WHO Director General Dr Tedros Adhanom Ghebreyesus greets Afrigen’s Prof Petro Terblanche at the mRNA facility in South Africa

The establishment of an “mRNA hub” in South Africa to build the capacity of low- and middle-income countries (LMICs) to develop vaccines during the COVID-19 pandemic was widely hailed as a solution to Africa’s lack of manufacturing ability.

But three years after its launch in June 2021, the hub faces uncertainties, risks and shortfalls –  including that it may simply become a “technological solution” that maintains the status quo rather than a genuine transfer of knowledge and capacity to LMICs, according to a recent report

Authors Professor Matthew Herder, chair in Applied Public Health at Dalhousie University in Canada and Ximena Benavides from Yale University in the US, base their observations on interviews with 35 key players and numerous documents, some of which were obtained via an access to information request to the Canadian government.

The hub is the initiative of the World Health Organization (WHO) and the Medicines Patent Pool (MPP). Spurred by the failure of high-income countries to share their COVID-19 vaccines at a time of extreme need, the WHO and MPP selected a South African consortium comprising biopharmaceutical company Afrigen Biologics, vaccine producer Biovac and the SA Medicines and Research Council, as its partner to kickstart a facility capable of developing and producing mRNA vaccines in a LMIC. 

Once this was done, they were to teach other facilities in LMICs across the world how to do the same.

The mRNA programme currently includes the South African consortium and 14 other LMIC-based partners.

The current mRNA programme partners

Championing voluntary IP transfer

But the way in which the hub is governed and operates does not sufficiently transfer power and capacity to LMICs, the authors contend.

“The architects of the programme are working within the existing system of biopharmaceutical production and, at the same time, preserving their own control over the programme’s design and preferred measures meant to remedy shortfalls in equitable access to mRNA-based interventions,” they argue.

“In particular, MPP continues to champion voluntary [intellectual property] licensing as the optimal means to improve local production capacity in LMICs even though that mechanism did not attract collaboration from more established mRNA manufacturers in the context of COVID-19 and slowed adoption of a more transformative end-to-end approach to R&D and manufacturing.”

They also argue that the “technological outcomes” of the programme are uncertain unless there is “significant reform and concerted effort to redistribute not just IP, but agency to LMIC actors”.

Without these “there is a significant risk that the programme, which is claimed by WHO and MPP as a collective effort to improve manufacturing capacity in LMICs for LMICs, will not solve the problem of equitable access to biopharmaceutical innovation”.

‘In line with status quo’

While the mRNA programme may improve the sharing of knowledge, the authors observe, it has been developed “in line with the status quo” of global biopharmaceutical production.

This includes “weak conditionalities around product affordability, participants’ freedom to contract with third parties, and acceptance of market-based competition”, they argue.

The WHO and MPP also exert “tight control over the programme” and this “evokes the dynamics that are often in play in global health, to the detriment of empowering LMIC-based manufacturers to generate mRNA products in response to local health needs”, they argue.

For example, the MPP has created its own technology transfer unit to manage technology transfer within the mRNA programme. But typically, technology is transferred from one party with direct experience in using it, to another, through sharing hands-on know-how. 

“I’ve worked for more than 30 years in the industry. You do not have a remote group that does tech transfer. If a group is going to do tech transfer, it needs to be in the facility that’s sending the technology out,” one participant told the authors.

The hub’s donors – France, the European Commission, Germany, Norway, Belgium, Canada, South Africa and the African Union – have committed $117 million to the programme (with $89 million received so far).

But some of the high-income countries (HICs) that have invested in the mRNA programme have also made demands that have shaped the programme. Canada, for example, stipulated that its funding be allocated to the hub in Cape Town and four other countries only: Senegal, Nigeria, Kenya and Bangladesh.

“According to one interview participant, while HICs are supportive of transferring technology to LMICs, they would prefer that such transfers do not extend to the more upstream inputs into mRNA vaccine production, including novel LNPs and antigens,” the authors note.

Charles Gore (MPP), Petro Terreblanche (Afrigen), WHO’s Dr Tedros Ghebreysus,South Africa’s Health Minister Dr Joe Paahla, and Anne Tvinnereim, Norwegian Minister of International Development, at the ribbon-cutting to formally open Afrigen  on 20 April, 2023.

Contradictory legal agreements – and pricing silence

The report notes that the MPP has crafted a set of legal agreements including a technology transfer template in which LMICs are granted a “non-exclusive, royalty-free, non-sublicensable, non-transferable, irrevocable, fully paid-up, royalty-free licence” to the technology.

They also get access to any rights held by Afrigen and Biovac “to make, or have made, use, offer for sale, sell, have sold, export or import” products in their respective territories and other LMICs.

In exchange, LMICs must grant MPP a worldwide, non-exclusive, royalty-free licence to data and the inventions to “facilitate the development and equitable access of health technologies”.

Brazil’s Bio-Manguinhos has baulked at the idea that technology it has developed with  funding from the Brazilian government “would flow to manufacturers from participating LMICs, which in some cases, are for-profit commercial entities, without anything in return”, with official Patricia Neves describing this as an “injustice”.

South Africa also contested the absence of royalties, and its agreement with MPP states that any licence may include a “royalty sacrifice”.

Meanwhile, Indonesia’s BioFarma negotiated the right to sell products to HIC. 

“MPP also stopped short of requiring that resulting mRNA products be priced affordably for populations in need outside of a Public Health Emergency of International Concern (PHEIC),” the authors note.

If an mRNA product developed by an LMIC partners targets a PHEIC, they cannot charge more than the cost of production plus a 20% mark-up.

“Traditionally, MPP has not interfered in pricing. Our model is based on competition, and clearly we are potentially giving this to 15 companies around the world,” MPP executive director Charles Gore told the authors.

In response, the authors remark that the MPP “appears to be comfortable relying on free-market competition among LMIC-based manufacturers instead of imposing affordability clauses when it comes to products generated by virtue of participating in the mRNA programme”.

Moving beyond COVID

A researcher in the WHO mRNA hub at Afrigen in South Africa.

It took Prof Petro Terblanche’s Afrigen only two months to develop an mRNA vaccine for COVID-19 based largely on a Moderna “recipe” published online. It has since transferred this knowledge to facilities in countries including Bangladesh, Serbia and Brazil.

But the urgency related to COVID-19 has passed. Expanding the programme’s focus upstream is now seen as crucial to its overall sustainability given that demand for COVID-19 vaccines is limited. 

At a meeting in Bangkok in late 2023, WHO and MPP officials outlined “potential sub-consortia – engaging partners both inside and outside of the programme – focused on R&D around pathogens of shared, regional interest,” according to the authors.

Afrigen is increasingly focusing on the development of second-generation technologies important in mRNA production, such as novel lipid nanoparticles (LNPs), and new disease targets like TB, malaria and HIV.

“The critical question is whether the funding that has been secured for the programme and supporting the development of these second-generation mRNA technologies has been leveraged into a shared set of commitments geared towards improving equitable access,” the authors note.

While Afrigen targeted 11 potential diseases for mRNA product development, its proposals focusing on Lassa fever, RSV, and other disease targets have been turned down by a variety of funders.

Terblanche has conceded that her “hand will now be forced to prioritise” in favour of market rewards – particularly as the MPP expects the programme to be “self-sustaining” by 2026.

But an increasing number of “use patents” that claim IP on the use of mRNA technology are being filed in South Africa and other LMICs, and these threaten to block Afrigen and partners’ R&D plans.

Recalling that some of the companies that took part in the the influenza vaccine hub later shut down production, WHO’s Martin Friede estimates that if a handful of LMIC manufacturers manage to make mRNA vaccines, the programme will be an overall success.

Meanwhile, MPP’s Gore noted that “we are funding [Afrigen] to develop and then shift [the technology] out,” but “they don’t [yet] have a business model.”

MPP’s Marie-Paule Kieny speculates that Afrigen will, in the end, probably yield to market forces: “The hub is really there to establish a first platform and improvement, and to help with an early pipeline. After that we are fully aware that Afrigen is a private company, at one point they will try to find somebody to buy them out and to get the benefit,” she told the authors.

