Children with cancer outside Okhmatdyt Hospital after the attack.

Russia’s bombing of a children’s hospital and women’s health centre in Ukraine’s capital Kiev on Monday is “abominable”, said UN High Commissioner for Human Rights Volker Türk.

“Civilians must be protected, and the laws of war strictly adhered to,” added Türk. “There must be prompt, thorough and independent investigations into these latest grave attacks on civilians and civilian infrastructure, and those responsible must be held to account.”

“Shockingly, one of the strikes severely damaged the intensive care, surgical and oncology wards of Okhmatdyt, which is Ukraine’s largest children’s referral hospital, and destroyed its children’s toxicology department, where children receive dialysis,” said Türk.

Okhmatdyt Hospital serves more than 20,000 children annually. Monday’s missile attack struck a medical building at the hospital where children were receiving dialysis, while also damaging the intensive care, operating, and oncology departments, according to the Minister of Health of Ukraine.

The entire hospital is without electricity, preventing the use of ventilators and other urgent care.

Dr Tedros Adhanom Ghebreyesus, Director General of the World Health Organisation (WHO), said that “several floors of the largest children’s hospital in Kyiv were severely impacted today, disrupting the hospital’s operations and affecting its ability to provide critical care to the young patients.”


Meanwhile, Türk said that OHCHR staff visiting the scene shortly after the attack had “observed children receiving treatment for cancer in hospital beds set up in parks and on streets, where medical workers had quickly established triage areas, amongst chaos, dust and debris.”

Health officials said the entire hospital was now without electricity, preventing the use of ventilators and other urgent care. It was not immediately clear how many people were killed in the strike.

The ISIDA Medical Centre, one of the largest women’s health and family planning centres in Ukraine, was also affected by the attack, with several casualties.

The attack comes the day before a NATO summit in Washington DC.

Russia has attacked Ukraine’s health care workers, facilities, and other medical infrastructure at least 1,442 times since its invasion of Ukraine in February 2022 and 13 April 2024,according to data from a partnership made up of the Ukrainian Health Center, Physicians for Human Rights (PHR) and others.

Russian attacks on Ukraine health care since February 2022.

“Russia’s strategy in Ukraine includes attacking babies and children. Domestic and international actors should intensify efforts to hold perpetrators accountable for these war crimes,” said Uliana Poltavets, PHR’s Ukraine emergency response coordinator in a statement.

Researchers have documented 79 attacks that affected children’s health care, including 54 attacks that destroyed or damaged children’s hospitals.

“Today’s devastating attack on the largest children’s hospital is emblematic of Russia’s onslaught against Ukraine’s health care system. Again and again, we have witnessed Russian forces attack vulnerable patients, health workers, and hospitals across the country,” said Poltavets.

PHR called on “domestic and international prosecutors, including the International Criminal Court, to prioritise the investigation and prosecution of attacks on health care.”

Image Credits: Twitter.

Sierra Leone First Lady Fatima Bio

Sierra Leone’s President Julius Maada Bio signed into law the Prohibition of Child Marriage Act last week, introducing a penalty of at least 15 years and a fine of around $4,000 for any man who marries a girl under 18.

The law also prohibits cohabiting with a child, and fines for anyone arranging, aiding or attending such marriage ceremonies.

First Lady Fatima Bio’s “Hands Off Our Girls” campaign has been instrumental in advocating against child marriage in Sierra Leone.

Sierra Leone has one of the highest rates of child marriages in Africa, alongside Niger and Nigeria. According to the 2019 Sierra Leone Demographic and Health Surveys, 30% of girls in Sierra Leone are married before their 18th birthday.

In 2020, there were 800,000 child brides, half of whom were married before they turned 15, according to UNICEF. The country of slightly over eight million people also has a high rate of female genital mutilation.

“Child marriages fuel the high adolescent pregnancy rate in Sierra Leone where, tragically, pregnancy complications are the leading cause of death for girls aged 15-19,” according to Human Rights Watch (HRW).

In 2021, the country introduced a policy of “radical inclusion” in schools, targeting and marginalised groups including girls, particularly pregnant girls and parent learners. 

Last year, Sierra Leone passed an education law that guarantees children free education, including one year of pre-primary. 

“The legislation is a milestone in Sierra Leone’s journey towards gender equality and child protection. It also sets a pathway forward for other African nations, such as Tanzania and Zambia, to revoke laws that permit child marriage, and ensure girls can complete primary and secondary education,” said HRW.

 

Neurons with tau protein highlighted in red.

Eli Lilly’s Alzheimer’s therapy, donanemab, has received FDA approval, offering new hope for patients with early symptomatic Alzheimer’s disease. The newly approved treatment, branded Kisunla, is set to challenge existing therapies from Eisai and Biogen. 

Clinical trials have shown Kisunla to be effective for individuals in the mild cognitive impairment or mild dementia stages of the disease, potentially marking a significant advancement in Alzheimer’s care.

The drug is administered as an intravenous infusion every four weeks. 

Alzheimer’s disease is a degenerative condition of the brain that impacts over 6.5 million Americans and over 55 million people worldwide. It causes a gradual decline in memory, cognitive functions, and, eventually, the ability to perform daily activities. The disease is marked by structural changes in the brain, such as the buildup of amyloid beta plaques and neurofibrillary tangles made of tau protein, which is supposed to help stabilize the internal skeleton of neurons in the brain. 

The Alzheimer’s Association celebrated the FDA’s decision.

“This is real progress,” said Joanne Pike, Alzheimer’s Association president and CEO, in a statement. “Today’s approval allows people more options and greater opportunity to have more time. Having multiple treatment options is the kind of advancement we’ve all been waiting for — all of us who have been touched, even blindsided, by this difficult and devastating disease.”

