A convention of the Polish Left party, one of leading advocates for legalizing abortion.

Poland’s right-wing Law and Justice (PiS) party, which championed the country’s restrictive abortion laws, was voted out of power last October, but the path to improving access to abortion is not fast or straight forward.

“First of all, we need accessible abortions and we need, which is extremely important, the decriminalisation of abortion support,” activist Agata Adamczuk told Health Policy Watch. She is from Dziewuchy Dziewuchom (Gals Help Gals) Foundation, a Polish feminist NGO providing information on safe abortions. 

Yet, Parliamentary Speaker Szymon Hołownia says it’s not a good time to introduce abortion reform, the Polish Press Agency reports. According to Hołownia, parliamentarians may vote against any abortion reforms if they are placed on the agenda before the local government elections on 7 April, fearing reactions of more conservative voters.

“If we proceed after the [local] elections, the chances will be much greater. Talks and declarations about supporting the draft bills in the first reading will start,” said Hołownia, adding that discussion on a draft abortion reform Bill was set down for 11 April.

Coalition politics

Hołownia is leader of Polska 2050, a new Christian Democrat party,  and one of the three parties that make up the ruling coalition. The group is ambiguous in their stance towards reproductive rights, whereas the other two parties in ruling coalition, the New Left and Prime Minister Donald Tusk’s Civic Platform, have made abortion on demand up to the 12th week of pregnancy one of their priorities.

“It’s a good first step, in the right direction, but it’s not enough,” Adamczuk highlighted.

Even if there is a law granting abortion on demand until the 12th week of pregnancy, in practice it likely won’t be respected “because we’ve already faced such situations”, she adds.

Last year, demonstrations were held in 60 cities in protest against the unnecessary deaths of women because hospitals were reluctant to abort pregnancies that endangered their lives, even though performing them would have been legal, Newsweek Poland reported.

However, the Civic Platform and the New Left remain optimistic that abortion rights are a necessary and realistic goal for the current term of the parliament.

“We have the right to and we want the draft bill on abortion to be finally proceeded in the Sejm,” said Anna Maria Żukowska, a leader of the New Left, during the party’s summit.

Yet a new Bill to make abortion access less restrictive is likely to face opposition of some parties in the Catholic country, including the possibility that President Andrzej Duda, who is aligned to PiS, may veto it. He has been quoted as saying that advocating abortion access is “demanding the right to kill”.

Abortion mostly forbidden – but still happening

Poland’s abortion laws are the second most restrictive in Europe, with only Malta reaching a lower score on legality and accessibility, according to the Abortion Policies Atlas.

A comparison of abortion-related policies in Europe. Poland with considerably more restrictive laws than most countries.

Performing the procedure is now legal only in cases of rape and where there is serious risk to the mother’s health. Even then, doctors are permitted conscientious objection to performing abortions, which further limits access to abortion.

In 2020, the politicised Constitutional Tribunal ruled that it was against the Polish Constitution to allow abortion if there was a serious deformation of the foetus.

As a result of this ruling, the number of legal abortions decreased tenfold, amounting to only about a hundred cases per year since 2020, according to Statista.

Yet the total annual number of abortions is estimated to be between 80,000 and 93,000. Numerous NGOs help provide information and organisational support for ordering abortion pills online or assisting women to schedule a surgical abortion abroad.

Lack of education 

Women’s protests following the Constitutional Tribunal’s ruling are credited with helping to unseat the PiS party in the last parliamentary elections. The ruling coalition has made abortion on demand until the 12th week of pregnancy one of their top priorities.

Women’s Strike protests in Warsaw, 2020, against the constitutional tribunal sentence dramatically limiting access to abortions.

Even if the relaxation of abortion laws happens, it will do little to improve reproductive rights in Poland, according to Adamczuk. 

“Politicians should acknowledge the fact that simply changing the law will not automatically mean changing the situation for abortion accessibility. We need a more holistic revolution there,” she said.

“What we need is to do work at the ground level, to fight abortion stigma,” she stresses, pointing out that Polish medical circles are reluctant to provide abortion. 

The recent Polish Gynaecologists Association guidelines, for instance, say all other options should be tried before performing the procedure on a patient whose mental health is likely to suffer if they give birth.

Another crucial element is medical education: right now, no classes on abortion care are included in the gynaecologists’ curricula, Adamczuk says. 

Some sources highlight the causal link between the lack of education and the lack of accessibility. 

“If doctors receive the message that abortion is not a normal medical procedure during their studies, they will be more likely to carry on that opinion,” the activist added. “Performing abortions is almost exclusively our burden, of us activists, and most probably that won’t change in the nearest future.”

Decriminalising help

“We simply cannot be penalised for doing the job of the state,” Adamczuk highlighted, pointing out that decriminalising abortion help is one of the most urgent changes that need to happen. 

Last year, Polish abortion activist Justyna Wydrzyńska was found guilty of facilitating abortion and sentenced to eight months of community service. 

Although she declared that the court’s decision won’t stop her from continuing her work, such cases may have had a chilling effect on abortion access.

However, Wydrzyńska’s trial might have inspired another draft Bill currently waiting to be proceeded on decriminalising abortion support. 

The New Left has also proposed other Bills to advance women’s rights, including a change to the definition of rape and more favourable rules for maternity leave.

“We’re glad that abortion is the talk of the town right now, that there’s discussion about it,” says Adamczuk. “But just discussing is far too little.”

Image Credits: Lewica, Abortion Policies Atlas, Greenpeace Polska.

UN Security Council approves a first-ever resolution calling for a cease-fire in Gaza

WHO Director General Dr Tedros Adhanom Ghebreyesus on Monday welcomed a UN Security Council resolution calling for a ceasefire and the assurance of humanitarian aid in Gaza, and the immediate release of all hostages. 

