Microplastics have been found in the arteries .

Doctors and scientists are concerned about the impact of plastics, not only on the environment but on human health – and new research has found a potential link between microplastics and heart attacks and strokes. 

When plastics enter the environment, humans may inhale or ingest them. Moreover, just as plastics can take centuries to break down on earth, plastics do not easily break down within our bodies, potentially leading to accumulation over time.

Multiple studies have already detected microplastics in various organs, from the lungs to the placenta.

The newest study, published in the New England Journal of Medicine last month, involved more than 250 people who had carotid artery disease and were having surgery to remove the build-up of plaque from their carotid arteries, the main arteries that supply the brain with blood, located in the neck. 

More than half (58%) of these patients had microplastics or even smaller nanoplastics in a main artery, and those who did were 4.5 times more likely to experience a heart attack, a stroke or death in the approximately 34 months after the surgery than were those whose arteries were plastic-free.

The researchers collected plaque samples from 257 patients during their surgeries and performed a chemical analysis on them. They found that 150 had microplastics and nanoplastics in their arterial plaque, mainly polyethylene (in all 150 people) and polyvinyl chloride (in 31). 

These are two of the most commonly used plastics in the world; the researchers looked for 11 plastics.  

Polyethylene is usually used for packaging, such as plastic bags or containers. Polyvinyl chloride is a more versatile plastic used for anything from medical devices to window frames and flooring.

In addition to the increased risk of heart attack or stroke, the researchers also found that those with microplastics in their plaque samples had higher levels of biomarkers for inflammation.

However, the researchers pointed out that individuals with microplastics in their plaque also exhibited other risk factors such as smoking, high cholesterol, diabetes, and heart and circulatory diseases, all of which elevate the risk of heart attack and stroke to begin with. 

Moreover, since all of the study participants were already undergoing carotid artery surgery and were known to have carotid artery disease, it is too early to tell whether the results of this study can be generalized to a broader population. 

In addition, the researchers stressed that the study does not prove that microplastics cause heart attack or stroke, only that there is a potential relationship. 

Dr Steve Nissen, a heart expert at the Cleveland Clinic, told The Independent that while “the study is intriguing,” it has “substantial limitations.” 

He said, “It’s a wake-up call that perhaps we need to take the problem of microplastics more seriously. As a cause for heart disease? Not proven. As a potential cause? Yes, maybe.”

Cardiac function 

This is not the first study to examine the link between plastics and human health. A similar, separate study published earlier this year in Environment International also examined the effect of microplastics and nanoplastics on the cardiovascular system, finding that these plastics “affected cardiac functions and caused toxicity on (micro)vascular sites.”

Effects included abnormal heart rate, cardiac function impairment, pericardial edema, and myocardial fibrosis, as well as hemolysis, thrombosis, blood coagulation, and vascular endothelial damage. 

This latest study comes as global representatives, led by the United Nations Environment Programme (UNEP), are working to finalize a plastics treaty to help eliminate plastic pollution by the end of the year.

The fourth session of the Intergovernmental Negotiating Committee to develop an international legally binding instrument on plastic pollution, including in the marine environment (INC-4), is scheduled to take place from 23- 29 April in Ottawa, Canada

Image Credits: University of Oregon.

Afghan opium poppy cultivation sustains many rual communities – and keeps many in the adiction vicious cycle

The ‘forgotten crisis’ of Afghanistan has exposed more and more young Afghans to mental health problems and drug abuse amid dwindling donor support and crumbling healthcare under the Taliban regime, said experts at a high-level side event at the recent meeting of the Commission on Narcotic Drugs in Vienna Austria.

Since the Taliban imposed a drug ban in April 2022, opium poppy cultivation in the war-ravaged country has dropped by around 95%, according to the United Nations Office on Drugs and Crime (UNODC). 

But experts claim that drug abuse, particularly among the youth, is getting worse – and is being compounded by a lack of treatment.

The WHO estimates that around 2.9 million people abuse drugs in the country, while nine million have mental health issues in a population of around 38,3 million.

Holistic approach

At the side-event on “Mental health and substance use disorders in Afghanistan”, hosted by the World Health Organization (WHO), UNODC, the European Union (EU) and the Japanese government, stakeholders said the rapidly deteriorating socio-political environment in the country poses new challenges that require a more holistic approach and engagement with the Taliban authorities to save millions of lives. 

Jean-Luc Lemahieu, UNODC’s director of policy analysis and public affairs, said that many youngsters trying to escape the Taliban’s oppressive system of governance are vulnerable to drug abuse and exploitation, including radicalization.

To confront those threats, a system of community-based programmes anchored around existing primary health care services, should be developed, he and other experts speaking at the session emphasized. Those need to address both drug addiction and offer “active livelihood support and vocational skill training.”

Opium poppy farming in Afghanistan dramatically decreased after a 2022 drug ban.

UN officials noted that the “near-total contraction of the opiate economy is expected to have far-reaching consequences” for rural communities who relied on income from cultivating opium.

“Farmers’ income from selling the 2023 opium harvest to traders fell by more than 92 per cent from an estimated $1,360 million for the 2022 harvest to $110 million in 2023,” according to UNODC.

The WHO estimates that 23.7 million Afghan people will need humanitarian assistance this year as economic conditions in the country deteriorate. In addition, 9.5 million people have no or very limited access to healthcare.

Experts at the event warned that mental health and drug addiction can have far reaching public health consequences, including higher mortality rates, infectious diseases like HIV, hepatitis as well as diminished productivity.

Social tensions

Raffaella Iodice, Chargée d’Affaires and deputy head of the EU Delegation to Afghanistan, told the conference that mental health issues and drug addiction can trigger social tensions and negatively influence stability in communities. 