Slows cognitive decline by at least 22%

The approval was based on an extensive double-blind, placebo-controlled, parallel-group study evaluating the efficacy of Kisunla in slowing cognitive decline in participants with varying levels of tau protein in the brain. Tau is a protein that helps to stabilise the neurons in the brain. 

The study, conducted over 72 weeks with 1,736 patients averaging 73 years old, revealed that those receiving Kisunla experienced a 35% reduction in cognitive decline compared to those on placebo among individuals with low to medium tau levels. 

Even among participants with higher tau levels, the treatment demonstrated a meaningful but slightly reduced effect. Overall, including all tau levels, Kisunla slowed cognitive decline by 22% and reduced the likelihood of progressing to the next stage of the disease by 39% compared to placebo.

Additionally, the study monitored amyloid plaque levels using positron emission tomography (PET) scans throughout the treatment period. Results showed substantial reductions in amyloid plaques over time among patients receiving Kisunla, with reductions of 61% at six months, 80% at 12 months, and 84% at 18 months compared to baseline levels. These findings suggest that Kisunla not only targets cognitive decline but also effectively reduces the hallmark amyloid pathology associated with Alzheimer’s disease progression.

Potential side effects

For some patients, there is a risk of amyloid-related imaging abnormalities (ARIA) developing, the FDA said. ARIA typically manifests as temporary brain swelling, sometimes accompanied by small areas of bleeding on or in the brain. While ARIA often resolves on its own and may not cause symptoms, rare instances of severe and potentially life-threatening events have been reported. ARIA is a recognized side effect of antibody therapies targeting amyloid.

Infusion-related reactions are also a concern, including flu-like symptoms, nausea, vomiting, changes in blood pressure, and hypersensitivity reactions such as anaphylaxis (a severe allergic reaction) and angioedema (swelling). 

Kisunla joins Leqembi, on market since 2023

Kisunla is the third drug to receive FDA approval, although only the second is now available for use. Leqembi, a collaboration between Biogen of the United States and Eisai of Japan, gained approval in July 2023. In an 18-month Phase III trial, Leqembi demonstrated a 27% reduction in cognitive decline among early-stage Alzheimer’s patients compared to those receiving a placebo.

Another drug, aducanumab, also developed by Biogen and Eisai, was granted accelerated approval by the FDA in June 2021. However, due to some side effects, the therapy was pulled from the market. 

The Alzheimer’s Association emphasized the importance of early detection and diagnosis now that multiple FDA-approved treatments for Alzheimer’s are available. The organization stressed that timely access to these treatments is crucial for maximizing their benefits, asserting that no stage or entity should hinder or delay such access.

“Too many roadblocks have prevented individuals from getting equitable access to these beneficial treatments for far too long,” said Pike. “It is equally important that clinicians and health care systems are informed and prepared to help the individuals who could benefit. The Alzheimer’s Association is working with health systems and providers to ensure they have the tools and resources to meet the needs of their patients.”

Image Credits: Gerry Shaw/ EnCor Biotechnology Inc.

Fishing vessels at the Bridgetown Fisheries Complex in Barbados damaged by Hurricane Beryl.

Hurricane Beryl, which has destroyed homes and infrastructure in large parts of the eastern Caribbean, is the first first-ever Category 4 hurricane recorded in the region in June – and a portend of devastating changes in weather patterns.

It also underscores the need for urgent international assistance to Small Island Developing States (SIDS) to strengthen early warning systems and the climate resilience of key infrastructure – notably water, sanitation and health services, according to experts.

The hurricane reached peak speed of 265 km per hour at times as it whipped though Barbados, Grenada, St Vincent and the Grenadines, Haiti, northern Venezuela, the Dominician Republic, Cayman Islands, and Jamaica.

“The storm first impacted Barbados, causing severe damage to the south coast and significantly affecting the fishing industry with over 200 fishing vessels damaged or destroyed,” according to the International Federation of Red Cross and Red Crescent Societies (IFRC).

On Union Island, part of Saint Vincent and the Grenadines, 90% of infrastructure has been damaged, including houses, roads and the airport. 

Some 95% of homes in Grenada’s Carriacou and Petite Martinique islands, are damaged, and around 3,000 people are shelters, the IFRC added.

Parts of Jamaica’s St Elizabeth region in the south east were also devastated, with around 1,000 people taking refuge in shelters. The Dominican Republic, Cayman Islands reported damage. 

Venezuela’s President Nicolas Maduro said that 8,000 houses had been destroyed, according to Reuters.

More to still come?

“Hurricane Beryl, the first hurricane of the 2024 Atlantic hurricane season, rapidly strengthened to a Category 5 storm unusually early in the year,” according to a report from the National Ocean and Atmospheric Administration (NOAA), which is part of the US Department of Commerce 

“This explosive strengthening was fuelled in part by exceptionally warm ocean temperatures. That heat was one of the factors behind NOAA’s prediction in May of an 85% chance that the 2024 Atlantic hurricane season would be above normal.”

Sea surface temperatures were close to those usually found in mid-September, the peak of hurricane season, added NOAA.

In late May, NOAA weather forecasters predicted an 85% chance of above-normal hurricane for the 2024 Atlantic hurricane season, which runs from 1 June 1 to 30 November.

It also forecast eight  to 13 hurricanes, with four to seven likely to be “major” hurricanes (winds of over 178km per hour) in coming months.

Early warning systems 

“The unprecedented hurricane demonstrates the importance of effective multi-hazard early warning systems to save lives,” according to United Nations Disaster Risk Reduction (UNDRR).

“Globally, the sustained investments in those systems are making progress in reducing the loss of life in disasters. But economic losses are escalating. Every year millions of households lose their livelihood and risk being pushed into poverty. Ensuring that infrastructure is resilient and that communities ‘build back better’ in the face of future hazards is essential,” added UNDRR.