The resolution, which passed with a vote of 14 in favor and the United States abstaining, was the first resolution to pass the body since the 7 October attack by Hamas-led gunmen on Israeli communities that left 1,200 Israelis dead, and triggered Israel’s massive invasion of Gaza in a war that so far has resulted in the deaths of over 32,000 Palestinians, according to Gaza’s Hamas-run health ministry.  

Fighting continues in Shifa and raging around two more Gaza hospitals

Gaza’s Al Shifa hospital during a WHO visit on Friday 1 March – was only just getting back into service after months of siege, officials say.

The director-general’s comments came as fierce fighting continued to rage in and around three strategically placed Gazan hospitals – Al Shifa in the north, and Nasser and Al Amal Hospitals in Khan Younis. 

Israel claims to have killed over 170 Hamas militants in battles at Shifa over the past week, including Hamas chief of internal security, Faiq Mabhouh, along with detaining around 800 people on the hospital grounds. 

Hamas and Islamic Jihad gunmen continued to barricade themselves inside parts of the facility Monday night, Israel said.  The claims were denied by Hamas, which said that over a dozen patients had died during the operation, the most prolonged in a health facility since the war began.   

Patients and health workers who managed to leave the compound described harrowing scenes, with a shortage of food and water, and bodies piling up on the hospital grounds. 

Dr. Tayseer al-Tanna, 54, a vascular surgeon, told the New York Times that Israeli forces had gathered doctors and patients together in parts of the hospital, while they swept the grounds outside.

“The Israeli military didn’t treat us violently,” Dr. Al-Tanna was quoted as saying. “But we had almost no food and water.”   

He declined to comment on whether Palestinian fighters had fortified themselves in parts of the medical complex.

On Monday evening, Israel’s military spokesman claimed that Hamas and Islamic Jihad forces were still positioned inside the hospital’s emergency room, the maternity ward and a burn ward, were firing at Israeli forces, and throwing mortar shells from their positions.  

Following its first incursion into the hospital in November, Israel exposed video footage of Israeli hostages being brought into Shifa on 7 October. It also displayed caches of arms, ammunition and a tunnel dug underneath the compound. But experts later disputed the army’s claims that the hospital had been a major Hamas command and control centre.  On Monday, 17 March, Israel said that it had moved back into the hospital during an overnight operation, after it discovered leading Hamas military operatives regrouping there.

The hospital was only just getting back into service after weeks of siege in northern Gaza, in which medical supply deliveries were largely blocked, said Rick Peeperkorn speaking at a WHO press conference last Thursday.

“Shifa hospital was bouncing back and providing minimal services,” he said. But then a planned WHO mission to the hospital last week was cancelled by Israel. 

“It was cancelled due to the ongoing insecurity in the region. And this is, again, I think we’ve raised so often, what is needed is an effective and a transparent, workable deconfliction mechanism,” Peeperkorn said. 

The northern Gaza area is desperately in need of emergency malnutrition measures to stave off looming famine, he assserted. Hospitals also need to play a key role in this, he said, acting as “nutrition stabilisation centres” while northern Gaza, the area most at risk, is flooded “with ready-to-use therapeutic foods,” followed by a return to local food production as soon as possible.

Al Amal and Nasser Hospitals also now under siege 

Meanwhile, two other hospitals in the southern Gaza city of Khan Younis, Al Amal and Al Nasser, also came under siege by Israeli troops over the weekend, as fierce fighting raged in surrounding neighbourhoods.   

In separate statements, both Hamas officials in Gaza and the Palestinian Authority in the West Bank claimed that Israel had launched assaults on the hospitals, resulting in a number of casualties. Israel denied its forces had entered the hospitals, but said they had been cordoned off during fighting in the area.  

“@WHO and @ochaopt are extremely worried about the safety of the patients, companions, and the few health workers remaining at the hospital. We urgently need safe access to ensure patients can be provided with life-saving care,” stated an X post by WHO’s Office for the Occupied Palestinian Territories. 

“Our team was not given clearance to proceed to the hospital for assessment and facilitating patient transfer this evening but was able to assist nine health workers who walked from Al-Amal to south #Gaza with water and first aid.

“International law is clear: patients, health workers, and civilians must be protected. We urge parties to the conflict to respect their obligations.”

Image Credits: UN News , WHO.

mpox virus
Both Clade I and II strains of mpox are circulating in outbreak stricken DRC

WHO officials said that they are trying to expedite delivery of mpox vaccines to outbreak-stricken DR Congo through talks with the world’s only two mpox vaccine manufacturers, as well as appeals for vaccine donations and negotiations with DRC officials.

But speaking at a press briefing on Thursday, WHO’s Dr Mike Ryan, Executive Director of Health Emergencies, and technical lead Maria Van Kerkhove were unable to provide concrete details as to when significant quantities of vaccines could be rolled out – and how many, in light of the global shortage of supplies.  

Despite two years of millions of doses of global mpox vaccine rollout, there has been no mass administration of the vaccines so far in DRC or other west African countries. This is despite the fact that the region, and DRC in particular, is now the epicenter of the largest and deadliest mpox outbreak to date. 

The problems are multiple – ranging from global supply lines to local regulatory hurdles, stigma around mpox and vaccine hesitancy. 

Mpox lesions

At the global level, the production line of Bavarian Nordic, the Belgium-based manufacturer of one the world’s two available mpox vaccines, MVA-BN, halted its production for months in 2022 due to building renovations.  

Then in August, 2023, it received a $120 million contract from the US Biomedical Advanced Research and Development Authority (BARDA) to manufacture new mpox vaccine product in bulk.  But that has only partly restored the depleted US stockpile – believed to be the world’s largest.  

At the same time, stigma around the disease, which can be sexually transmitted, as well as around vaccines more generally has also held back progress in the DRC – one of the most vaccine-hesitant countries in Africa. 

An attempt to donate doses of mpox vaccine was stalled for more than a year, Bavarian Nordic Chief Executive Paul Chaplin said in a statement to Reuters, in December 2023. National regulatory approval of vaccines and medicines has thus inched forward at snail’s pace. 