“Investing in drug demand reduction and mental health, quality, evidence-based and comprehensive treatment and prevention can pave the way for more sustainable and resilient communities that are critical for advancing the overall economic situation,” she said.

The EU is supporting a 100-bed Female and Children Drug Addiction Treatment Centre (DATC) in Kabul, which was established in December 2023.

It assists mothers and children up to the age of 17, offering “child counselling sessions that surpass conventional education, acting as a crucial pillar of support for young minds navigating the complexities of addiction”, according to a report from the WHO EMRO region. 

Expanding outpatient services at primary health care level

Abdul Hakim, who was enrolled in a drug addiction treatment centre in Kabul eight months ago after 20 years of drug addiction,  told Health Policy Watch that the easy availability of drugs was one of main reasons why many return to addiction after treatment and recovery.  

“If the authorities collect the drugs and dealers from the market, we will recover and stop using drugs,” he said.

Kabul city resident Gholam Ali, whose son became addicted to drugs eight years ago, told Health Policy Watch that his son has been treated several times, but easy access to drugs has made him addicted to it again. 

“There was no clinic left that I did not take my son to. He is treated for one or two months in each clinic, but when he leaves the clinic, there are drug addicts and drugs available outside, and he turns to drugs again,” said Ali.

Anja Busse, a UNODC programme officer working on prevention, treatment and rehabilitation,  said that the treatment model that exists in Afghanistan right now, based around clinics in large cities, is unable to meet the needs in the sprawling country, where rural needs are neglected. 

“The outpatient services in the community would need to be widely expanded and to be integrated in the community based health care approaches to have a continuum of care,” said Busse.

“ The reduced availability of previously widely used opioids at local markets has potentially increased risks for people with drug dependence due to increased levels of police interactions.”

Afghanistan’s health system system has been struggling to meet mounting demands amid dwindling aid and restrictions. Stigma is also a problem.

“Whether we are facing a mental health patient or substance use disorder client, we are facing a major stigma issue and most of the communities,” said Dr Vail Al-Raas, the mental health and psychosocial support coordinator at the International Medical Corps in Afghanistan.

She suggested the mental health treatment programs should be integrated into existing public health primary care programmes to use existing infrastructure and resources. 

“This can give [these programmes] a good chance to expand and be implemented on the ground, and interest has recently been shown by some donors.”

Image Credits: Resolute Support Media, UNODC.

The new generation of obesity drugs have reached sky-high popularity – and command high prices.

Demand for diabetes drugs such as Wegovy, Ozempic, Rybelsis and Trulicity has soared since they have been clinically proven to help weight loss – but they are massively overpriced in the US and unavailable in most low- and middle-income countries (LMIC), according to Médecins Sans Frontières (MSF).

The mark-up for these drugs – called glucagon-like peptide 1 agonists (GLP-1) – in the US is almost 40,000%, according to a paper published in JAMA last week authored by Yale University’s Dr Melissa Barber and MSF’s Dr Dzintars Gotham, Dr Helen Bygrave and Christa Cepuch.

The authors modelled the manufacturing costs of a variety of diabetes medications and added a modest profit margin.

“MSF’s study estimates that GLP-1s for diabetes could be sold at a profit for just $0.89 per month, compared to the price of $95 per month charged in Brazil, $115 per month charged in South Africa, $230 charged in Latvia and at least $353 charged in the US [based on Medicare price], which is a 39,562% markup over what the estimated generic price could be,” according to MSF’s press release. In fact, the US drug costs are usually much higher, reaching as much as about $1000 monthly.

Novo Nordisk makes both Ozempic and Wegovy (which contains a higher dose of the active ingredient, semaglutide, than Ozempic), while Eli Lilly makes Trulicity. Some are oral pills and others are injections.

US Senator Bernie Sanders has called on Novo Nordisk to lower the price of Ozempic Wegovy in the US to no more than what they charge for this drug in Canada.

“The American people are sick and tired of paying, by far, the highest prices in the world for prescription drugs while the pharmaceutical industry enjoys huge profits,” said Sanders in a statement.

“As a result of a major grassroots movement, Novo Nordisk did the right thing by recently reducing the price of its insulin products by some 75% in America. Novo Nordisk, a company that made nearly $15 billion in profits last year, must now do the right thing with respect to Ozempic and Wegovy,” added Sanders, who chairs the US Senate Health, Education, Labor, and Pensions Committee.

FDA approval for weight management

While GLP-1 drugs were made to treat diabetes, in 2021 the US Food and Drug Administration (FDA) approved Wegovy for weight management in people with a body-mass index (BMI) of over 30, or a BMI of over 27 with underlying conditions such as high blood pressure.

“Novo Nordisk and Eli Lilly are the only producers of these GLP-1s today, and their intellectual property barriers on the drugs and injection devices block any generic manufacturing that could help drive prices down,” MSF notes.

“The corporations have not even announced a price for low- and middle-income countries, nor have they licensed these drugs so that generic manufacturers could make them, which would help to meet global demand and drive prices down,” MSF says, noting that because they are now being used for weight loss in high-income countries, the companies are “unable to meet the massive demand”.

Co-author Christa Cepuch, pharmacist coordinator at MSF’s Access Campaign, describes the new drugs as “an absolute game changer for people living with diabetes”, but cannot be accessed by people in LMICs.

“Eli Lilly and Novo Nordisk can in no way supply the world with the amount of these medicines needed to meet global demand, so they must immediately relinquish their stranglehold and allow them to be produced by more manufacturers around the world,” said Cepuch.