Damage sustained to the airport and surrounding areas on Union Island in the Grenadines during Hurricane Beryl.

In late May, the Fourth International Conference on SIDS adopted the Antigua and Barbuda Agenda for SIDS, a 10-year development agenda that  appeals for international assistance to address climate change.

The Agenda notes that “SIDS are facing the unrelenting and compounding impacts of climate change, biodiversity loss, pollution, disasters and natural hazards, health and other social related challenges and economic vulnerabilities.”

Key climate change challenges include “erratic precipitation, increasingly frequent and extreme weather phenomena, more frequent and severe tropical cyclones, floods and drought, diminishing fresh water resources, desertification, coastal erosion, land degradation and sea-level rise.”

However, there has been a “progressive deterioration” in SIDS’ ability to “withstand external shocks and enhance their resilience” – largely as a result of the economic impact of COVID-19 and climate challenges.

Financial reform to build resilience 

Protestors call on wealth countries to pay for climate-related loss and damage at COP27.

“In the wake of Hurricane Beryl, it is clear that we must redouble our efforts to build resilience and preparedness in the face of growing disaster risk, especially for small island developing states, which have contributed the least to the climate crisis but suffer the greatest costs,” said UNDRR head Kamal Kishore.

Kishore appealed for international support for the Antigua and Barbuda Agenda, which “integrates disaster risk reduction as central to climate change adaptation and sustainable development in SIDS with clear calls to action on enhancing multi-hazard early warning systems and resilient infrastructure.”

There have also been numerous calls for reform of the international financial architecture to assist developing countries most affected by climate change who are being forced to borrow money to address climate crises largely caused by wealthy nations. 

The most significant of these is the 2022 Bridgetown Initiative, spearheaded by Prime Minister Mia Mottley of Barbados. This called for key actions including new loan mechanisms, reform of the world’s development banks, and a loss and damages fund to enable developing countries to access to resilient finance to address climate and development crises.

The UN climate change conference, COP27, agreed to establish a loss and damage fund during the UN Climate Change Conference (COP27) in 2022. However, there is resistance from a number of wealthier countries to this as the world continues to experience record-breaking extreme weather events.

Meanwhile, the International Cort of Justice (ICJ) is expected to hold public hearings and issue an advisory later this year on the international legal obligations countries have to safeguard people against climate change. 

This follows the adoption last year of a landmark UN resolution to seek such an advisory opinion from the ICJ. While not legally binding, the advisory opinion holds legal and moral weight and will spotlight the human rights impacts of climate policy.

Image Credits: UNDP, AfricaNews.

Over one-half of Americans are not sure if pasteurised milk is safer than raw milk. In the time of avian flu epidemics in US cattle, this could even prove dangerous.

As the fourth human case of H5N1 avian flu in a US farmworker in Colorado was confirmed Wednesday by the US Centers for Disease Control and Prevention (CDC), so far, only farm workers, and not consumers, have reported avian flu infections.

This is likely due, at least in part, to the successful inactivation of the virus during the milk pasteurization process, experts say. And yet one-half or more Americans seem to have little idea about the dangers of drinking raw milk, according to a recent poll conducted by the University of Pennsylvania researchers.

The survey, which included a demographically representative sample of the US adult population, found that less than half (47% percent) of the U.S. adults surveyed understood that drinking raw milk not as safe as drinking pasteurized milk. Conversely, 53% of respondents don’t actually believe that pasteurized milk is safer. And 9% of respondents actually believed raw  milk is safer, while 15% said it was just as safe and 30% were unsure.  

Nearly a quarter (24%) of Americans either do not believe that pasteurization is effective at killing bacteria and viruses in milk products (4%) or are not sure whether this is true (20%), according to the survey of over 1000 US adults, conducted by the Annenberg Public Policy Center (APPC). The survey has a 3-3.5% statistical error rate.

Around half of US adults failed to recognize that raw milk  can be more dangerous than pasteurized milk products.

That, despite the fact that studies report that pasteurized milk limits hospitalizations for related illnesses by an order of 45, according to the APPC report. 

The French Scientist Louis Pasteur invented the pasteurization process 160 years ago, after recognizing that it killed off otherwise dangerous bacteria present in unheated wine. The process, which soon became a milk industry standard in the United States, successfully inactivates the modern-day avian flu virus, significantly limiting the risk of infection for the general public. 

Politics and milk 

In fact, only about 2% of Americans report drinking raw milk at least once a month, according to a Food and Drug Administration (FDA) study based on 2019 data.

Paradoxically, however, raw milk sales in the US have increased in recent months, according to some US media reports, despite the recent risks posed by a widening circle of avian influenza among dairy cattle.

Debate has been spurred  by the increased anti-science bent of some US political leaders. Presidential candidate Robert F. Kennedy Jr., for instance, who also has been a staunch opponent of COVID vaccination, has been quoted saying that he drinks raw milk exclusively.

The APPC survey also found that Republicans are more likely than Democrats to believe that drinking raw milk is as safe as pasteurized milk (57% vs. 37%). People living in an urban environment also are more likely to believe that pastuerized milk is safer than raw milk as compared to people in a rural environment (49% vs. 32%).

“The difference in views of raw milk that we see between Democrats and Republicans is difficult to disentangle from the difference between rural and urban dwellers,” said Kathleen Hall Jamieson, director of the Annenberg Public Policy Center. “Those in rural areas are both more likely to identify as Republicans and to consume raw milk.”

55 more dairy herds reported infected in last 30 days

Some 55 more cattle herds in seven states have been infected with the virus over the past 30 days, according to CDC tracking. Infections in the past 30 days represent 40% of the total of 138 cattle herds infected in 12 states since the outbreak in dairy cattle was first reported on 25 March, the CDC reported. 

