New INB co-chair Anne-Claire Amprou is welcomed by existing co-chair Precious Matsoso,
New INB co-chair Anne-Claire Amprou is welcomed by existing co-chair Precious Matsoso.

Anne-Claire Amprou, French Ambassador for Global Health, has replaced Roland Driece of the Netherlands as the co-chair of the World Health Organization (WHO) Intergovernmental Negotiating Body (INB) that is hammering out the pandemic agreement.

However, Amprou, who coordinated the French response to COVID-19 and was a member of the international Ebola task force, is interim co-chair pending further discussion in the WHO European region.

New vice-chair Fleur Davis (Australia), joins existing vice-chairs Tovar da Silva Nunes (Brazil), Dr Viroj Tangcharoensathien (Thailand) and Amr Ramadan (Egypt).

The two new representatives bring more much-needed gender balance into the male-dominated leadership of the INB.

Australia’s Ambassador Fleur Davies is new INB vice-chair.

Welcoming the two new representatives, WHO Director General Dr Tedros Adhanom Ghebreyesus said that “consensus over the outstanding issues is possible within a relatively short time, if you prioritise public health over other considerations”.  

“We must always keep the urgency of this generational agreement at the forefront because, as the current outbreak of H5N1 reminds us, the next pandemic may be around the corner,” added Tedros.

He urged delegates to use the two-day meeting to “make the necessary adjustments that will allow you to move towards consensus and reach our shared goal of a pandemic agreement for a safer and more equitable world for all.”

‘Precarious moment’

Describing the global community as being in a “precarious moment” as it awaited the pandemic agreement, Eswatini appealed for equity to remain the focus of the talks to “address inequities that were experienced by most developing countries during the COVID-19 pandemic”.

The Africa Group supports the proposal that the next INB meeting in September focuses on  Article 12, the vexed issue of pathogen access and benefit sharing (PABS), added Eswatini, speaking on behalf of the Africa region and Egypt.

Africa wants any decision on PABS to be included in the main agreement, not as a “separate instrument”, said Eswatini, a small, landlocked country in southern Africa.

South Africa later added that PABS “has the potential of unlocking blockages in other areas” so “it is prudent to allocate sufficient time for the PABS system, followed by the other articles, which are all interrelated and crucial for a meaningful PABS system”.

Estwatini also called for shorter, less intense INB meetings, explaining that the marathon sessions of the past were extremely taxing on small delegations.

Ethiopia, South Africa and Indonesia also stressed their preference for the agreement to be sealed by the end of this year via a World Health Assembly (WHA) Special Session in December.

“Let’s work back from that date,” said Ethiopia’s Ambassador Tsegab Kebebew Daka during discussions on the work plan.

This plan proposes an 11th INB meeting from 9-20th September and a 12th meeting from 4-15 November. No negotiations are possible in October as various WHO regions hold their conferences. However, delegates proposed inter-sessional meeting during that month including sessions with experts to make progress.

The deadline for calling the WHA special session to discuss and adopt the pandemic agreement is 15 November.

More important to ‘get it right than do it fast’

US Ambassador Pamela Hamamoto

US Ambassador Pamela Hamamoto cautioned against haste, warning that there was “little time to reach a consensus agreement with many complex issues remaining”.

“It is more important to get it right than to do it fast. In order to be successful, this agreement has to be implementable,” said Hamamoto, who cast doubt on an agreement materialising from only two INB negotiations.

“We have concerns that two formal negotiating sessions will be sufficient to conclude a meaningful pandemic agreement by year end 2024. We are fully committed to trying, but we do not advise pushing critical issues in their entirety off to a future process. 

“To meet a December target, we need to find the right balance of what to include in the pandemic agreement and which details should be deferred to future working groups. The current INB 11 proposal assumes we can reach consensus on at least one article per day, which may be overly ambitious.”

The US proposed focusing on “core issues where additional understanding and alignment is needed regarding fundamental concepts, specifically Article 12, Articles 4 and 5, and the legal framework for proposed protocols or annexes”.

Hamamoto also proposed that talks be fast-tracked by informal working groups on key stumbling blocks, a robust intercessional work between the September and November INB meetings and consultation with experts, scientific institutions, the Quadripartite (the four UN agencies dealing with One Health), and the private sector.

“We need concrete ways to seek expert, technical and legal advice, perhaps through the use of expert advisory groups along the lines used in the ongoing plastics treaty negotiations,” said Hamamoto, adding that the US supports stakeholders being allowed to observe the drafting group. 

IHR overlap?

The European Union’s Americo Zampetti called for the WHO Secretariat to guide the INB on overlaps between the pandemic agreement and the recently agreed International Health Regulations (IHR) to help “cleaning up certain areas in the text”.

The EU, Mexico, Australia, Jamaica and several other countries also voiced support for greater involvement of non-state actors in the talks.

Mexico pointed out that their presence would help to counter disinformation about the pandemic agreement.

The meeting concludes on Wednesday and will have modified the proposed work plan and process.

At the interactive live mentorship session on the future of innovation and intellectual property

“Don’t be afraid to take risks. Think outside the box. Be agile. Adapt to change.”

This was some of the advice young innovators in the life sciences field received last week during an interactive live mentorship session on the sidelines of the World Intellectual Property Organization (WIPO) General Assembly.

Organized by WIPO and IFPMA (International Federation of Pharmaceutical Manufacturers and Associations), the panel discussion delved into the challenges and opportunities surrounding innovation and intellectual property in life sciences. The event brought together professionals from the private and public sectors, including academia and research, for a comprehensive discussion.

Josefa Cortés, founder and CEO of Palpa, offered the first piece of advice: get a mentor. 

Her company encourages women under 40 to perform regular breast self-exams using a sponge that simulates a palpable tumor. According to Cortés, a good mentor will believe in you and help you believe in yourself. Mentors can also “foster an entrepreneurial mindset and eliminate cultural barriers.”

Palpa CEO Josefa Cortés and Arthur Queval, CEO of Loop Medical.

Brighton Samatanga, founder and CEO of the Biotech Institute, discussed the importance of strategic partnerships. His company has benefited from various collaborations, including equipment sharing and joint research projects.

“We’ve also formed a partnership with the government, creating a public-private collaboration,” Samatanga said. “We now have access to their supercomputer and can use it for our bioinformatics work.”

Biggest innovation challenge: funding 

Panelist Syed Saader Ahmed, founding director and CEO of TechInvention Lifecare, highlighted the critical issue of funding. He noted that securing funding is the biggest challenge young innovators face. To survive, his company created an additional revenue stream.