Taking gloves off to join in partnership

Dr Mike Ryan mpox press conference
Dr Mike Ryan, WHO Executive Director of Health Emergencies at a recent press conference

“We know that production capacity of the manufacturers is closely held proprietary information sometimes, but we have an idea of production,” Ryan said, adding. “I think Bavarian Nordic has been very open to discussing how they could scale up production. 

“And I do know that GAVI and others are willing to engage around how the existing vaccines beyond donations could also be procured.  

“So we are taking the gloves off to join hands in partnership – not to beat anyone around on the head,” Ryan said. 

The MVA-BN vaccine as well as a second vaccine, LC16 KMB, produced by the Japanese firm KM Biologics, both present technical challenges in terms of their administration as well, Ryan pointed out. The MVA-BN requires two jabs – a challenge in settings like DRC wracked by conflict and insecurity.  

The LC16 vaccine, on the other hand, requires intradermal administration – a relatively simple skin jab, but still a procedure requiring training for the health workers unfamiliar with the technique.  

In addition, Ryan added, neither vaccine has yet been formally approved for use in children – and amongst the 250 deaths seen so far in DRC this year, most victims have been children under the age of 15. 

Targeting vaccines due to limited supplies 

“Given limited supply, limited availability of vaccines need to really be able to use those vaccines in a targeted way to reach those who are most at risk,” Van Kerkhove said. 

“We’re currently looking at a number of different ways the vaccines could enter into the country, led by our country office, the Ministry of Health and their partners. We’re looking at bilateral donations, at the use of vaccines as part of a response strategy – at a number of different options apply, but we’re also looking at supply,” she stressed, adding:  “We’re looking at how many doses could be available. And then of course the strategies in which those vaccines can be used in outbreak situations.”

Still trying to understand the epidemiology ’

While the barriers remain, virus transmission continues to expand within communities and geographies. 

“In 2024 alone there have been more than 3000 suspected cases and about 250 deaths with a crude case fatality ratio around 7.8%,” said Van Kerkhove, of the outbreak, the largest ever seen by the DRC to date.  

The high fatality rate is due to the fact that most cases seen so far in the DRC have been of the Clade I mpox virus, which very deadly. 

In contrast, it was the much milder Clade II virus that triggered WHO’s declaration of a global health emergency in 2022 – which it began circulating widely outside of Africa, primarily among men who have sex with men. The emergency  was declared to be over in 2023, after the successful rollout of millions of vaccines among at-risk groups in high and middle income countries.  

As well as being more deadly, the patterns of transmission of the Clade I virus in DRC and West Africa, also appear to be much more varied – although sexual transmission is a factor, it is not the only one.

DRC and global health officials are thus struggling to “better understand the epidemiology,” of the outbreak, which is happening amongs a wide variety of communities and populations – from children to sex workers.  

“There are clearly different outbreaks that are happening, some are happening among sex workers, some are zoonotic transmission and some family clusters,” Van Kerkhove said. 

“We’re working with our country office in DRC, our regional office and many different partners to look at the types of interventions that can prevent infections, but also stop transmission,” Van Kerkhove said. “And one of those interventions is vaccines.”  

“We had a big partnership meeting yesterday. A lot of people are now actively engaged. But let’s be real here.  We do have to look at the different types of scenarios and be realistic about how much vaccine is available, how quickly the vaccines can be used, and how they can optimally be used in different parts of DRC and beyond. To have the biggest impact in stopping human-to-human transmission.”

Image Credits: National Foundation for Infectious Diseases , Tessa Davis/Twitter , WHO.

What actions and strategies are required for countries and communities to have more agency in their health?

This is the topic of the latest episode of the Global Health Matters “Dialogues” podcast series, in which host Dr. Garry Aslanyan tries to “blow up some of the echo chambers that exist in global health.”

In this episode, he talks with Olusoji Adeyi, a seasoned Nigerian global health practitioner who has held many prominent leadership positions, about overhauling the existing power dynamics in global health.

Dr. Garry Aslanyan (left) and Olusoji (Soji) Adeyi
Dr. Garry Aslanyan (left) and Olusoji (Soji) Adeyi

“Aid is still used as a lever to exert power over nations at times,” Aslanyan said.

Adeyi proposed six essential changes to turn the situation around.

No. 1—Have clarity of purpose.

No. 2—Consider the needs, realities, and interests of recipient countries as the starting point for any deliberation.

No. 3—Emphasise learning.

“All too often, it’s almost as if principal actors in global health resist learning because such learning might threaten the status quo,” said Adeyi. “When it threatens the status quo, it threatens the current imbalance. And so it’s shut down or suffocated.”

No. 4—Overhaul the legacy foreign aid paradigm, including ending aid for basic health services and commodities and goods.

“This is not a call for an abrupt cessation today,” Adeyi stressed, “but it ought to be done, say by the year 2030, that’s a six to seven-year period so that there’s a finite date in sight and there is a transition out of it, with exceptions only for say countries at war, because then we’re talking about humanitarian purposes or countries that have suffered sudden and devastating natural disasters. Those would be sensible exceptions there.”

No. 5—End the current practice of technical assistance so that the aid given via technical assistance is no longer tied to the source of financing for that technical assistance.

No. 6—Developing/improving/supporting mission-critical institutions in low- and lower-middle-income countries.

Systemic Flaws in Vaccine Distribution

Adeyi highlighted the vaccine distribution process during the COVID-19 pandemic as a prime illustration of systemic flaws. He told Aslanyan that during the pandemic’s peak, “a few individuals convened at Davos and hastily drafted what would essentially become global policy for distributing COVID-19 vaccines and related technologies to low- and middle-income nations.”

