The Global Pandemic Preparedness Summit in Brazil was addressed by arounf 80 experts over two days.

As climate change drives disease outbreaks, the world remains ill-prepared for another pandemic – lacking in collaborative surveillance, diagnostic tools and finance, speakers told the Global Pandemic Preparedness Summit (GPPS) in Brazil.

The two-day summit, attended by a global who’s who of pandemic experts, aimed to “reinvigorate the momentum for pandemic preparedness and response” – but it also offered a sober assessment of global shortcomings.

“Over half of pathogens are being amplified by climate change. With the global circulation of pathogens, there is a larger risk for transmission across different continents,” warned Professor Tulio de Oliveira, the South Africa-based scientist who is a key driver of Africa’s pathogen genome surveillance.

One of Prof Tulio de Oliveira’s slides.

Ethiopia is experiencing its biggest dengue outbreak, while Burkina Faso is also dealing with dengue after a four-year break. There’s a new strain of Chikungunya and a new lineage of cholera in Cameroon, he noted.

The increased interaction between animals, humans and the environment – in part caused by the destruction of environments and migration – has increased the mobility of pathogens, De Oliveira told the summit, hosted by Brazil’s Ministry of Health of Brazil, the Coalition for Epidemic Preparedness Innovations (CEPI), and the Oswaldo Cruz Foundation (Fiocruz).

The WHO is responding to 42 graded emergencies, 15 of which are Grade Three emergencies requiring international assistance, said Dr Mike Ryan, the WHO’s Executive Director of Health Emergencies.

“We’re tracking today a further 168 ongoing health emergencies around the world being managed at a national level, and … responding to cholera in 30 countries, mpox, avian influenza, H5N1, dengue and yellow fever, as well as multiple health emergencies related to war and natural disasters.”

“It’s our very connectedness that exposes us. We are the most connected human population in history. We live in mainly densely populated urban areas where we work, move, gather and socialise intensely.”

Prof Tulio de Oliveira, Director of the Centre for Epidemic Response and Innovation in South Africa.

Diagnostic gaps

According to the non-profit organisation FIND, of 21 pathogens with outbreak potential, SARS-CoV-2 is the only pathogen for which there is adequate diagnostic readiness.

FIND launched its Pathogen Diagnostic Readiness Index (PDxRI), a comprehensive tool for evaluating diagnostic preparedness at the summit. 

“Fast, equitably distributed diagnostics are essential to spot & stem an emerging pandemic. FIND have a partnership-driven, five-year roadmap for diagnostic readiness to achieve the 100 Days Mission. But this requires $100 million in seed funding,” said FIND’s Dr Marta Fernandez Suarez.

The 100 Days mission refers to the need to develop vaccines, tests and treatments within 100 days of an outbreak, and enable access to those who need them most to prevent pandemics.

“Infectious diseases can pop up quickly and we need to make sure we are ready to respond quickly and equitably,” said CEPI CEO Dr Richard Hatchett.

“If a new coronavirus were to emerge, there is the potential we could respond in 100 days. But if a new disease were from the Paramyxovirus or Orthopoxvirus family, we’d likely not be ready yet. Importantly, we are moving in the right direction – but to reach the 100 Days Mission we need to advance capabilities with medical countermeasures and globalise access to these technologies. ”

Access gaps

Anban Pillay, South Africa’s Deputy Director-General of Health, noted that his country had been charged a higher price for COVID-19 vaccines than Europe.

“There are huge problems with the conduct of the pharmaceutical industry when it came to access to vaccines,” said Pillay. “They didn’t provide access. They raised the prices. They decided not to give certain countries stock, even though we were paying higher prices than Europe.

“So we need a different global system about where we access vaccines and other countermeasures, a system that’s equitable, that is linked to need.”

“But access supposes that you have something to access,” noted Dr Mona Nemer, the Canadian government’s Chief Scientific Advisor and Chair of the 100 Days Mission Steering Group.

“And clearly, when it comes to diagnostics and therapeutics, and I dare say to vaccines, for the for the all the different viral families that we now have in front of us, we have a long way to go.”

Financial gaps

The Pandemic Fund’s Priya Basu said that the World Bank had been able to mobilize $2 billion in seed capital from 28 contributors to start the fund and seen “tremendous demand, and good quality projects”. 

During the first round of funding last year, projects “really focused on coordination and collaboration across different arms of government – health, finance, agriculture, animal husbandry, livestock, environment, all coming together”

But demand has far outstripped available finances, with the Fund having raised $850 million but received high quality proposals worth $7 billion.

“One of our biggest challenges is really to raise more money to maintain that momentum, because soon we’ll see a lot of disappointed countries if they don’t receive the money. And so that’s why we’ve just launched our investment case, our short term resource mobilization effort, last week,” said Basu.

Political progress at INB

Ambassador Tovar da Silva Nunes

Post-COVID, much of the world’s focus has been on politicians at the World Health Organization (WHO) negotiating a pandemic agreement. 

Brazil’s Ambassador Tovar da Silva Nunes, who is a vice-chairperson of the WHO’s International Negotiating Board (INB), told the summit he was confident that an agreement would be reached before the next World Health Assembly.

Da Silva Nunes and Ambassador Anne-Claire Amprou will be chairing a sub-committee on pathogen access and benefit sharing (PABS), the biggest sticking point in the talks.

“If we are able to solve what we call article 12, the doors are open for us to conclude the agreement in good time,” Nunes told delegates.

He added that there was no longer much disagreement on clauses relating to One Health.

“There was a perception that a One Health approach that is not a complete approach was wrong and it was not leading to equity,” he explained, adding that lack access to clean water, for example, was a factor in the spread of certain diseases.

“Vector-borne diseases are clearly related to [access to water]. So it has to be complete. This is overcome. We have decided to incorporate one health. It’s a major step for global community health, provided that it is done in a very balanced way.”

Ryan noted that the finer details of PABS might take time, but without a broad international “it will be very hard to achieve what this conference is setting out to achieve”.

Global South solidarity

“Global partnerships are key to the 100 Days Mission’s success,” said Brazil’s Minister of Health, Dr Nísia Trindade Lima. 

“Post-COVID, we’ve learned that equitable R&D, investment and access are crucial for public health. We cannot work only within our countries; we must think beyond borders. It’s time for science, technology, and innovation to unite for robust public health policies. We must work together in global health so that it becomes a reality.”

Summitt attendees from the Global South signed the Rio de Janeiro Declaration, which calls for greater collaboration between partners within the Global North and Global South to overcome disparities in access to health tools and countermeasures in low- and middle-income countries. 

The Declaration also urges global health partners to prioritise research and equitable access policies to focus on end-to-end R&D and support the establishment of the Alliance for Regional and Local Production, Innovation and Access, as discussed within Brazil’s G20 Presidency framework.

“It’s time to think and design a different world with a new mindset to build global health systems and strengthen global pandemic preparedness and response, with coordination between the Global South and North,” Professor Mario Moreira, President of Fiocruz, which initiated the declaration.

Around a quarter of young women have experienced abuse in an intimate relationship by the age of 20.

By the time they turn 20 years old, nearly a quarter (24%) of adolescent girls who have been in a relationship will have experienced physical or sexual violence from their intimate partner, according to a report from the World Health Organization (WHO) published Monday found.

Even though the prevalence of violence among teenagers largely parallels that of women overall, minors are more affected because of their economic dependence and the devastating effect it has on their health and life prospects.

“Intimate partner violence is starting alarmingly early for millions of young women around the world,” said Dr Pascale Allotey, Director of WHO’s Sexual and Reproductive Health and Research Department in a press release.