‘Failure of imagination’

But the authors describe the “near inevitability of Afrigen’s exit in the eyes of those who designed the programme” as an indication of the “underlying failure of imagination concerning how the mRNA programme is governed”. 

A more “inclusive and decentralised” governance structures could “shield initiatives such as the mRNA programme from the risks and constraints posed by dominant market actors”. 

This decentralized structure could involve “representatives from participating LMICs capable of steering the programme’s R&D towards local population” in the overall governance and day-to-day decision-making., they argue.

“Second, multiple actors would need to serve as regional mRNA hubs – as originally planned – in order to mitigate the risk that one organization’s failure (or acquisition by an outside actor) might compromise the programme as a whole,” they argue.

“Instead, WHO and MPP internalised programme decision-making within two hand-picked committees [the “Scientific and Technical Review Committee and the mRNA Scientific Advisory Committee], leaned on private actors like Afrigen to play crucial roles, preserved their discretion about what projects and partnerships to pursue, and limited input from LMIC governments and civil society during the programme’s first two-plus years of operation,” they note.

“It remains to be seen whether MPP, which has ascended in the sphere of global health during the pandemic as a result of its role as the central power broker for the entire mRNA programme, will over time cede some of its control and take the steps necessary to truly empower LMIC manufacturers,” they observe.

Health Policy Watch will publish an interview with the Medicines Patent Pool responding to these findings shortly.

Image Credits: WHO, WHO, Kerry Cullinan.

WHO Director-General Dr Tedros Adhanom Ghebreyesus, (left) and Dr Vanessa Kerry, CEO of the health non-profit Seed Global Health (middle) in conversation with Ravi Agrawal, editor-in-chief of Foreign Policy (right).

Specific health actions need to be included in countries’ climate targets – officially called the Nationally Determined Contributions (NDCs) – according to several health advocates speaking at the UN Climate Week in New York City over the past week.

“Our agenda should be health-centric,” said Dr Tedros Adhanom Ghebreyesus, Director General of the World Health Organization (WHO), speaking on the sidelines of the annual UN General Assembly.

“We need to use the resources wisely, meaning targeting those populations, affected populations and then from there of course you can move to the rest because resources are limited,” Tedros said.

The demand for a holistic view in framing NDCs to ensure a “healthy and stable future” in was also reiterated in a signed letter by 20 leading civil society organizations and sent to officials at the UN Framework Convention on Climate Change (UNFCC), the entity supporting global response to climate change.

The rise in extreme weather events, such as heatwaves and floods, are directly impacting health and healthcare facilities. 

Dr Vanessa Kerry, CEO of the health non-profit Seed Global Health, called for health to be “embedded in the NDCs”. 

“We need to have health metrics, and we need to stop thinking about it as a sunk cost, but rather as an investment,” Kerry said. 

Centering health at COP

This decade, health has already gone from being a side note at the annual UN Climate Conference of Parties (COP) to having a day dedicated to the subject at the last COP in Dubai, United Arab Emirates (UAE). 

Both the Baku (Azerbaijan) COP presidency, which will  host this year and the Belém (Brazil) COP presidency, which will host next year, said that they aim to integrate health into climate conversations further.  

“Brazil was hit this year with the biggest dengue epidemic for ever, and this was the very consequence of the climate change and the high temperature that we are facing in Brazil and in all of the world,” said Ethel Maciel, Brazil’s Secretary of Health Surveillance and Environment.

She added that health equity will be a major focus and that Brazil has appointed a specific coordinator to work on the link between climate change and health equity.

The speed and extent of action though rely also on resources. For instance, the UAE recognized that having the resources and universal health coverage helps as they have the building blocks for what you need to be healthy. 

“We would say, for the nationally determined contributions, please embed [and] institutionalize targets for health in there, be they things like the impact of air pollution on health, be they heat stroke, be they mental health issues, number of events prevented. Whatever they are, please institutionalize certain metrics of health inside your nationally determined contributions,” urged Prof Maha Taysir Barakat, Assistant Minister for Health and Life Sciences in the UAE Ministry of Foreign Affairs. 

Prof Maha Taysir Barakat, Assistant Minister for Health and Life Sciences in the UAE Ministry of Foreign Affairs

Dr Maria Neira, WHO’s director of Environment, Climate Change and Health, drew attention to the fact that access to renewable energy will improve health by reducing air pollution.  

“So now we need to use health as a motivation. The health argument that we are taking to the COPs has to be extremely strong, and we are the ones that needs to engage,” she said, referring to the health sector.  

Working with cities for impact

It has become clear over the years that national governments are slow to move on climate targets. In addition, when it comes to the climate and health link, a range of stakeholders are needed for effective response. 

The Baku COP Presidency has an initiative on climate resilient cities of which health will be a big part. 

Patty O’Hayer, global head of corporate affairs at Reckitt, said that city mayors need to be supported to bring out change as they have a unique perspective and don’t work in silos. 

“Cities give you that kind of umbrella way that you can look at all of those aspects and make sure that you’re spending your time, your effort, your energy around the social determinants of health, decarbonizing the health care systems and thinking about public health in a much more holistic way,” she said. 

 

 

UN High Level Meeting, presided over by heads of FAO and UNEP (far left), and WHO WOAH (right), approves new declaration to fight AMR.

A UN High Level Meeting on Antimicrobial Resistance (AMR) pledged to reduce by 10% deaths from drug resistant bacteria over the next six years in a new declaration on the “silent, slow-motion pandemic” that could kill some 39 million more people by 2050.

Thursday’s milestone statement, the first on the topic since 2016, also pledges to raise $100 million to fund the updating of countries’ AMR action plans and their implementation. 

It also formalizes the standing of the Quadripartite secretariat made up of the World Health Organization (WHO), UN Environment (UNEP), the Food and Agriculture Organization (FAO), and the World Organization of Animal Health (WOAH), as the body coordinating global AMR response across the human, animal and environmental sectors.  

 Step forward despite no target for reducing animal antibiotic use

Mia Mottley, Prime Minister Barbados, at press briefing on on AMR threat before the HLM session.

The final draft of the declaration failed to include an earlier target to reduce the animal use of antibiotics by 30% by 2030, due to pressure from meat-producing nations and the farm industry. 

This, critics say, remains a serious shortcoming in the final draft as livestock use comprises as much as 73% of global sales of a range of antimicrobial agents (including antibiotics, antivirals and antiparasitics). 

Even so, the initiative was hailed as a major step forward in spurring more action on trends that few governments have fully recognized until very recently. 

“This declaration.. is an impressive blueprint for action,” declared Barbados Prime Minister Mia Mottley, who has become a global leader and advocate on AMR. 

“But the truth is the hard work starts tomorrow,” she said. “We’ve set a very, very modest target of $100 million [for national plans of action] and I hope that we can reach out to the leaders within the private sector, the pharmaceutical industries, the meat industries, all of the various players. 

“Because, as I’ve said very often with climate, unless they have a plan to live on a different planet, then we have to define the win-win solution for us all.”

No country is immune

WHO Director General Dr Tedros Adhanom Ghebreyesus at the UN High Level Meeting on AMR.

 “No country is immune to this threat, but low and middle income countries bear the greatest burden,” WHO Director General Dr Tedros Adhanom Ghebreyesus warned in his remarks.

“The threat of AMR cuts across the health of humans, animals, agriculture and our environment, and so must its solutions,” Tedros added.  “That’s why WHO, FAO and UNEP are working together closely with the World Organization for Animal Health (WOAH) in a One Health approach.” 

While 90% of countries have developed AMR action plans, only 11% of countries have allocated budgets to implement those plans, he said. 

As next steps, Tedros said that WHO and other members of the Quadrapartite would set up an independent science panel to produce a major report synthesizing evidence for more action on AMR by 2025.  WHO would also update its decade old global strategy on AMR by 2026. 

Deaths from superbugs 

New drug resistant bacterial strains are emerging more and more rapidly after the introduction of new antibiotics: WHO

Drug resistant bacteria are estimated to have killed an estimated 1.14 million people in 2021, and were somehow associated with the deaths of 4.71 million people, according to estimates published in The Lancet in mid-September. 