The steep price of the drugs is hampering access even in the US, although the country’s federal health insurance programme, Medicare, recently struck a deal with Novo Nordisk, to cover the cost of Wegovy – but strictly for preventing heart attacks and strokes not for weight loss, Reuters reported. 

“The American people are sick and tired of paying, by far, the highest prices in the world for prescription drugs while the pharmaceutical industry enjoys huge profits,” said sen. Bernie Sanders, Chairman of the Senate Committee on Health, Education, Labor, and Pensions on the US cost of GLP-1s.

“Ozempic has the potential to be a game changer in the diabetes and obesity epidemics in America. But, if we do not substantially reduce the price of this drug, millions who need it will be unable to afford it,” he continued.

Obesity’s heavy burden

The GLP-1 drugs stimulate insulin production and feeling of satiety (fullness), promote weight loss, lower blood pressure and cholesterol, improve blood flow in the heart and uptake of glucose in the muscles, according to the US National Institute of Health.

Side effects can include commonly nausea, diarrhea, vomiting, constipation, stomach pain, headache or stomach flu, and less often, depression with suicidal thoughts or kidney failure.

Doctors warn that they need to be taken alongside a healthy diet and exercise.

The US accounts for almost three-quarters of the sale of Novo-Nordisk’s Ozempic, Wegovy and Rybelsus, according to Pew Research Center. The country has an adult obesity rate of 42%, according to the American CDC, one of the highest in the world.

Despite steep prices and side-effects, GLP-1s have become wildly popular in the last few years, especially in the US. 

Obesity is a growing problem worldwide, affecting 890 million adults – 16% of the global population – in 2022, according to the World Health Organization (WHO). The prevalence of this condition more than doubled between 1990 and 2022.

Global costs of obesity and overweight are predicted to reach $3 trillion per year by 2030 and more than $18 trillion by 2060 at the current rate.

In relation to obesity, World Health Organization (WHO) Director General Dr Tedros Adhanom Ghebreyesus recently stressed that the private sector “must be held accountable for the health impacts of their products” as Health Policy Watch reported – a reference to the impact of products such as ultra-processed food and sugary drinks on obesity.

Being overweight and obese increases people’s risk for type 2 diabetes, heart disease and cancer, WHO highlights, also affecting bone health and reproduction and increase the risk of certain cancers.

Both conditions can be affected by gene composition, but are mostly a result of an imbalance of energy intake (diet) and energy expenditure (physical activity). As such, are largely dependent on the options the environment offers. 

“Obesity is a societal rather than an individual responsibility, with the solutions to be found through the creation of supportive environments and communities,” WHO says.

The analytics platform, Airfinity, argues that it would be beneficial for public health to administer Wegovy to not only to diabetics type 2 patients, as the current Medicare deal allows, but to all people in the US with a BMI over 40. 

If 60% of people living with obesity and 40% of those of a BMI above 35 received the drugs, this could prevent as many as 300 000 heart failures in the US by 2030, according to Airfinity

World distribution of obesity. Safe the extreme numbers for small populations (on the right), some Middle Eastern countries and the US show highest percentages.

The demand for the Novo Nordisk drugs has more than quadrupled between 2019 and 2021, reaching 8.2 million prescriptions.

In fact, the demand was so high that it caused many months of shortages in the US, making it difficult for many to obtain their doses, Reuters reports.

Even those who do not have any medical reason to take GLP-1s often ask their doctors for a prescription. The drugs, seen as a miraculous way to achieveachieve wards a perfect body shape, feed hope that impossible beauty standards can be attained with a weekly injection.

Despite the surge in demand for these drugs, it’s important to recognize that they alone cannot address the societal challenges associated with obesity. 

According to the WHO website, “Stopping the rise in obesity demands multisectoral actions such as food manufacturing, marketing and pricing and others that seek to address the wider determinants of health (such as poverty reduction and urban planning).”

“While we are unaware of the analysis used in the [MSF] study, we have always recognized the need for continuous evaluation of innovation and affordability levers to support greater access of our products,” said Novo Nordisk in a statement. “We continue to support greater health equity to those in need of diabetes treatment and care.”

Image Credits: Chemist4u, Pew Research Center.

Uganda’s Deputy Chief Justice Richard Buteera (centre) delivers the Constitutional Court ruling.

Uganda’s Constitutional Court ruled on Wednesday that the country’s draconian  Anti-Homosexuality Act 2023 complies with the country’s Constitution in all but four aspects. 

“We decline to nullify the Anti-Homosexuality Act 2023 in its entirety neither would we grant a permanent injunction against its enforcement,” Deputy Chief Justice Richard Buteera,  told the Kampala courtroom and a capacity Zoom audience of 500.

The four sections that were struck down by the five-judge panel – 3 (2c), 9, 11 (2d) and 14 – were “inconsistent with right to health, privacy and freedom of religion”, according to the court.

“The nullified sections had criminalised the letting of premises for use for homosexual purposes, the failure by anyone to report acts of homosexuality to the police for appropriate action, and the engagement in acts of homosexuality by anyone which results into the other persons contracting a terminal illness,” according to a statement from the court.

Buteera said that the mandatory reporting to authorities of people suspected of having committed homosexual offences violated individual rights.

While the court has struck down the possibility of landlords being imprisoned for renting premises to homosexuals, it has maintained that prison terms of up to 20 years for journalists “promoting homosexuality” were legitimate.

In delivering the unanimous judgement, Buteera said that constraints on the media aligned with sections of the country’s Communications Act and Anti-Pornography Act, which “aim to uphold societal morals by limiting the use of media to publish or broadcast offensive material”.

The Act’s legitimacy was contested by 22 Ugandan human rights advocates including Member of Parliament Fox Oywelowo Odoi (the only MP to vote against the Act), legal academics Prof. Sylvia Tamale and Rutaro Robert and Bishop James Lubega Banda.