States affected by avian flu spread in dairy cattle

The real number of infections of both humans and cattle is very likely underestimated, insofar as farmers have been reluctant to have their staff or herds tested, experts warn.

Even so, the CDC maintained that infection risks for the general public remain low. 

“Based on the information available at this time, this infection does not change CDC’s current H5N1 bird flu human health risk assessment for the U.S. general public, which the agency considers to be low,” the CDC said in a statement.

Image Credits: Cotonbro studio, APCC, CDC.

Scientists at the West African Centre for Cell Biology and Infectious Pathogens (WACCBIP), University of Ghana, setting up a genome sequencing experiment in the laboratory.

Almost 15 years ago, when the University of Ghana established its Office of Research, Innovation, and Development, it did so with the goal of bolstering the West African nation’s research capacity. 

In the African region, where less than 0.5% of GDP is devoted to research, and a significant number of Africa’s educated is siphoned off to other countries, the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR) has spearheaded the effort to make universities like the University of Ghana research-intensive and competitive. 

TDR support for research capacity-strengthening activities at the University of Ghana focuses on enabling researchers to tackle infectious diseases of poverty through quality implementation research, the study of bridging basic science research and practice. 

This could mean examining why many patients on antiretroviral therapy drop out of treatment, or identifying barriers to TB treatment adherence – both the subject of recent publications authored by researchers at the University of Ghana.

Capacity-building works

Professor Gordon A. Awandare at TDR’s Joint Coordinating Board meeting in Geneva, 12 June 2024

“Capacity-building actually works,” remarked Professor Gordon A Awandare,  Pro Vice-Cancellor of Academic Student Affairs at the University of Ghana, at a TDR 50th anniversary event in Geneva, where he gave a detailed review of the collaboration before TDR’s Joint Coordinating Board on June 12. 

He cited, as one example, his own career trajectory. Awandare began a career in research through a TDR grant that allowed him to complete his masters training, and then got an opportunity to study for a PhD at the University of Pittsburgh while attending a  conference on malaria with support from TDR.  He returned home to the University of Ghana in 2010, founding the West African Centre for Cell Biology of Infectious Pathogens (WACCBIP) in 2014. Since then, the Centre, supported by the Wellcome Trust and the World Bank, has endowed 400 fellowships and received $53 million in grants, thereby directly reducing the “brain drain” across the African region.

A decade-long partnership

The University of Ghana leads efforts to train students in implementation research. Newly enrolled master’s students during their lab induction at WACCBIP, University of Ghana.

In 2014 the University of Ghana’s School of Public Health  signed a partnership agreement with TDR to create a regional training center that leads activities in the African region for strengthening capacity in implementation research to tackle infectious diseases of poverty.

The initiative has so far trained more than 25,000 individuals across Africa, including health practitioners, decision-makers and researchers.                                    

“Looking at how far we’ve come as a training centre, it is our desire to become a centre of excellence where the annual programmes can be extended to say five years,” said Professor Phyllis Dako-Gyeke, who led the TDR-supported research training programmes at University of Ghana until her passing on 11 June. 

But the success of an almost decade-long relationship is not without its challenges. Sustainable donor support and aligned interests on research priorities remain key, she said.           

Real-time research 

Implementation researchers at UG have tackled issues from TB treatment adherence to antiretroviral therapy. Here, a community health worker conducts an interview in Obuasi, Ghana to identify barriers and facilitators for TB control.

Dr Emmanuel Asampong, coordinator of the regional training centre at the University of Ghana, notes that “the impact of implementation research on disease themes in Africa and beyond is impressive because the initiative uses  real-time research results in various contexts – such as the neglected tropical diseases programme, the national malaria programme, and the tuberculosis control programme – to provide solutions to challenges.” 

The global program, which has played a significant role in positioning University of Ghana as a research-intensive university, supports seven regional training centres across six WHO regions. With additional partners in Colombia, Indonesia, Kazakhstan, Malaysia, Senegal and Tunisia, the program develops and updates implementation research courses, provides faculty training and supports career development. 

Map of capacity building TDR regional training centers
The global program, which has played a significant role in positioning University of Ghana as a research institution, also supports NTD research in six WHO regions.

The University of Ghana also partners with TDR on a postgraduate training scheme, which provides a full academic scholarship  for master’s students. The training is specifically focused on implementation research to tackle infectious diseases of poverty. 

The list of TDR alumni across the world runs long, and the University of Ghana can claim many  public health leaders among them. 

“My postgraduate training at the University of Ghana, supported by TDR, was an invaluable catalyst in shaping my academic and professional journey,” said Dr Mbele Whiteson, Senior Resident Medical Officer at the Ministry of Health in Zambia. “I have learned to recognize the intricate interplay between health outcomes and social determinants.”‎

This is the third article in a series on TDR’s research capacity strengthening programme – building skills of public health researchers, implementers, health practitioners and policy-makers in the fast-developing field of implementation research for improving uptake of effective health interventions.

Sophia Samantaroy contributed to the writing and research of this story.

Image Credits: WACCBIP, TDR, African Regional Training Centre (ARTC), University of Ghana/TDR.

modernaAs H5N1 avian flu spreads in US dairy cows, the US Department of Health and Human Services (HHS) has granted approximately $176 million to Moderna to develop an mRNA-based vaccine for influenza with pandemic-potential.

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

This award will help Moderna to set up additional pandemic influenza vaccine response capability, using existing domestic large-scale commercial mRNA-based technology and manufacturing platforms developed during the COVID-19 pandemic and ongoing seasonal influenza vaccine development, according to HHS.

The US government has also secured a fair pricing agreement “which will continue ensuring enduring equitable access to vaccines,” it added. Moderna’s COVID-19 vaccine was one of the most expensive on the market during the pandemic.