Those initial sketches materialized into ACT-A for accelerated access to COVID technologies and COVAX, managed by Gavi. Consequently, during the pandemic’s peak, high-income nations stockpiled vaccines, leaving African countries in a predicament where even those countries that wanted to buy vaccines had to rely on donations rather than purchase vaccines themselves.

“If you go to buy a car, a computer, or a pair of shoes, you are empowered as the buyer,” Adeyi explained. “But if you are waiting for somebody to donate a car, a pair of shoes, or a computer to you, you are disempowered, and you are at the mercy of the donor. And, of course, COVID did not live up to the hype.

“If you had accountable leadership, they would acknowledge that failure and find ways to do better,” he continued. “But the leadership of Gavi did the exact opposite by claiming they had established a blueprint for how to get vaccines to poor people in an emergency, which was just the exact opposite of what had happened.”

Adeyi said that this illustrates how significant power imbalances result in policies, decisions, and practices that counter the interests of those intended to benefit.

Previous “Dialogues” episode: A Conversation with Daisy Hernández.

Listen to previous episodes of Global Health Matters on Health Policy Watch.

Image Credits: Screenshot, Global Health Matters Podcast.

Routine testing for tuberculosis in Lima, Peru.

Tuberculosis has long been the neglected stepchild of global health – but new diagnostic tools and treatments, artificial intelligence (AI) and debt swaps to help countries meet their targets have come into play and are making a difference. 

“There is fresh momentum,” says Dr Jamie Tonsing, Senior TB advisor at the Global Fund, in a wide-ranging interview with Health Policy Watch.

“I’ve just come back from a meeting in Manila, where the discussion was all around AI for TB,” she adds.

One of these involves an AI tool that can read chest X-rays and predict whether a person is likely to have TB.

“The chest X-ray goes into the computer and the image is read by software and gives you a threshold above which a person is likely to have TB,” explains Tonsing.

“It’s a screening tool that needs to be followed by a proper molecular test. But this is very exciting because we don’t have radiologists everywhere, and TB is often in the most hard to reach, vulnerable population groups.”

Up to 50% of people with TB do not have the classical symptoms of TB, Tonsing adds.

“So the only way they will be diagnosed early and before they have symptoms is when they do a chest X-ray. And so that’s why we’re very excited by this new advance in technology.”

Jamie Tonsing, Senior TB advisor at the Global Fund,

Those with TB can be started on treatment immediately. Children under the age of five and people living with HIV who don’t have TB but have been exposed to someone with the disease, can be given TB preventive treatment to protect them.

Over three-quarters of international financing for TB comes from Global Fund, which also spends around $150 million per year to new digital tools. These are being used in places like Bangladesh, Paraguay and Indonesia to screen people in remote areas.

Bangladesh, is using digital X-rays with AI and telemedicine to rapidly screen people for TB, while health workers in Paraguay, are using portable X-ray machines and AI technology in prisons screen and diagnose people with TB fast, according to Dr Mohammed Yassi, the Global Fund’s TB advisor.

Cheaper testing for drug-resistance

GeneXpert diagnostics have become the gold standard for TB testing, particularly for drug-resistant TB (DR TB), which is difficult to diagnosis through the traditional sputum smear technologies or chest X-rays.  GeneXpert can rapidly detect rifampicin-resistant TB (a proxy for DR-TB diagnosis) along with drug-susceptible TB.  But the diagnostic machines need electricity and are expensive to operate.

Four years ago, the World Health Organization (WHO) endorsed another rapid molecular test called Truenat, which is also able to detect DR-TB – but is cheaper than GeneXpert and can run on batteries.

The Global Fund and Stop TB Partnership have signed an agreement with Truenat’s manufacturer, Molbio Diagnostics, to provide the machines at a reduced price in all countries that are supported by the two organisations and USAID.

In theory, results from these machines are supposed to be processed in two hours. But in practice, it usually takes clinics a few days to process.

“We need to find the people we are missing. So despite all the good progress, our global detection rate is 77% and we have said we need to get that up to 90%. So all the innovations are important, but what we also really need is point-of-care rapid tests like we have for malaria and HIV,” says Tonsing.

“In the past year, the Global Fund secured a 20% reduction in the price of the most commonly used molecular diagnostic test and a 55% reduction in the price of a key treatment for multidrug-resistant TB,” according to Peter Sands, executive director of the Global Fund.

Better treatment for DR TB

People with DR-TB used to spend 12 to 24 months in hospital, and take lots of pills and injections. But in May 2022, this changed dramatically when the WHO recommended an all-oral six-month regimen known as BPaLM –  a regimen of bedaquiline (B), pretomanid (Pa), linezolid (L) and moxifloxacin (M).

“The shorter duration, lower cost, lower pill burden and high efficacy of this novel regimen should enable much better treatment and treatment outcomes.. while also helping health systems to provide care for more people,” the WHO announced.

But the challenge is to ensure that countries adopt the new guidelines. Drug resistant TB is very high in the central region of Eastern Europe, but the management of TB is still  centralised with people still being admitted to hospital for months in many countries. 

The Global Fund is investing in BPalM, and encouraging countries to adopt the regimen, allow patients to stay at home and train staff and civil society organisations about how it works.

The older drug-resistant TB treatment (above) compared with new BPaL regimen (below).

Innovative financing

COVID has depleted many countries’ budgets, especially in the low-and middle-income countries most likely to be struggling with TB.

“Domestic budgets for TB are often not being increased commensurate with the need,” says Tonsing. “Every year, we get around $5 billion for the global TB response whereas the need is around $13 billion, so that gap is huge.”

Since 2017, the World Bank and the Global Fund have supported many countries by investing with blended finance transactions. For example, a loan buydown in India was tied to increased domestic financing for TB care and prevention. 

Debt2Health is an innovative financing mechanism designed to increase domestic financing in health by converting debt repayments into investments in public health programmes. Under individually negotiated “debt swap” agreements, a creditor nation forgoes repayment of a loan when the beneficiary nation agrees to invest all or part of the freed-up resources in a Global Fund-supported programme.