She highlighted the “profound and lasting harms” such experiences have and called for more health focus on prevention and targeted support for girls.

Using  WHO’s Global database on prevalence of violence against women, the report analyzes data over the last two decades from 161 countries on violence against adolescent girls aged 15-19 years old.

The analysis focuses on sexual and physical violence; psychological violence was excluded due to a lack of commonly agreed on comparison measures.

Long-lasting consequences of partner violence 

Health, educational achievement, future relationships, and the lifelong prospects of young people overall are all affected by intimate partner violence. 

Such violence also has direct effects on physical and mental health, heightening the risk of depression and anxiety disorders, but also injuries, unplanned pregnancies, and sexually transmitted infections.

According to the WHO, 42% of women aged 15-49 who experienced intimate partner violence report an injury as its consequence. 

Intimate partner violence also raises the risk of a miscarriage (16% more likely) or a pre-term birth (41% more likely). Victims were also nearly three times as likely to be infected with a sexually transmitted disease, in comparison to other girls and young women.

Power imbalances drive partner violence

The prevalence of intimate partner violence varies depending on region: from as little as 3% of teenage girls experiencing it in Georgia to as much as 49% in Papua New Guinea.

There are considerable regional differences in the prevalence of intimate partner violence, ranging from 47% in Oceania and 40% in Sub-Saharan Africa to 10% and 11% in Central Europe and Central Asia respectively.

It is generally more common in lower-income countries where women have less power than male partners.

A lower proportion of girls enrolled in secondary school, weaker legal property ownership and inheritance rights, and child marriage all conspire to foster conditions of economic dependency and social isolation that increase the risks of abuse in intimate relationships, the research found.

The keys to improving the situation are “ensuring secondary education for all girls, securing gender-equal property rights and ending harmful practices such as child marriage, which are often underpinned by the same inequitable gender norms that perpetuate violence against women and girls,” said the report’s author, Dr Lynnmarie Sardinha.

Education, legal, and economic empowerment

Currently, no country is on track to achieve the target of eliminating violence against women and girls by 2030, as countries pledged to do under Target 5.2.1 of the 2030 Sustainable Development Goals.

The study highlights the urgent need to strengthen early prevention measures and support services made especially for adolescents. Actions to advance women’s and girls’ agency and rights are another important measure.

Effective interventions can include school programmes that educate all students on healthy relationships and violence prevention, but also more general legal protections and economic empowerment.

Image Credits: USAID, WHO.

A Palestinian girl on bus from Gaza to Israel’s Ramon airfield for airlift to the UAE

Updated: The World Health Organization confirmed Tuesday evening that it had evacuated 85 severely ill and wounded Gazans to the United Arab Emirates for advanced treatment via Israel’s Ramon airfield. 

The complex operation occurred as tensions escalated in the region following the deaths of 12 children in a Golan Heights Druze community –  apparently from a missile fired by the Lebanese Shi’ite Hizbullah. 

The carefully planned evacuation had originally been scheduled to take place on Monday, WHO confirmed. Israel’s Prime Minister Benjamin Netanyahu reportedly had delayed the plan after a missile hit on the soccer field of Majdal Shams, a mountain tourist town near the Lebanese border, early Saturday evening, killing a dozen children aged 10-16. Hizbullah denied responsibility for the attack, but western experts and intelligence sources said that evidence points to a rocket from Lebanon. 

Tuesday’s evacuation of some 35 children and 50 adults, along with 63 family members and care-givers, finally took place under a shroud of secrecy, and on a day when tensions between Israel and Hizbullah soared to new heights as Hizbullah fired over 50 more missiles into northern Israel, killing one more person.

In the early evening, Israel’s response for the Majdal Shams attack finally came in the form of a retaliatory strike on a Beirut apartment building, targeting a senior Hizbullah military commander in an area near the milita’s headquarters, and causing dozens of casualties, according to Lebanese reports. 

Hizbullah has been fighting alongside Gaza’s Hamas ever since the deadly 7 October attacks that triggered the current war.  The Druze, meanwhile, are members of an ancient religious minority whose communities dot the border regions of pre-1967 Israel and the Golan Heights, not to mention Lebanon and Syria – implicating them in the wider Israeli-Arab conflict on multiple fronts.

Majdal Shams, in the Golan Heights, is considered occupied Syrian territory by the United Nations, but it was annexed by Israel in 1981, becoming a popular Israeli tourist destination with rich natural resources and archeological history. Since the eruption of the Syrian civil war over a decade ago, an increasing number of Golan Druze, who already had Israeli residency, have also taken on citizenship. 

‘We hope this paves the way for evacuation corridors via all possible routes’

Sick and injured Palestinians board a bus leaving Gaza for an airlift  to medical treatment in the UAE via Israel’s Ramon airfield.

Reports of a plan to begin airlifting hundreds of seriously ill and wounded children out of Gaza to the UAE via Israel’s Ramon airfield in the Negev desert first surfaced in media reports last week, despite WHO’s efforts to keep the mission under tight wraps. 

The airlift scheme came against a background of mounting international criticism of Israel’s seizure of the Rafah border crossing between Gaza and Egypt in early May. That effectively sealed off the only available route for medical evacuees, as well as for Gazans who could afford the hefty visa fees to escape the war. 

“The patients had cancer, injuries, blood diseases, congenital conditions, neurological conditions, cardiac and liver and renal disease,” said WHO’s Director General Dr Tedros Adhanom Ghebreyesus in an X post, Tuesday evening.

“We hope this paves the way for the establishment of evacuation corridors via all possible routes,” he added.

The WHO team organized and managed the transfer of patients from over half a dozen areas in Gaza to Israel’s Kerem Shalom crossing under “extremely challenging conditions” the organization said, including active conflict in various parts of Gaza. After the original mission was postponed Sunday, some injured and ill patients had to be held at a Médecins Sans Frontières (MSF) field hospital site, pending Tuesday’s final evacuation.

Speaking at a UN press briefing in Geneva on Tuesday, WHO spokesperson Christian Lindmeier said that some 10,000 people, in all, were in need of medical evacuation – as continued waves of conflict-related displacement, malnutrition and interruptions in medical services continue to haunt Gaza’s 2 million Palestinian residents.  

Since October 2023, around 5000 people have been evacuated for treatment outside Gaza during the grinding nine months of war, with over 80% receiving care in Egypt, Qatar and the UAE.

Many Gazans new rounds of displacement as WHO dispatches 1 million polio vaccines

Administering oral polio vaccine – Gaza’s vaccination rates have dropped sharply.

Lindmeier also echoed recent calls by regional health ministers for a cease fire and an ‘enabling environment’ so that a massive polio vaccination campaign could safely take place in the coming days and weeks.

“Otherwise, the vaccines would be sitting as many other trucks are across the border, either on the Rafah side or at the other checkpoints either inside…or outside Gaza,” Lindmeier said.

WHO last Friday said that it was dispatching 1 million polio vaccines to Gaza after evidence of vaccine derived polio virus was found in local sewage sources. 

No actual cases of polio, which can lead to paralysis and even death, have been reported so far in Gaza. But since the beginning of the war on 7 October, 2023, polio immunization rates have dropped by about 10%, WHO and other global health authorities have observed. And that increases the risk that under-vaccinated Gaza children and adults, who are also suffering from a lack of clean water access and widespread malnourishment, could fall ill. 

“Having vaccine-derived polio virus in the sewage very likely means that it’s out there somewhere in people,” Lindmeier said. “So the risk of (it)… spreading further is there and it would be a setback definitely (for global efforts).”