“The award made today is part of our longstanding commitment to strengthen our preparedness for pandemic influenza,” noted Assistant Secretary for Preparedness and Response Dawn O’Connell.

“Adding this technology to our pandemic flu toolkit enhances our ability to be nimble and quick against the circulating strains and their potential variants.”

The rapid spread of H5N1 bird flu in US dairy cows has rattled the US, affecting 12 states, according to the American Veterinary Medical Association.

The award will enable the rapid development of an mRNA vaccine targeted to various influenza strains with pandemic potential, and enable development and manufacturing to pivot quickly, if needed, to address other threats.

Image Credits: Jernej Furman/Flickr.

 Some 750 million people globally want to quit smoking but most lack access to help to do so.

Digital cessation programmes, behavioural support, and medication for tobacco cessation in adults are some of the measures contained in first-ever guidelines to help people quit smoking published recently by the World Health Organization (WHO). 

One in five adults – 1.25 billion users worldwide – consume various tobacco products such as  cigarettes, heated tobacco products, water pipes, smokeless tobacco products, or cigars. 

Even though more than half of them – around 750 million – want to quit, only 30% have access to effective cessation services.

Among the treatments recommended to help them are counselling, teaching patients to change their smoking-related habits, dedicated apps or calls, nicotine replacement therapy and medication.

 What works best is a combined approach: behavioural support and pharmacotherapy, WHO states. Member states are encouraged to provide quitting help for no or low fee to make it as accessible as possible.

The guideline marks a “crucial milestone” in combatting tobacco addiction, WHO Director-General, Dr Tedros Adhanom Ghebreyesus said in a press release. “It empowers countries with the essential tools to effectively support individuals in quitting tobacco and alleviate the global burden of tobacco-related diseases.”

Tobacco smoking affects nearly every organ of the body, causing over 20 types of cancer, increasing the risk of heart disease, stroke, and many other conditions. According to the WHO, tobacco kills half of its users and affects non-smokers through second-hand exposure.

Health system change, medication and behavioural support

The guidelines feature advised changes in the health systems: tobacco use status and implemented cessation interventions should be included in the patient’s medical records; it is also recommended that health care workers are trained on the appropriate therapies and provide a short behavioural support talk to smokers who want to quit. 

Treatments included in the guidelines: counselling, digital support, pharmacotherapy, and embedding smoking cessation in the healthcare system are key recommendations.

Pharmacotherapy using nicotine replacement therapy and drugs such as varenicline, bupropion, and cytisine, especially when combined with behavioural support. This may include skills and strategies for changing behaviour as well as more general counselling. 

Traditional, complementary and alternative therapies are not recommended due to insufficient evidence for their effectiveness.

Varenicline, but not vapes

While the guidelines strongly recommend the use of varenicline, they do not mention a possible role for vapes in quitting traditional cigarettes, more harmful than their e-cigarette alternative. 

A recent study published by the JAMA Network suggests vaping can be as efficient as varenicline in helping smokers quit – although, as WHO argues, it has little effect at the population level. 

WHO states that “e-cigarettes are beyond the scope of this guideline because the potential benefits and harms of using these products are complex, and are addressed in a separate body of literature. These products may be addressed in the future as evidence accumulates.”

The tobacco industry is highly invested in marketing vapes, framing them as a safer alternative to traditional smoking even though they are also addictive and harmful. The WHO might be more cautious to promote e-cigarettes knowing its statements can be used by tobacco firms to promote their products.

“We need to deeply appreciate the strength it takes and the suffering endured by individuals and their loved ones to overcome this addiction,” said Dr Rüdiger Krech, Director of Health Promotion at WHO, in a press release. “These guidelines are designed to help communities and governments provide the best possible support and assistance for those on this challenging journey.”

Image Credits: Sarah Johnson, WHO.

Pollution in Delhi peaks in late autumn when drifting emissions from crop burning exacerbate the usual urban household, traffic and industrial sources

A growing body of evidence from India is firmly establishing the country’s toxic levels of air pollution as a leading cause of ill health, particularly non-communicable diseases (NCDs).

The results are significant because the country’s politicians have repeatedly questioned the validity of research that links air pollution with reduced life expectancy and worsening health. 

As many as 80 out of the 100 most polluted cities in the world are in India, as Health Policy Watch reported earlier ithis year, making air pollution a huge health stressor. 

The latest research from India demonstrates how air pollution is worsening anaemia, hypertension, diabetes, cholesterol levels and mental health, as well as other diseases.

Around 74% of all deaths worldwide are attributed to NCDs, according to the World Health Organization (WHO), and while air pollution is already a major risk factor, worsening air quality will worsen the disease burden due to NCDs further. 

Dr Soumya Swaminathan, fomer WHO Chief Scientist.

“The evidence base on the health impacts of air pollution in India is growing. There is a fair amount of data now on the adverse effects of poor air quality on not only respiratory diseases like asthma and COPD [chronic obstructive pulmonary disease], but also cardiovascular and neurological diseases, as well as an increase in metabolic disorders like diabetes mellitus,” former WHO chief scientist Dr Soumya Swaminathan told Health Policy Watch.

“The impact is particularly serious among pregnant women and young children, because it affects the growing organs of the fetus and young child and is likely to have permanent effects on physical and cognitive development,” added Swaminathan, who recently became co-chairperson of Our Common Air (OCA), a new global commission that has been launched by Clean Air Fund (CAF) in London, and the Council on Energy, Environment and Water (CEEW) in New Delhi. 

“[MS Swaminathan Research Foundation] has recently completed a study on the impacts of climate change on women and children in India, where air pollution is one of the major considerations and the evidence has all been collated,” she said of the foundation started by her father that she now chairs.

There are now around 500 studies on the impact of air pollution on health in India, according to Palak Balyan who leads the research team at Climate Trends, a Delhi-based research consultancy. 