In the declaration, countries committed to reducing annual AMR deaths by 10% using a 2019 baseline level of mortality. In that year, 1.27 million deaths were attributed to drug resistant bacteria while 4.95 million deaths were somehow associated with drug resistant infections.  

Should global efforts to curb AMR fail, drug resistant pathogens could become the number one cause of death by 2050, warned Mottley at a press briefing just ahead of the High Level Meeting.

That would mean just going to the dentist, or getting cut doing garden work could lead to life threatening infections for some people “purely because of the ineffectiveness of the antibiotics,” Mottley warned.

“This, therefore, is a press conference not for us with grey hairs, so much, but for the young people in the world because they are the ones who will have to face the possible threat of a reversal of a century of medical progress in what we dub the ‘silent, slow motion pandemic,'” Mottley said.

Even so, AMR has already hit millions of families in the world, including her own, with tragic results, she added: “When I started this journey, I didn’t know it would become personal for me and my family, and I pray that no family has to experience what we did with respect to the loss of someone purely because of the ineffectiveness of antibiotics to be able to deal with infection.”

Four pronged assault – priorities for health and environmental sector 

The declaration outlines a four-part strategy to combat AMR. It calls for more careful use of antimicrobial agents in healthcare, farming, and animal sectors, alongside improved management of untreated sewage and hospital emissions. These emissions create environments where microbes from urine and feces can mutate and develop resistance to antibiotics, which are also released by hospitals and communities.

There is an urgent need for new antibiotics in many classes – and too few products in R&D.

Tedros, Mottley and others also called out the alarming dearth of new antimicrobials in the product pipeline. 

The number of pharma firms working on new antibiotics has declined substantially since 2000 due to the perception that there is little profitability in producing new products that can’t be used in large volumes, precisely because that may foster a spiral of new resistance risks.  

Mottley said that antibiotics should be recognized as a “global public good” with “dedicated financing”’ that goes beyond commercial investments.  

“I hope, therefore, that the World Bank in the general discussion as to its own reform and its movement towards the finance of global public goods and the guardian of global public commons, will be able to see appreciable progress in its reform efforts, so that this can be one of the early beneficiaries…  because…, this is as much an existential crisis.” 

Tackling fake medicines, sewage discharge and hospital emissions

Inger Andersen, United Nations Environment Programme at the UN High Level Meeting.

Tackling fake and substandard medicines, which can also lead to emergent resistance, is another huge priority cited in the declaration. And along with reducing overuse of antibiotics at risk of becoming impotent, as per WHO’s AWaRe classifications, there is a need to improve access to the right antibiotic formulations in low- and middle-income countries, where many more people still die from lack of any access whatsoever, Tedros emphasized. 

Moreover, some 56% of sewage effluent discharged is untreated, leaving cesspools of pathogens to breed and develop in lakes, rivers and aquifers of developing countries, in particular, pointed out Inger Andersen, Executive Director of the UN Environment Programme. 

Prevention is key to stop antimicrobials from leaking into our environment from municipal wastewater, from municipal waste, as well as wastewater from pharmaceutical production, hospitals, and farms that over use and intensify crop production sprayed with antimicrobials, Andersen added.  

“The pharmaceutical sector can strengthen inspection systems, change incentives and importantly, we can change subsidies and ensure adequate waste and waste management containment,” Andersen said. 

“The food and agriculture sector can take preventive action to limit the use of antimicrobials and to reduce the discharge from crops and terrestrial and aquatic, marine and animal and fish production facilities and the healthcare sector can improve access to high quality, hospital-specific wastewater treatment systems.

“This will take political determination, she stressed. “This will take leadership. These actions and more must be backed at the highest level, with policies, with laws and with regulations to reduce effluent releases.”

Animal use remains ‘elephant’ in AMR arena

Most of the world’s antibiotics sold are consumed by livestock not people – where they are often use as growth promoters or to prevent, rather than treat, infections.

But in terms of sheer volumes of use, antimicrobial use in the livestock sector remains one of the biggest threats to curbing AMR trends. It is estimated that some 73% of antimicrobials sold globally are used in livestock production, including continued use of antibiotics as growth agents in many nations.

Dropping the 30% target for their reduction significantly weakens the armory of the new declaration, observers said. 

“The AMR political declaration heralds a major shift in the global health response for AMR notably with the inclusion of commitment for targets and accountability including the recognition of the Quadripartite Joint Secretariat as the central coordinating mechanism as well as the call to establish an Independent Panel” said Dr Haileyesus Getahun, CEO of the South-South HeDPAC partnership. He led the foundation of the Quadripartite Secretariat, and served as its first director, in a previous role at WHO. 

“But it is very disappointing to see that the Muscat Manifesto targets on the 30% reduction of antimicrobial use in animals is not included, despite endorsement by 47 countries, ” he added, referring to a November 2022 declaration issued at the end of a High-Level Ministerial Conference on AMR hosted by the Sultanate of Oman in Muscat as part of the lead-up to the 2024 UN High Level Meeting. 

“Commitment for the targets would have galvanised county-level action not only to strengthen the animal health system but also the research and development for alternatives to antimicrobials,” Getahun said.

“It is unfortunate that there was a major push back by the animal food industry who were able to influence some member states and even divide the Quadripartite organizations on this very topic.”

WOAH cites its plans for action in animal sector

Emmanuelle Soubeyran, WOAH Director General, speaking at the UN HLM.

There is, however, increasing recognition that overuse of antibiotics and other antimicrobials also represents an economic threat to the meat and dairy industry as the drugs will also become less effective in animal populations, asserted new WOAH Director General, Emmanuelle Soubeyran, at the HLM meeting.

“Drug resistant pathogens could jeopardize food security for over two billion people globally, more specifically on livestock, if no action is taken,” she said. 

“The impacts of AMR on livestock could reduce global GDP by $40 billion per year,” she said.  “But achieving a global 30% reduction in animal antimicrobial use within five years can raise [global] GDP in 2050 by €14 billion. 

“Thus, the World Organization for Animal Health welcomes the political declaration in alliance with our four priorities.”

Improving access to animal vaccination as an alternative to antimicrobials

Soubeyran said that improving access to animal vaccinations for vaccine-preventable diseases can reduce unnecessary use of antimicrobials. 

“We welcome your commitment to define animal vaccination strategies with clear implementation plans… and we’ll update the priority list of diseases of which vaccines could reduce antimicrobial use.”

At the same time, she admitted that the animal sector needs to do more to reduce its use of drugs deemed by the WHO to be “highest priority” for use in human health – and not animals. 

“The use in animals of highest priority antimicrobials to human health has been globally reduced to 16%,” she said.  “Regulation, awareness campaign, trainings, and public private partnerships have allowed such developments. 

“But we strongly encourage all of you, all of our members, to accelerate along this line. So, the important gaps still observed in the compliance with our international standards are closed.”

Economic carrot and stick

Since 2015, WOAH has seen the number of countries reporting quantitative data on antimicrobial use in animals increase three-fold, with 130 member states [of 183] now reporting, she added at a press briefing just before the HLM.

At the same time, the Paris-based WOAH, unlike FAO, WHO and UNEP, is not a UN-affiliated agency. Member states’ reports of their antimicrobial use are voluntary and not made public, leaving researchers to cull regional and country data from surveillance data on international drug sales in the animal health market. 

For instance, a  2019 WOAH report on trends in use of antibiotics as growth promoters, showed a decline in the practice. But not all 183 member states report data, and WOAH does not name the 45 countries that did report but continue antibiotic use for growth promotion.  

Among countries that continue to use antibiotics as growth promoters, the overall use of antibiotics is much higher overall, without much regard for risks, Soubeyran acknowledged. 

“Some 76% of WOAH members still using antimicrobials as growth promoters have not carried out a risk assessment … and countries using antimicrobials for growth promotion in livestock have an estimated average of 45% higher antimicrobial use than countries that do not use growth promoters.” 

Despite the resistance to change, emerging new economic data showing how antimicrobial abuse in livestock could lead to big economic losses over time, while judicious use will yield economic benefits, could begin to make a difference to the industry and policy makers. 

 “It is something very important to say to the sector,” she said. 