This is not the first time, either, that polio has circulated in sewage in the densely-populated region. In 2022, Israel conducted its own emergency polio vaccination campaign amongst under-vaccinated groups after a 4-year old Jerusalem child fell ill while six others were diagnosed with asymptomatic cases, and the virus was identified in sewage samples, as well. 

Mounting water, sewage and sanitation crisis 

Explosion of a vital water reservoir in Rafah has prompted outrage internationally and within Israel.

Along with that, there is a mounting water, sewage and sanitation crisis in Gaza – exacerbated by the recent Israeli army explosion of a large water reservoir in Rafah. 

Also speaking at the Tuesday UN briefing, James Elder, a spokesperson for the United Nations Children’s Fund (UNICEF), denounced the blowing up of the Rafah water facility last week at Tel  Sultan – calling it an act of  “blatant disregard” for children’s rights. 

The range of water availability in Gaza is currently 2-9 litres per person per day, he pointed out – whereas the humanitarian minimum standard is 15 liters – and that is notwithstanding the sweltering temperatures Gazans are currently facing at the peak of summer – with daytime temperatures averaging highs of 36°.

Israel’s military has not commented publicly on the incident. But military police are  reportedly probing the incident as a suspected violation of international law, which may have also been sanctioned by a local commander, Israeli media reported. 

The incident provoked expressions of outrage within Israel, as well as internationally, after a soldier who participated in the demolition of the reservoir, known as Canada well, posted a video on Instagram, and later on X, celebrating the explosion with a caption stating it was “in honor of the Sabbath” – the Jewish day of rest.   

The reservoir and solar-powered water treatment facility, was developed by Canada’s International Development Agency in the 1990s and supplies a large proportion of the city’s water needs.

Some 20,000 Palestinians remain in the Rafah area, including in the Tel Sultan area, which had not been subject to forced evacuation.  Around 1.4 million displaced Palestinians had been sheltering there before Israelis forces moved into the southern border city in May.

“Somehow people are holding on, but of course we are now in that deathly cycle whereby children are very malnourished, there is immense heat, there is lack of water, there’s a horrendous lack of sanitation and that’s the cycle,” Elder observed. “On top of that, of course, there is a very, very active conflict.”

Image Credits: X/@Dr Tedros, WHO, Global Polio Eradication Initiative, X/Times of Israel.

South Africa’s Dudu Dlamini (left) explains that her HIV, diabetes and hypertension are all treated at different health facilities. The Global Fund’s Vindi Singh looks on.

As the disease burden in developing countries shifts from infectious to non-communicable diseases (NCDs), governments and patient advocates are grappling with how to re-engineer healthcare systems to address both.

The extraordinary global focus on HIV has resulted in a siloed network of HIV clinics to treat the virus – but there is growing acknowledgement that countries’ HIV gains will be lost if they don’t get NCDs under control.

“People living with HIV are disproportionately affected with NCDs. It is estimated that one in three people living with HIV have either hypertension or other NCDs,” says Professor Kaushik Ramaiya, General Secretary of the Tanzania NCD Alliance and a member of the NCD Alliance Board.

“People living with HIV (PLHIV) have an increased incidence for more than 20 non-AIDS defining cancers, while women living with HIV are up to six times more likely to develop cervical cancer,” he told an event organised by the NCD Alliance at the International AIDS Conference in Munich last week.

There are almost 40 million people with HIV, mostly in developing countries, and many are succumbing prematurely to heart disease, diabetes, strokes and other NCDs. This is often because HIV programmes are so focused on their patients’ HIV that they don’t diagnose and treat these other conditions early enough.

‘I could take ARVS well and die of high blood’

South African Dudu Dlamini lives with HIV, hypertension and diabetes. As a sex worker and the advocacy officer for Sex Workers Education and Advocacy Taskforce (SWEAT), Dlamini knows what marginalisation means.

“We are criminalised,” Dlamini told the meeting. “It is not easy for me to identify as a sex worker. Our doctors don’t know about us. For my HIV, I am treated in one place. For my high blood, another place and for my blood sugar, somewhere else.”

Having three different treatment sites costs time and transport money, and sex workers default on medication “because we are not able to keep all the appointments”, says Dlamini.

“My vision is for sex workers to be helped for all the conditions at the same time; a place where we can identify freely as sex workers and get treated –  for STIs, and all other conditions – in one place. I need one folder with all my medical history and background because I might be taking antiretrovirals well but tomorrow I die from high blood.”

Her experience echoes that of several other people living with HIV and NCDs, as captured by the NCD Alliance in a collection of testimonies that makes the case for integrated care.

Global commitment to integration made back in 2021

NCD Alliance CEO Katie Dain.

At the 2021 United Nations High-Level Meeting on HIV and AIDS, global leaders committed to ensuring that “90% of people living with and affected by HIV have access to people-centred and context-specific, integrated services for HIV and other diseases, including NCDs and mental health by 2025”, NCD Alliance CEO Katie Dain told the meeting.

“This, in many ways, is one of the real frontiers of the global HIV response, recognising that people living with HIV are living longer thanks to advancements in antiretroviral antiretroviral therapy,” she added.

Ntombifuthi Ginindza, from Eswatini Ministry of Health in southern Africa, knowledges the urgency of “integrating NCD treatment into HIV setting”.

Eswatini has an estimated HIV prevalence rate of 25% in people aged 15 to 49, one of the highest rates in the world. 

It has made remarkable progress, achieving a 72% decline in HIV infections and a 55% decline in AIDS-related deaths since 2010. But its premature mortality for NCDs in moving in the opposite direction, growing from 27% in 2015 to 35% currently.

“We are integrating NCDs into HIV setting. In the spirit of client-centredness, we’re working on an integrated chronic disease framework, which is mainly focusing on integration at primary level facilities,” said Ginindza.

“We are trying to sustain the gains that we have made on HIV. There is a lot that we have achieved through HIV, so we want to leverage the resources that we have in place for HIV as we are transitioning HIV clinics to chronic disease clinics.”

Four different models of integration

PATH Kenya’s Nicolas Odiyo and WHO’s Dr Prebo Barango

Dr Nicholas Odiyo, Senior Technical Advisor for PATH Kenya, says his non-profit healthcare group has implemented various different models for HIV and NCD integration in Kenya, India, the Democratic Republic of the Congo (DRC) and Vietnam. 

One model involves screening for certain NCDs at HIV clinics, based on the patients’ assessed risk factors, particularly hypertension, diabetes and cervical cancer, said Odiyo.

The second involves community-based screening, mainly run by community health promoters with blood pressure machines and glucometers to test for hypertension and diabetes.

The third model is integrating “continuous screening for hypertension and diabetes” into HIV programmes, while the final model involves comprehensive care for all, with NCD and HIV screening for the entire population in universal healthcare.

Blood sugar levels can easily be checked with a glucometer

Some donors are on board

HIV donors are also increasingly accepting that they need to incorporate NCD care to safeguard people living with HIV.

The US President’s Emergency Plan for AIDS Relief (PEPFAR) supports the integration of hypertension in five countries that are doing well with HIV, Botswana, Eswatini, Lesotho, Namibia and Rwanda, said PEPFAR ensior advisor Ritu Pati.

“PEPFAR’s HIV hypertension integration initiative was launched in response to  Ambassador [John Nkengasong’s] keen interest to address the very high rates of uncontrolled blood pressure amongst people living with HIV (PLHIV,” said Pati.

The five countries have received supplementary funding of $5 million for a year to improve  hypertension control in PLHIV, although this funding cannot be used to buy anti-hypertensive medication. 