They said that it violated various constitutional rights, including the right to privacy and freedom from discrimination, as well as going against Uganda’s international human rights  commitments.

Frank Mugisha, of Sexual Minorities Uganda and Convening for Equality co-convener, described the ruling as “wrong and  deplorable”, and called on “all governments, UN partners, and multilateral institutions such as the World Bank and the Global Fund to likewise intensify their demand that this law be struck down”.
“This ruling should result in further restrictions to funding for Uganda – no donor should be funding anti-LGBTQ+ hate and human rights violations,” said Mugisha, one of Uganda’s most prominent LGBTQ activists.

Nicholas Opiyo of human rights group Chapter Four Uganda, said his organisation “vehemently disagrees” with the court’s finding and the basis on which it was reached.

“We approached the court expecting it to apply the law in defence of human rights and not rely on public sentiments, and vague cultural values arguments,” said Opiyo.

Life sentence and death penalty

Transgender rights
Protests have been held worldwide in support of the Ugandan LGBTI community as it faces attack.

The Anti-Homosexuality Act introduces “the offence of homosexuality”, with a potential life sentence for a same-sex “sexual act”. It also allows the death penalty for “aggravated homosexuality”, including sex acts with children, disabled people or those drugged against their will, or committed by people living with HIV – actions that are already criminalised by other laws.

Since the Act was passed last May, the World Bank has suspended new loans to Uganda and the US President’s Emergency Plan to Fight AIDS (Pepfar) has declined to advance plans for the country. There has also been widespread condemnation of the law.

Buteera claimed that the Act had been passed “against the backdrop of the recruitment of children into the practice of homosexuality. That is the mischief that Section 11 [dealing with the “promotion of homosexuality”] of the Act seeks to address.”

‘Absence of global consensus’ on LGBTQ rights

The court presented seven points as the basis for its decision, including that “sister jurisdictions” have “decriminalised consensual homosexuality between adults in private space”.

However, it referred to the absence of global consensus “regarding non-discrimination based sexual orientation, gender identity, gender expression and sex characteristics (SOGIESC)”. 

“This is reflected in the fact that to date non-discrimination on the basis of the SOGIESC variables has not explicitly found its way into international human rights treaties. Instead, it has been ‘vetoed’ by a bloc of resistant (UN) member states that has prevented the adoption of a binding declaration or similar instrument to strengthen protections for LGBTI human rights,” according to the court.

The court also referred to conflicts between “a universal understanding of human rights and respecting the diversity and freedom of human cultures” and between “individuals’ right to self-determination, self-perception and bodily autonomy, on the one hand; and the communal or societal right to social, political and cultural self-determination” on the other.

Finally, it described the Anti-Homosexuality Act as “a reflection of the socio-cultural realities of the Ugandan society, and was passed by an overwhelming majority of the democratically elected representatives of the Ugandan citizens”. 

Win for government

Dr Adrian Jjuukho, Ugandan human rights lawyer and executive director of Human Rights Awareness and Promotion Forum (HRAPF), which was one of the petitioners against the Act, described the ruling as “only intended to please donors in the health sector so that they can continue to provide the funds that are much needed while sacrificing LGBTI persons in the process”.

“The Court has nullified provisions that directly impede health service provision including reporting obligations, and where the victim acquires a terminal illness. This clears the way for health funding but does not actually clear the way for proper service provision,” said Jjuukho, writing on X (Twitter).

In a guarded statement, UNAIDS Regional Director for Eastern and Southern Africa Anne Githuku-Shongwe, said that “evidence shows that criminalizing populations most at risk of HIV, such as the LGBTQ+ communities, obstructs access to life-saving health and HIV services, which undermines public health and the overall HIV response in the country.”

“To achieve the goal of ending the AIDS pandemic by 2030, it is vital to ensure that everyone has equal access to health services without fear,” she added. UNAIDS provided evidence in support of the petitioners on certain clauses via an amicus brief.

Meanwhile, Ugandan feminist lawyer Sunshine Fionah Komusana told Health Policy Watch that “the ruling impacts everyone”.

“With the kind of government we have, I don’t know how anyone would be celebrating, knowing very well the different tags they use to deny people freedom of expression and association.,” said Komusana.

“Anti-human rights groups are gaining ground and before we know it, these kinds of legislation will be feeding into retraction of several other rights. See examples of reintroduction of legislation to legalise female genital mutilation and child marriages in some countries. These legislations harm all of us.”

Hundreds of people have already been arrested and attacked since the Act was introduced last May. In one case, a man was attacked in his home by a group of men one night. He was beaten and some of his property burnt by the mob, which accused him of being a homosexual.

In a similar incident, a lesbian was attacked by two men in her home. She had been evicted by her landlord on the grounds of homosexuality but did not have the resources to move.

International reaction to the court’s ruling will no doubt be keenly watched by countries contemplating their own anti-LGBTQ laws, such as Ghana, Kenya, South Sudan and Tanzania.

In February, ​​Ghana’s Parliament unanimously passed one of the world’s most draconian anti-LGBTIQ Bills which includes a mandatory three-year prison sentence for a person who simply “identifies” as lesbian, gay, bisexual, transgender, intersex or queer”. However, the president has yet to sign it into law.

Image Credits: Alisdare Hickson/Flickr.

Although smallpox has been eradicated, it is possib;le to recreate it from published genomes.

In the wake of surging mpox cases in the DRC and the emergence of novel orthopoxviruses, the US needs to rapidly bolster its smallpox readiness, preparedness, and response, according to a new report from the National Academies of Sciences, Engineering, and Medicine. 