She added that some gaps persist as the availability of health data is limited and most of the research comes from clusters around key cities like Delhi and Chennai, but not as much from the country’s rural areas.

Globally there were 8.1 million deaths due to air pollution in 2021.

Shocking and counter-intuitive statistics 

A few statistics that have emerged from recent research have been shocking and some even counter-intuitive, Swaminathan said. 

“The fact that women who stay mostly indoors [in cities] are often exposed to a higher dose of air pollutants than men who work outdoors. This has been documented in a study from Delhi… The fact that life expectancy in parts of north India is reduced by as much as five to seven years because of poor air quality,” she said. 

Indoor air pollution in the developing world is linked to the lack of access to clean cooking fuels, and the health impacts that research has highlighted would have takeaways for other developing countries in similar situation around Asia, Africa and Latin America.   

Swaminathan added that it is also becoming clear that air pollution affects not just the respiratory system but also distant organs like the heart, blood vessels and the brain, which is alarming. 

The State of the Global Air report 2024 listed air pollution as the second largest risk factor of deaths in 2021 after hypertension. However air pollution is also known to worsen hypertension.

Air pollution was the second largest risk factor of deaths in 2021.

 

“Globally, it is established that exposure to air pollution is a major risk factor for hypertension,” said Professor Sagnik Dey from the Centre for Atmospheric Sciences at the Indian Institute of Technology in Delhi. Most of this research is in developed countries but research from India is also emerging on this connection.

All the countries in the top five most polluted in the world are low-and middle-income countries with low resources and high hypertension burden. 

Dey added that initiatives like the India Hypertension Control Initiative focus on screening programmes which have a place but improving air quality will have to go with it. 

“We have strong evidence that additionally if India really works towards clean air, there will be a much accelerated progress and much larger health benefit,” Dey said.

Remaining research gaps

Establishing the health impacts of air pollution requires robust health data, and Balyan said most of the India-based research uses credible health data sourced from the country’s National Family and Health Survey (NFHS) which offers a representative sample. 

But this data is secondary data, and while there are studies that use primary data from communities, getting this data can be challenging. 

Even when the patients come into the health system, often this data is not captured as healthcare professionals are spread thin.
“Doctors are not trained or equipped with this kind of knowledge and also they don’t have this much of time to devote to each patient. When they ask patients’ history they rarely go to the any kind of questions which relates the problem of that patient to environmental stress or occupational stress,” Balyan said. 

Dey also added that a key gap is that often that the health and environment departments work in silos.

Enough evidence to act

Despite the difficulties of gathering primary data, there is enough compelling evidence both globally and on the India level for policy makers to act. 

Currently China, India and Pakistan top the list of the countries with the most number of air pollution deaths, according to the State of the Global Air report 2024. 

India recently re-elected Prime Minister Narendra Modi’s government for the third time. Issues related to health, climate and environment were rarely brought up by his government or the opposition during the election campaign. But India’s air quality has not shown any significant improvement in the past half a decade despite allocation of budgets, and in fact has worsened in some pockets, as Health Policy Watch reported earlier. 

Experts said improvements in air quality will be followed by health gains for the local communities. 

“Many cities around the world have improved air quality in relatively short time-periods and have seen positive impacts on health very quickly. Investing in air quality will have huge pay-offs for health and also for the economy,  and should be a high priority for all governments,” Swaminathan said. 

Image Credits: Flickr, State of Global Air Report 2024.

Satellite technology for telehealth consultations in a rural Guyana community; one of a number of health innovations the small Caribbean nation has spearheaded recently.

While this week’s CARICOM summit in Grenada has been postponed due to Hurricane Beryl, when it does convenes, a key item on the agenda will be the new ‘HeDPAC’ initiative to deepen South-South partnerships to meet shared global health challenges – from pandemic threats to climate change.

In remote communities of Guyana, the introduction of new satellite technology is enabling freshly trained community health workers to get patients an accurate diagnosis and rapid, appropriate treatment in ways unimaginable only a few years ago.  

In Rwanda, meanwhile, the government’s achievement in getting the COVID-19 vaccine innovator, BioNTech, to set up its first mRNA manufacturing facility in Kigali is a success story that small island states in the Caribbean would love to emulate. 

At a high-powered dinner on the sidelines of the recent World Health Assembly, health ministers and high level officials from Africa and the Americas, set out a shared vision for a way forward on closer collaboration between the two regions under the umbrella of a new South-South partnership initiative, known as HeDPAC (Health Development Partnership for Africa and the Caribbean). 

The initiative grew out of an initial set of pandemic-era collaborations between Africa and the Caribbean and was incubated at WHO  until its launch as an independent non-profit in December 2023. 

“HeDPAC offers a model for self-service cooperation. And for sharing knowledge, expertise and resources,” said WHO Director General Dr Tedros Adhanom Ghebreyesus, at the event, noting that the aim is to enhance health infrastructure, improve access to essential medicines, and strengthen health systems.” 

WHO Director General Dr Tedros Adhanom Ghebreyesus

Partnership building self-sufficiency  

The overarching aim, says HeDPAC CEO Haileysus Getahun, is to foster a partnership  between countries in the global south around key objectives critical to handling future pandemics, as well as creating more robust health systems today. 

The peak of the COVID-19 pandemic exposed the flaws in models of North-South cooperation that have come to dominate the global health landscape – when countries in the Global North hoarded the vaccines, medicines and medical products, he observed. The lack of equity and global solidarity were glaringly absent. 

South-south collaboration is one important antidote; a way to foster more self-sufficiency among countries and stakeholders on a more even playing field with a vision of universal health coverage. 

Three concrete priorities   

Jarbas Barbosa, WHO Regional Director of the Americas/PAHO.