“We work in the field of vaccines,” Saader explained. “Many of our scientists had experience in GMP manufacturing, quality assurance, and quality control. So, we set up a strategic and consulting advisory group and began taking on vaccine capacity and infrastructure advisory projects in low and middle-income countries.

“We started with one project,” he continued, “and thought that our indigenous research and vaccines would take off within two or three years [and we would stop these efforts]. But what began as an ancillary revenue stream has become a main revenue source. It’s now a standalone vertical.

“We are advisors to the World Bank and the Asian Development Bank, working on a large human vaccine project in Ethiopia and a veterinary vaccine project in Botswana. This has kept us bootstrapped and sustained our revenue flow.”

His advice to young entrepreneurs: identify an ancillary revenue stream that doesn’t require many resources but can generate early revenue. That will get things moving.

Inside one of the TechInvention laboratory sites

Saader also recommended staying asset-light. Instead of investing in expensive equipment, such as for a lab, he suggested that young innovators seek out accelerators or incubators where they can conduct their research.

“These facilities are affordable and do not infringe on your intellectual property,” Saader said.

Finally, he advised the event’s sponsors that there needs to be a balance between innovation and access in life sciences. He praised the collaboration between WIPO and IFPMA and suggested further partnerships with organizations like CEPII.

Saader also emphasized the importance of focusing on innovations with significant social impacts, such as life sciences, climate change, and sustainability. He proposed expedited procedures for patent filings in these areas to facilitate faster approvals.

The IP debate

Pharmaceutical companies and civil society continually clash over access to generic medicines in developing nations. As the central registry for patents worldwide, WIPO plays a pivotal role in shaping global health innovation policies.

This IFPMA-hosted event at WIPO’s assembly stressed that patent systems are crucial for safeguarding the rights of young entrepreneurs in sectors like pharmaceuticals, vaccines, and medical equipment.

Proponents assert that patents incentivize innovators by granting them exclusive rights over their inventions, enabling them to monetize their innovations and further drive progress.

Conversely, civil society organizations (CSOs) often contend that patents can create monopolies that keep prices high and restrict access to essential medications and technologies in critical moments.

The ongoing tensions between fostering innovation and ensuring equitable global access to life-saving medical products, means that debate over intellectual property (IP) will always be contentious in Geneva’s diplomatic circles.

‘Innovation cannot remain an idea’

The bottom line, however, is how Edward Kwakwa, assistant director general for the Global Challenges and Partnerships Sector at WIPO, put it: “Innovation cannot remain an idea.”

“We need to support grassroots innovation and consider commercialization, technology transfer, and more,” Kwakwa said. “Innovation requires resilience and the right support network. It takes mentorship and a willingness to collaborate across disciplines. Regulatory structures need to adapt to speak the language of innovation today.

“If we don’t provide the necessary support and frameworks, innovators will seek alternatives elsewhere.”

Image Credits: TechInvention.

Girls and women protest outside Gambia’s parliament this week in protest against attempts to reintroduce female genital mutilation.

The Gambia’s parliament voted by a substantial margin on Monday to uphold a ban on female genital mutilation (FGM), defeating a Bill by conservative lawmakers and religious leaders.

Thirty four of the 53 MPs voted against the Private Members’ Bill introduced by MP Almameh Gibba from the Alliance for the Patriotic Reorientation and Construction (APRC), which was supported by Imam Abdoulie Fatty, a long-time advocate for FGM.

In April, the parliament supported the decision for the Bill to be referred to its business committee for more discussion. Less than 9% of MPs are female in the conservative, majority Muslim country and there was fear that the country’s 2015 ban on FGM was in jeopardy.

The decision was commended by UNICEF Executive Director Catherine Russell, UNFPA Executive Director Natalia Kanem, World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus, UN Women Executive Director Sima Bahous, and UN High Commissioner for Human Rights Volker Türk.

“FGM involves cutting or removing some or all of the external female genitalia. Mostly carried out on infants and young girls, it can inflict severe immediate and long-term physical and psychological damage, including infection, later childbearing complications, and post-traumatic stress disorder,” according to the leaders in a joint statement.

The Gambia banned FGM in 2015 but enforcement of the ban is weak. Almost three-quarters of Gambian women are estimated to have been subjected to the practice, and almost half were cut before their 15th birthday.

There has only been one FGM-related conviction in the past nine years, and that involved three women for cutting babies aged four to 12 months old, according to women’s rights activist Jama Jack. They received fines which were paid by Fatty via a public fundraising campaign, added Jack.The global leaders acknowledged “the fragility of progress to end FGM”.

“Assaults on women’s and girls’ rights in countries around the globe have meant that hard-won gains are in danger of being lost,” they added.

“In some countries, advancements have stalled or reversed due to pushback against girls’ and women’s rights, instability, and conflict, disrupting services and prevention programmes. 

Continued advocacy

“That is why legislative bans on FGM, while a crucial foundation for interventions, cannot alone end FGM.”

They called for “continued advocacy to advance gender equality, end violence against girls and women, and secure the gains made to accelerate progress to end FGM”.

To do so, they recommended more engagement with communities and grassroots organizations; working with traditional, political, and religious leaders; training health workers, and raising awareness effectively about the harms caused by the practice.  

“Supporting survivors of FGM remains as urgent as ever. Many suffer from long-term physical and psychological harm that can result from the procedure, and need comprehensive medical and psychological care to heal from the scars inflicted by this harmful practice.   

“We remain steadfast in our commitment to support the government, civil society, and communities in The Gambia in the fight against FGM. Together, we must not rest until we ensure that all girls and women can live free from violence and harmful practices and that their rights, bodily integrity, and dignity are upheld.”

Control over women’s sexuality

FGM is practised mainly to  “control” women’s sexuality. Around 90% of women in Somalia, Guinea and Djibouti are subjected to FGM.

Over 230 million girls and women alive today have undergone female genital mutilation (FGM), according to a report from the UN children’s agency, UNICEF. This is a 15% increase since eight years ago.

“The pace of progress to end FGM remains slow, lagging behind population growth, especially in places where FGM is most common, and far off-pace to meet the UN’s Sustainable Development Goal to eliminate the practice. The global pace of decline would need to be 27 times faster to end the practice by 2030,” UNICEF notes.

However, progress to prevent FGM is possible. In the past 30 years, FGM has declined in Kenya from moderate to low prevalence; Sierra Leone has dropped high to moderately high prevalence and Egypt is beginning to decline from a previously near-universal level.