For example, in April 2021 Germany, Indonesia, and the Global Fund signed an agreement to  increase support to TB in Indonesia by converting €50 million of debt owed by Indonesia to Germany into investments in public health programmes supported by the Global Fund in Indonesia.

Still off track

“We have recovered from COVID-19 and in 2022, a record number of TB cases were identified – 7.3 million out of 10.6 million estimated cases. That’s a big new high and we  think, once we get the 2023 data, it will easily cross over eight million,” says Tonsing.

“So we’re getting back on track after being off track but but I don’t think we will be able to make it to the UN high level meeting, or even the 2030 SDG targets.”

Image Credits: Socios en Salud, Marc Bader/ The Global Fund, Dato Koridze .

Glacier
Last year smashed records as the hottest year since 1850, causing the loss of hundreds of gigatonnes of ice coverage and extreme weather across the globe

Heatwaves, floods, wildfires, and droughts unleashed global mayhem in 2023, as the year broke multiple climate records, according to the World Meteorological Organization’s (WMO) State of the Global Climate Report released this week.

It was the hottest year in recorded history, with global average near-surface temperature of 1.45℃ above the pre-industrial baseline.

“Never have we been so close – albeit on a temporary basis at the moment – to the 1.5° C lower limit of the Paris Agreement on climate change,” said WMO Secretary-General Celeste Saulo at a press conference this week.

“Climate change is about much more than temperatures. What we witnessed in 2023, especially with the unprecedented ocean warmth, glacier retreat and Antarctic sea ice loss, is cause for particular concern,” she said.

‘Climate crisis is the defining challenge that humanity faces’

The WMO’s annual report offers a dire snapshot of the world’s climate, sounding a “red alert” for countries to double down on efforts to control global warming. 

For United Nations (UN) Secretary General António Guterres, the earth itself is issuing a “distress call” as 2023 saw record greenhouse gas levels, surface temperatures, ocean heat and acidification, sea level rise, and Antarctic sea ice cover and glacier retreat. 

“The impact of all this is stark, brutal and accelerating with deadly force,” said Guterres in a video message at the launch of the report.

Mean surface temperature anomalies as a result of climate change
Both landmasses and oceans saw record-setting heat

The report confirms 2023 as the hottest year on record, noting that globally, every month from June to December broke records. 

September 2023 was particularly noteworthy, surpassing the previous global record for that month by a wide margin (0.46 to 0.54 °C).

The shift from La Nina to El Nino weather conditions have exacerbated the greenhouse gas effects on warming, and the report also warns of rapidly warming oceans. 

At any given point in 2023, close to a third of the oceans were experiencing a heatwave, by the end of the year, most of the global oceans had experienced heatwave conditions. The most affected was the North Atlantic, with marine temperatures exceeding 3°C above average. 

However, the southern ocean continues to store the largest amount of heat, accounting for around 32% of the global ocean heat content (OHC) content increase since 1958. The Atlantic Ocean accounts for approximately 31% of the global 0–2000 m OHC increase; the Pacific Ocean around 26%.

These intense marine heatwaves harm entire ecosystems and further stress coral reefs. The combination of warming oceans and increased atmospheric carbon dioxide concentrations have further acidified the global ocean. The WMO expects the warming to continue “irreversibly” on a dramatic scale of “hundreds to thousands of years.”

Ice sheets shrink, sea level rise doubles 

Ice sheet coverage graphs
Both Greenland and Antarctic Ice Sheets experienced dramatic losses in ice mass

Heatwaves are not the only phenomenon threatening the planet’s ocean. Global mean sea level reached record highs this year, while the rate of rise in the past ten years has doubled from 2.13 mm/year between 1993 and 2002, to 4.77 mm/year. 

Several factors converge to create this alarming rise: warmer oceans, the switch from La Nina to El Nino, and melting glaciers. 

Both glacier and sea-ice melt accelerated this past year, with Antarctic sea-ice reaching “an absolute record low” not seen since 1979. 

The Greenland Ice Sheet and Antarctic Ice Sheet lost 372 gigatonnes of mass per year from 2016 to 2020, up from 105 gigatonnes/year in 1992-1996.

“Antarctic sea ice was one million square kilometres smaller than the previous record low for the time of year. That’s an area almost 25 times the size of Switzerland,” noted Guterres. 

Beyond the poles, glaciers in western Northern America and Europe suffered the largest loss of ice on record, particularly in the European Alps. The mountain range lost 10% of its remaining volume in just the past two years. 

The toll of extreme weather

Canadian wildfires graph
Canadian wildfires burned through millions of hectacres in the past year alone

Extreme weather including cyclones, rainfall-induced flooding, wildfires, and heatwaves continued to lead to severe socioeconomic impacts. 

Wildfires in Hawaii, Canada and Europe led to loss of life, the destruction of homes and large-scale air pollution. Flooding associated with extreme rainfall from Mediterranean Cyclone Daniel affected Greece, Bulgaria, Türkiye, and Libya. 

“There were particularly devastating consequences for vulnerable populations who suffer disproportionate impacts,” writes WMO Secretary-General Saulo in her forward to the report.

“Extreme climate conditions exacerbated humanitarian crises, with millions experiencing acute food insecurity and hundreds of thousands displaced from their homes.”

Food security, population displacement and impacts on vulnerable populations continue to be of mounting concern in 2023, with weather and climate hazards exacerbating the situation in many parts of the world.

The report calls attention to the fact that the number of people who are acutely food insecure worldwide has more than doubled, from 149 million people before the COVID-19 pandemic to 333 million people in 2023, citing World Food Programme (WFP) numbers.

Climate and extreme weather events are directly tied to the dire food insecurity situation in much of the world; in Southern Africa, for example, Cyclone Freddy submerged extensive agricultural areas and inflicted severe damage on crops in February 2023.