The issues HeDPAC is targeting are not new, but they are perhaps the most critical building blocks to change. They include: 

  • More local R&D, manufacturing of drugs, vaccines and other medical products; 
  • Health workforce strengthening, particularly at primacy health care levels; 
  • Building health system resilience to shocks ranging from climate to supply chain breaks. 

“These are completely aligned with our regional priorities,” declared Jarbas Barbosa, WHO Regional Director of the Americas/PAHO, at the WHA conversation.  

Along with the dependency on outside sources for vital medical supplies laid bare during COVID,  Latin American and Caribbean countries currently are facing a shortage of some 600,000 health care workers, Barbosa observed. 

In Africa, the shortages are even more glaring, according to WHO. A 2023 report showed 37 African nations ranked below the global recommended minimum of 4-5 health workers per 1,000 population.

When the South swings together ….

Alison Drayton, Assistant Secretary-General for Human and Social Development at CARICOM

Registered in Rwanda and Barbados, the initiative aims to work with heads of state and political leaders but without the bureaucratic handcuffs of a formal intergovernmental organization, Getahun said. 

Early champions included the President of Rwanda, Paul Kagame,  Prime Minister of Barbados Mia Mottley and President Irfaan Ali of Guyana. Mottley gained international recognition for her Bridgetown initiative for international debt reform aimed at reducing the crippling burden of low- and middle-income countries to free up more funds for investments in solutions for climate, health and other vital development priorities. 

“My experience has been when the South swings together, we achieve far beyond our wildest dreams,” said Alison Drayton, Assistant Secretary-General for Human and Social Development at CARICOM, the intergovernmental organization of 20 Caribbean states, at the WHA event.

She noted that CARICOM and HeDPAC are currently engaged in the development an MOU to address the three priority areas of: health workforce, health system resilience and local manufacturing of medical products. 

The discussions on collaboration will continue at the 47th CARICOM Conference of Heads of Government. The meeting, planned this week in Grenada, has been postponed because of the effects of Hurricane Beryl.

Moving beyond pandemic poverty 

Barbados received its first shipment of 33,600 doses of COVID-19 vaccines, through the WHO co-sponsored COVAX facility, in April 2021. But after an initial spurt, COVAX deliveries faltered, leaving many low- and middle-income countries scrambling.

On the other side of the ocean, the African Union is a key partner with bonds forged in the early days of the COVID pandemic, when both African and Caribbean countries found themselves struggling desperately to obtain the most basic medical products like protective masks and gloves, and later vaccines.  

“When the world wouldn’t give us vaccines and the world wouldn’t sell us vaccines, and we pulled together an important procurement initiative, to my amazement, it was not just Africa but our brothers and our sisters from the Caribbean who supported this,” declared Dr. Ayoade Alakija, who had, at the time, been asked to lead the Africa Union’s Vaccine Delivery Alliance (AVDA). 

Thanks to those relationships, Caribbean countries like Jamaica, ultimately secured significant  vaccine supplies from African partners at a time when rich nation hoarding and the rise of India’s SARS-CoV2 Delta variant made vaccines almost impossible to secure.  

“And so we have done this before, this South-South collaboration… because we are the same people,” she said.

It was in that period that the initial framework for HeDPAC was laid, recounted Getahun, in an interview with Health Policy Watch. 

HeDPAC CEO Haileysus Getahun

“At the time, Prime Minister Mia Mottley of Barbados was the head of the CARICOM. She reached out to African Union president Uhuru Kenyatta (president of Kenya until 2022). She asked for collaboration between Africa and the Caribbean,” said Getahun.

“After that discussion, the first meeting of the heads of government of CARICOM and the AU was held in September 2021, which laid out clear steps for the two regions to collaborate.”

In November 2022, Mottley, Kagame [then AU champion for Institutional Reform],  and Guyana’s President Irgaan Ali met in Sharm el-Sheikh in November 2022 on the margins of COP27. 

Together with European Commissioner Ursula von der Leyen, Africa CDC and WHO’s DG, the African and Caribbean Heads of State etched the outlines for a new ‘transatlantic alliance for health and vaccine equity.’ 

The initiative quickly won  support in other quarters, including the International Finance Corporation, the World Bank’s investment arm, and several major philanthropies.    

“After observing the inequities and inequalities of COVID, we have to take the valuable lessons  and if a pandemic happens again, the valuable lessons will not be forgotten,” Getahun remarked.

Paul Kagame, Mia Mottley and Ursula von der Leyen at a meeting on the margins of COP27 in Sharm el Sheikh,  November 2022.

“What makes us unique is that we work with heads of government, ministers and political leaders at the highest level to advance a common vision of health development. We utilize political clout but without the handcuffs of a formal intergovernmental organization,” Getahun said. 

HeDPAC’s priorities emerged from a series of consultations of Ministers of Health from the two regions, he said, pointing out that all three pillars – manufacturing, health workforce and resilience – are all critical to greater pandemic preparedness as well as vibrant health systems more broadly. 

“These are the most pressing challenges, on which we will focus. The rationale is not to try to be everywhere.”

And while the first priority is fostering cooperation between like-minded African nations and the Caribbean, that mandate could eventually extend to promoting South-South collaborations more broadly, Getahun suggests.  

“We believe Africa-Caribbean partnership is the starting point, but we are also drawing interest from countries in other regions.’’

Learning from Rwanda’s experience with BioNTech  

International political leaders at the launch of BioNTech’s new facility in Kigali in December 2023.

As just one example of learning from others’ experience, Caribbean nations like Guyana are keen to see how they could duplicate Rwanda’s success in bringing a major pharma experience to their region.

In December 2023, BioNTech launched its first ‘BioNTainer’ in Kigali. The 35,000 m2 modular manufacturing facility is set to produce new mRNA vaccine candidates for malaria, tuberculosis and HIV for use firstly in clinical trials – followed by mass rollout if they are demonstrated to be efficacious.   