HIV medicine dolutegravir has a significantly smaller carbon footprint than similar antiretroviral medication.

The lifesaving HIV treatment dolutegravir (DTG), used by 24 million people in low-and middle-income countries (LMICs), has unexpectedly contributed to a significant reduction in carbon emissions when compared to the previous standard of care, efavirenz, according to the latest report by global health initiative Unitaid.

The report estimates that the transition to DTG will have prevented over 26 million tons of CO2 from entering the atmosphere from 2017 to 2027. The emissions reduction is comparable to eliminating 10 years’ of carbon emissions from Geneva, Switzerland, according to the report released on Monday.

This is the first report to analyze the environmental impacts of a single widely used medicine compared to its alternative. It builds on Unitaid’s From milligrams to megatons report last year which analyzed the climate and nature assessment of 10 key public health products in its portfolio.

“One of the outcomes of this study of 10 products was that carbon emissions can be really significant and one product stood out as particularly important, it’s this one, dolutegravir,” Vincent Bretin, Director of Unitaid’s Results and Climate Team told Health Policy Watch.

“So, it’s [this report] really a deep dive on that comparison. And it’s showing that the previous generation of efavirenz was actually producing more emissions. So, all the steps required to manufacture it resulted in more carbon emissions worldwide compared to the current treatment,” he said.

Unitaid is hosted at the World Health Organization (WHO) and focuses mainly on supporting the treatment of tuberculosis, malaria, and HIV/AIDS along with its deadly co-infections in LMICs.

As global carbon emissions continue to rise and climate impacts worsen, different sectors are being called on to reduce their carbon footprint, while also meeting development agenda. It is in this context that Unitaid’s report provides a viable path forward for the reduction in the health sector’s carbon emissions.

Health sector’s carbon emissions

Health sector’s carbon emissions stand at roughly 5% of the global carbon emissions and is larger than the emissions of many big countries. While this has been discussed for a few years now, as Health Policy Watch has reported earlier, nothing concrete has been done to reduce these emissions.

Some 50-70% of the healthcare sector’s emissions comes from supply chains, according to various estimates, said Bretin. In the case of HIV treatment, 90% of the emissions come from the upstream part of the manufacturing process, he said.

DTG is the most effective and lowest-cost antiretroviral drug ever. It was rapidly scaled up across low- and middle-income countries starting in 2017, thanks to a concerted global effort by Unitaid, manufacturers, governments, global health organizations and affected communities. DTG is now the standard of care in over 110 low- and middle-income countries.

“This report demonstrates that we can achieve significant health improvements while also making strides in reducing carbon emissions. By adopting innovative practices and prioritizing sustainability, we can ensure that medicines like DTG are not only effective but also environmentally responsible,” Bretin said.

The reason for the reduction in emissions was found to be that DTG requires a smaller quantity of active pharmaceutical ingredients which naturally lowers emissions during the production process.

While DTG’s carbon footprint is significantly lower than its predecessor, it still remains very high, the report said, and there is a need for all stakeholders to work together to lower it further.

Need for innovation in the health sector

The sector will have to focus on technology upgrades and innovation to reduce carbon emissions of drugs and other pharmaceutical products.

The report outlines several measures that can be taken to reduce emissions from DTG even further, with the potential for application to other commonly used drugs.

Up to 40% of these emissions could be reduced through cost-saving measures such as process optimization to improve energy and material efficiency, and another 50% could be reduced by adopting green energy and materials, the report says.

Optimized supply chains, supported by coordinated efforts to improve distribution and production processes, will also be needed to further enhance environmental efficiency.

“While it (this report) demonstrates the potential for health interventions to contribute to our climate goals, it also highlights a missed opportunity: had climate considerations been mainstreamed into design of these efforts, its carbon footprint could have been reduced much further,” wrote Oyun Sanjaasuren, Director of External Affairs at the Green Climate Fund, the world’s largest climate fund, in the report’s foreword.

Unitaid hopes that the report encourages drug manufacturers, innovators, public health players and governments to look at the carbon emissions of the health sector.

“I think it’s the broader ecosystem that we need to look at that needs to shift from where we are right now to integrating climate considerations into our policies, ways of working approaches,” Bretin said.

No mechanism to prevent ‘greenwashing’

But promoting some products as greener than others opens the sector up to greenwashing – a form of marketing spin to persuade the public that the products are environmentally friendly.

End users have no way of knowing whether the drugs are green if more companies and entities use this claim while marketing their drugs.

“We don’t have yet the systems, the methods, the standards, as a global health community to do this in a standardized way, and to audit for instance, or to request information from manufacturers to ensure that what they do is really what they claim they’re doing,” Bretin acknowledged.

Unitaid’s report comes days before the International AIDS Society (IAS) Conference – the premier global event on HIV research and policy.

Image Credits: Unsplash, Unitaid report.

Prime Minister of Côte d’Ivoire, Robert Beugré Mambé; Minister of Health of Côte d’Ivoire, Pierre Dimba; Gavi CEO Dr Sania Nishtar; Kouyate Aïcha (mother); and Diomandé Aboulaye (son, 8 months).

Côte d’Ivoire became the first country to roll out the new R21/Matrix-M vaccine with the first child vaccinated in Abidjan on Monday.

The vaccine, co-developed by the University of Oxford and Serum Institute of India (SII), was granted prequalification status by the World Health Organization (WHO) in December last year.

This follows the approval of the malaria vaccine, RTS,S. Both vaccines are expected to have a high public health impact. 

Every year 600,000 people die of malaria in Africa, according to the WHO. Children under five years of age make up at least 80% of those deaths. 

Although the number of malaria-related deaths has fallen from 3,222 in 2017 to 1,316 in 2020 in Côte d’Ivoire, the mosquito-borne disease kills four people a day, mostly small children, and “remains the leading cause of medical consultations”, according to the Ministry of Health.

Wide implementation of the malaria vaccines, in conjunction with existing prevention methods like the use of bed nets, is expected to save tens of thousands of young lives each year.

 SII has manufactured 25 million doses of the vaccine and is committed to scaling up to 100 million doses annually, offering the vaccine at less than $4 per dose. 

“Reducing the malaria burden is finally within sight. Today’s start of the R21/Matrix-M™ vaccine roll-out marks a monumental milestone after years of incredible work with our partners at Oxford and Novavax,” said SII CEO Adar Poonwalla.