The report brought together experts from across the country to critically evaluate the state of smallpox vaccines, diagnostics, and therapeutics, known as medical countermeasures (MCMs), in the event of an outbreak.

Improving MCMs is crucial for enhancing the nation’s ability to combat a smallpox outbreak or deliberate attack, the report emphasizes. It also stresses the importance of fortifying public health and healthcare systems to swiftly and effectively respond, including mechanisms for rapid vaccine distribution.

An ‘evolving bio-threat and technology landscape’

With advancements in genome sequencing and editing technology, it is now possible to recreate live smallpox virus from published genomes, the report warns. 

US population changes and advancements in gene editing and synthesis technologies have drastically altered the potential for a smallpox outbreak or attack in recent years. But these technologies significantly raise the risk of accidental or intentional release, challenging readiness planning and potentially altering the epidemiology and clinical presentations of the disease. 

The report notes that even if all existing collections of the virus were destroyed, reemergence is still a threat.

Despite the risks, the report underscores the necessity of continued research involving live variola virus for developing and enhancing smallpox MCMs. This research is essential for creating more effective therapies, validating vaccine and treatment efficacy, and establishing animal models for research purposes.

Research using these viruses can also fill gaps in our fundamental understanding of orthopoxvirus biology, ecology, evolution, transmission, and disease onset in humans.

A call for MCM research and development

Three main categories of MCMs need improvement: diagnostics, vaccines, and therapeutics. More accurate diagnostic tests to detect smallpox and related viruses at earlier stages is paramount. 

Vaccine safety is also an issue, and the report calls for research into vaccines that can be used across different populations and that are available as a single dose. 

“Developing new smallpox vaccines that use a multi-vaccine platform – which use common vaccine vectors, manufacturing ingredients, and processes – would improve the capacity for rapid production and reduce the need for stockpiling.”

Lastly, the report advocates for safer and more diversified therapeutics, such as antivirals with different and diverse targets, mechanisms, and routes of administration, to supplement existing antivirals. 

Vulnerabilities: too few manufacturers

The smallpox vaccine protects against mpox. 

The report concluded that the small number of manufacturers capable of producing smallpox medical countermeasures is a specific vulnerability, and that there is currently insufficient capacity to scale production in the event of a large outbreak or attack. 

Logistics and supply chain management planning is critical, as is planning for regulatory responsiveness. Clinical and public health guidance also needs to be updated to reflect new data and medical countermeasures so that health care providers and others on the front line of public health have the capability and capacity to respond to smallpox.

The need for global cooperation

Both the COVID-19 pandemic and mpox outbreaks revealed gaps in the US’s ability to respond to new infectious diseases. Specifically, the COVID-19 pandemic exposed weaknesses in the ability of US public health and health care systems to adapt and respond to an unfamiliar pathogen. Mpox, on the other hand, showed the challenges of rapidly making diagnostics, vaccines, and therapeutics available at scale.

Furthermore, the mpox outbreak brought to light the lack of diverse smallpox therapeutics options. Currently, standard research methods rely on challenge studies in animals to understand MCM efficacy in humans, leading to issues with accurately understanding the safety and efficacy in humans. 

“The gaps in our ability to respond to a new infectious disease were revealed by the COVID-19 pandemic and recent mpox outbreak,” said committee chair Prof Larry Gostin, director of the O’Neill Institute for National and Global Health Law at Georgetown Law and professor of medicine at Georgetown University.

“It is vital to prioritize research into the development of safer and more effective smallpox diagnostics, vaccines, and therapeutics, make judicious choices in stockpiling, and have modern, well-practiced, and adaptable plans for responding in the event of a smallpox outbreak,” added Gostin, who is also director of the WHO Collaborating Center on National and Global Health Law.

Research and development for these MCMs needs to not only consider the actual device or product, but also the ability to “deploy at scale” and equitably to meet the challenges of public acceptance.

The report urges effective risk communication for vaccines, as the same challenges with vaccine hesitancy and misinformation could occur in a smallpox outbreak.

While the report primarily focused on US readiness and response capabilities, it does note the impact of growing global interdependence in detecting and containing potential smallpox outbreaks.

“The COVID-19 pandemic and pox multi-country outbreak, both declared Public Health Emergencies of International Concern (PHEIC) by WHO, underscore the need for further domestic global coordination for preparedness and response against novel pathogens including orthopoxvirus events,” note the report authors. 

This means preemptively supporting international MCM capacity as any US response will be “significantly affected” by the ability of other countries to detect and surveil. The report notes that global solidarity is a key component to rapidly identify, contain, respond, and ensure equitable MCM allocation in a smallpox event.

Preparedness for similar viruses

Smallpox-related viruses such as mpox, Alaskapox, and cowpox are increasingly found in humans, magnifying the need for medical countermeasures that can detect, treat, and prevent these diseases.

The report notes that most mpox therapeutics were developed because of investments in smallpox therapeutics. 

“Direct investment in developing therapeutics targeting circulating orthopoxviruses could similarly benefit smallpox therapeutic preparedness and would likely have more immediate utility and potentially achieve commercial viability.”

Image Credits: Isao Arita/ WHO.

Save Hands for Girls campaigns against female genital mutilation in The Gambia by working with schools, parents and organisations.

Global health and parliamentary leaders have offered to support The Gambia to maintain its  ban on female genital mutilation (FGM), expressing “profound concern” over a recent attempt to reverse the ban. 

The business committee of Gambia’s parliament is currently contemplating whether to allow the passage of a Private Members Bill which aims to reverse the landmark Women’s (Amendment) Act of 2015, which outlawed FGM.