“There are many things that are happening in Africa. There are many things that are happening in South America, but very often the good things that happen on one side [of the ocean] are not shared with the other side,” said Guyana’s Minister of Health Frank Anthony at the WHA side event.

 “This will be a platform by which we can share what is happening between the two regions – and HeDPAC can be the bridge that allows us to do that.”

“From the pandemic we could see the needs and the inequities that exist because of lack of medicines or vaccines, and we don’t want that to be repeated. In some cases we had monies available, but we could not get the things that we needed.  

“And therefore, we thought that if we can fix this by locating manufacturing in our regions, so that when these things occur we can easily be able to access it, that this is going to be an important way to prepare for future pandemics.

“What Rwanda has done is major….  Using the mRNA vaccine platform can be a good way to produce other types of vaccines. And I think this is going to be the future. So if we can borrow what they have done, if they can assist us with accelerating [the process], that would be extremely positive. 

Using technology – hybrid courses and satellite health consultations 

At the same time, Caribbean nations also have valuable lessons to share.  

The Guyana Health Minister described how his country, with a widely dispersed population of just 800,000 people, has initiated a new hybrid programme of nurses training to rapidly expand the workforce. 

Guyana’s innovative nurses training initiative grabbed headlines in local media.

The online programme, developed through a collaboration with the University of Sao Paulo’s College of Nursing, enrolled nearly 1200 nurse trainees in 2023 its first year and plans to scale up further over the next several years.  

Simulation centres are being established in core health care facilities along the coast and in more remote regions, to allow students to participate in practicals that are essential for the Registered Nurses (RN) degree.     

“We can easily share that with other countries that are interested in using the courses that we have,” said Anthony. “You don’t have to move from Africa. You don’t have to move from the Caribbean. You will be able to go online and get these courses. That’s how we can share trying to find solutions to the problems that are facing us.”

Courses for community health workers also are being revamped, with health workers taught to use telecom and satellite technology to diagnose serious diseases in remote locations with the support of experts elsewhere. 

Satellite technology in rural Guyana enables high-quality telehealth consultations

“We call it ‘’tele-pathology’,” said Anthony, describing how high-resolution slides of suspect tissue can be quickly relayed to a partner hospital, Mount Sinai in New York City, to diagnose dangerous malignancies. 

Some two dozen clinics in remote regions of the country have been equipped with satellite technologies that allow doctors to “examine” patients remotely together with a local health worker to obtain a fast diagnosis in an emergency. .  

He shared the recent story of one patient whose life was saved through the quick action of a community health worker whose remote consultation led to the rapid diagnosis of life-threatening sepsis. 

“They called a medivac and he was airlifted to a hospital and operated on right away. Otherwise, he probably would have died by the time they figured out what’s wrong and got him to the hospital.”  

Elevating the status of community health workers  

Translating such stories of success into more systematic approaches is one of the big challenges that HeDPAC wants to facilitate, said Getahun. 

He notes that while community health workers are the foundations of primary health care, many  countries still treat them as quasi-volunteers, working for stipends and funded by donor grants – rather than as civil servants in the public health system. 

Catalyzing government moves to advance their status as regular civil servants is one important  HeDPAC target, he says. “This creates employment opportunities for women with far-reaching societal impacts’’.     

Mapping of Community Health Worker accreditation and salary status in Africa, Latin America and the Caribbean.

Throughout much of central and southern Africa, CHWs lack either regular salaries or accreditation.

In Rwanda, a PHC success story, CHWs are accredited but not salaried. But a major 4×4 reform of the health workforce launched in 2023 by the national government could lead to changes for that workforce as well. The 4×4 initiative is part of a broader Rwandan aspiration to quadruple the healthcare workforce and meet the WHO recommended goal of at least 4 health care professionals per 1000 people. 

And as an outgrowth of the new Africa-Caribbean links, doctors and nurses from Cuba are supporting Rwanda with training for its health workforce, said Rwanda’s Minister of Health, Dr. Sabin Nsanzimana.

“As we speak, a group of Cuban doctors has landed in Rwanda to support our 4×4 initiative,” he said. 

It takes guts…   

Ethiopian Minister of Health, Dr Mekdes Daba.

Regional collaborations in manufacturing and procurement will become all the more critical as countries seek to realize the promise and potential of the new African Vaccine Manufacturing Alliance (AVMA), experts also note. 

Only last week, AVMA secured commitments of more than $1 billion in finance at the kickoff at  the Gavi, the vaccine alliance replenishment drive co-hosted by France and the African Centres for Disease Control. The new initiative aims to facilitate the production of 60% of the continents’ vaccine needs with local supplies by 2040.  

Collective manufacturing and procurement arrangements are just as vital to small Caribbean nations that can’t possibly compete alone in global markets.  

“It’s so important to take a regional and cross regional approach, with south south solutions because it offers the possibility of creating economies of scale, and more sustainable production, and building thus a diversified production capacity,” said Johanna Hill, World Trade Organization Deputy Director. 

“Initiatives like this take guts and that’s where HeDPAC has been born – from that guts of taking into consideration South- South collaboration,” added Ethiopia’s Minister of Health, Dr Mekdes Daba.  

“I lost my grandma from COVID, a very dear, very dear person to me,” she added.  “We’ve [all] lost parents, family members, and it was very late for us to get the vaccine. So when things like a pandemic happen, we see how interconnected we are. 

“Now, it’s time to use this connectedness to realize our potential for South-South Collaboration.” 

This story was updated to note the postponement of the CARICOM meeting.

Image Credits: @DPA, HeDPAC, Caricom.org, PMO Barbados, Guyana Standard , Community Health Impact Coalition @Mapbox @OpenStreetMap.