Image Credits: Yvan Hutin/WHO, IFPMA, Flickr: Paul van de Velde.

Nearly 4.1 billion people, roughly half the planet’s population, experienced unusually hot temperatures between June and August, in what was Earth’s hottest season on record.

Climate change made these high temperatures three times more likely, according to the latest report by Climate Central, a US-based non-profit of scientists and science communicators that conducts research on climate change.  

The average person experienced 17 extra days of risky heat because of climate change during this period. Risky heat days are when temperatures are hotter than 90% of the temperatures recorded in a local area from 1991-2020. Heat-related health risks rise when temperatures climb above this local threshold.

The report looked at 22 regions across 218 countries and territories using the Climate Shift Index (CSI), a metric developed by Climate Central and launched in 2022, that quantifies the influence of climate change on daily temperatures.
The report is among the growing pieces of evidence on the deadly impact of heat. In July this year UN Secretary-General António Guterres called on countries to act on heat by protecting vulnerable populations and by investing in early warning systems. 

The health impacts of climate change have also been discussed at the ongoing climate week in New York as well as the United Nations General Assembly.

Hottest season on record

The effects of human-induced climate change, mainly from burning fossil fuels, were evident in all regions of the world in the form of extreme heat, climate scientists found.  

The heat was so bad that one in four people on the planet had no break from climate change-driven heat. On every day in June, July, and August, they experienced unusually warm temperatures made at least three times more likely by climate change. 

Global exposure peaked on 13 August, by which time 4.1 billion people or roughly half (50%) of all people worldwide experienced unusual heat at CSI level 3 or higher.

Over two billion people or 25% of the global population experienced 30 or more days of risky heat that were made at least three times more likely by climate change. 

This heat can worsen underlying illnesses including cardiovascular disease, diabetes, mental health, asthma, and can increase the risk of accidents and transmission of some infectious diseases, according to the World Health Organization (WHO).  
Heavy rainfall, deadly floods and storms, and raging wildfires were also exacerbated during this period. 

Global phenomenon

The areas affected by deadly heat were spread around the world. This included nearly the entire population of the Caribbean and at least three in every four people in Western Asia, Micronesia, Northern Africa, and Southern Europe. 

As many as 72 countries, home to more than 2.3 billion people, experienced their hottest June–August period since at 1970. The average person in these countries experienced a very strong influence of climate change on 34 of the 92 total days from June-August.

Around 180 cities in the Northern Hemisphere where June to August were the summer months had at least one dangerous extreme heatwave. Heatwaves were calculated as a place having at least five consecutive days with temperatures hotter than 99% of temperatures recorded in that city from 1991-2020.

Across these 180 cities, extreme heat waves of this intensity and duration are, on average, 21 times more likely today because of human-caused climate change, the report found. 

Influence of climate change 

The report did not just look at the heat extremes but also the influence of climate change.

Of the 22 regions analyzed, the highest regional average temperature anomalies were in Eastern Europe. The region experienced temperatures 1.9°C above normal, and 14 days with temperatures very strongly influenced by climate change.

Western Asia, Southern Europe, Northern Africa and Eastern Asia were other regions that saw temperatures significantly above normal for several days.

WHO and the World Meteorological Organization (WMO) are already working together to draw attention and respond to the health impacts of heat on human health. 

Guterres has reiterated the call for limiting temperature rise to 1.5°C by phasing out fossil fuels and scaling up investment in renewable energy to prevent further heat escalation. 

Image Credits: Dikaseva/ Unsplash.

European Health Forum underway in Bad Hofgastein, Austria.

BAD HOFGASTEIN, Austria — Declining health is driving more citizens to support far-right, populist parties and reducing overall participation in the democratic process, according to a new review of studies from a World Health Organization-backed (WHO) think tank.

The report, released Wednesday by the European Observatory on Health Systems and Policies, analyzed 97 studies at the intersection of health, democracy and populism. 

“There are two findings. One of them is that ill health reduces political participation. The other, possibly more shocking, is that ill health leads to a substantially larger likelihood that you’re going to vote for whatever your local populist radical right party is,” said Scott Greer, lead author of the report and professor of Global Health Management and Policy at the University of Michigan.

Europeans who report worse health have much lower trust in political actors and lower satisfaction with democratic and health institutions

Europe faces a perfect storm of health challenges that could shake its political foundations, the study warns. An ageing population, rising chronic illness rates, and COVID-19’s after-effects combine with looming threats from climate change, conflict-driven migration, and widening income gaps. 

These pressures have exposed weaknesses in health systems and put health at the center of the European political battleground for the foreseeable future, with over half of Europeans saying health is their top political priority, according to Comission data.

“The stakes if you’re an elected politician are really high,” Greer said. 

The report found that people in poor health are significantly less likely to vote, often by margins of 10 to 20 percentage points compared to healthier individuals. This trend has been documented across Europe, the United States, and Canada.

When those in poor health do vote, they are primarily supporting far-right populist parties. Greer pointed to the 2016 Brexit referendum as an example of how health issues can influence major political outcomes. 

“Moving from self-reported fair to poor health makes you about 16-20% more likely to vote for the populist radical right,” Greer explained. “It is mathematically possible that the number of people in the United Kingdom whose health state deteriorated as a fairly clear consequence of the Cameron government’s austerity budgets and who therefore voted for Brexit is larger than the Brexit victory margin.” 

Scott Greer, lead author of the report and professor of Global Health Management and Policy at the University of Michigan

Protecting health, rebuilding trust in democracy

“Policies that protect health and ability are not only essential to preserving the economic and social well-being of Europe – but they may also be essential to rebuilding trust in democracy and democratic institutions,” the authors state.

While the study focuses on how health influences political behaviour, experts caution that the relationship between health and politics is complex and potentially bidirectional. For instance, research has shown that political affiliations can influence health behaviors, from Trump supporters frequently rejecting COVID-19 precautions in the United States to Labour supporters in the United Kingdom more likely to smoke. 

Untangling the causal relationships between health, socioeconomic factors, and political preferences presents significant challenges. However, the authors argue that the mounting evidence is compelling enough to warrant serious attention from policymakers.

“To be clear, population health is unlikely to be the primary driver of the rise in anti-democratic politics,” the authors explain. “Even so, the connection between the two highlights an important shortcoming in the performance of democratic institutions: people in poor health have systematically low trust in their health systems and governments.” 

Mistrust in political actors and dissatisfaction with democratic and health institutions are widespread throughout Europe

The shift towards populism marks a dramatic change from historical patterns. Until recently, people in poorer health typically favored left-leaning parties that supported greater health and social protections. However, the rise of right-wing populist movements has provided a new outlet for voters frustrated with existing institutions.

“Why does becoming seriously sick seem to lead to this change in political behaviour? The answer is trust,” Greer said. “People whose health status gets worse tend to lose trust in the healthcare system, the political system, the elements of society at large, and they tend to lose a sense of agency.”

This loss of trust appears to be driving support for parties that promise to reshape what they describe as a “failing” political establishment, even when these parties often oppose public health measures.

The study cites examples such as the National Rally in France, the Alternative for Germany (AfD), and Vox in Spain as typical European populist parties that have attracted support from voters in poor health.

Historical data identified in the report suggests this is not a unique phenomenon. German communities with worsening mortality in the 1930s became more supportive of the Nazi Party, while Italian cities hit harder by the 1918 influenza pandemic showed greater support for the Fascist Party in the 1924 election.

“Governments are moving through uncharted waters, facing new crises that threaten both health and the long-standing political order,” the report states. “A better understanding of the interplay between these forces and their impact on political thought and action can help policy-makers protect not only the health of populations but also democratic institutions.” 

If we aren’t fixing health – why expect votes? 

Clemens Martin Auer, President of European Health Forum Gastein

Minutes before the new data was presented, Clemens Martin Auer, President of the European Health Forum Gastein, challenged the health policy experts in attendance: Does anyone believe our system is properly addressing the impending crises of health workforce shortages? 

No hands were raised. 

“The healthcare sector has to be clear that it contributes to populism,” Martin Auer said. “Stop just talking about problems without operationally solving them… … just wait until they throw our incompetence to solve health problems to delegitimise democratic legitimacy.” 