“Close to 30% of men and women in sub-Saharan Africa over the age of 30 have hypertension, and at the same time, only a small proportion of them have controlled blood pressure. So the idea is, is that if we can proactively address hypertension in the populations that we serve, we can then reduce the incidence of cardiovascular events and thereby reduce mortality.

‘It’s become increasingly clear that we need to address hypertension amongst PLHIV to improve their health outcomes and preserve the gains of our PEPFAR programs.”

Pati adds that the integrated service delivery model has many benefits:  “It reduces the number of clinic appointments for PLHIV, promotes early diagnosis and treatment of co-morbidities, minimises service duplication, which really may lead to cost savings, and allows [healthcare] providers to have a comprehensive view of their patients history and offer them patient-centred care.”

Better still, PEPFAR has evidence that the integration of HIV services with primary health care “can actually improve HIV clinical outcomes such as continuity of treatment and viral load suppression”.

The Global Fund includes “integrated people-centred health services” in its strategy for 2023-2028, said Vindi Singh, the fund’s senior disease advisor on HIV treatment

HIV funding in some countries incorporates cervical cancer and hypertension services, Singh noted. Kenya and South Africa have also included HIV and NCD integration in their national strategic plans for HIV.

Stigma and competition

STOPAids CEO Mike Podmore.

But as Ramaiya notes, the stigma associated with HIV means that is far easier for people living with HIV to accept NCD integration than HIV clinics than it is to integrate HIV services into non-HIV clinics.

“You need a policy cohesion that starts from the Ministry of Health and local government, because HIV is a vertical program and TB is a vertical program. So when you are trying to integrate an NCD programme within HIV, you need to have a cross communications with those other programs.”

STOPAids CEO Mike Podmore concluded the event by noting that “with a projected 71% of people living with HIV having at least one NCD by 2035”, the focus on “trailblazing quality integration is necessary and compelling”. 

But Podmore warned that “it is essential that we do not allow HIV and other health issues like NCDs to be in competition to each other in a zero-sum game of flatlined resources”.

“We need to champion quality integration and synergies across health issues that build greater equality across diseases. 

‘It is also essential that the global health community restructures and recalibrates itself to ensure that inequalities of the COVID pandemic response cannot be repeated again, and that there is much stronger coordination of external actors at country level, led by country stakeholders.”

Image Credits: Dischem.

Lab technician at Afrigen, the Cape Town-based firm hosting the WHO co-sponsored Vaccine Technology Transfer Hub.

The Argentina-based biotech firm,  Sinergium Biotech, has agreed to share know-how on the production of an mRNA vaccine for Avian influenza (H5N1) with WHO’s  Tecnology Transfer Hub so that an affordable vaccine could rapidly be produced for developing countries, WHO said Monday.

The agreement marks the first time that a vaccine developer has actually volunteered know-how to the hub, which was founded by WHO in 2021 together with the Medicines Patent Pool, and is hosted by the South African firm Afrigen, based in Cape Town.

Sinergium “has developed candidate H5N1 vaccines and aims to establish proof-of-concept in preclinical models. Once the preclinical data package is concluded, the technology, materials, and expertise will be shared with other manufacturing partners, aiding the acceleration of the development of H5N1 vaccine candidates, and bolstering pandemic preparedness efforts.” said WHO in a statement.

“This initiative exemplifies why WHO established the mRNA Technology Transfer Programme – to foster greater research, development and production in low- and middle-income countries, so that when the next pandemic arrives, the world will be better prepared to mount a more effective and more equitable response,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.

H5N1 is first vaccine target for the hub since COVID-19

Colorized transmission electron micrograph of Avian influenza A H5N1 viruses (seen in gold) grown in MDCK cells (seen in green).

Following it’s launch, the Afrigen mRNA Technology Transfer Programme focused mostly on testing and developing an mRNA COVID-19 vaccine candidate.  Progress, however, was slow because the major mRNA vaccine manufacturers, Moderna and Pfizer, refused to share their know-how on the WHO-sponsored platform – opting to sign licencing agreements to manufacture COVID vaccines under their brand identities with other manufacturers elsewhere in Africa.

So the agreement by Sinergium to share its IP and partner directly with the WHO co-hosted hub is a breakthrough for the global health agency – which has long sought a role in the emerging mRNA vaccine market –  to reduce costs and make vaccines more accessible in low- and middle-income countries.

The new agreement signed with a Latin-American based firm also takes a small, but meaningful, step towards the ‘regionalization’ of vaccine markets, WHO officials said on Monday.

“This announcement underscores the importance of not only geographically diversifying the innovation and production of health technologies including and recognizing the capacities in Latin American and the Caribbean, but also the importance of early planning for access and the sharing of knowledge and technologies during the research and development processes,” said Dr Jarbas Barbosa, Director of the Pan American Health Organization (PAHO), WHO’s Regional Office for the Americas.

Dr Alejandro Gil, Chief Executive Officer of Sinergium, credited PAHO’s “strong support it offers to regional manufacturers in the Americas” with playing an instrumental role in the deal.

“Sinergium’s enhanced capacity and readiness to apply our expertise to H5N1 will play a vital role in this effort towards global pandemic preparedness. …We are excited to tackle this public health challenge and our R&D team will continue to work closely with the Programme Partners.”

Along with the base at Afrigen, WHO’s mRNA technology transfer hub programme includes Institut Pasteur in Senegal – and is planned to eventually includes manufacturers in over a dozen other low- and middle-income countries around the world.

Moderna also advancing a candidate vaccine with US government help

172 dairy herds in 13 states have so far been affected by the spread of avian flu in dairy cattle since the outbreak was reported in late March.

 

Moderna is reportedly at a more advanced stage in the process of developing and mRNA vaccine for the virus, which is spreading rapidly amongst dairy cattle herds in the United States.  In early July, the US government awarded the Cambridge-based firm $176 million to advance development of “an mRNA-based pandemic influenza vaccine.”

“We have successfully taken lessons learned during the COVID-19 pandemic and used them to better prepare for future public health crises. As part of that, we continue to develop new vaccines and other tools to help address influenza and bolster our pandemic response capabilities,” said HHS Secretary Xavier Becerra, at the time of the announcement.

While WHO has so far assured that the risks to humans of avian flu remain low, as long as human-to-human transmission is not occurring, the ever-widening transmission of the deadly virus amongst different animal species increases the risks that it may one day soon mutate in a way that it can more easily infect, and be transmitted, amongst humans.

And in the absence of effective vaccines, which are also widely available, that could unleash yet another pandemic on the world.

Image Credits: Afrigen, CDC/ Courtesy of Cynthia Goldsmith, CDC.

Mathias Ofoke during his routine blood sugar test at the Ezza Ofu Health Centre, Ebonyi State, Nigeria.

Fifteen-year-old Mathias Ofoke is one of four children in his family born with type 1 diabetes. Whenever his symptoms worsened, he was taken to the nearest primary healthcare (PHC) center where he was repeatedly treated for malaria. 

It wasn’t until February, when a non-governmental organization (NGO), Abby Cares Foundation, organized a clinical outreach at Ezza Ofu Health Centre that Ofoke’s condition was properly diagnosed. 

His blood sugar result of 543 mg/dL alarmed everyone when it was displayed on the glucometer screen. But the understaffed PHC facility at Ezza Ofu could not admit him as they were not properly equipped to care for him.

The NGO facilitated his admission to a secondary health facility and began sourcing insulin for his treatment.

“We frequently see cases of hypertension, diabetes, and cancer but we are not able to manage them, so we refer,” says Elizabeth Nwovu, the officer-in-charge at Ezza Ofu Health Centre. She is a community health extension worker (CHEW) who trained to be a matron.