The vaccination “signifies the culmination of years of dedicated research and manufacturing efforts” by the two partners, they said in a joint media release.

 “The roll-out of the R21/Matrix-M™ malaria vaccine marks the start of a new era in malaria control interventions with the high efficacy vaccine now accessible at a modest price and very large scale to many countries in greatest need. We hope that very soon this vaccine can be provided to all countries in Africa who wish to use it,” said Professor Adrian Hill, Director of the Jenner Institute at Oxford University.

A total of 656,600 doses have been sent to the country, which will initially vaccinate 250,000 children aged up to 23 months across all 16 regions. 

The R21/Matrix-M vaccine has also been authorised by Ghana, Nigeria, Burkina Faso, and the Central African Republic. 

Gavi, WHO, UNICEF, the Global Fund and others are working with countries on their plans for vaccine roll out as part of holistic malaria control and prevention plans.

Fifteen African countries are expected to introduce malaria vaccines with Gavi support in 2024, and countries plan to reach around 6.6 million children with the malaria vaccine in 2024 and 2025. Gavi and partners are working with more than 30 African countries that have expressed interest in introducing the malaria vaccine.

 Gavi CEO Dr Sania Nishtar said: “Africa has borne the brunt of malaria for far too long, and Côte d’Ivoire has suffered more than most. With two safe and effective vaccines now available alongside other interventions, we have an opportunity to finally turn the tide against this killer disease.”

Image Credits: Miléquêm Diarassouba/ Gavi.

A health worker in Niger administers a vaccine to a baby

Childhood immunisation has stalled in the past year, mainly due to increased global conflict, with the number of children receiving no vaccines increasing to 14.5 million in 2023 – up from 13.9 million in 2022.

There has also been an almost threefold increase in measles cases in the past year – a sign of inadequate vaccinations – including in conflict-ridden Sudan, Yemen and Afghanistan.

This is according to the latest global immunisation estimates for 2023 based on data from 194 countries, that was released on Monday (15 July) by the World Health Organization (WHO) and UNICEF.

Around 55% of the “zero-dose” children “live in countries that have some aspect of the country that is fragile, conflict-affected or a vulnerable setting”, according to Dr Kate O’Brien, WHO Director of Immunization. These areas only contributed to 28% of global births.

Fragile and vulnerable settings usually refer to situations where humanitarian crises, armed conflicts and natural disasters prevail.

Sudan’s vaccination rate plunged from 75% in 2022 to 57% last year, with the result that about 700,000 children received no vaccines. This represents over 43% of all unvaccinated children in the region, noted Dr Ephrem Lemango, UNICEF’s global head of immunisation, at a media briefing to launch the data.

Palestine has been unable to document immunisation figures since September 2023 because of Israeli attacks in the region. However, Ukrainian immunisation has improved despite Russian attacks.

“Children who are living in [conflict-ridden and vulnerable] settings also lack security, lack nutrition, lack healthcare, and are most likely, as a result of those things, to die from a vaccine-preventable disease if they get it,” O’Brien told the briefing.

The needle also did not move for basic immunisation – the global marker for this being that children get three doses of the DTP combination vaccine for diphtheria, tetanus and pertussis (whooping cough).

While 84% of children – 108 million – got three DTP vaccinations in 2023, this was the same figure as the previous year. 

The WHO’s conflict-ridden Middle East and North Africa region recorded a 4% decline DTP vaccination.

Aside from the zero-dose children, 6.5 million children did not get all three doses of DTP. 

The zero-dose children and the under-immunized children amounted to 21 million kids in 2023 – 2.7 million more than before the pandemic, when there were 18.3 million of these un- or under-vaccinated children, O’Brien noted.

The COVID-19 pandemic significantly disrupted childhood vaccinations, one of the most powerful global weapons to protect babies and young children from serious illness and death.

UNICEF, the WHO and Gavi, the global vaccine alliance, united last year with “The Big Catch-up” campaign to regain lost ground. 

Twenty-five of the 35 low-income countries targeted have either recovered to pre-pandemic levels or have improved their coverage in the past year.

Bright spots: HPV vaccine expansion

In Freetown in Sierra Leone, students at St Augustine School receive the HPV vaccine.

There was a 3% reduction in zero-dose children in the Americas, largely thanks to an impressive recovery in Brazil.

Africa reduced its zero-dose children by 1% (to 6.7 million), with Chad, South Sudan,  Mauritania, Tanzania and Cameroon singled out for their improvements. Ethiopia also improved its immunisation following a reduction in conflict in Tigray.

Global coverage of the human papilloma virus (HPV) vaccine to prevent cervical cancer jumped by 7% last year, with 27% of girls receiving the first dose of HPV vaccine.

“This increase was largely driven by really strong introductions of HPV vaccine in large countries, including Bangladesh, Indonesia and Nigeria, which were supported by Gavi,” said O’Brien.

However, China, India and Russia have yet to introduce the HPV vaccine.

In addition, most countries are only vaccinating girls although males are both carriers of the virus that can be passed on to females during sex, and can be affected by penile and throat cancers caused by HPV.

O Brien explained that while the WHO recommends that both girls and boys get the HPV vaccine, “the priority, especially in the introduction phase of vaccine, is for provision of the vaccine to girls”, as the largest disease burden relates to cervical cancer.

“Once countries have well functioning programs, then an advancement in the program would be to consider moving including boys.”

Rising measles cases

“Immunization stands as one of humanity’s greatest achievements, and it has saved over 154 million lives over the past 50 years, with measles vaccination alone responsible for about 60% of this,” noted Dr Ephrem Lemango, UNICEF’s global head of immunisation.

“And yet, measles outbreaks continue to rise as measles vaccination coverage stalls. For example, the world saw over 300,000 confirmed measles cases in 2023 which is an almost threefold increase compared to what we had in 2022.”

Lemango noted that only 83% of children received their first measles vaccine dose, and 74% were fully protected by a second measles vaccine.

Afghanistan, Angola and Yemen had the lowest measles vaccination rates. However, countries without conflicts such as Indonesia and Pakistan also had low rates. Some of the setbacks related to countries’ weak economies following COVID, said O’Brien.

“Over the past five years, about 103 countries with inadequate vaccine coverage saw measles outbreaks,” said Lemango. “[This] contrasted sharply with the remaining 91 countries, where coverage exceeds 90% and no outbreaks occurred.”

“Measles outbreaks are the canary in the coalmine, exposing and exploiting gaps in immunization and hitting the most vulnerable first,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.