Martin Auer didn’t mince words at a closed-door presser earlier Wednesday either. Populism, in his view, isn’t just about finger-pointing. EU citizens keep flagging health as their top concern and demanding reform in the sector. And when they don’t see the changes they’re after? Well, their ballots are doing the talking.

“We have to act, we have to make people not vote for populists, and we have to act in these areas where people are affected by health policy measures,” Martin Auer said. “Every single person is affected by the healthcare sector. 

“If we don’t do anything, that is why people support populists.”

EU Health Commissioner controversy

Ursula von der Leyen outraged European health advocates and MEPs with her selection of Olivér Várhelyi to be the bloc’s next health commissioner. 

Meanwhile, Austrian Health Minister Johannes Rauch joined the chorus of European officials alarmed at the appointment of a far-right, EU-skeptic, Viktor Orban loyalist with no health experience to lead the bloc’s health policy for the next five years. 

“This is a very important department,” Rauch said on Wednesday, speaking at a closed-door press briefing at Gastein. “I am worried that if a representative of an EU-hostile government is appointed, this will lead to problems.” 

Olivér Várhelyi, Hungary’s nominee for EU commissioner, has faced fierce backlash from Brussels insiders since Commission Chief Ursula von der Leyen announced last week he would head Health and Animal Welfare in her next commission.

European Parliament members have ample reasons to oppose Várhelyi’s appointment as health commissioner – chief among these an incident last year when he was heard on a hot microphone calling MEPs “idiots.”

MEPs also remain furious at his unilateral declaration last year that the EU would cut off all aid to Palestinians, which he had no authority to do and was quickly overruled by Von der Leyen. His close ties to Israeli officials, including meeting with Prime Minister Benjamin Netanyahu and Defense Minister Noav Gallant after the International Criminal Court issued arrest warrants for their arrests for war crimes, have left MEPs worried he could impact EU assistance to Gazans. 

Former staff and Hungarian officials are also not fans of Várhelyi, variously describing him to Politico as “incredibly rude,” having an “appetite to humiliate,” and running his office in an environment of “emotional terror.” 

Várhelyi’s loyalty to Orban has also raised fears that, should he be appointed, no action at the EU level on abortion protections or reproductive rights will be possible during his mandate – a goal many states had hoped to advance. 

The complex European health portfolio handed to Várhelyi is set to include major files such as a complete revamp of EU pharmaceutical regulations, the European data space, and building a European Health Union, continuing efforts to combat cancer, and promoting preventive health,” von der Leyen said.

Várhelyi is also viewed in some MEP circles as being friendly to pharmaceutical interests given his three years as the leader of the EU’s intellectual property rights division from 2008 to 2011 – a potential conflict of interest given that, as Commissioner, he would oversee the reworking of pharmaceutical regulations. 

His appointed has to be agreed to by the European Parliament’s environment and health committee, and there is widespread expectation that he is unlikely to get past the MEPs represented there. 

But if he does, some solace can be found in that he is not the only Commissioner with power to influence health given the EU’s labyrinthine structure.

Health-related responsibilities will be spread across several portfolios. Commissioners from Spain and Romania will share oversight of certain health tasks, while a Belgian representative will focus on emergency preparedness and medical supplies. Meanwhile, France’s nominee to the Industrial Strategy role is set to spearhead efforts in biotechnology and pharmaceutical policy development.

Image Credits: European Commission.

Geneva Graduate Institute panellists David Evans, Erika Placella, Nathan Sussman (chair) and Alegnta Gebreyesus.

Financing for public health is dwindling in many countries, sapped by COVID-related economic difficulties, debt repayment and “poly crises” such as climate and conflict. 

“In the current economic conditions, the only way [some countries can spend more on health] when their overall government spending is going down, is to give more priority to health in government budgets,” said David Evans, visiting professor in interdisciplinary programmes at the Geneva Graduate Institute (GGI) told a recent event on health financing organised by the institute.

But, Evans warned: “Historically, when your government expenditure is falling, giving more priority to health is often very politically difficult. It doesn’t happen very often.”

“Some of you are involved in the push to have more money for pandemic preparedness and response. It’s very worthy, but if the budget is going down, where is that money going to come from?” asked Evans, who described competition between different urgent needs as a “zero-sum game”.

Development assistance for health in 2021

However, he said there was much diversity within low-income countries and middle-income countries, with some facing economic contraction or stagnation while others were progressing.

“It might be time to think about changing the criteria under which countries get development assistance.”

Evans also identified some opportunities including debt restructuring, special drawing rights at the International Monetary Fund (IMF) and the reform of international financial institutions to direct more money to countries most affected by economic crisis.

Development Assistance for Health: challenges and opportunities.

Seeking complementarity

Erika Placella, head of health at the Swiss Agency for Development and Cooperation (SDC), agreed that the “competition for replenishment” with a “proliferation of funds and the fragmentation of initiatives” was “a zero-sum game”.

“In this zero-sum game, there is a race to find the smallest comparative advantage and the sexiest narrative,” said Placella.

Every international negotiation forum and resolution calls for a dedicated fund and new global health instruments are also being introduced, she added.

“So it is a very fragmented landscape, [and] it’s very difficult to navigate it.”

SDC was pushing for “complementarity” at a global level, said Placella.

“I’m going to take off with the pandemic preparedness and response from the Swiss government. First of all, instead of supporting new ventures and new narratives and new funds, we tried to adapt the mandate of existing organizations to the current context and needs and to promote complementarity. 

“A lot of our partners already had pandemic prevention, preparedness and response (PPR) functions, but in our narrative, it was not understood as such,” she said.

Organisations such as UNAIDS, the Global Fund and FIND include PPR, she noted.

“So we are trying to leverage and to build on what partners were already contributing to in the PPR space, instead of further fragmenting the financing landscape.”

The Swiss government’s health funding uses “many instruments to support health”, including global and thematic work supported through large health organisations including the World Health Organization (WHO) as well as bilateral cooperation.

These different avenues are important to address bottlenecks, she added.

“We also take a systematic approach to avoid further fragmentation. For example with mpox, we are supporting strengthening the primary health care services to include sexual reproductive health services.”

Ethiopia’s dependence

Ethiopian health diplomat Alegnta Gebreyesus said that almost half of her country’s health expenditure depends on overseas development assistance (ODA) so the funding crunch could impact on all aspects of health.

To mitigate this, Ethiopia is discussing setting up a health fund – “a sort of basket fund” which will cover a range of key health issues, with government matching donor investment in some of these.

The fund “would cater for resilience, health system strengthening, equity and, of course, preparedness for pandemics,” she added.

But high prices for medicines, vaccines and other medical commodities can only be addressed by building “a conducive environment for sustainable local manufacturing” at country and regional level – covering research and development, supply chain and logistics, the regulatory system, technology transfer and know-how.

Joyce Ng’ang’a, senior policy advisor at WACI Health.

Kenyan Joyce Ng’ang’a, senior policy advisor at WACI Health, a Nairobi-based health advocacy organisation, said the current global health landscape is already in a poly crisis involving pandemics (COVD-19 and now mpox), food shortages and climate change. 

“We need to make health a priority. We need to make health a political agenda. I believe that there is enough money in the world to fund health and to replenish the global health institutions,” said Ng’ang’a.

“As civil societies and communities, we refuse to accept that there’s not enough money to fund systemic issues for health,” she said, calling for a health approach that started by tackling the social determinants of health.

“By the time cases are coming to the health facility or hospital, the community health system has failed because there should have been preventive and promotive care at community level.

“Most LMICs now have a deliberate strategy on community health and how health is structured, and at the basic unit is the primary level, which is a prevention and health promotion.”

The ECDC chief said the move is part of a broader strategy to increase global public health cooperation before the next pandemic.

The European Centre for Disease Prevention and Control (ECDC) will sign an official memorandum of understanding with its Japanese counterpart next month, the director of Europe’s largest public health agency announced Wednesday.

“Next month I will sign a cooperation agreement with the Japanese Center for Disease Control,” said Pamela Rendi-Wagner, who took over the agency in June.