The Bill was introduced by Almameh Gibba, an MP from the Alliance for the Patriotic Reorientation and Construction (APRC), with the support of Imam Abdoulie Fatty, a notorious proponent of FGM. The process involves the partial of total removal of external female genitalia – supposedly to “control” women’s sexuality – and is usually performed on girls under the age of 15.

But this attempt to reintroduce FGM has been condemned by the leadership of both the Partnership for Maternal, Newborn & Child Health (PMNCH), the world’s largest alliance for women’s, children’s, and adolescent’s health and well-being, which is hosted by World Health Organization (WHO), and the Inter-Parliamentary Union (IPU), the global organisation of national parliaments.

They urge the Members of the National Assembly to continue to protect the “hard-won” ban on FGM, warning in a statement issued over the weekend that repealing the ban “would not only undermine this progress but also perpetuate a cycle of discrimination and violence against women and girls”.

Despite the banning of FGM nine years ago, 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 involving 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.

‘All possible support’

“We pledge all possible support to The Gambia in strengthening its efforts to prevent and address this harmful practice through multi-sectoral actions. This includes ensuring robust enforcement mechanisms, increasing access to quality healthcare services, and promoting gender equality and women’s empowerment initiatives,” according to the statement, which is signed by PMNCH leaders Helen Clark, Joy Phumaphi, Githinji Gitahi and Flavia Bustreo, and IPU Secretary General Martin Chungong.

“FGM is a grave violation of human rights and a harmful practice with severe health consequences, including physical, psychological, and reproductive and sexual health complications,” they add.

“FGM is associated with increased risks of postpartum hemorrhage, perinatal death, as well as urinary tract infections, menstrual difficulties and mental health conditions over the life course of women and girls.”

The PMNCH and the IPU emphasise the importance of upholding international human rights standards and commitments to protect women and girls from all forms of violence and discrimination.

“As a signatory to various international instruments, including the Convention on the Rights of the Child (CRC), Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), the African Charter on the Rights and Welfare of the Child (ACRWC) and the Protocol to the African Charter on Human and People’s Rights on the Rights of Women in Africa (Maputo Protocol), The Gambia has a duty to uphold its obligations to its people and prioritize the health and rights of its population,” they remind the country.

Domino effect?

“Combatting FGM requires partnership at all levels. Parliamentarians can develop and uphold comprehensive legal frameworks; opinion leaders, including faith leaders, are needed to speak out firmly against the practice; community members, including health workers, can carry out powerful awareness campaigns based on lived experience, ensuring that care and support for survivors are integrated into sexual, reproductive, maternal, newborn, child and adolescent health (SRMNCAH) services.”

Meanwhile, Bustreo, who chairs PMNCH’s governance and ethics committee, said that her organisation was concerned about potential copycat moves.

“The concern lies in the potential for a domino effect if an anti-FGM law is repealed, signaling to others that similar regressive steps are acceptable,” Bustreo told Health Policy Watch.

“This isn’t merely about changing legislation; it’s about preserving the progress made in safeguarding the rights and well-being of women and girls. Repealing such laws threatens to erase years of dedicated advocacy and community engagement.” 

Around 90% of women in Somalia, Guinea and Djibouti are subjected to FGM, and a range of organisations fear that The Gambia’s reversal will encourage other countries in West Africa to follow suit.

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, released earlier this month. This is a 15% increase since eight years ago.

Image Credits: Safe Hands for Girls.

CoViNet – The new network includes nearly 3 dozen research laboratories across the world with an expanded mandate.

The World Health Organization (WHO) has launched a new network, CoViNet, aimed at identifying, monitoring, and evaluating SARS-CoV-2, MERS-CoV, and emerging coronaviruses that pose significant public health risks.

The program expands on the WHO COVID-19 reference laboratory network, established in January 2020, in the early days of the pandemic.

Originally, the network’s primary goal was to offer confirmatory testing to countries lacking the capacity for testing SARS-CoV-2, including new variants. Over time, the requirements related to SARS-CoV-2 have changed. As such, CoViNet, with its “enhanced epidemiological and laboratory capacities,” according to WHO, will focus on tracking the virus’s evolution and the spread of variants and evaluating how these variants affect public health. The network brings together experts in animal health and environmental surveillance, other existing coronaviruses, and the identification of novel coronaviruses that could negatively affect human health. 

One Health focus 

The network will emphasize the significance of adopting a “OneHealth” strategy, the agency also added in a press release. The COVID-19 pandemic underscored the need for a comprehensive health approach that considers interactions among various species. The virus likely originated from a bat and was transmitted to humans through infected mammals kept and processed under unhygienic conditions at a market in Wuhan, China.

Finally, CoViNet will contribute to shaping WHO policies regarding public health and medical interventions. The data collected by CoViNet will inform the decisions of WHO’s Technical Advisory Groups on Viral Evolution and Vaccine Composition, among others. This will help ensure global health strategies and tools are grounded in the most up-to-date scientific insights.

“Coronaviruses have time and again demonstrated their epidemic and pandemic risk. We thank our partners from around the world who are working to better understand high-threat coronaviruses like SARS, MERS, and COVID-19 and to detect novel coronaviruses,” said Dr Maria Van Kerkhove, acting Director of WHO’s Department of Epidemic and Pandemic Preparedness and Prevention. “This new global network for coronaviruses will ensure timely detection, monitoring, and assessment of coronaviruses of public health importance.”

So far, 36 laboratories from 21 countries are involved in the network – from FIOCRUZ in Brazil to Geneva University Hospitals, Institut Pasteur in Dakar, Senegal, and Pakistan’s National Institute of Health.  Representatives from the labs met last week in Geneva to finalize an action plan for the next 12 months.