“This is a solvable problem. Measles vaccine is cheap and can be delivered even in the most difficult places. WHO is committed to working with all our partners to support countries to close these gaps and protect the most at-risk children as quickly as possible.”

Vaccine hesitancy from COVID misinformation

A rising lack of confidence in vaccines – also a COVID-19 setback  – has affected uptake of routine childhood vaccinations.

“During the pandemic, we all experienced a huge amount of misinformation and disinformation, and this is continuing to reverberate in many countries, and is actually resulting in deaths,” said O’Brien. 

“It’s resulting in children and adults and adolescents not getting vaccinated when they are recommended to be vaccinated, and is causing harm. Misinformation and disinformation, are a health threat themselves, and they actually cost people their lives.”

“The latest trends demonstrate that many countries continue to miss far too many children,” said UNICEF Executive Director Catherine Russell.

“Closing the immunization gap requires a global effort, with governments, partners, and local leaders investing in primary healthcare and community workers to ensure every child gets vaccinated, and that overall healthcare is strengthened.”

Image Credits: Gavi, Gavi.

Dr Tedros Adhanom Ghebreyesus warns about the growing threat of mpox and other infectious diseases as well as conflict-related health emergencies at a WHO press briefing Wednesday

The outbreak of a new and dangerous strain of mpox in the eastern Democratic Republic of Congo has now spread to Goma, eastern DRC’s largest city with 25 cases reported, mostly in the city’s displaced persons camps, WHO officials confirmed on Thursday. 

And with person-to-person transmission occurring, particularly within communities on the move after fleeing attacks by Congo’s M23 rebel forces, there is a rising risk of cross border spread of the new strain, WHO officials warned at a press conference Thursday. 

The wide-ranging WHO press briefing also touched upon half a dozen other health emergencies and threats, including the soaring worldwide rate of dengue virus cases and evidence of an ever-widening outbreak of H5N1 avian flu amongst dairy cattle in the United States. 

WHO Director General Dr Tedros Adhanom Ghebreyesus also touched upon the continuing toll of war in Sudan; Gaza and Ukraine, including the recent Russian bombing of a children’s hospital in Kiev and Israel’s recent order to Gaza City Palestinian residents to move southward again in a grinding war against Hamas that just entered its ninth month. 

Goma cases could fuel more cross-border infections

WHO mpox specialist Dr Rosamund Lewis.

In the case of DRC’s mpox outbreak, the risk of cross border infection is growing, insofar as Goma sits astride a busy transport hub, right alongside the border with Rwanda. 

“There is a risk of cross border infection as the virus continues to move because the  borders are very porous with neighboring countries – Rwanda, Burundi, even perhaps Uganda. There’s clearly a lot of population movements across those borders,” said WHO mpox specialist Dr Rosamund Lewis. 

“Large scale population movements, internally displaced population movements, insecure settings – these all bring associated risks, but also the facts that not all cases are reported, not necessarily detected.   

“The strain that is transmitting, so far, is exclusively person-to-person,” she added, ruling out any connection between the new outbreak and animal hosts that historically harboured the disease in the wild. “It is largely through sexual contact, initially, including amongst sex workers, and increasingly in the community.”

WHO working to expand access to diagnostics and, eventually, immunization

mpox virus
Both Clade I and II strains of mpox are circulating in DRC – but a new strain of Clade I transmitted by sexual contact is worrying health officials the most.

She said that comparatively high rates of laboratory testing of cases confirms that the dominant mpox strain being transmitted is part of the more severe Clade 1 family of mpox virus – which has up to a 10% fatality rate. 

However, in the case of the new strain, many people still experience only mild symptoms, which then pass under the wire of detection.

“The proportion of cases that are laboratory confirmed is very high, and the proportion of those that are tested that turned out to be Clade 1 mpox is also very high. So we’re confident in the data that we’re seeing and need to continue to support the Ministry of Health for a robust response in that region.” 

Current efforts are focused mostly on expanding diagnosis and treatment, she said.  Although the DRC recently approved the emergency use of mpox vaccines, rollout has yet to begun – and Lewis provided no strategy or timeline for how and when the vaccines might eventually be deployed. 

Largest ever mpox outbreak in DRC

Father of six, sought safety for his family at a displacement site near Goma after his wife was killed by a bombing in North Kivu province.

Congo has seen 20,000 cases and more than 1,000 deaths from mpox since the start of 2023, according to WHO and national Congolese authorities – the largest ever mpox outbreak to be recorded. 

“More than 11,000 cases have been reported this year and 445 deaths, with children the most affected,” said WHO’s Director General Dr Tedros, speaking at the briefing. 

He noted that South Africa, as well, has recently reported 20 cases of mpox to WHO, including three deaths – the first cases seen in the country since 2022. 

“The cases were all men and most self-identified as men who have sex with men. None had reported any history of international travel, which suggests that the confirmed cases are a small proportion of all cases, and that community transmission is ongoing,” Dr Tedros said. 

As with DRC, WHO is supporting South Africa to respond to the outbreak, to engage the affected communities and to develop immunization strategies, he said.

Regional conflicts fueling more hunger, disease and despair 

Aicha Madar fled to Chad with daughter Fatima after armed men set fire to her village in Sudan. Photo

In terms of conflict related emergencies, WHO officials said it was providing medical supplies to Ukrainian hospitals that are receiving children evacuated from a Children’s hospital in Kiev on Monday, just minutes before a large part of the complex took a direct hit – apparently from a Russian missile, according to the UN.  

WHO was also assessing damage to medical equipment at the Okhmatdyt hospital, where the intensive care, oncology and surgery wards were most heavily damaged.  

More than 600 children were in the hospital just before the missile struck. A rapid evacuation meant that only two people, including one child, were killed – despite massive infrastructure damage to what is the largest children’s hospital in the country. 

In Sudan, meanwhile, the number of displaced people has now grown to 12.7 million including 10.5 million internally displaced and 2.2 million who have sought refuge in neighboring countries. 

At the same time, “access to health services continues to be severely constrained due to insecurity and shortages of medicines, medical supplies and health workers.  Almost 15 million people need urgent health assistance,” said Tedros adding that “the risk of famine is growing with more than half of Sudan’s populations facing crisis levels of food security or worse.”

Chad, in particular, has been overwhelmed with refugees.  