IDF Diabetes Atlas

An estimated 27% of deaths in Nigeria are linked to diabetes, cancer, cardiovascular and chronic respiratory diseases. These four major non-communicable diseases (NCDs) are the leading causes of mortality globally, with the majority of deaths occurring in low- and middle-income countries (LMICs). 

Diabetes, characterized by elevated blood glucose levels, affects 537 million adults (20-79 years) worldwide. This number is expected to rise by 46% in 2045. 

As urbanization increases, diets change and populations age, Nigeria has also seen a surge in adults living with diabetes, from 209,400 in 2000 to 3.6 million in 2021—only South Africa had a higher prevalence in 2021. 

Diabetes is responsible for about 4.5% of deaths in people under 60 years old in Nigeria, with common complications including hyperglycemic emergencies, diabetic foot ulcers, chronic kidney disease and stroke.

PHCs prioritized in NCD management 

A national survey on NCDs conducted between 1990 and 1992 revealed that less than a quarter of the estimated 1.05 million Nigerians living with diabetes were aware of their condition. Following this survey, the Nigerian government attempted to integrate NCDs into PHC facilities, but these efforts met with minimal success.

Efforts to tackle NCDs in Nigeria were reignited in 2021 following the Brazzaville Declaration on NCDs and the subsequent political declaration at the 66th United Nations General Assembly on the Prevention and Control of NCDs. These declarations set the precedent for the WHO Global NCD Action Plan 2013-2020, which has now been extended to 2030.

Over the years, Nigeria has built on these regional and global strategies to develop several national policies for NCD prevention and control. Notable among these are the National Multi-Sectoral Action Plan for the Prevention and Control of NCDs and the National Guideline for the Prevention, Control, and Management of Diabetes Mellitus in Nigeria.

The scope of the national guideline for diabetes management was developed using the Population, Intervention, Professions, Outcomes, and Healthcare setting (PIPOH) checklist. 

The interventions outlined in the guideline emphasize the importance of integrating community health workers, such as CHEWs, and scaling-up screening, diagnosis and treatment in PHC facilities.

Task-shifting to community health workers

According to the national diabetes guideline, a key indicator of progress is the successful delegation of certain aspects of diabetes care to lower-level health professionals, such as CHEWs and lay health workers.

Similarly, the national multi-sectoral action plan, which informed sections of the diabetes guideline, recommends expansion of the Task-Shifting and Task-Sharing Policy for Essential Health Care Services to include NCD management among its priority areas. Currently, this policy focuses on maternal and child health, and communicable diseases (HIV/AIDS, malaria, and tuberculosis).

In line with this recommendation, during the technical session of the 64th National Council on Health (NCH) in November 2023, the Ministry of Health and Social Welfare announced plans for a National Task-Shifting and Task-Sharing (NTSTS) policy focused on the prevention and control of NCDs.

Elizabeth Nwovu, a community health extension worker (CHEW) and the officer-in-charge at Ezza Ofu Health Centre, Ebonyi State, Nigeria.

“This policy, if adopted, will complement the existing Task-Shifting and Task-Sharing Policy for Essential Health Care Services,” said Dr Anyaike Chukwuma, Director of Public Health, during the event.

The NTSTS policy aims to address the rising burden of NCDs in Nigeria by decentralizing preventive, diagnostic, treatment, and rehabilitative services to PHC facilities.

“By implementing this policy, the country hopes to adopt a patient-centered approach, accelerate progress towards NCD prevention and control, achieve universal health coverage, and work towards the Sustainable Development Goals,” Chukwuma added.

PHCs are ready but support is inadequate

“PHCs are not adequately supplied with medications,” said Nneka Nwankwo, founder of Abby Cares Foundation. She has over 20 years’ experience in public health and social services.

Her NGO sources Ofoke’s daily insulin injection from a tertiary hospital in the city center. Nigeria’s annual diabetes-related health expenditure per person is estimated at $499.7, which falls below the African regional average. If current trends continue, the prevalence of diabetes in the country is predicted to increase by up to 120% by 2045.

In his study on improving primary health care services for NCDs in Nigeria, Whenayon Ajisegiri found that some government stakeholders’ skepticism about the qualifications of community health workers, who constitute the majority of the PHC workforce, has been used to justify the limited supply of NCD drugs at PHCs. Ironically, NCD drugs are contained in the list of essential medicine and should be available at PHC facilities.

“When PHC facilities repeatedly fail to provide patients’ medications, it leads to frustration. And when you lose patients’ trust in the initial stages, it is difficult to regain,” said Nwankwo.

Patient flow for NCD service delivery at the PHC level, with enablers and barriers along the pathway.

A survey of 30 PHCs in Abuja, Nigeria’s capital city, reported a readiness to integrate diabetes care in terms of available paper-based health management information systems, equipment, and personnel. However, the poor availability of diabetes medications makes it impossible to harness this opportunity.

“If we can get access to testing kits and the drugs, it will improve our ability to manage patients with diabetes,” said Nwaovu.

The survey recommended a subsidized drug-revolving fund mechanism to maintain drug inventory, drawing from programs like the Hypertension Treatment in Nigeria (HTN) Program and the Academic Model Providing Access To Healthcare (AMPATH) program in Kenya.

Community health workers play an integral role

The slow progress in integrating diabetes and other NCDs into PHCs is also linked to the omission of community health workers from NCD policies.

The critical shortage and uneven distribution of skilled health workers, particularly physicians and nurses, have necessitated the deployment of community health workers to support essential health services delivery.

Prior to the introduction of the NTSTS, existing policies like the National Standing Orders, which guides the training and practice of community health workers, restricted their role to only screening and referral. Ajisegiri noted that frequent referrals to higher health facilities—secondary and tertiary—could undermine public trust in the services provided at PHCs.

Formalization of task-sharing 

Given the Nigerian government’s prioritization of PHCs to tackle NCDs, experts have advocated for capacity building, while formalizing task-sharing and task-shifting policies for NCDs among community health workers.

In a survey of 30 PHCs in Abuja, Nigeria’s capital city, only 37% reported having at least one staff member trained in diabetes diagnosis and management within the past two years. With the NTSTS for NCDs set to be adopted, Nigeria appears to be on track to address this issue. 

This task-sharing and task-shifting model has already been successfully implemented in maternal and child care, as well as in the management of infectious diseases.

While this approach is expected to help the government maximize the available health workforce for NCD management, it is crucial to allocate sufficient resources to PHC to enhance infrastructure, ensure consistent medicine supplies, and bridge the significant skill gap among community health workers. Additionally, refining the practice scope in the National Standing Orders is essential to prevent interprofessional role conflict.

Funding and political will are paramount

The national multi-sectoral action plan acknowledged the problem of medication access and called for action towards ensuring a reliable supply of essential medicines for treating diabetes and other major NCDs.

It recommended expanding the Basic Minimum Package of Health Services, funded by the Basic Healthcare Provision Fund (BHCPF), to cover comprehensive care and treatment of NCDs. The BHCPF serves as a catalytic funding source to enhance access to primary health care, particularly for poor and vulnerable groups. 

This expansion aims to reduce out-of-pocket expenses for treatment. However, funding for the BHCPF has been inconsistent. 

Nwankwo recalled that Ofoke’s father was reluctant to bring his other children living with diabetes for treatment due to the costs. Despite her offer to subsidize the insulin injections by 50%, her efforts to persuade him were unsuccessful. 

“Even with your help, I can’t afford it,” she remembered him saying. Eventually, he brought one more child for screening.