Her remarks came at a closed-door press briefing on pandemic preparedness at the European Health Forum in Gastein, Austria. She said the deal was part of a wider European effort to expand global cooperation within and outside the EU to better prepare for future pandemics.

“Scientists [globally] need to understand each other before the crisis, not during the crisis,” Rendi-Wagner said. “We learned our lessons from the pandemic.”

The ECDC chief added that the agency has deepened its ties with many other centres for disease control globally since the COVID-19 pandemic, including a four-year partnership with Africa CDC signed in 2021 with financial support from the European Commission.

The memorandum of understanding with Japan will add the country to a list of CDCs that have signed such agreements with the European agency, including those in the United States, China, Mexico, the United Kingdom and South Korea.

ECDC collaborators without official agreements include regional CDCs in Africa, the Caribbean and Gulf states, as well as Israel, Singapore, Thailand and Australia.

In her closing remarks, the ECDC chief warned global public health authorities that the window to prepare for the next pandemic “will close” and urged immediate action.

“Only joint and cooperative preparedness will allow us to cope with pandemics in the future,” Rendi-Wagner said.

Image Credits: ECDC.

Clinician monitors telehealth platform
A clinician monitors a Pan-American Health Organization-developed telehealth platform in Trinidad and Tobago.

Investing in as little as $0.24 per patient per year in digital health interventions – telemedicine, mobile messaging, and chatbots – could significantly lower the burden of non-communicable diseases (NCDs), says a new report from the World Health Organization (WHO) and the International Telecommunication Union (UTI). These interventions could avert 2 million deaths and 7 million acute events and hospitalizations over the next decade. 

The report comes as the United Nations General Assembly meets in New York City this week. 

Non-communicable diseases cause 74% of all deaths globally and are on track to cost $30 trillion in lost productivity by 2030. 

The newly released publication highlights the promise of digital health interventions in tackling this growing crisis, especially through expanded healthcare access. Behavioral choices fuel many NCDs, says the report, and digital health could enable individuals to “take control of their own health and well-being” through personalized health content delivery.

Digital health interventions proved to be powerful tools in managing NCDs during the COVID-19 pandemic, from electronic vaccine passes to telemedicine, but the report warns that the rollout of these technologies requires widespread access, and guardrails to protect patient data. 

“The future of health is digital,” said WHO director-general Tedros Adhanom Ghebreyesus and Doreen Bogdan Martin, ITU secretary-general in a statement. “We must work together to promote universal access to these innovations and prevent them from becoming another driver of inequality. While the new technologies hold great potential, strong governance, ethics, digital skills and equity are essential to realize their potential and to avoid risks such as unethical data collection and biases encoded in artificial intelligence.”

Chat bots, telemedicine, online counseling could “close gap” of NCD care

Digital health benefits for NCDs
Th report found that up to 2 million lives could be saved in the next decade if countries invest in less than 25 cents per patient yearly.

Chronic conditions typically require long-term management, which is often unavailable at primary health care level in many low- and middle-income countries. 

So digital health solutions “can help patients to track their symptoms, manage their medications and monitor their progress over time,” the WHO report notes.

Patients, healthcare providers, and the public can use these tools for diagnosis, treatment and management and for disease prevention through diet and  lifestyle interventions. 

Digital health interventions span a host of technologies, including: online programs for patient education; mobile apps, virtual reality, and other telehealth and telemedicine technologies for rapid diagnosis and treatment; connected and wearable devices for monitoring health conditions; as well as online peer support and counseling. Meanwhile, the health sector is incorporating artificial intelligence and big data-enabled apps to diagnose, monitor, and support NCDs. 

“The digital revolution has the potential to unleash a health revolution,” said Bogdan-Martin at the report release, on the margins of the UN General Assembly’s Summit for the Future in New York City. 

Digital tools can support individuals in understanding their risk factors for NCDs, WHO said in a statement. “Four major risk factors linked to our everyday environment – tobacco use, unhealthy diet, the harmful use of alcohol and physical inactivity – drive responses in our bodies that also increase NCD risk: raised blood pressure, obesity, raised blood glucose and raised cholesterol.” 

Mental health conditions – prevention and treatment

The report warns that in addition to NCDs, mental health conditions present a looming concern – and one that is in dire need of more healthcare coverage, including through digital solutions. In 2019 alone, nearly a billion people lived with a mental disorder, of whom only a “fraction” received care. These conditions account for the largest proportion of years lived with disability, and lead to a higher risk of premature death. 

With expanded healthcare delivery options, argues the report, people with mental health conditions are more likely to seek timely care. For a person living with dementia, for example, a service like mobile messaging with a doctor provides discreet access to support. 

These measures can continue to optimize health service delivery and influence health-related behavior, especially when it comes to preventing and managing NCDs, says the report.

COVID-19 pandemic shed light on digital health potential

digital health strategies for NCDs
Digital health can help prevent non-communicable diseases through education, monitoring, and increased access to care.

With healthcare systems disrupted during the COVID-19 pandemic, many providers switched to offering digital services when possible. Health systems quickly turned to online counseling, telemedicine, and digital vaccine records to continue providing care.

“Although interest in digital health grew during and after the pandemic, few solutions have scaled successfully,”  Alexey Kulikov, deputy head of secretariat for the UN NCD Task Force, told Health Policy Watch. “A key challenge has been the use of siloed, monolithic systems that lack integration with broader digital infrastructure, making them hard to manage. The report promotes ‘smart’ investments in digital health, emphasizing a whole-of-government, collaborative approach that focuses on interoperability and cross-sector integration for long-term success.”

Now, for patients in rural or underserved areas, the benefits of digital health measures means telemedicine is here to stay to overcome the barriers to accessing health care, including geographical distance, transport and cost.  “Additionally, digital health contributes to environmental sustainability by reducing the need for travel through
telemedicine and virtual care, thereby lowering healthcare’s carbon footprint,” noted Kulikov.

While significant progress has been made in combating NCDs, the integration of digital health technologies into mainstream health systems remains a “challenge,” the WHO said in a statement. For countries still developing internet infrastructure, digital health programs must first overcome internet access issues, and begin developing digital health strategies. 

Only 60% of countries have such a strategy, and many are slow to integrate new technologies into existing health infrastructure, the WHO notes. Which is why the report highlights the urgency for country-level investments in digital infrastructure.  

“We call for greater collaboration between the health and tech sectors, including the development of strong digital public infrastructure, essential for the delivery of digital health services that can benefit people everywhere without leaving anyone behind,” said Bodgan-Martin.

Image Credits: PAHO, WHO , WHO.

Over 130 United Nations member states convened in New York City Sunday and Monday for a long-anticipated Summit of the Future  that aimed to press the “reset button” on stalled global development goals and polarized geopolitical debate.

The event, held  just ahead of the annual debate in the U.N. General Assembly, kicked off with the adoption of the “Pact for the Future,” alongside two key annexes: a “Global Digital Compact” and the “Declaration of Future Generations.”

The non-binding declarations cover the world’s most critical global issues, including: peace and security, sustainable development, climate change, digital cooperation, human rights, gender equality, and empowering youth and future generations.

The pact outlines 56 specific “actions” that member states need to take, underscoring the growing complexity of threats to global peace, highlighting the dangers of nuclear conflict, and confirming the core principles of the United Nations.

A central promise of the pact is accelerating progress on the 2030 Sustainable Development Goals (SDGs), which aspire to universal healthcare access, the eradication of extreme poverty and hunger, the promotion of gender equality, climate and environmental sustainability and the expansion of education worldwide.

“With so much dividing us and with so many wars going on, I think we can salute yesterday’s agreement and that we came together and be able to agree on ambitious targets,” said Norwegian Prime Minister Jonas Gahr Støre, speaking at Monday’s session.

“The pact for the future provides a vision for this across all the UN’s three main pillars that should be solutions… First, we have reaffirmed our commitment to international law, including human rights… Those who deliberately breach it must be held accountable.”

Address climate change and transform energy systems

“Second, we urgently need to address climate change, cut emissions, transform our energy systems and protect the environment,” he said, noting that addressing climate also requires increasing climate finance and investments and providing provide sufficient and timely debt relief to deeply indebted low- and middle-income countries.