“Across the globe, millions of people, including internally displaced persons, refugees, and migrants, are on the move or have been forced to flee their homes and communities because of disasters exacerbated by climate stresses and shocks,” states the WMO.

The consequences of global inaction

Greenhouse gas emissions
Greenhouse gas emissions continued to climb in 2023 despite growing investment in renewables

“The scientific knowledge about climate change has existed for more than five decades, and yet we missed an entire generation of opportunity,” said Saulo said to media in Geneva. 

She urged the climate change response to be governed by the “welfare of future generations, but not the short-term economic interests.”

The cost of inaction is staggering, the report warns. In the next 75 years, it may reach 1.266 trillion, representing the difference in losses between a business-as-usual scenario and a 1.5° C pathway. Noting that this figure is likely a significant underestimate, the UN weather experts call for immediate climate action.  

The report emphasizes that adaptation finance continues to be “insufficient.” Though adaptation finance reached an all-time high of 63 billion in 2021 and 2022, the global adaptation financing gap is widening, falling well short of the estimated 212 billion per year needed up to 2030 in developing countries alone.

There is, however, reason for hope. Renewable energy generation and capacity surged this past year, driven by solar, wind, and hydropower. 

In 2023, renewable capacity additions increased by almost 50% from 2022, for a total of 510 gigawatts (GW) – the highest rate observed in the past two decades.

“The good news is that we can still keep our planet’s long-term temperature rise below that limit, and avoid the worst of climate chaos,” remarked Guterres. “We know how to do it.” 

“There’s still time to throw out a lifeline to people and planet. But leaders must step up and act – now.”

Image Credits: Melissa Bradley, World Meteorological Organization.

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

An effort by Gambia’s parliament to reintroduce female genital mutilation (FGM) has been met with widespread condemnation by women’s and human rights organisations.

Gambia’s Members of Parliament voted overwhelmingly this week to refer the Private Member’s Bill that seeks to repeal the Women’s (Amendment) Act of 2015 that banned FGM to parliament’s business committee for further consideration. It may be reintroduced within weeks.

Supporters of the Bill claim that the practice is important for “cultural and religious reasons” in the conservative Muslim-dominated country. 

Only four of the 47 MPs present opposed the decision to entertain the Bill further in Gambia’s parliament, which is made up of 53 male MPs and only five women MPs.

However, Deputy Speaker Seedy SK Njie expressed his support for the current status quo on X, stating that “the FGM law is here to stay. We’re committed to keeping Gambian women and girls safe.”

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, who advocates for FGM for religious and cultural reasons.

It is being opposed by a number of organisations, including the Network Against Gender-Based Violence and Think Young Women, which is also opposed to child brides.

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.

“It is very disappointing that, after the long fight Gambian activists put up to advance women’s rights, parliament is preparing to consider this backward move,” said Michèle Eken, senior researcher at Amnesty International’s West and Central Africa office.

“The potential repeal of the FGM ban in The Gambia sends a dangerous message, not just domestically, but internationally,” said Women Leaders Network for Development. (RFLD)

“Other countries grappling with FGM might see this as an opportunity to dismantle their own safeguards, putting millions more girls at risk.

“Proponents of repealing the ban often frame it as an attack on cultural and religious traditions. However, this narrative is misleading. Culture is not static; it evolves with time. Harmful practices, like FGM, have no place in a society that values human rights and equality. The right to health, enshrined in international law, supersedes cultural justifications for practices that cause demonstrable harm,” added RFLD.

Lack of enforcement

Despite the ban on FGM in the three-million strong nation, there has only been one 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.

“We must recognise that the practice is rooted in the desire to control our bodies and our sexuality, and any concessions we make today will be applied to other forms of violence we face, because the goalpost will always be shifted,” Jack wrote in a blog this week.

“We have already seen Abdoulie Fatty mention the law prohibiting child marriage, and just as we predicted, they will come for every legislation protecting women and girls.”

FGM 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.

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

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.

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

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

Violation of rights

“In every form in which it is practised, FGM is a violation of girls’ and women’s fundamental human rights, including their rights to health, security and dignity,” according to UNICEF, which estimates that four million girls and women are at risk every year.

“FGM has no health benefits and can lead to serious, long-term complications and even death. Immediate health risks include haemorrhage, shock, infection, HIV transmission, urine retention and severe pain,” said UNICEF, adding that psychological impacts ranged from girls losing trust in her caregivers, anxiety and depression.

“In adulthood, girls subjected to FGM are more likely to suffer infertility or complications during childbirth, including postpartum haemorrhage, stillbirth and early neonatal death.”

Ironically, Gambia’s decision comes in international women’s month and during a global meeting of the UN Commission on the Status of Women. The theme of the 68th meeting of the commission is “Accelerating the achievement of gender equality and the empowerment of all women and girls by addressing poverty and strengthening institutions and financing with a gender perspective”.

Microscopic view of mycobacterium tuberculosis in the lungs.

A Phase 3 trial of a tuberculosis vaccine candidate has been launched in South Africa, according to the Bill & Melinda Gates Medical Research Institute (Gates MRI).

The candidate vaccine – referred to as  M72/AS01E – “could potentially become the first vaccine to help prevent pulmonary TB in adolescents and adults, the most common form of the disease, and the first new TB vaccine in over a century”, according to Gates MRI, which is sponsoring the trial along with funding support from Wellcome Trust and the Bill and Melinda Gates Foundation.

“The launch of this pivotal Phase 3 trial demonstrates our commitment to harnessing the power of medical innovation to fight diseases like TB that are particularly devastating for low- and middle-income countries,” said Dr Emilio Emini, CEO of the Gates MRI. 

“Clinical study of the vaccine will still require years, but our incredible partners in South Africa and elsewhere who have come together for the Phase 3 study share our hope in the vaccine’s potential.”

M72/AS01E was originally designed and clinically evaluated by the biopharma company GSK up to the proof-of-concept phase (Phase 2b). 