Nneka Nwankwo, founder of Abby Cares Foundation in her office in Abakiliki, Ebonyi State, Nigeria

Only half of the initial 55.1 billion naira allocated to the BHCPF in 2018 was released and by 2021, the budget had decreased to 35 billion naira. Between 2019 and 2022, it is estimated that 89 billion naira was allocated through the BHCPF, with only 7,250 out of the 35,514 Primary Healthcare Centres in the country receiving these funds.

This scenario is all too familiar for Nwankwo. “At Ezza Ofu Health Centre, the quota for the health insurance scheme is around 300 people, but it’s just a drop in the pond,” she said. During her organization’s first outreach at the PHC, over 1,000 people showed up seeking medical care. “Creating policies is not enough if they are not backed with the right resources,” she added.

Pius Ukpai contributed to this reporting from Ebonyi State, Nigeria.

Image Credits: Chimdiebube Ikechukwu, IDF Diabetes Atlas, Whenayon Ajisegiri.

An extract from the online campaign to ‘Kick Big Soda out of sport’.

Leading global health organisations have called for Coca-Cola to be removed as a major sponsor of the Olympic Games and an end to sponsorship by “Big Soda” of all other sporting events.

Sixty organisations and over 35,000 people have signed an online petition as part of the “Kick Big Soda Out of Sport “campaign, ahead of the opening of the Olympic Games in Paris on Friday (26 July).

“Sugary drinks harm people and our planet. By accepting billions from Coca-Cola to sponsor the Olympic Games, the International Olympic Committee (IOC) implicitly endorses a world where health and environmental harms are ‘sports-washed’ away, undermining commitments to use sport to create a better world,” according to the petition.

It adds that sugary drinks are a major contributor to rising rates of obesity, Type 2 diabetes and heart disease and that Coca-Cola targets children with its marketing.

The petition also says that Coca Cola is damaging the environment with “plastic pollution, carbon emissions and water depletion”.

“With continued Coca-Cola sponsorship, how does the IOC intend to meet its commitment to WHO to promote a healthy society through sport, to advance Sustainable Development Goal 3 (“Good health and well-being”) and prevent non communicable diseases (NCDs)?” it asks.

It urges the IOC to “prioritize the health and well-being of people and our planet over Big Soda’s corporate interests” by terminating Coca-Cola’s Olympic sponsorship, and committing to not accepting future sponsorship from corporations that harm public health and the environment.

“Serving as a major sponsor of the Olympics allows companies to blanket venues and events with their logos, reaching an audience of over 3 billion watching at home,” said Trish Cotter, global lead of the food policy program at Vital Strategies. 

“Alongside growing opposition to soda’s involvement in sport, athletes themselves are beginning to speak up about which companies should be permitted to sponsor sporting events. For example, at Euro 2020 Cristiano Ronaldo made a strong statement when he pointedly removed two bottles of Coca-Cola that were placed in front of him at a news conference.”

‘Contradicts IOC’s mission’

“The link between sugary beverages and chronic and largely preventable diseases such as diabetes, cancer and heart disease is well established,” said Dr. Barry Popkin, W. R. Kenan Jr. Distinguished Professor of nutrition at the University of North Carolina at Chapel Hill Gillings School of Global Public Health. 

“Allowing Coca-Cola to continue as a key sponsor of the Olympic Games directly contradicts the IOC’s mission and undermines the efforts and achievements of Olympic athletes.

“The most insidious actions of the beverage industry, however, are their marketing strategies, which disproportionately target children and adolescents. These tactics perpetuate unhealthy consumption patterns, setting young people up for lifetimes of poor dietary habits and health risks.”

“This campaign is bringing much-needed attention to the ways sugary drink companies use sport to add to their bottom line,” said Nzama Mbalati, Chief Executive Officer of HEALA, a civil society coalition in South Africa advocating for a more just food system.

“This petition underscores the need for the IOC to prioritise the health of people and the sustainability of our planet over commercial interests,” said Alejandro Calvillo, Director of El Poder del Consumidor, a consumer rights nonprofit in Mexico. 

“By distancing itself from Big Soda, the IOC has an unprecedented opportunity to uphold its reputation as a beacon of integrity, excellence and social responsibility.”

“Kick Big Soda Out of Sport” is the beginning of a movement to remove all sugary beverage sponsorship from sport. The campaign is led by concerned global health organizations and advocates and highlights the harmful effects of sugary drinks on our health and the planet.

António Guterres delivering a video message during the launch of the State of Food Security and Nutrition report Wednesday.

Global levels of hunger remain stagnant at the highest rates seen in over a decade, as one in 11 people worldwide (8.9%) faced hunger, or undernourishment, in 2023, according to the latest State of Food Security and Nutrition (SOFI) report, released on Wednesday.

The report, a collaboration between the Food and Agriculture Organization (FAO), International Fund for Agricultural Development (IFAD), UNICEF, the World Food Programme (WFP) and the World Health Organization, summarizes the lackluster progress made toward the second Sustainable Development Goal (SDG2): “No Hunger.”

In 2023, nearly one-third (28.9%) of the global population was food insecure, lacking regular access to adequate food. A third of the world’s people ran out of food at certain times during the year, and went an entire day or more without eating, the report found.

That’s in comparison to 21.5% of people facing moderate or severe food insecurity in 2015, when the Sustainable Development Goals were first adopted.  

That growing number is a combined result of climate change, regional conflicts, economic downturns, and other destabilizing factors, found in many low- and middle-income countries. Amongst the countries with high levels of food insecurity,  74% were affected by one or more such drivers.

Regional rates of food insecurity have increased since 2020 in Africa, remained largely unchanged in Asia, and declined in Latin America – but not to 2015 levels.

“Hunger, food insecurity and malnutrition remain a global crisis,” said Antonio Guterres, United Nations’ Secretary-General, during the report launch at the G20 meeting in Brazil on Wednesday. But “we can solve this crisis and finance is the key.”

Progress made towards eradicating hunger, made in the years of the Millennium Development Goals, slumped in 2015 – paradoxically that was the same year that the 2030 Sustainable Development Goals, including SDG2, No Hunger, was adopted. Hunger rates climbed even higher during the COVID pandemic, remaining stagnant ever since. 

Overall, estimated 713-757 million people are hungry or “undernourished” – defined as habitually consuming insufficient food to provide energy levels needed for a normal active and healthy life, according to the SOFI report. 

And in Africa, the number of people who are chronically undernourished rose in 2023 to 20.4% of the continent’s population. In Asia, levels of hunger remained unchanged (8%), while hunger levels in Latin America and the Caribbean declined somewhat to (6%).

Most countries off track in reaching SDG nutrition goals as well

Few countries are on track to meet global nutrition targets: maximising exclusive breastfeeding and minimising low birthweight, stunting and wasting, anemia, and overweight.

In terms of seven nutrition goals that are also asociated with the SDG2, there has been some moderate progress on infants and children – even though most countries remain off track with respect to the goals overall.

Rates of stunting and wasting (one indicator of progress for SDG 2.2) – which means children failing to reach their height or muscle volume – declined among children younger than five years old over the last decade.

Similarly, progress has been made in exclusive breastfeeding of infants under six months of age: a practice long-recommended by the WHO because of its beneficial effects for mother and child health. 

In 2022, 48% of infants under the age of six months were exclusively breast fed only, as compared to 37.1% in 2012. 

Among children younger than five years of age, stunting and wasting rates have declined. The number of infants breastfed during their first six months increased.

The improved numbers are “showing that investments in maternal and child nutrition pay off,” stated Catherine Russell, the Executive Director of UNICEF, noting that the economic benefits of breastfeeding support programmes are just as large as health-related ones, with $35 return of every dollar invested.