“Most communities in Chad have been very hospitable, offering food, water and shelter for refugees. But the needs are overwhelming,” he said, noting that a recent WHO joint mission to the refugee areas assessed the potential fo scale up cross border operations to meet needs of those refugees and build health system capacity – “Despite the increasing needs in both Chad and Sudan, WHO has only 18% of the funds we need to meet those needs,” Tedros warned, saying that “the international community must do better than that. 

Gaza – hunger, displacement … and trash

Trash and sewage accumulated due to months of war exacerbate infectious disease risks in Gaza.

In terms of Gaza, more than 10,000 seriously ill Palestinian patients remained trapped in the enclave awaiting evacuation since the closure of the Gaza-Egypt Rafah crossing following Israel’s military occupation of the area in early May, Dr Tedros said. 

Almost the entire population of Gaza still faces acute food insecurity, with one in four facing starvation, Tedros added, saying:  “At the same time, very few supplies are getting into Gaza with only five WHO trucks allowed into Gaza last week, and more than 34 trucks still waiting at Egypt’s Al Arish crossing into Gaza.”  A further 40 trucks are waiting at other crossings, he noted. 

And the already desperate situation may only get worse following Israel’s recent order to Gaza City residents to evacuate south – for the second time since Israel’s invasion of Gaza nine months ago. Israel attacked following the 7 October attack by Hamas on nearby Israeli communities that left 1200 Israelis dead and some 240 taken hostage. Since then, some 38,000 Gazan Palestinians have since been killed, according to Palestinian health authorities, while Hamas continues to hold 120 Israeli and foreign nationals hostages – of which less than half may still be alive.

On a trip to Gaza last week, Hanan al Balkhy, WHO’s Regional Director for the Eastern Mediterranean Region said she saw “first hand the scale of devastation, lives and homes in ruins, hospitals overwhelmed and a fully destroyed city. 

“The lack of fuel is compromising all health and humanitarian operations. Running sewage and garbage litter demolished streets with the smell of fermenting waste permeating the area. 

“This situation is providing the perfect breeding ground for diseases to spread, leading to an increase in cases of acute watery diarrhoea and acute respiratory infections among many others. 

“Ongoing violence and the breakdown of law and order are devastating in an already crippled city, creating an extremely high risk environment, not just for aid workers, but for everyone. The breakdown of law and order also makes it nearly impossible to manage gender-based violence exposing displaced Palestinians to additional life threatening risks.

“As a result of increasing hostilities and soaring needs, WHO has expanded its medical supply chain. However much of this aid remains stuck on the wrong side of the borders. With only a fraction reaching, Gaza. And even when supplies do, the breakdown, again, I repeat of law and order makes it challenging for our teams to deliver them to hospitals that urgently need them.” 

Image Credits: © UNHCR/Blaise Sanyila, National Foundation for Infectious Diseases , WFP/Jacques David, UNRWA .

A recent cyberattack on South Africa’s labs has showcased the importance of adequate biosecurity measures.

Artificial Intelligence (AI) technologies, cyberattacks, genetic engineering, and amateur-led biology experiments could all pose threats to a country, according to the World Health Organisation’s (WHO) updated guidance on lab biosecurity.

The guidance aims to help national regulatory bodies and other institutions “establish or strengthen frameworks for handling high-consequence pathogens”.

It features a comprehensive set of rules, best practices, and recommendations for managing laboratory biosecurity risks and procedures at laboratory, institutional, and national levels. 

The guidance needed to be updated as “rapid technological developments and advances in methods manipulating biological material in the past decade have redefined the biological threat landscapes,” according to the guidance’s authors. 

The WHO identified biosafety and biosecurity awareness as one of member states’ “weakest core capacities” after a review in 2022.

This year’s World Health Assembly adopted a resolution on ‘Strengthening laboratory biological risk management’ which calls on member states to enhance laboratory biosafety “by including essential elements of biological risk mitigation and management within their national laboratory biosafety and laboratory biosecurity strategies, policies, programmes, and mechanisms”.

It also called on the WHO to guide member states, particularly on how to deal with “high-consequence biological agents, that would, in case of release or exposure, cause significant harm or potentially catastrophic consequences”.

New technologies, institutional monitoring, and risk assessment methods

A distribution of regulatory, review, and monitoring responsibilities between agencies

Biosecurity aims to prevent “intentional or accidental unauthorized access to, and loss, theft, misuse, diversion or release or even weaponization” of biological material, but also equipment, information, or technology, according to the guide.

Developed in consultation with the WHO Technical Advisory Group on Biosafety (TAG-B) and other stakeholders, the lab biosecurity guidance covers threats to lab biosecurity and methods of managing them. 

It describes emerging technologies that could present a threat to lab security. Next to the well-known disinformation, AI technologies, or genetic engineering, it also puts into focus other potentially risky domains: amateur-led biology experiments or making high-consequence research publically available.

The guide also offers a review of risk control measures, including staff screening and training, auditing, and cybersecurity, as well as a step-by-step guide to developing risk assessment procedures.

A step-by-step instruction on developing context-appropriate biosecurity risk assessment framework, as featured in the guidance

It also proposes setting up national and international institutions tasked with approving and overseeing research involving biohazards.

Cyberattacks affect South Africa, UK labs

There has been a  72% increase in data breaches between 2021 and 2023, highlighting the importance of resilient laboratory systems. 

In the past month, for example, both the UK and South African laboratory services have suffered from cyberattacks affecting patients’ test results.

The British National Health Service suffered from a hacker attack in early June, setting back the waiting time for blood test results by up to six months, The Guardian reported.

In late June, the South African National Health Laboratory Service (NHLS) was hacked causing a near-paralysis of the public healthcare system as no test results were available.

“We recognise the magnitude of the situation and the concerns it may generate,” said South Africa’s NHLS, in a Daily Maverick report. 

“It has been established that sections of our system have been deleted, including in our backup server and this will require rebuilding the affected parts. Unfortunately, this will take time,” the organisation’s representatives added.

Image Credits: WHO.

The ninth meeting of the Intergovernmental Negotiating Body (INB) meeting in May in Geneva

A day during the week of 16 December has been suggested for a World Health Assembly (WHA) special session to consider the pandemic agreement – but that is to remain strictly in pencil until there is clarity about the progress made in negotiations.

After two years of talks, including weeks of late-night meetings in the run-up to the WHA, World Health Organization (WHO) member states failed to meet the May deadline for the pandemic agreement.

But they are soldiering on from next week when the Intergovernmental Negotiating Body (INB) meets next Tuesday and Wednesday (16-17 July) for the 10th time.