In 2020, GSK announced a partnership with the Gates MRI for its further development. GSK continues to provide technical assistance and is supplying the adjuvant component for the Phase 3 trial and will provide the adjuvant post-licensure should the trial be successful. An adjuvant is an ingredient used in some vaccines that can help create a stronger immune response. 

Up to 60 trial sites

“Reaching Phase 3 with an urgently needed TB vaccine candidate is an important moment for South Africans because it demonstrates that there is a strong local and global commitment to fight a disease that remains distressingly common in our communities,” said Dr Lee Fairlie, national principal investigator for the trial in South Africa.

“South Africa also has considerable experience with TB- and vaccine-related clinical trials and a strong track record for protecting patient safety and generating high quality data essential for regulatory approvals.”

At full capacity, the trial will include up to 20,000 participants, including people living with HIV, at up to 60 trial sites in South Africa, Zambia, Malawi, Mozambique, Kenya, Indonesia and Vietnam. 

“After dedicating over 20 years to developing this essential candidate vaccine, we at GSK are delighted that the Phase 3 trial is underway,” said Deborah Waterhouse, CEO of ViiV Healthcare and GSK’s president of global health.

“Developing and ensuring access to global health products is complex but our collaboration with the Gates MRI, Wellcome and the Gates Foundation exemplifies the transformative power of leveraging diverse partners’ expertise to change the trajectory of challenging diseases, like TB, which place a huge burden on communities around the world.”

WHO investment case for screening and prevention

Every dollar invested in TB screening and prevention will translate to $39 in economic and health gain, according to the World Health Organization (WHO) investment case released this week.

The analysis is based on the results of a modelling study developed with the governments of four countries – Brazil, Georgia, Kenya and South Africa. 

“The investment case outlines the health and economic rationale for investing in evidence-based, WHO-recommended interventions on TB screening and prevention that can contribute to advancing universal health coverage,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Today, we have the knowledge, tools and political commitment that can end this millennia-old disease that remains one of the world’s top infectious killers,” he said. 

TB causes 1.3 million deaths each year and affects millions more, mostly in low-and middle-income countries. Global efforts to combat TB have saved an estimated 75 million lives since the year 2000, according to the WHO.

This year, World Tuberculosis Day on 24 March is being commemorated under the theme ‘Yes! We can end TB!’ conveying a message of hope.

But WHO experts conceded that access to TB drugs remained constrained due to limited investments, speaking at a press conference on Monday. 

Screening and preventive treatment cuts costs

Implementing TB screening along with preventive treatment can substantially reduce TB incidence and mortality, according to the investment report. It argues that these crucial public health investments are essential for addressing the needs of vulnerable populations.

In 2022, WHO reported a significant worldwide recovery in the scale-up of access to TB diagnosis and treatment services, with the highest figure recorded since WHO began global TB monitoring in 1995.

But so far the scale-up of access to TB preventive treatment has been slow. It is also vital to offer TB preventive treatment to those with HIV, household contacts of TB patients, and other high-risk groups.

The global number of people living with HIV and household contacts of people with TB who were provided with TB preventive treatment increased to 3.8 million in 2022 or about 60% of those targeted that year in line with the commitments made at the UN High-Level Meeting of 2018.

Dr Saskia Den Boon, Technical Officer at the WHO’s Global TB Programme.


“Strategies to provide TB preventive treatments are often linked to screening to find and treat people with TB earlier in the course of their disease. And this helped to reduce transmission and improve outcomes. TB screening is a key intervention to find and treat the millions of people not accessing care for TB disease,” Dr Saskia Den Boon, Technical Officer at the WHO’s Global TB Programme.

Lack of vaccines

Vaccines are normally an effective preventive strategy but currently the only available vaccine for TB is the BCG vaccine that is over a century old.

“That’s the BCG, which was only for kids and it is not really effective to provide adults protection against TB,” said Ashna Ashesh, a TB survivor and public health professional and representative of WHO Civil Society Taskforce on TB.

“We’ve seen how fast we can work when we put our money where our mouth is with COVID. We had a vaccine within a year. But that wasn’t because we started from scratch in that one year. We invested in decades of mRNA research that then allowed us to quickly develop the COVID vaccine.”

Dr Tereza Kasaeva, Director of the Global Tuberculosis Programme at the WHO


“It’s absolutely unacceptable that in 21st century with a lot of innovations, we still don’t have new effective TB vaccine,” said Dr Tereza Kasaeva, WHO’s TB director. “This area of the development of new vaccines, it’s very expensive, highly risky area,” she added. 

Kasaeva said that there are more than 16 candidates in the pipeline and newer vaccines could come in the market in the next five years but added that investments are needed.

“And if you look, first of all at the situation with funding of TB research, [it is] less than o$1 billion annually. Overall investments in TB research are absolutely not sufficient,” she said. 

Multidrug-resistant TB 

Multidrug-resistant TB (MDR-TB) remains a public health crisis. While an estimated 410,000 people developed multidrug-resistant or rifampicin-resistant TB in 2022, only about two in five people accessed treatment.

The global targets approved at the 2023 UN High-Level Meeting on TB include: reaching 90% of people in need with TB prevention and care services; using a WHO-recommended rapid test as the first method of diagnosing TB; providing a health and social benefit package to all people with TB; ensuring the availability of at least one new TB vaccine that is safe and effective; and closing funding gaps for TB implementation and research by 2027.

Following the commitments made by Heads of State at the UN High-Level Meeting in 2023 to accelerate progress to end TB, this year’s focus is on tangible action, the world health body said. 

Additional reporting by Kerry Cullinan.

Image Credits: Roche .

A child gets vaccinated against measles during the outbreak in the DRC.

Discussion about disease outbreaks dominated the biannual meeting of the Strategic Advisory Group of Experts on Immunization (SAGE) – which its chairperson described as  “alarming” as the aim of the group is to ensure early vaccination to prevent outbreaks.