Healthy diet unaffordable for a third of the world’s population

For children as well as adults, an adequate caloric intake still does not equal good nutrition. More than a third of the world’s population, 2.8 billion people, could not afford a healthy diet in 2022, falling back to pre-pandemic levels. In low-income countries, the rate of “malnutrition” was as high as 71.5%. 

Rising rates of obesity, often coexisting with under-nourishment, constitute a double burden for national health systems. “This is a […] cost for the society because overweight and obesity will create non-communicable diseases that will affect our finances: we will spend significantly more on health,” said Maximo Torero, FAO’s Chief Economist, at the report’s launch Wednesday.

Healthy, nutritious food is often unavailable locally or may be unaffordable because of income inequalities. Should nothing change, 582 million people are projected to be chronically undernourished at the end of the decade, the SOFI report warns.

“We’re standing still,” said FAO’s Director-General, Qu Dongyu, during the report launch. A “real change of agrifood systems is the only way to address the major drivers of food insecurity.” Climate change, conflicts and other factors make agriculture more unpredictable, highlighting the need to build more resilient farming systems. “I appeal to donors and other international partners to be more risk-tolerant,” Dongyu continued. “We need to be ready for the unforeseen.”

Shift in the financing of agrifood systems needed to end hunger ‘in our lifetime’                                                        

The global prevalence of hunger, declining until 2014, has stalled, then increased again during the pandemic.

Between 2005 and 2014, steady progress was made in reducing hunger – from 12.2% to 7.3% of the global population. Then, from 2015 to 2019, hunger levels fluctuated only slightly between 7.7% and 7.5% of the global population – rising sharply at the start of the pandemic and still remaining higher than any time since 2008. 

Yet, agencies involved in making the report remain optimistic about reaching the SDG goals. 

“The elimination of hunger and malnutrition is not just a vague ambition,” but rather “something that can be achieved absolutely in our lifetime,” said Francesco Branca, WHO Director Nutrition and Food Safety Department, during a press conference Monday.

What’s needed to eliminate hunger is “a shift in the way we are financing Food Security and Nutrition,” said Sara Savastano, Director of IFAD’s Research and Impact Assessment Division. More long-term projects which look at food security more holistically, beyond sector boundaries are necessary to address the core drivers of the crisis instead of simply applying bandaids to crises, she said.

Consensus on such shared financial goals is needed so as to better use existing funds, SOFI’s authors emphasized at an earlier, pre-launch briefing on 18 July, on the sidelines of the UN Economic and Social Council (ECOSOC) High-Level Political Forum in New York City.

New UN Report Calls for Fresh Approach to Ending Food Insecurity and Hunger

Expand scope of food security investments 

To quantify and evaluate the programmes aimed at enhancing food security, the SOFI report says that aid and investments in food security needs to move beyond consumer-based food supports, to agri-food systems. 

Financial resources need to be “directed towards strengthening the resilience of agrifood systems to the major drivers and underlying structural factors of hunger, food insecurity and malnutrition,” the report states.

And for that to happen, a more coherent definition of a food security investments, as well as an overarching strategy, needs to be articulated for reaching the “no hunger” goal.

“Right now it’s impossible to determine how much financing is going to end hunger and malnutrition,” said Saskia Depee, Senior Nutrition Advisor at the WFP during a press briefing Monday, just just before the report’s release. 

But policies and interventions needed to end hunger and malnutrition could amount to several trillion US dollars over many years, experts agree.

“Nutrition and food security, and especially nutrition, are long term behavioral changes… requiring time and investment,” Sevastano said. 

Supporting small holder farmers 

Alvaro Lario, President of IFAD, during the SOFI report launch.

Much more funding needs to be invested in strengthening agrifood systems, which are ultimately responsible for food production, the report’s authors agree.

“The world of agrifood systems … is where most hunger is, [it is also] …a world that will be facing uncertainties because of climate change,” highlighted Torero. Donors also need to accept uncertainty in food security investments, counting on the significant benefits in case of success.

As part of investing in more sustainable agricultural systems, support for food producers that are pushed to the sides by agri-business investors should be a priority.  

Funds for women in agriculture, grants for Indigenous Peoples, or smallholder farmers could increase their crops and boost their financial independence. 

”Small farms under five hectares produce almost half of our food on less than one fifth of the farmland,” said Alvaro Lario, President of IFAD during the ECOSOC meeting. “Imagine what they could achieve if we invested in them much more.”

Image Credits: SOFI 2024.

Professor Linda-Gail Bekker from South Africa presents the results of the PURPOSE 1 trial at the conference.

MUNICH – Delegates at the International AIDS conference leapt to their feet in delight after results from one of the most promising HIV prevention trial in the history of the epidemic – a twice-yearly injection of lenacapavir that prevented 100% of new HIV infections – were presented on Wednesday.

Principal investigator Professor Linda-Gail Bekker from South Africa told the conference that none of the 2,134 women aged 16 to 25 who had received lenacapavir on the PURPOSE 1 trial contracted HIV.

The results, also published in the New England Journal of Medicine, compared the injectable lenacapavir with two regimens involving daily pills that have previously proven to be effective as HIV pre-exposure prophylaxis (PrEP).


However, by the end of the trial, the 3,204 women in the two pill groups reported HIV cases similar to projected population-based HIV acquisition – not because the pills didn’t work but because participants’ adherence was “low”.

Young people generally find it difficult to take daily pills because they fear being questioned about it, according to another trial from Uganda due to be presented at the conference.

Describing the results as “stellar”, Bekker said that the medicine offers “a highly effective, tolerable and discreet choice that could potentially improve PrEP uptake and persistence, helping us to reduce HIV in cisgender women globally”.

“PURPOSE 1 also sets a new standard for person-centered HIV prevention trials, demonstrating what can happen when a thoughtful scientific and community-focused trial design, a promising drug candidate and an inclusive trial implementation plan come together,” added Bekker, who is director of the Desmond Tutu HIV Center at the University of Cape Town. 

Results from the PURPOSE 2 trial testing lenacapavir in men, transgender and non-binary people who have sex with men in Argentina, Brazil, Mexico, Peru, South Africa, Thailand and the US is expected by early 2025. 

International AIDS Society president Sharon Lewin described the trial results as “a breakthrough advance with huge public health potential”.

“If approved and delivered – rapidly, affordably, and equitably – to those who need or want it, this long-acting tool could help accelerate global progress in HIV prevention. We all owe a debt of gratitude to the thousands of young women in South Africa and Uganda who volunteered to be part of this study,” said Lewin.

Gilead under pressure to lower price

Activists at AIDS2024 protest against the high price of lenacapavir

HIV leaders, activists and researchers have called on lenacapavir producer Gilead to make its medicine widely accessible.

“We still have 1.3 million new HIV infections per year. UNAIDS wants this ‘miracle’ prevention drug to reach all those who need it, now, not in six years’ time,” said UNAIDS executive director Winnie Byanyima at a media briefing on Wednesday.

She urged Gilead to “move quickly to licence lenacapavir to generic producers” via the Medicines Patent Pool.

“Generic producers bring prices down and serve all countries where the majority of people who are at risk live,” added Byanyima.

On Tuesday, activists protested at Gilead’s conference booth demanding that the company make the medicine 100% accessible.

At present, lenacapavir is licensed in the US as Sunlenca for people with drug-resistant HIV and sells for $42,000 a year – yet generic companies can make it for as little as $40, according to research conducted by Dr Andrew Hill. 

Doctors, researchers and activists all want easy access for those who need lenacapavir for HIV prevention – and that means lower prices.

AIDS Healthcare Foundation (AHF), which supports two million patients in 47 countries, said that Gilead’s failure to make its HIV medicines accessible is “costing lives”.

