.

The vote’s outcome sparked nationwide protests. On July 23, women’s rights activists demonstrated in front of parliament and in several cities, continuing pro-choice rallies against Tusk’s that began in January. Protesters repurposed slogans from 2020 demonstrations against PiS, now directing them at PSL.

Women’s Strike protests in Warsaw, 2020, against the constitutional tribunal sentence dramatically limiting access to abortions. July demonstrations reused slogans from previous protests, directing them against the PSL.

According to pre-election polls last October, PSL was at risk of falling just below the electoral threshold – an outcome that may have provided a path for Law and Justice to retain power. As a a pro-democratic NGO said in a pre-electoral public statement, voters of the anty-Law and Justice coalition should consider “a strategic vote for the Third Way, regardless of their support for the Civic Platform or the New Left.”

The electoral score for the alliance reached 13% instead of the expected 8%: a sudden boost mostly credited to strategic voting. PSL now owes many of its parliamentary seats – and role in government – to voters who support more abortion liberalization than the party is willing to offer. 

Almost half of the coalition voters (44%) are disappointed with the lack of abortion law liberalisation, concluded a poll conducted in June. The number rises to 57% among women aged 18-39, an especially numerous group in the last elections.

First of four competing proposals

The July 12 vote, however, is only the first of four competing proposals aimed at easing Poland’s strict abortion laws. Three more bills await consideration by a special parliamentary committee but face an uncertain future due to ideological rifts within the coalition.

Two bills from the Civic Platform and the New Left would legalise abortion on demand up to 12 weeks, while a third bill, proposed by PSL and Poland 2050, seeks to reinstate exemptions only for fetal defects, returning the law of the land to its pre-2021 state.  

Even if future bills pass parliament, they face another hurdle: Polish President Andrzej Duda, of the conservative opposition Law and Justice party, has vowed to veto any decriminalization bill, citing abortions as “depriving people of life”. 

Duda’s term extends until mid-2025, giving him veto power over any legislative changes for more than a year. Overriding a presidential veto requires a three-fifths majority in parliament, a threshold that seems unattainable given the coalition’s struggle to secure even simple majorities on abortion-related legislation.

The Constitutional Tribunal, still dominated by rightist Law and Justice-appointed judges, could also overturn new laws enacted by Parliament.

Exploring ways to circumvent a presidential veto

The government is exploring alternatives to circumvent presidential vetoes on abortion-related legislation. After President Andrzej Duda vetoed a bill on March 29 that would have made a morning-after contraceptive pill available without prescription, Health Minister Izabela Leszczyna quickly countered with a workaround.

Leszczyna introduced new regulations allowing pharmacists to write prescriptions for the pills, making them available by May. While effective in this case, officials acknowledge such administrative measures are generally less potent than laws passed by parliament.

In July, Attorney General and Justice Minister Adam Bodnar issued new guidelines for prosecutors, offering another temporary solution in the absence of a bill decrmininalising abortion assistance. The directive aims to clarity which cases should be pursued and which should not. 

Under these guidelines, prosecutors are instructed to target organised groups profiting from the sale of abortion pills, but NGOs simply writing about abortion assistance are to be left alone. The guidelines suggest that doctors who refuse to terminate pregnancies that endanger a patient’s health could face criminal charges.

Abortion debate unfolds in era of rapid social change

Abortion rights by country. In comparison to its neighbours, Poland stands out with its restrictive laws on abortion.

Poland’s abortion debate is unfolding against a backdrop of rapid social change. Support for liberalising abortion laws has risen from 29% in 2016 to nearly 60% in December 2023, although support for abortion on demand up to 12 weeks – endorsed by Tusk and the Left – remains below 40%, according to a poll conducted by market research firm Ipsos.

The struggle has deep historical roots. Before 1993, Poland had one of Europe’s most liberal abortion laws. However, post-communism, the Catholic Church’s growing influence led to restrictions, against strong public opposition.

As Poland upheld its 1993 abortion restrictions, 60 countries worldwide have expanded access to the procedure. Polish women, facing hurdles to legal abortions, have taken their fight to the European Court of Human Rights. The court has ruled against Poland in several cases, citing violations of women’s rights.

Civic Platform’s growing political clout may still carry the bills forward

Despite setbacks, the New Left party plans to reintroduce the decriminalisation bill in late autumn, hoping to pick up at least three of the votes that it lost via the absence of Civic Platform and other coalition members in July.

Civic Platform’s recent victory in European Parliament elections may also signal shifting tides. In that contest, Tusk’s party secured 37.1% of the Polish vote, outperforming all other major mainstream parties in the EU. 

The victory was seen as a signal that Warsaw’s Mayor Rafal Trzaskowski, also a member of Civic Platform, has a real chance of winning next year’s Polish presidential election, potentially aligning the presidency and its veto power with Tusk’s government. 

For now, activists like Adamczuk continue their work. “It’s always worth it to have hope,” she said. “We’re really wearing ourselves out, using a lot of our time and resources for this.” 

The only thing that the failure of the bill changes in the work to advance abortion rights, Adamczuk said, is “that we’re more and more angry.”

Stefan Anderson edited and contributed reporting to this story. 

Image Credits: Klub Lewicy, Greenpeace Polska, Council on Foreign Relations.