WHO has reported 6,932,591 coronavirus deaths and 766,440,796 cases since the pandemic began – although the real number of deaths worldwide is presumed to have been far higher. The pandemic was declared over last year, while the number of people dying from the disease has declined since the Omicron variant first detected in the fall of 2021 in southern Africa became dominant.  But WHO has continued to encourage countries to report weekly aggregate indicators of COVID-19 morbidity and mortality and variant surveillance data, warning that new variants of the virus, or other related emerging viruses could still pose a global health risk. 

Image Credits: WHO .

INB co-chairs Roland Driece and Precious Matsoso.

The fractious pandemic agreement talks – supposed to end with an agreement on Thursday (28 March) – have limped into extra time, with World Health Organization (WHO) member states resolving to hold an additional intergovernmental negotiating body (INB) meeting from 29 April to 10 May.

The World Health Assembly (WHA), which begins on 27 May, is supposed to adopt the agreement, intended to be a global guide on how to prevent, prepare for, and respond to, pandemics.

But the best case scenario is for the WHA to adopt an “instrument of essentials”, a bare-bones text that will be fleshed out over the next 12 to 24 months in advance of the proposed Conference of Parties, according to people close to the talks.

At the briefing at the end of Thursday’s talks, which started almost four hours later than scheduled, INB co-chair Roland Driece said that “there is no champagne”.

“We had long intensive discussions, but we have not succeeded in concluding this meeting,” added Driece. 

Consensus text

Instead, the INB Bureau would get a revised text to member states by no later than 18 April.

However, this text would be different from the previous one as it would aim to draw out consensus points rather than provide a shopping list of issues.

“That text will be building on the current one but also be different in focus and in level of detail, like we discussed before, but still trying to operationalise equity as much as we can,” said Driece. “We will build on the consensus already identified. Consensus is an important word.”

Extract from the INB 9 reportback

The INB drafting group will focus on “agreeing text”, and member states were also urged to “provide the Bureau with any convergence text resulting from informal consultations, as soon as possible”.

Meanwhile, when the INB resumes, there will be space for “structured informal meetings or working groups, as needed, to progress the work”.

At the start of the two-week negotiations, a number of member states had complained that their proposals and agreements reached in sub-groups had not been reflected in the Bureau’s draft text.

The focus on consensus appeared to cheer delegates, including Switzerland which said there was “a clear way forward”. Switzerland had refused to accept the draft text at the start of the talks.

Meanwhile, WHO Director General Dr Tedros Adhanom Ghebreyesus implored delegates to draw on the “spirit of Geneva” to conclude the talks.

“Let the spirit of Geneva – the spirit of cooperation, mutual respect, and shared responsibility – guide your deliberations as you work towards finalising the agreement by the set deadline in May this year,” said a visibly tired Tedros.

“Together let us reaffirm our commitment to global health security, to solidarity in times of crisis and to a future where no one is left behind by operationalising equity with international law,” added Tedros.

WHO Director General Dr Tedros, flanked by WHO head of health emergencies, Dr Mike Ryan, at INB 9.

Putting on a brave face?

Finding consensus points may be hard in the coming days as many countries appear to have lost patience with one another, and with the INB Bureau and WHO Secretariat members who have been steering the process.

Countries across the political spectrum accused one another of refusing to make compromises, and criticised the Bureau for failing to provide direction.

However, the geopolitical reality is that some of the 194 member states are at war, while others are long-term trade enemies. This was never going to be easy, despite the recent trauma of COVID-19.

In the past two weeks, so much text has been added to the 31-page draft that the meeting started with that it had swollen to a completely unwieldy 100-page draft by Tuesday 26 March with multiple opposing clauses contained in brackets.

For example, by last Saturday (23 March), 50 countries had submitted at least one bracketed suggestion for Article 11, which deals with technology transfer, according to Knowledge Ecology International (KEI), which had two observers at the meeting.

However, the now notorious Article 12, which deals with pathogen access and benefit-sharing (PABS), remains the biggest obstacle.

The European Union believes that there is a place for intellectual property rights in PABS. However, this has been rejected by the Group on Equity – an alliance of 34 countries  – and the Africa region.

But the Group on Equity, which includes countries with large generic medicine producers such as India, Brazil and Indonesia, has also been accused of trying to secure advantages for these companies but taking a hard line on technology transfer.

Meanwhile, Colombia blamed the lack of progress in the past two weeks on “changing modalities, which were sometimes unclear, but also because we’re facing a highly complex document”.

“We support the Bureau in producing a streamline text and one which can achieve consensus but it will have to have substantive provisions which will take us beyond the status quo. The agreement that we will reach must be clearly based on the principles of equity and solidarity that tragic experiences that we live through during the COVID 19 pandemic.

Additional reporting by Elaine Ruth Fletcher

Women over the age of 60 and women with disabilities, face a higher risk of abuse yet their experiences are largely hidden in most data, according to two new publications released today by the World Health Organization (WHO).

Where there is data, these groups face high prevalence, with one systematic review finding greater risks of intimate partner violence for women with disabilities and another finding higher rates of sexual violence. 

“Older women and women with disabilities are under-represented in much of the available research on violence against women, which undermines the ability of programmes to meet their particular needs,” said Dr Lynnmarie Sardinha, Technical Officer at WHO and the UN Special Programme on Human Reproduction (HRP) for Violence against Women Data and Measurement.

Sardinha is one of the authors of two new WHO briefs on measuring violence against older women and against women with disabilities. These briefs are the first in a series on neglected forms of violence by the UN Women-WHO Joint Programme on Violence against Women Data. 

“Understanding how diverse women and girls are differently affected, and if and how they are accessing services, is critical to ending violence in all its forms,” said Sardinha.