The pact also calls for the global community to work towards an inclusive, open and secure digital future for all, he noted, pointing out that “some 2.6 billion people remain excluded from the digital world. For too many people also they lack access to electricity.”

Finally, he called for “preventive diplomacy and peace building” to be at the center of global efforts on sustainable development, including “a more transparent, inclusive and effective Security Council with great limitations to the use of veto,” as well as a greater presence of under-represented groups in global governance.

Is this pact a genuine path forward, or is it another lofty rhetoric exercise?

Despite the bright notes, many critics question the real-world impact the pact will have, in light of the world’s geopolitical polarization and stalled progress already seen on most SDGs.

“It was great to see people clapping for the new Pact, but the lagging SDGs problem is not one of planning but rather execution.  Let’s clap louder for results,” Peter Singer, a former top advisor to Director General Tedos Adhanom Ghebreyesus, told Health Policy Watch. “That means complementing SDGs with GSD (Getting Sh*t Done): better governance, scaling innovation, and translating data into delivery.”

Only 17% of the 2015 SDG targets are on track to reach the 2030 Goals, Singer pointed out in a blog published just ahead of the Summit.

“Rather than critically examine why the SDGs are off track and support countries to overcome these obstacles, the U.N. comes up with a new list of things it wants to accomplish,” Singer continued. “But if you failed to accomplish the last thing you promised and now do not critically examine the underlying reasons for that failure, why would anyone believe you could accomplish the next big thing?

“This is the same for health as it is for every SDG.  SDGs are fought and won in countries, but the UN can start by ‘cleaning its house from the inside out.’”

Guterres hails the pact as ‘step-change’

Defying the doubters, U.N. Secretary-General Antonio Guterres hailed the adoption of the Pact for the Future, at the start of the two-day summit as a “step-change towards more effective, inclusive, networked multilateralism.

“Excellencies, throughout my life, whether as an activist or at the United Nations, I have learned that people never agree on the past. To rebuild trust, we must start from the present and look toward the future,” Guterres said.

U.N. Secretary-General Antonio Guterres
U.N. Secretary-General Antonio Guterres

The pact, negotiated over the past nine months, represents the fruits of a dialogue launched in 2020 as the United Nations marked its 75th anniversary with a “global conversation” on people’s hopes and fears for the future. That dialogue set the stage for what would eventually become the Summit of the Future four years later.

Guterres had long championed the need for both the summit and the pact, emphasising that global crises have exposed the urgent necessity for U.N. reform and the transformation of international financial systems. These crises include ongoing conflicts in Russia/Ukraine, Israel/Gaza, and Sudan, insufficient progress on climate change, mounting national debt, and the unregulated rise of new technologies.

“I called for this Summit because 21st-century challenges require 21st-century solutions: frameworks that are networked and inclusive, drawing on the expertise of all humanity,” Guterres said in his opening speech on Sunday “Our world is heading off the rails, and we need tough decisions to get back on track.”

Specifically, he has called for major reforms to global institutions, including changes in the structure and rules governing the 15-member U.N. Security Council, where constant vetos by Russia, China and the United States of initiatives backed by rivals have progressively weakened the clout of the global body.  Guterres has also stressed the importance of redesigning multilateral finance and developing a system of global governance over the use of artificial intelligence.

Philemon Yang, President of the 79th U.N. General Assembly
Philemon Yang, President of the 79th U.N. General Assembly

Cameroon’s Philemon Yang, President of the 79th U.N. General Assembly, echoed these sentiments as he opened the event, saying, “We stand at a crossroads of global transformation, facing unprecedented challenges that demand urgent, collective action.” He continued, “The commitments embodied in the pact and its annexes reflect the collective will of member states. They must guide our actions to promote international peace and security, accelerate the sustainable development goals, foster just and inclusive societies, and ensure technologies serve the common good of humankind. We must move forward together in a spirit of solidarity and multilateral cooperation.”

Throughout the summit’s two days of speeches and presentations, delegates discussed the pressing need for a transformed United Nations capable of addressing today’s intertwined political, social, economic, and ecological crises. Key issues raised included failing to meet sustainable development and climate change goals, rising global military expenditures, and the need for debt relief to low-income nations that cannot afford to provide basic services.

Nearly half of the world’s population live in countries spending more on debt than health or education

“Our delivery and commitments made on sustainable development and climate change have been so much less than what was committed,” said Michael D. Higgins, President of Ireland. “The failure to achieve peace, eliminate acute global poverty, hunger or the consequences of climate change and biodiversity loss have been accompanied by a return to an arms race. Last year, global military expenditure increased by 6.8% to $2.44 billion, the highest ever recorded.”

Michael D. Higgins, President of Ireland
Michael D. Higgins, President of Ireland

Some 3.2 billion people live in nations that spend more on debt interest payments than on essential services like education and healthcare, Higgins added. Along with gaps in basic social services, the debt burden also leaves them with insufficient resources for making capital investments in the energy transition and sustainable development.

Charles Michel, President of the European Council
Charles Michel, President of the European Council

“We need to make our international financial architecture more effective and more inclusive,” agreed Charles Michel, President of the  European Council, the European Union’s governing body.

“Developing Countries need more private and public money now. We must also tackle that problem because we cannot accept that low- and middle-income countries must choose between fighting poverty and fighting climate change. They must do both, and we must support them to do both.”

Reforms in the UN Security Council

Kuwait, meanwhile, stressed the need for reforms to the U.N. Security Council, including fairer geographic distribution of Security Council membership.

Crown Prince of the State of Kuwait, Sabah Al-Khalid Al-Sabah
Crown Prince of the State of Kuwait, Sabah Al-Khalid Al-Sabah

“We agree with the Secretary General when he said that it is impossible to put the future for our children and grandchildren through an order or a system that was built by our forefathers without taking into account the future of young people,” said the Crown Prince of the State of Kuwait, Sabah Al-Khalid Al-Sabah.

“We are required today to work on introducing serious and practical changes to the global economic governance system, to networks of financial security, to international tax cooperation. We must reform multilateral development banks and address the problem of sovereign debts.”

Harnessing Technology

The challenges and opportunities presented by new technologies, particularly artificial intelligence, was another topic at the center of discussion.  Member states also stressed the importance of ensuring more equitable access to digital tools essential to education, healthcare, poverty alleviation and sustainable development.

“We believe that science and technology are foundations of a sustainable environment. Therefore, we are working on the digital transformation of our economy and providing an integrated and comprehensive database to support decision-making,” said Mohammed Shia’ Al Sudani, the Prime Minister of Iraq. This requires equitable access to AI tools and the capacity to benefit from AI and other digital technologies in a “responsible and moral way” he emphasized.

Jamaica's Prime Minister, Andrew Holness
Jamaica’s Prime Minister, Andrew Holness

Jamaica’s Prime Minister, Andrew Holness, expressed similar sentiments, adding that “admittedly, new technologies, such as artificial intelligence and robotics, create new challenges to security and some livelihoods. However, they also create important opportunities, especially for young people, and hold great potential to empower generations, transform economies, and solve complex challenges. So great is the potential, in fact, that we must emphasise the importance of international cooperation to address the challenges and harness the opportunities, especially for the benefit of people in developing countries.”

War and peace: Addressing ‘double standards’

The ongoing destruction of war in regional hotspots, particularly Ukraine and Gaza served as a grim backdrop to discussions.

garbage accumulates in gaza, raising risk of polio
Garbage accumulates in Gaza, contaminating water supplies and raising the risk of polio.

Kuwait’s Al-Sabah called for ‘universal adherence’ to international law and conventions, and the elimination of double standards. He pointed to the situation in Gaza as an example of the U.N. Security Council’s failure to prevent aggression and highlighted the damaging consequences of inconsistent enforcement of international law.

He further urged the international community to prioritise reforming global governance, and to establish a more inclusive, effective, transparent, and accountable Security Council.

Qatar, a key player in the Israel-Hamas negotiations over a ceasefire in exchange for a release of Israeli hostages still held by Hamas, also referred to the Gaza conflict, stressing that development cannot be achieved without solid peace, security, and stability foundations.

“Qatar maintains its efforts in mediation to prevent and resolve conflicts in a peaceful manner,” said Prime Minister Sheikh Mohammed bin Abdulrahman Al Thani.