The agenda of this meeting is largely concerned with process rather than content, as member states contemplate a pathway that may finally clinch an agreement.

New co-chairs?

Top of the agenda is the proposal to “rotate” members of the INB Bureau – and the possible election of two new co-chairs.

The Bureau, which runs the negotiations, consists of six regional representatives, including co-chairs Roland Driece from The Netherlands and South Africa’s Precious Matsoso. 

Some member states have blamed the Bureau for the slow pace of talks, and there have also been complaints that some iterations of the draft agreements failed to reflect key positions and agreements.

The African Group has indicated that it wants to retain Matsoso and the agenda leaves the decision of the rotation of other Bureau members to the WHO regions.


The second agenda item deals with the work plan, meeting schedule and proposed updates. This will take the bulk of the two-day meeting, bar a section on the consideration of other entities to be added as official stakeholders.

The work plan proposes a meeting from 9-20th September. This will focus on Article 12, with discussion on  w Articles  4, 5, 9, 10, 11, 13, 13bis, 14 and relevant sections of Article 1. The meeting will also discuss the relationship between the WHO Pandemic Agreement and its legal instruments.

This will be followed by another meeting on 4-15 November “focusing on the preamble, relevant sections of Article 1, Articles 3, 19, 20, 21, 24, 26, 31, 32, 33 and 34”, according to documentation sent this week to non-state actors in official relations with the WHO.

These articles cover, amongst others, the sticky issues of pathogen access and benefit sharing (PABS), One Health and access to health products during a pandemic.

The deadline for calling the WHA special session to discuss and adopt the pandemic agreement will be 15 November.

If there is no evident agreement by then, member states will need to agree on “an updated work plan and meeting schedule, depending on progress made,” according to the WHO documentation.

The 13th meeting of the INB will take place from 2 – 6 December and, all going well, will proceed to the WHA special session.

If there is no agreement and no special session, a 14th NB meeting has been scheduled for 24 – 28 February 2025.

The WHA gave negotiators up to a year – the next WHA in May 2025 – to reach agreement.

Civil society demands a place at INB table

WHO member states are also under pressure from civil society to open the talks up – at the very least to allow civil society organisations recognised as stakeholders in the pandemic preparation process to be present during negotiations.

More than 140 civil society organisations (CSO) and supporters from 40 countries issued an open call this week to the INB and WHO member states to “demand the official involvement of CSOs in all remaining negotiations in the INB process for a new pandemic agreement.”

CSOs that are identified as relevant stakeholders in the INB process – including patient advocacy groups, humanitarian organisations and pharmaceutical company representatives – have relied on “brief, piecemeal” interactions with negotiators for information.

The “failure to facilitate” their meaningful participation in the  negotiation process “risks rolling back on best practice in global negotiations,” according to the call.

They want member states to “use the opportunity of the renewed INB mandate” to include CSOs, communities and academics in all INB meetings, and provide them with all documentation “in a timely manner”.

Meanwhile, a letter to the INB from The Elders, The Global Preparedness Monitoring Board, The Independent Panel for Pandemic Preparedness and Response, Pandemic Action Network, The Panel for a Global Public Health Convention, and Spark Street Advisors issued Wednesday also called for the process to be opened up.

Aside from opening that talks up to relevant CSOs and independent experts, the group proposes that co-chairs build trust by “explaining why certain texts were proposed”, ensure the “full representation of all member states” in working groups and provide timely information about the negotiations.

These measures will improve “effectiveness, transparency, and counter misinformation,” they note.

Image Credits: WHO .

Farmer Kusum Gaikwad finds it increasingly difficult to work in the fields and finish daily chores because air pollution has severely impacted her health.

JAMBHALI, India – Farmer Kusum Gaikwad’s work start at 4 am daily. First, she burns the firewood and farm residue to heat water for 10 family members.  

By 7 am, she reaches the fields, manoeuvring through thousands of sugarcane plants, removing weeds, and checking for pests and diseases that could hamper their growth. This is followed by tremendous backbreaking labor, where she collects and lifts over 100kg of cattle fodder in the relentless heat. 

This has been her routine for the past two decades. But in 2017, Gaikwad started to get frequent headaches. Dizziness and severe pain in the chest and abdomen followed.

“It was unbearable, but I kept working for four months,” she says. Eventually, when it became difficult for her to even move out of bed, she consulted a doctor and was diagnosed with hypertension. 

She returned to the same routine within a week. Two years later, she was diagnosed with type 2 diabetes and also reported weakening of her bones. 

‘Mountains of smoke’

With the rising exposure to extreme heat and air pollution, Kusum Gaikwad was first diagnosed with hypertension and then type 2 diabetes.

Perplexed, Gaikwad, now 66 years old, was determined to find the causes of her illnesses. When she went to the fields again in Jambhali village in India’s Maharashtra state, she met over 20 women who complained of similar symptoms.

“Everyone was coughing throughout the day, and that’s when I realized it was the air pollution,” she told Health Policy Watch.

Soon, Gaikwad found that almost every family in her village was burning at least 50 kg kilograms of firewood, agricultural residues, plastic bags, and seedling trays every day to heat water and cook food.

“Every morning, you can see a mountain of smoke here,” she says.

Over the years, a growing number of studies have found air pollution to be a risk factor for several noncommunicable diseases (NCDs), some of which include cardiovascular and respiratory diseases, heart attacks, and lower respiratory infections.

A paper published in 2020 analyzed the impact of air pollution on the health of 39,259 Chinese adults, finding that long-term exposure to air pollutants increased blood pressure and hypertension. 

Similarly, a study from India found that both short and long-term exposure to ambient PM2.5, fine particulate matter smaller than 2.5 micrometers that penetrate deep into the lungs, was associated with increased hypertension. 

In India, deaths from NCDs have increased from 38% of total mortality in 1990 to 62% in 2016.  The annual particulate pollution in India has increased by almost 68% from 1998 to 2021, reducing the average life expectancy by 2.3 years. 

Extreme heat exacerbates air pollution 

When chronic asthma becomes severe at night, Rajakka Tasgave leans against the wall, waiting for her labored breathing to ease.

Rajakka Tasgave, 65, has become scared of going to the fields, something she has done for over five decades. 

“Every day, I see at least one woman collapsing because of the extreme heat. Someday, even I can be one of them,” she shared earlier this year. 

It didn’t take long for her turn, though. After collapsing in the fields in March, when the temperature topped 40 degrees Celsius in Jambhali, the doctor advised her to stop working in extreme heat. 