AHF associate advocacy director John Farina described Gilead’s pricing as “arbitrary”, aimed at profiteering rather than protecting lives.

“What is the point of 100% efficacy if nobody can access it?” asked AHF India director Dr Sam Prasad at a media briefing on Tuesday.

“The US has the high price of $42,000 for the package [of two shots]. How many people can afford it?” added Prasad, who warned Gilead not to “come to India with lawyers and try to influence our patent laws”.

Dr Helen Bygrave of Medecins sans Frontieres (MSF) Access Campaign said that lenacapavir could be “life-changing for people at risk of getting HIV and could reverse the epidemic if it is made affordable in the countries with the highest rate of new infections”.

“Gilead has a long track record of undermining global access by excluding middle-income countries from voluntary licensing deals and artificially restricting licensees,” said Health GAP’s Asia Russell. “We call on governments to break Gilead’s monopoly, by issuing non-voluntary licenses, wherever Gilead’s patents present a barrier.” 

HIV community organizations in India, Argentina, Thailand and Vietnam – the Thai Network of People living with HIV (TNP+), DNP+, Fundación Grupo Efecto Positivo, and the Vietnam Network of People living with HIV (VNP+) – have already filed eight oppositions against Gilead’s lenacapavir patent applications.

Gilead promises ‘access price’

UNAIDS executive director Winnie Byanyima (2nd right) and Gilead Vice President Jared Baeten (2nd right) address a media briefing.

Addressing a media briefing on Wednesday, Gilead Vice President Jared Baeten said that lenacapavir will be available for generic production and promised that in the interim, his company would make high-volume orders for an “access price”.

The company noted in a press release on Wednesday that “lenacapavir for HIV prevention remains an investigational drug until approved by regulatory authorities”, and it is “too early to state the price of lenacapavir for HIV prevention”.  It is currently only licensed in the US for drug-resistant HIV.

“Gilead is committed to access pricing for high-incidence, resource-limited countries. The current price for the approved indication in the heavily treated HIV population will not be our reference,” it added.

“Gilead will ensure dedicated supply of lenacapavir for HIV prevention in the countries where the need is greatest until voluntary licensing partners are able to supply high-quality, low-cost versions of lenacapavir,” the company noted, adding that it is “developing a robust direct voluntary licensing program to expedite access to those versions of lenacapavir in high-incidence, resource-limited countries”. 

However, Baeten did not comment on whether his company would work through the Medicines Patent Pool to licence generics.

Image Credits: IAS.

Almost half of the world’s population suffers from a neurological condition, yet in low-income countries, most lack access to medicines needed for treatment.

Nearly half of the world’s population suffers from some form of neurological condition ranging from simple migraines to Alzheimers. And yet in low-income countries, more than 75% of people needing neurological treatment cannot access care, according to a new World Health Organization report released on Tuesday, World Brain Day.  

The treatment gap – the difference between the number of people with a condition and those receiving treatment for it – is the combined result of misconceptions about neurological diseases, low diagnostic capacity and limited access to medicines.

“Most people with neurological disorders struggle to access the treatment they need for their conditions because these medicines do not reach them or are too expensive,” said Dévora Kestel, Director of WHO’s Department of Mental Health, Brain Health and Substance Use in a press statement. 

Should that change, “the impact of neurological disorders can be significantly decreased and quality of life improved.”

Using epilepsy and Parkinson’s disease as tracer conditions, the new WHO report identifies bottlenecks in existing treatments, particularly access to care in remote and rural areas.  

Affordability, procurement and availability of specialists are among the main barriers of access to neurological treatment.

The report also advocates for more education about neurological disorders to reduce stigma. And it recommends that neurological treatments  be integrated more completely into the essential medicines lists (EMLs) of national authorities as well as WHO’s own recommended essential medicines listing.

Finally, local healthcare systems need to budget for procurement of such medications – while international donors and agencies consider how to make treatments more affordable – including through donor-supported funding. 

Treatment access, but also prevention programmes, “will take a whole of society approach, especially given that the whole of society is impacted either directly or indirectly by these diseases,” said Dr David Dodick, co-chair of World Brain Day, at a briefing Monday, just ahead of the WHO report launch.

Nearly half of the world’s population suffers from a neurological condition 

In 2021, almost half of the world’s population, or 3.4 billion individuals suffered from a neurological condition, including side effects from a stroke, Alzheimer’s disease, neonatal brain injury, or chronic migraines, according to the Institute for Health Metrics and Evaluation (IHME) data. 

But the burden is distributed unevenly, with over 80% of the deaths related to neurological conditions, as well as losses in healthy life years, occurring in low- and middle-income countries.

Burden of neurological disorders amount for a total of 443 million years of healthy life years lost globally.

Neurological conditions are a leading cause of healthy life years lost (disability-adjusted life years, or DALYs) in 2021, ahead of cardiovascular diseases. In 2021, that amounted to a total of 443 million healthy life years lost due to a  chronic  illness, disability, or premature death.

Over the last three decades, DALYs associated with neurological conditions rose by 18% – and that is likely to increase further as a result of aging populations as well as lifestyle and environmental risks.

Over 80% of premature deaths from neurological conditions occurs in low- and middle-income countries – which have only 0.1 neurologist, on average, per 100,000 people. 

That is in comparison to 7.1 neurologists per 100,000 people in high-income countries, said Dodick.

On a more positive note, when diagnosis and treatment are available, then some 90% of strokes, 40% of dementia cases, and 30% of epilepsies are preventable. 

“We know what the modifiable risk factors are for some of the most prevalent and disabling neurological conditions, like stroke and Alzheimer’s disease, for example,” Dodick said.

Barriers to reaching global goals set out by WHA in 2022

The report identifies barriers limiting attainment of goals set by the World Health Assembly in 2022 to improve access to neurological care and treatment by 2031. 

The goals, laid out in the Intersectional global plan on epilepsy (IGAP), aim to have four out of five countries providing essential medicines and technologies to manage neurological disorders in primary health care settings within the coming decade. 

Disability-adjusted life years (DALYs) lost to neurological conditions: 80% of the global DALYs occur in low- and middle-income countries.

Even when treatment methods for neurological conditions are theoretically available, patients face many obstacles to accessing care. 

In African and Eastern Mediterranean regions, for instance, children with epilepsy are less likely to attend school because of the stigma surrounding the disorder. As the report shows, lack of knowledge about Parkinson’s and epilepsy, and exclusionary practices around people with those conditions, are common issues.

More regional manufacturing of medicines can bolster supply chains

The paucity of medicines available in pharmacies and clinics also was highlighted by country-level surveys included in the WHO report. 

In Ghana, for instance, out of 180 drug stores surveyed, levitiracetam, which is used to treat epilepsy, was available in only 50% of urban pharmacies and not at all in rural areas. Similarly, another epilepsy medicine, phenobarbital, was only available in roughly every second urban drug stores and in one in three rural pharmacies.

The report highlights the need for regional manufacturing of such medicines as well as more robust supply chains, overall, to ensure that such essential drugs are accessible. 

Consistent regulatory authorization of essential neurological medicines and ensuring their inclusion in national essential medicines lists, could also lead to more state financing support, improving treatment affordability.

Finally, the report also identifies the need for more specialised healthcare staff, particularly in rural areas, as well as more systematic data collection to improve surveillance. 

Neurological health access should be “inclusive and equitable”, also on the prevention level, said Prof. Tissa Wijeratne, Co-Chair, World Brain Day, during the webinar. “Access to preventative measures at community level, grassroot level, individual level, […] should be available to everybody across the world.”

Image Credits: WHO, IHME.