“We reiterate our call to reach a ceasefire agreement and to release all hostages,” Al Thani said. “We call on the international community to take a clear and decisive stance against violations of international humanitarian law and human rights law.”

Japan, meanwhile, addressed the “increasingly dire situation” around nuclear disarmament and non-proliferation, nearly 80 years after American nuclear bombing raids on the Japanese cities of Hiroshima and Nagasaki.

“No matter how difficult the path to a world without nuclear weapons may be, we cannot stop our progress,” said Japan’s Prime Minister, Fumio Kishida.

Call to action on adolescent health

Another aspect of Summit emphasis was the future of the world’s youths. And related to that, WHO issued a call on the summit margins for greater attention to the mental, sexual and reproductive health of adolescents.

“Promoting and protecting the health and rights of young people is essential to building a better future for our world,” said Tedros in one of Monday’s breakout sessions, that saw the launch of a WHO report on adolescent health.

The WHO report found that least one in seven adolescents globally now suffer from a mental disorder; close to one in 10 teenagers is obese; and sexually transmitted infections are on the rise.

“Failing to address the health threats that adolescents face – some long-standing, some emerging – will not only have serious and life-threatening consequences for young people themselves but will create spiralling economic costs,” Tedros pointed out.

He condemned efforts to restrict young people’s access to sexual and reproductive healthcare, and sex education, which he said were a result of the recent pushback against gender equality and human rights in some countries and societies.

He emphasised that policies imposing strict age limits on young people’s access to vital reproductive health services, will only boomerang, leading to more HIV/AIDS and other sexually transmitted infections, as well as other spiraling health impacts on societies.

There are around 1.3 billion adolescents globally today – more than ever before.

“Adolescents are powerful and incredibly creative forces for good when they are able to shape the agenda for their wellbeing and their future,” said Rajat Khosla, executive director of the Partnership for Maternal, Newborn and Child Health, which co-hosted the launch of the WHO report. “Leaders must listen to what young people want and ensure they are active partners and decision-makers.”

Image Credits: Screenshot, UNRWA , Reproductive Health Supplies Coalition/ Unsplash.

The chairs of the One Health congress, Marietjie Venter and Misheck Mulumba, with a representative from Singapore, which hosted the last congress.

CAPE TOWN – Drug-resistant pathogens have been found in the Kuwaiti sea, soil and rivers in South Africa, Nigerian poultry, Ugandan pigs and numerous other sites, according to scientists at the eighth global One Health congress held in Cape Town over the past four days.

This evidence was presented on the eve of Thursday’s United Nations High-Level Meeting on Antimicrobial Resistance (AMR), where global leaders are due to adopt a political declaration aimed at addressing the alarming possibility that drug resistance will render many antibiotics useless in coming years – leaving humans vulnerable to death from common germs.

Around three-quarters of antibiotics are used on animals and AMR can only be addressed if urgent changes are made to agricultural practices, particularly in low and middle-income countries (LMICs), focusing on the overuse of antibiotics, and the management of wastewater.

This underscores the importance of a One Health response, which means developing an integrated approach to human, animal and environmental health.

Sewage is a major source of AMR

Mary Chibwe reported on high levels of AMR in a South African river.

Sewage is a major source of AMR, yet farmers in many countries use untreated wastewater to irrigate their crops. This spreads pathogens to vegetables and the animals and humans that eat them.

Lack of sanitation is also driving AMR. Researcher Mary Chibwe painted an alarming picture of a South African river teeming with pathogens in the places where people lived alongside it in shacks. With no sanitation, everything ends up in the water – including human and animal faeces, used nappies, trash and unfinished medicine, said Chibwe.

“Industrial effluents are also contributing to AMR, through the discharge of heavy metals, residues and other pollutants,” she added.

Chibwe’s research found 87,5% of water samples were positive for Campylobacter, a bacteria that causes diarrhoea, in parts of the Swartkops River where there was high human activity. (The river flows near the biggest city in South Africa’s Eastern Cape province.)

Some 81% of these samples contained Campylobacter multi-drug resistant gene B, and 62,5% were resistant to tetracycline.

China’s Chendi Zhu reported an “alarming” level of AMR in E-coli samples.

China’s Chendi Zhu reported on a study in Guangxi region, home to half a million people. Samples of E-coli were collected from slaughterhouses, local markets, households, farms and hospitals.

“The overall rate of multi-drug resistance was an alarmingly high 87,3%,” he reported. “The high multi-drug resistance rate highlights the critical need for integrated surveillance and intervention strategies that encompass human, animal and environmental health.”

Other studies and posters showed antibiotic-resistant Salmonella in poultry being sold in Ghana and Nigeria, drug-resistant pathogens in pigs in Uganda, and many other alarming examples of how widespread AMR is.

Wild animals are not exempt

Even wild animals are not exempt from AMR. Ghana’s Winnifred Offih-Kyei reported on research on the carcasses of 60 wild animals at a bushmeat market in the Ashanti region. Some 522 bacteria were isolated, and there was an almost total resistance (97%) to Ampicillin, with high resistance to Cefotaxime (84.6%) and Tetracycline (78.2%).

“Wildlife are important reservoirs of AMR,” said  Offih-Kyei. “The continuous consumption of bushmeat may heighten AMR and limit the effective treatment of bacterial infections in both humans and animals.”

Around 60% of emerging infectious diseases come from animals, while three-quarters of the 30 new human pathogens detected in the last 30 years originated in animals, according to the World Health Organization (WHO).

Yewande Alimi, head of One Health and AMR at the Africa Centres for Disease Control and Prevention, told the congress that outbreaks of zoonotic diseases on the continent have jumped from 63% to about 85% in the past decade.

“We are faced with a multi-faceted crises dealing with several other health issues, economic issues, and this is why the One Health approach is important,” said Alimi.

Managing animal, human and environmental health has become more and more important. Thus in 2022, the FAO, WHO, UN Environmental Program (UNEP) and the World Organization of Animal Health (WOAH) formalised their leadership of One Health, now known as the Quadripartite.

Thanawat Tiensen, the Food and Agricultural Organization (FAO)’s Director of Animal Production and Health, speaking via a video message.

Thanawat Tiensen, the Food and Agricultural Organization (FAO)’s Director of Animal Production and Health, described AMR as “a silent pandemic with devastating effect on food production, ecosystems and economies”. 

“FAO is leading the fight against AMR with a 10-year global initiative to reduce the need for antimicrobials on farms for a sustainable agri-food system transformation,” said Tiensen.

In addition, FAO’s international AMR antimicrobial resistance monitoring system called InFARM, helps countries to collect and analyze AMR surveillance and monitoring data, primarily from livestock, fisheries and agriculture, he added.

Strengthening countries’ One Health efforts

Maria Van Kerkhove, interim Director of Epidemic and Pandemic Preparedness and Prevention.

The WHO’s Maria Van Kerkhove, interim Director of Epidemic and Pandemic Preparedness and Prevention, told the congress on Monday that the WHO has identified 18 pathogens that have the potential to cause epidemics and pandemics. These include mpox, dengue, Heniparviruses and Nipah.

The WHO is building a dashboard to map the emergence and spillover potential of these pathogens, which will eventually include diagnostic resources, available healthcare systems services and reporting capacity.

“Our aim is partly efficacy. Working with governments to say: ‘You do know the risks that are there, but how do you consider the following based on the changes that we’re seeing in terms of climate, in terms of urbanization, in terms of displaced people, so that governments can anticipate and be ready.”

WHO is building a data dashboard focusing on 18 pathogens with epidemic and pandemic potential.

There is also a global arbovirus initiative focusing on dengue, chikungunya, yellow fever and Zika and a global focus on respiratory threats, added Van Kerkhove. 

“We would like a world that is on alert. We don’t want every individual on alert. We need governments to be on alert and across different sectors, looking at different legal aspects, looking at financial aspects. So that, where we can prevent, we do and when we can’t, that we mitigate as much as we can. 

“These spillovers that we see happening, which will continue to happen, don’t amplify. And all of this is based on a foundation of science, trust, transparency and collaboration,” she concluded.