According to the WHO, one in three women worldwide experience physical and/or sexual violence in their lifetime, whether from their intimate partners or from others. The prevalence of violence ranges from 20% in the WHO’s Western Pacific region, to 22% in Europe, and as high as 31- 33% in the Africa, Eastern Mediterranean and South-East Asia regions.

Additional risks

But older women and women with disabilities also face specific risks and additional forms of abuse, sometimes at the hands of caregivers or health care professionals. These include coercive and controlling behaviours such as withholding of medicines, assistive devices or other aspects of care, and financial abuse.

In older age, intimate partner violence tends to change from physical to psychological abuse, including threats of abandonment, although more research is needed to understand how power dynamics shift in older age.

Older women and women with disabilities can be extremely isolated when violence occurs, making it more difficult for them to escape and report the abuse. Stigma and discrimination can further reduce access to services or information, or result in their accounts of violence being dismissed by responders.

“Gender-based violence is rooted in unequal power and control over women,” said Dr Avni Amin, Head of the Rights and Equality across the Life Course Unit at WHO and HRP. 

“For older women and women with disabilities, their dependency and isolation are further exploited by perpetrators, increasing their risk of abuse. Services must be responsive to their needs and identify appropriate contacts through the health and care systems, so that all women experiencing violence can access empathetic, survivor-centered care.”

Noting that older women are currently represented in only about 10% of data on violence against women, the WHO recommends extending the age limit for survey participation and incorporating questions relating to different types of violence, encompassing a broad spectrum of disabilities.

They also advocate for user-friendly formats such as Braille or EasyRead to enhance the accessibility and participation of some disabled women.

Image Credits: UN Women.

Bats captured from the Kitaka mine in Uganda were discovered to be the source of a Marburg virus outbreak in July 2007.

As World Health Organization (WHO) member states bang heads in Geneva over a pandemic agreement to keep the world safe, a group of scientists has challenged global decision-makers to pay far more attention to humans’ relationship with animals.

“Although preparedness and response have received significant focus, prevention, especially the prevention of zoonotic spillover, remains largely absent from global conversations,” write the 24 scientists from a range of different global institutions in an article in Nature Communications published on Tuesday (26 March).

Using bats as their case study, they show how environmental changes exacerbate zoonotic spillover – and identify the “ecological interventions that can disrupt these spillover mechanisms”.

Primary prevention of zoonotic spillover

Their ecological countermeasures focus on bats because a number of major epidemics and pandemics” – SARS-CoV-2, Ebola, SARS-CoV-1, MERS-CoV, and Nipah virus –  have an evolutionary origin in bats.

Certain bat species also host four of the nine diseases identified by the WHO as having the potential to generate epidemics that pose a great risk to public health.

So what does an ecological approach look like when applied to bats? The authors propose three measures to prevent zoonotic spillover from bats to humans.

The first involves protecting where bats eat, which involves numerous interventions including preserving and restoring vegetation diversity and structural complexity in bat foraging habitats.

In subtropical Australia, for example, Pteropus species bats (which carry the deadly Hendra virus) feed on nectar in winter-flowering forests. But in some areas, over 90% of these forests have been destroyed.

“Replanting winter habitats would be a sustainable, scalable, and effective strategy to reduce the risk of spillover of not just Hendra virus, but other viruses carried by Pteropus species bats,” they argue.

Preventing zoonotic spillover involves protecting bats where they eat and roost and protecting people wo interact with them.

The second measure involves protecting where bats roost.

“Roosts are locations where bats sleep, shelter, mate, socialise, and raise their young. With few exceptions, bats cannot construct shelters and must roost in pre-existing natural (eg, caves, rock crevices, tree cavities, and tree foliage) or human-made (eg, buildings, bridges, mines) structures,” the authors state.

The third measure involves protecting people and their livestock who come into contact with bats. This can be done by reducing livestock’s interactions with bats and bat excreta and providing personal protective equipment for peoplein contact with bats or their excreta.

In Malaysia, for example, “a regulation requiring fruit trees to be planted at a distance from pig sties may explain the lack of subsequent Nipah virus spillovers”, the authors note.

Integrating ecological and biomedical approaches

“Recognising that pandemics originate in ecological systems, we advocate for integrating ecological approaches alongside biomedical approaches in a comprehensive and balanced pandemic prevention strategy,” they argue.

Pandemics almost always start with a microbe infecting a wild animal in a natural environment, but when a wild animal then infects a human, this is often triggered by “human-caused land-use change”. The more land use changes, the greater the risk of zoonotic spillover.

“Designing land management and conservation strategies to explicitly limit spillover is central to meeting the challenge of pandemic prevention at a global scale,” they argue.

“In our view, the most effective strategy to reduce the probability of another pandemic is to preserve intact ecosystems and bolster their resilience through restoration and the creation of buffer zones.

“Our primary emphasis should be on maintaining and enhancing the integrity and resilience of still-intact landscapes to prevent new interfaces that could enable the emergence of Disease X.”

Pandemic agreement and One Health

Article 5 of the draft pandemic agreement is devoted to One Health, which it defines as “an integrated, unifying approach that aims to sustainably balance and optimise the health of people, animals and ecosystems. It recognizes that the health of humans, domestic and wild animals, plants and the wider environment (including ecosystems) is closely linked and interdependent”.

According to the draft agreement, parties will commit to a One Health approach for pandemic prevention, preparedness and response that is “coherent, comprehensive, integrated, coordinated and collaborative among relevant actors and sectors”.

Proposed measures include engaging communities to prevent, detect and respond to zoonotic outbreaks; workforce training; updating international standards and guidelines, and developing multilateral mechanisms to help developing countries to adopt a One Health approach.

Image Credits: Chris Black/WHO.