“The outbreak-related recommendations is a sign that normalcy is starting to be living with outbreaks,” warned Dr Hanna Nohynek, chair of SAGE, which advises the World Health Organization (WHO) on immunisation.

“My plea to nations is to give us sufficient resources so that we can run our programmes properly and our surveillance systems properly so that we don’t have to deal with outbreaks but we can actually keep up our good vaccine coverage.” 

Mpox: different epidemiology 

There is a “significant” mpox outbreak in the Democratic Republic of Congo (DRC) that involves Clade I of the disease and is predominantly affecting children.

But this outbreak has “a very different epidemiology” from the multi-country outbreak in 2022, which involved the milder Clade II and was mainly spread through sexual transmission, particularly in men having sex with men, said Dr Kate O’Brien, WHO Director of Immunization, Vaccines and Biologicals.

Dr Kate O’Brien, WHO Director of Immunization, Vaccines and Biologicals.

“It’s really important to understand what the source of the mpox exposure is [in DRC], which is presumably related in part to zoonotic transmission, and potentially transmission then in the household or in the community,” she added.

Children in the DRC are being given mpox vaccines (both on- and off-label, depending on which vaccine is involved), and O’Brien urged the country to conduct evaluations of its performance “which we expect to be very high in settings of community transmission”.

“The vast majority of mpox vaccine data is from high income countries and predominantly in communities where there has been sexual transmission,” she noted.

“We have a lack of research, be it clinical research or epidemiological research, in relation to diseases that are most pressing in low income countries and the issue came up in particular in relation to mpox,” said SAGE’s executive secretary, Dr Joachim Hombach, who is also WHO senior health advisor.

“More research needs to be done and, whenever possible local research because the competencies are there it is just that the resources are not, so that more data is generated to allow for more robust policy and for more robust understanding of the disease epidemiology.”

SAGE’s executive secretary, Dr Joachim Hombach.

Measles and misinformation

WHO releases annual measles case and death estimates, and for 2022 there were over nine million cases and 136,000 deaths.

“There are now over 50 countries that have large and disruptive measles outbreaks ongoing during the course of this past calendar year, and that’s about double the number of countries as occurred in 2022,” said O’Brien.

“We warned very much regularly during the course of the [COVD-19] pandemic what the impact would be of the backsliding in immunisation, and we’re seeing that happen now and we do expect that the 2023 numbers will be even worse than the 2022 numbers.”

While there had been an “infodemic” of vaccine-related misinformation during the pandemic, O’Brien stressed that lack of access to vaccines was behind the vast majority of children going unvaccinated. 

“The primary reason for unvaccinated people is really related to the ease of access and the quality of services. But this issue of misinformation, hesitancy and people’s understanding of the value of vaccines is very contributory and in some communities, this is a big contribution to people’s behaviour around vaccines,” she acknowledged.

“The reasons for this misinformation, hesitancy or lack of confidence in vaccines is very, very local so we can’t give global recommendations on exactly what to do,” she added.

However, she urged health authorities to listen to communities, and assure local leaders about the “life-saving nature of vaccines and the safety of vaccines”.

“I want to really emphasise the importance of the process that we have in WHO for pre-qualifying vaccines. Our procedure for pre-qualifying vaccines or issuing an emergency use listing is an assurance to countries that those vaccines are efficacious. They’re safe, and they’re manufactured with quality.”

Polio and Hepatitis E

Dr Hanna Nohynek, chair of SAGE

The wild poliovirus type one is only in circulation in a small geographic area of the border between Afghanistan and Pakistan, but SAGE is concerned about the circulation of vaccine-derived polio type one and type two (VDP2) in a number of African countries.

“Improving routine immunisation coverage is at the heart of getting the eradication goals,” stressed Nohynek.

SAGE is also concerned about Hepatitis E, a liver disease that “can be very severe, especially for pregnant women among whom the case fatality rate can be as high as 25%”, she added. 

“In fragile and conflict-affected and vulnerable settings, it’s really important that pregnant women have access to the vaccine,” said Nohynek.

SAGE has recommended a two-dose schedule, which is off label, instead of a three-dose schedule and additional research on hepatitis E vaccination during pregnancy, in people living with HIV and children under 16.

Image Credits: WHO DRC Office Twitter.


Seven Indian pharmaceutical companies made donations to domestic political parties while they were under investigation for substandard drug production, according to an investigation published in Scroll.

The companies named in the investigation included Hetero Labs and Hetero Healthcare, Torrent Pharma, Zydus Healthcare, Glenmark, Cipla, IPCA Laboratories Limited, and Intas Pharmaceutical. They were under investigation for substandard drugs including the anti-COVID drug, Remdesivir and anti-bacterial and anti-fungal medications.

Overall, some 35 pharmaceutical companies in India contributed nearly Rs 1,000 ($120 million) to political parties competing in the upcoming national elections, which are scheduled in phases through April and May this year.

The donations, originally anonymous, were made through the purchase of “electoral bonds”, system whereby an individual or an institution can fund a political party that was introduced by Prime Minister Narendra Modi’s government in 2017.

India’s Supreme Court recently directed the country’s public sector bank, State Bank of India, to disclose the names of the companies that made donations, and these names have been released by the Election Commission beginning on 14 March.

Punitive actions for failing a drug quality test can range from the suspension of manufacturing to the cancellation of a licence, and the decision lies with the Indian government.

The data released did not, as yet, disclose which political parties were supported, and to what extent. However, with just four weeks to go before the elections, India’s Supreme Court has pressed on for ‘complete disclosure’ of the data in a further order issued 18 March.

The analysis is part of an ongoing series of stories on the electoral bonds by a team of journalists from several independent news organisations including, Newslaundry, Scroll, and The News Minute.

Image Credits: AMR Industry Alliance, Glsun Mall/ Unsplash.