“From April to May, I didn’t step out of the house from 10am till evening,” she said. But this meant that she lost a significant chunk of her earnings as most of the farmwork happens during the day. 

Every day after returning from the fields, she experiences tremendous body aches. 

“Every week, I visit a doctor and take an injection (epidural steroid injection). Otherwise, I won’t be able to work.”

Alongside the unbearable heat, Tasgave frequently comes in contact with air pollutants from the nearby industries and firewood emissions. She has tried covering her face with the end drape of her saree, but that didn’t help. A few years back, she was diagnosed with chronic asthma. 

“If I forget to carry my inhaler, I will die of an attack,” she confides.

During extreme heat, her asthma becomes unbearable. She became breathless in May this year when the night temperatures didn’t drop as normal. 

“With no one to take me to the hospital, I leaned against the wall in the hope of easing my pain,” she shares. She found relief only the next day when a doctor administered medicines. 

Heart attacks and pulmonary diseases

Researchers have stepped up efforts to understand the combined effects of air pollution and extreme heat in the past few years. In one such paper published in Environment International, they investigated the impact of heat and air pollution on mortality in 36 countries.

The study found that heat-related mortality also increased with higher levels of air pollutants like PM, NO2, and O3. Moreover, they also saw an increase in PM—and O3-related mortality for higher air temperature levels. 

Extreme temperatures and higher concentrations of particulate matter significantly increase the risk of heart attacks, according to a study published in the American Heart Association’s journal, Circulation. 

The researchers examined 202,678 heart attacks from China’s Jiangsu province between 2015 and 2020. Also, they found that during extreme heat, women were at a greater risk of heart attack than men. 

In the presence of rising temperatures and high solar radiations, volatile organic compounds react with nitrogen oxides to form ozone, considered a harmful pollutant in the lower atmosphere. Ozone exposure can lead to respiratory infections.

As a result, many people from Jambhali are now suffering from chronic obstructive pulmonary disease (COPD), which restricts the airflow and causes breathing issues. The problem is so severe that this year’s State of Global Air Report found that 50% of global ozone-related COPD deaths were reported in India. 

Many Indian families still rely on open fires to cook food, risking their health.

Anxiety and stress rise with air pollution

Jambhali’s community healthcare worker Kamal Kore was always curious about why people like Gaikwad, Tasgave and many others have felt anxious and stressed over the past five years. 

“Year after year, the number of people complaining of anxiety and stress disorders has risen. A few cases had even culminated in cardiovascular ailments and deaths,” she says. 

After tracking over a thousand such cases, she found that, as air pollution increased, so did the number of people suffering from mental health issues.

Her observation isn’t a one-off case. A study published in April 2024 looked at more than 3,000 US counties, spanning over 315 million people, and found PM2.5 to be linked with depression and stress. These mental health issues, in turn, put people at risk of dying from cardiovascular diseases.

Its lead author, Dr Shady Abohashem of Massachusetts General Hospital, explains, “Biologically, PM2.5 can enter the bloodstream and induce systemic inflammation, oxidative stress, and neuroinflammation, all known to affect brain function and mood regulation.” 

The combined effect of PM2.5 and deteriorating mental health amplify the risk of premature cardiovascular mortality. 

“High PM2.5 exposure leads to systemic inflammation and endothelial dysfunction, critical factors in the development of cardiovascular diseases. When combined with poor mental health, which independently contributes to adverse cardiovascular outcomes through mechanisms like heightened stress response, disrupted sleep, and poor health behaviors, the risk is significantly magnified,” Abohashem explains. 

Air pollution disrupts sleep, causes depression

So severe was the impact that in counties with higher levels of PM2.5, people struggling with poor mental health experienced a threefold rise in premature cardiovascular mortality compared to those with better mental health in areas of lower pollution.

The problem isn’t restricted to the outdoor workers. Besides crop residue burning and industrial pollution, another source of PM2.5 is indoor air pollution caused by burning firewood. Many Indian families still rely on burning firewood for cooking. 

A study from India published in BMC Geriatrics this year found that indoor pollution led to sleep disorders and depression among older adults.

“Ambient air pollutants can travel from the nose through the olfactory nerve and reach crucial brain areas like the striatum, frontal cortex, and cerebellum, which are involved in various functions including movement, decision-making, and coordination,” says one of its authors, Dr Aparajita Chattopadhyay, a professor at the International Institute for Population Sciences in Mumbai. 

These pollutants trigger an inflammatory response which can lead to changes in the levels of neurotransmitters and, hence, disrupt an individual’s sleep and mood. 

“Sleep plays an important role in maintaining good health, failing which NCDs, including mental health issues, may crop up,” she adds. 

 Limited air quality warnings

The health problems caused by air pollution are mounting, as evident from community health worker Kamal Kore’s call records. The past five years have sent a jump in health issues – largely NCDs, especially since the temperature started rising rapidly. 

 “Every day, I get at least 10 calls from the villagers with complaints of cardiovascular and respiratory issues,” she shares, adding that she now spends most of her time making people aware of the harmful effects of air pollution.

 “Every day, I tell people to switch to clean energy sources for cooking and work during the hours when the pollution is comparatively lesser,” she says. 

“We don’t have any resources to deal with this.” 

A major problem healthcare workers like her face is the lack of adequate, real-time data on air pollution to warn patients about peaks. People currently simply observe the times of day when air pollution becomes severe and try to avoid these.  

Farmer Narayan Gaikwad who is exposed to a lot of air pollution daily says that the lack of real time data on air pollution in the village is a big hindrance to make people aware of air pollution and the hours they shouldn’t work out in the fields.

Gaikwad’s husband, Narayan Gaikwad, 77, has written several letters to the district authorities demanding strict measures to curb air pollution. 

“People don’t understand how much unhealthy air they are breathing because there’s no one monitoring air pollution in the village,” he says. “I am now asking people to stop working during those hours.”. 

Chattopadhyay suggests that older people avoid major sources of indoor air pollutants, ensure proper ventilation, and use clean fuel.

 “A positive and strong social circle is also necessary to be mentally fit. Adults must be made aware of cues of contentment in life much before they get old — financial stability,  strong social circle, and remaining active daily in various tasks,” she adds. 

Given Gaikwad’s declining health, her family is considering a solar water heating system despite its crippling cost. 

While this will help her somewhat, she is worried about the smoke from the neighborhoods. “A solution can never work in isolation. It has to happen at the community level,” she warns.

Image Credits: Sanket Jain.